rehabilitative frame of reference-1

Rehabilitative Frame of ReferenceBiomechanical Approach


OT 606

Spring 2004

Rehabilitative Frame of Reference

Rehabilitative Frame of Reference

• Philosophy: To enable a person with a physical or mental disability or chronic illness to achieve maximum function in the performance of his or her daily activities (p.538)

• Based on: medical sciences, physical sciences, social sciences.

Rehabilitation Frame of Reference

Rehabilitation Frame of Reference

• Rehabilitation: The process of helping a person perform competently in his or her social roles and daily activities (p.538).

• Focus: compensatory techniques, adaptive/assistive devices, environmental modifications

Rehabilitative Frame of Reference Assumptions


• 1. Through the use of compensation strategies and techniques an individual can restore independence when the underlying impairment cannot be remediated.

• 2. A person’s level of motivation affects the extent to which an individual regains independence

• 3. Environments in which daily activities are performed influence a person’s motivation for independence.



• 4. Rehabilitation involves the teaching-learning process. Therefore, cognitive skills are needed to learn and apply compensatory strategies. Motivation enables the person to participate fully in the teaching-learning process.

• 5. Clinical reasoning, used by the practitioner, begins with the individual's functional capabilities, then moves to the environments in which the person will function, and then to the types of compensatory strategies the person needs to use his or her capacities.

Rehabilitative Frame of Reference Evaluation


• Evaluation assesses client’s functioning in self care, work, and leisure.

• Evaluation involves:• Observation• Interviews of client’s daily living priorities• Client self-report re: ability to perform tasks



• Therapist focuses on:• 1. characteristics of environments in which client

functions• 2. equipment and client’s economic resources• 3. level of assistance/supervision available for

client• 4. developmental expectations for client

performance• 5. absent or limited performance components

(skills & abilities). (p.539)

Rehabilitative Frame of Reference Mechanisms for ChangeRehabilitative Frame of Reference Mechanisms for Change

• Assumption is that client’s impairment is stable

• Can alter function through compensatory strategies and adaptive equipment

• Therapist teaches client new ways to perform ADL’s.

Rehabilitative Frame of Reference Change in Function

Rehabilitative Frame of Reference Change in Function

• Client must• Be motivated• Be able to use compensatory strategies – and • have underlying perception/cognition to do that

• Environment must:• Have necessary

• equipment• Objects

• Support and feedback systems

Rehabilitative Frame of Reference Treatment

Rehabilitative Frame of Reference Treatment

• Includes purposeful activities:• Daily living• Work• Leisure

• Compensatory strategies• Practice of these tasks and strategies• Collaboration with client important• Client must cooperate• Therapist must be creative in problem-solving

Rehabilitative Frame of Reference Strengths and Limitations

Rehabilitative Frame of Reference Strengths and Limitations

• Strengths:• Long successful history• Focus on client capabilities, and

important ADL’s• Client centered• Evaluates Client’s interests,

roles, resources, environments, support systems

• Holistic perspective

• Weaknesses:• Some ADL instruments lack

validity/reliability testing – outcomes research is limited

• Does not address unmotivated client

• Does not offer alternative approaches if compensatory strategies ineffective or client unable to learn new ways of doing

• Does not address psychosocial needs of clients

• Linked to medical model

Biomechanical Frame of Reference Domains of concern

Biomechanical Frame of Reference Domains of concern

• 1. Structural stability

• 2. low-level endurance

• 3. Edema control

• 4. Passive range of motion (PROM)

• 5. Strength

• 6. High-level endurance

Biomechanical Frame of Reference – Assumptions

Biomechanical Frame of Reference – Assumptions

• 1. purposeful activities can be used to treat loss of ROM, strength, and endurance

• 2. After ROM, strength, and endurance are regained, the client will automatically regain function.

• 3. The principle of rest and stress: first the body must rest to heal itself; then structures must be stressed to regain range, strength, endurance

• 4. The biomechanical frame of reference is best suited for clients with an intact central nervous system because clients must be able to perform smooth, isolated movements (p.541).

Biomechanical Frame of Reference - Evaluation

Biomechanical Frame of Reference - Evaluation

• Domains of concern:• 1. Structural stability• 2. low-level endurance

• 3. Edema control• 4. Passive range of

motion (PROM)• 5. Strength

• 6. High-level endurance

• Evaluations:• 1. X-ray (Physician)• 2. Cardiac step charts,

recording time pt can tolerate sedentary activity

• 3. Volumetry• 4. Goniometry• 5. Manual muscle tests,

palpation, clinical observation

• 6. Number of reps or duration pt. can perform activity.

Biomechanical Frame of Reference –Client Practitioner Interaction

Biomechanical Frame of Reference –Client Practitioner Interaction

• Therapist must explain connection between client’s deficit and biomechanical goal and functional outcome.• in writing – for reimbursement purposes

and • verbally to client – because treatment can

be painful

Biomechanical Approach -Strengths and LimitationsBiomechanical Approach -Strengths and Limitations

• Strengths:• Easy to write

measurable goals – quantifiable

• Oldest form of treatment for physical disabilities

• Weaknesses:• Purposeful activities

much more effective than rote exercise

• Does not address pain, loss of sensation, incoordination



Whose Life is it Anyway?

Questions for “Whose Life is it Anyway?”

Questions for “Whose Life is it Anyway?”

• 1. Which approach is more appropriate for the main character– rehabilitative or biomechanical?

• 2. What would you suggest an OT do to help this person transition from hospital to home environment?

• 3. Treatment activities would you suggest?• 4. What are some barriers to treatment being

successful?• 5. What are some resources the main charcater has?• 6. If the main character had more use of his upper

extremities and trunk, what else could you have him do? Which approach would you use?

rehabilitative frame of reference-1

Documents

reference

compensatory

biomechanical

rehabilitative

limitations

daily activities

passive range

purposeful