Occupational Therapy Frames of Reference
A frame of reference is a theoretical basis for a treatment approach. This chart outlines the frames of reference commonly used in occupational therapy treatment and provides examples of how these frames of references are applied. Frames of reference that use more complicated or structured approaches are sometimes called models.
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|NEURO/REHAB FOR’S||COGNITIVE-BASED FOR’S||ORTHO/REHAB FOR’S||PEDS FOR’S||MENTAL HEALTH FOR’S|
|Biomechanical||Allen Cognitive Models||Biomechanical||Behavior Modification||Behavior Modification|
|Brunnstrom||Cognitive Behavioral||Compensatory||Developmental||Cognitive Perceptual/ Psychoeducational|
|Compensatory||Cognitive Perceptual/ Psychoeducational||Rehabilitative Model||Sensory Integration (SI)|
|Proprioceptive Neuromuscular Facilitation (PNF)|
|Frame of Reference or Model||Author or Research Base||Description||Examples of use during occupational therapy treatment||Video Examples|
|Allen Cognitive Model||Claudia Allen, MA, OTR, FAOTA||Model of assessment and treatment that is built around functional cognition, or the interaction between cognitive abilities and the activity setting that results in performance.||An occupational therapist administers the Allen Cognitive Levels screening test to determine how much assistance a new patient with mild dementia will need to follow precautions following hip replacement surgery
A cooking activity is structured by the occupational therapist to accommodate the cognitive skills of a patient with schizophrenia, based on the outcome of the Routine Task Inventory (RTI)
|Interview with Catherine Earhart about the Allen Cognitive Model
Sample home consultation for an elderly woman functioning at Allen Cognitive Level 4
|Behavioral Modification||Based on the principles of operant conditioning, developed by B.F. Skinner||Positive or negative reinforcement is used to elicit a desired response.||In a public-school setting, an occupational therapist asks a student to write three sentences, after which he may choose an activity that he would like to do.
A head injury patient is required to clean up the occupational therapy treatment area after throwing objects while refusing treatment.
|A simple explanation and examples of how to use behavior modification techniques with young children.|
|Biomechanical Frame of Reference||Unknown – this is the oldest frame of reference used in rehabilitation.||Therapeutic exercise is used to improve range of motion, strength and endurance, which is then thought to lead to improvements in functional abilities.||For an outpatient who has had rotator cuff surgery, an occupational therapist leads active range of motion exercises, and then has the patient reach for plastic glasses in a cupboard.
An occupational therapist has a patient complete upper body strengthening exercises to improve the patient’s ability to push up from a chair during transfers.
|An occupational therapist explains the principles and different movements associated with range of motion.
An occupational therapist demonstrates basic arm strengthening exercises.
|Brunnstrom Movement Therapy Frame of Reference||Signe Brunnstrom, PT||Synergies and reflexes that occur in early normal development are also a normal part of the recovery process for patients with hemiplegia following a stroke. These synergies should be facilitated and encouraged during treatment.||During occupational therapy treatment for a woman who has hemiplegia following a stroke, the occupational therapist has the woman perform a reaching activity with her unaffected arm while the therapist moves the affected arm in the same manner.||Occupational therapy assistants demonstrate the six stages of Brunnstrom Movement Therapy|
|Canadian Model of Occupational Performance||Canadian Association of Occupational Therapists||A framework that illustrates the interaction between people, their environments, and their occupations related to self care, productivity, and leisure.||An occupational therapist develops a treatment plan for a woman with rheumatoid arthritis, based on the woman’s desire to resume playing the organ at her church.||-Occupational therapy students explain the Canadian Model of Occupational Performance.|
|Cognitive Behavioral Frame of Reference||Based on the works of several researchers in the area of psychology who developed behavioral therapies in the 1920s and cognitive therapies in the 1960s.||People are taught to replace behaviors that result from abnormal thought processes with more normal or adaptive thought processes and behaviors.||An occupational therapist helps a young woman with Down’s Syndrome learn that she does not need to be afraid to use the bathroom by herself.||An animated video that explains cognitive behavioral therapy for older adults with depression.|
|Compensatory Frame of Reference||Unknown||Patients who will not regain functional skills can compensate by using adaptive equipment or techniques to complete tasks in a different way.||A woman with severe osteoporosis uses long handled gardening tools to weed her flowers while standing.
A man with multiple sclerosis who has short term memory problems uses a smart phone to set reminders for appointments.
|-An occupational therapist provides an adapted spoon to a woman with severe arthritis in her hands.
-A video explains precautions and adaptive equipment use for patients who have undergone hip replacement surgery.
|Developmental Frame of Reference||Based on the works of: Freud, Jung (Psychosocial)
Gessell (Physical and emotional milestones)
Piaget (Cognitive milestones)
Kohlberg, Wilcox, Gilligan (Moral reasoning)
|Development is sequential, and behaviors are primarily influenced by the extent to which an individual has mastered and integrated the previous stages. Each stage of development can only proceed normally if the preceding stages have been completed successfully. Incomplete development in areas of skill will therefore influence subsequent development.||Occupational therapy aims to prevent the development of maladaptive behavior and skills, and promotes growth and development to close the gap between expectation and ability, through the skilled application of activities.
Sensory processing difficulties and learning disabilities are addressed by using this model.
|Animated video explaining the Developmental FOR
|Dynamic Interactional Approach, previously called Cognitive Rehabilitation||Joan Toglia, PhD, OTR||Functional performance is restored for people with cognitive dysfunction by specifically focusing on the following areas: orientation, attention, visual processing, motor planning, cognition, occupational behaviors, and effort.||An occupational therapist structures a supported employment job activity for a man who has had a traumatic brain injury to accommodate his current problem solving and decision-making skills.||-Occupational therapy students explain the Dynamic Interactional Approach using creative methods.|
|Ecology of Human Performance||Winifred (Winnie) Dunn, PhD, OTR, FAOTA||A person’s occupational performance is viewed in relation to the context in which activity occurs. Activity is selected and adapted based on physical, social, temporal and cultural contexts.||An elderly man with Parkinson’s Disease can feed himself using regular utensils but is unable to finish a meal before his food gets cold. The occupational therapist provides the man with adapted dishes and utensils, which allows the man to finish a meal while his food is still warm.||Occupational therapy students provide examples of the Ecology of Human Performance in an entertaining manner.|
|Lifestyle Performance Model||Gail S. Fidler, OTR, FAOTA||A person’s total activity repertoire is considered within the context of that person’s world. The framework allows for a holistic approach to treatment.||An occupational therapist completes a full occupational profile with a man admitted to inpatient rehabilitation for a spinal cord injury. The profile includes daily routines, living situation, employment, leisure activities, relationships, spiritual views, and priorities for treatment.||Occupational therapy students use role playing to demonstrate the Lifestyle Performance Model.|
|Model of Human Occupation (MOHO)||Gary Kielhofner, DrPH, FAOTA||Occupation is assessed based on the three components of volition, habituation, and performance capacity, within the environmental context.||An occupational therapy assistant helps a 5th grade student with learning disabilities to improve his handwriting. The student has an interest in science, so the OTA has the student hand write and draw his own periodic table of the elements.||Occupational therapy educators document a case study of occupational therapy treatment based on MOHO for a woman with fibromyalgia.|
|Neurodevelopmental Treatment (NDT)||Berta Bobath, PT and Karel Bobath, MD||This frame of reference, used for rehabilitation for neurological conditions, focuses on specific handling techniques to facilitate normal posture and movement patterns while inhibiting abnormal patterns.||An occupational therapist physically positions a three-year-old child with cerebral palsy on his hands and knees while the child reaches to play with blocks.||NDT handling techniques are demonstrated in a therapy clinic with a young girl with cerebral palsy.|
|Occupational Adaptation||Janette K. Schkade, PhD, OTR and Sally Schultz, PhD, OTR||The integration of occupation and adaptation is viewed as a single, integrated process. The model focuses on improving adaptability, rather than functional skills.||An occupational therapist teaches a woman with multiple sclerosis how to drive using an adapted van.||Occupational therapy students demonstrate the rehabilitation process for a woman with a spinal cord injury following a car accident.|
|Person-Environment-Occupation-Performance Model (PEOP)||Charles H. Christiansen, EdD, OTR, OT(C), FAOTA and Carolyn Baum, PhD, OTR/L, FAOTA||The interaction between a person’s abilities, environmental factors, and the demands of occupation influences performance outcomes.||In a home health setting, an occupational therapist works with a woman with muscular dystrophy to adapt the bathroom in her new home so that she can shower independently.||Occupational therapy students present a case study using the PEOP Model.|
|Proprioceptive Neuromuscular Facilitation (PNF)||Herman Kabat, PhD, MD||A treatment model that focuses on motor development through the shift in flexor and extensor muscles, using diagonal movement patterns to facilitate mature motor movements.||An occupational therapist works with a woman who has had a stroke on reaching for cones in a diagonal pattern across her upper body, then has the woman apply the movement to combing her hair.||Occupational therapy students explain the principles of PNF.|
|Psychoanalytic and psychodynamic theory||Dr. Sigmund Freud and others||Personality development is driven by conscious and unconscious factors. The therapy process uses self awareness, emotional expression, social relationships, and defense mechanisms to help patients direct their actions to complete tasks.||An occupational therapist teaches a high school student with an anxiety disorder how to use relaxation techniques to help prepare for a test.||An occupational therapist uses an interactive story book based on psychodynamic theory while working with a young girl.|
|Psychoeducation, also called Cognitive-Perceptual Frame of Reference||Carol Anderson, PhD||A treatment model in which patients and their families are educated about their diseases in order to change their thinking and behavior.||An occupational therapist teaches an 8th grade student with a diagnosis of autism about his condition so that he understands why he needs to use noise reducing headphones during assemblies.||An animated video explains psychoeducation.|
|Rehabilitative Frame of Reference||Catherine Trombly Latham, SCD, OTR, FAOTA||A comprehensive approach to treatment in which the ultimate outcome is for the person to become as independent as possible despite any residual dysfunction. The primary focus of this frame of reference is adaptation to facilitate independence.||A man who has suffered a traumatic brain injury as a result of an automobile accident undergoes inpatient and outpatient occupational therapy services to improve physical, psychological and cognitive function. Upon discharge from occupational therapy services, he can live independently using memory aids to compensate for short term memory loss and large handled utensils and devices to compensate for fine motor deficits in his right hand.||A therapist describes the biomechanical and rehabilitative approaches.|
|Rood Frame of Reference||Margaret Rood, MA, OTR||A neurological treatment approach in which motor patterns are facilitated and normalized through the application of sensory stimulation to specific sensory receptors.||While working with a man who has hemiplegia following a stroke, an occupational therapist performs a quick stretch facilitation technique to the man’s affected triceps, followed by weight bearing on the affect arm.||Occupational therapy students demonstrate treatment techniques based on the Rood frame of reference.|
|Sensory Integration||A. Jean Ayres, PhD, OTR||This frame of reference is based on the way the brain receives sensory input from the environment and organizes it so that the body can respond with action. As normal development occurs, the brain’s ability to integrate sensory input matures.||An occupational therapist helps a child with attention deficit hyperactivity disorder (ADHD) to participate in vestibular swinging to organize and calm his neurological system so that he can sit still in his classroom.||Occupational therapy educators explain sensory integration and provide case examples.|
|Strengths Model||Charles A. Rapp, PhD||A mental health frame of reference in which the practitioner views people as individuals, not as patients or clients. A person’s strengths are the focus, not their weaknesses or “disability”.||An occupational therapist adapts a social studies lesson for a student with autism so that he can learn by reading and looking at pictures instead of listening to the teacher’s lecture, because visual memory is one of his strengths.||Occupational and physical therapists at a state conference discuss strengths-based practice.|
A Comparison of Occupation Based Frames of Reference
Several occupational therapy frames of reference are based on occupation and the various factors that influence how people engage in occupation. The following chart will compare the similarities and differences of these frames of reference to help clarify the structure of each.
|Canadian Model of Occupational Performance||Ecology of Human Performance||Lifestyle Performance Model||Model of Human Occupation (MOHO)||Occupational Adaptation||Person-Environment-Occupation-Performance Model (PEOP)|
|Overall description||A framework that illustrates the interaction between people, their environments, and their occupations related to self-care, productivity, and leisure.||A person’s occupational performance is viewed in relation to the context in which activity occurs. Activity is selected and adapted based on physical, social, temporal and cultural contexts.||A person’s total activity repertoire is considered within the context of that person’s world. The framework allows for a holistic approach to treatment.||Occupation is assessed based on the three components of volition, habituation, and performance capacity, within the environmental context.||The integration of occupation and adaptation is viewed as a single, integrated process. The model focuses on improving adaptability, rather than functional skills.||The interaction between a person’s abilities, environmental factors, and the demands of occupation influences performance outcomes.|
|Core component||Spirituality, which is considered the primary essence of a person||The context in which occupation occurs||Quality of life||Motivation for occupation||The person’s internal ability to master adaptive responses||Occupational performance and participation|
|Personal factors||Cognitive, affective, and physical factors||Experiences, sensorimotor skills, cognitive skills, psychosocial skills||Strengths, interests, capacities, customary patterns of daily living||Volition, habituation, performance capacity||Internal occupational adaptation process||Physiological, cognitive, spiritual, neurobehavioral, and psychological factors.|
|Environmental factors||Physical, institutional, cultural and social factors||The context in which occupation takes place||Interactive dimensions of interpersonal, societal, cultural, physical, and temporal elements||Objects, spaces, occupational forms, social, cultural and political demands.||Physical, social, and cultural properties||Social support, social and economic systems, culture and values, built environment and technology, natural environment|
|Focus of Inter-vention||The fit between person, environment and occupation.||Five alternatives: establish or restore, alter, adapt, prevent, create||Performance skills and lifestyle expectations within four domains: self-care and self-maintenance, intrinsic gratification, social contribution, and interpersonal relatedness||Volition and habituation||Narrow the gap between current occupational functioning and performance required by both the patient and the environment.||Enablers and barriers|
|Desired Outcome||Occupational engagement||Meeting performance needs||Enhancement of quality of life||Occupational adaptation||Self-initiation, generalization, and relative mastery||Occupational participation|
Su Ren Wong & Gail Fisher (2015) Comparing and Using Occupation-Focused Models, Occupational Therapy in Health Care, 29:3, 297-315, DOI: 10.3109/07380577.2015.1010130
Dunn, W., Brown, C., & McGuigan, A. (1994, July 01). The Ecology of Human Performance: A Framework for Considering the Effect of Context. Retrieved March 22, 2018, from https://ajot.aota.org/article.aspx?articleid=1873303
Fidler, G. S. (1996, February 01). Life-Style Performance: From Profile to Conceptual Model. Retrieved March 22, 2018, from https://ajot.aota.org/article.aspx?articleid=1862324
Schultz, S., & Schkade, J. K. (1992, October 01). Occupational Adaptation: Toward a Holistic Approach for Contemporary Practice, Part 2. Retrieved March 22, 2018, from https://ajot.aota.org/article.aspx?articleid=1875299