Frame of reference

The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function.

This frame of reference adapts a top-down approach to identify visual perceptual factors that limit an individual’s daily participation, and adaptive and compensation approaches are used to facilitate engagement in meaningful occupation. It uses theories from cognition, developmental psychology, education, and Warren’s developmental hierarchy of visual perceptual skills. Visual Perceptual skill development is viewed to be developed from a hierarchy, starting from oculomotor control, visual fields, visual acuity.

The social participation frame of reference emphasizes the power of emotion to motivate and engage children’s social participation. Early relationship with parents provides the foundation for children’s social development, because children give meaning to their own emotions and learn strategies in regulating their emotional states based on how others and environment responses to their emotions. At the same time, the children regulate the caregivers’ behaviors and then they learn how to regulate their own and others’ emotions during future social interactions.

The Neuro-Developmental Treatment (NDT) frame of reference is used to analyze and treat posture and movement impairments based on kinesiology and biomechanics. To identify difficulties and plan for intervention, the following concepts are to be considered in NDT, including planes of movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility. NDT assumes that posture and movement impairments are changeable. Thus, it utilizes movement analysis to identify missing or atypical elements.

Acquiring motor skill is a process that requires practices, feedback, and involvement of the learner. This frame of reference employs several principles from learning theory. It focuses on the child’s ability, characteristics of the task, skills required, environment, and regulatory conditions. Regulatory conditions are aspects of the environment that determine movement specifics, which are described in a continuum between closed and open tasks.

This frame of reference identifies functions and dysfunctions in five areas of handwriting for children, including proximal posture, components, use of writing tools, grasp, and handwriting. Good proximal control is required for functional and effective distal control of the writing tools. Either excessive postural stability or lack of postural stability during writing tasks is considered as dysfunctions. Components including ocular-motor skills, attention, and memory are considered as essential.

The Acquisitional frame of reference emphasizes the use of teaching-learning process and activities analysis, to achieve the goal which is the acquisition of specific skills or appropriate behaviors required for optimal performance within an environment. It also emphasizes on the context of the environment, functional behaviors, and learned skills. Behaviors are viewed as a response to the environment. People learn new skills during interactions with the environment and therefore, the role of environment in eliciting adaptive response is the main reinforcer in this frame of reference.

Psychodynamic Frame of Reference (psychodynamic FOR) is based on Dr. Sigmund Freud’s idea that human has the initiative to invest emotions and psychic energy to achieve basic needs and maintain relationship. When an individual fails to maintain healthy relationships due to the conflicts or insufficient ego defense mechanism, dysfunction will occur. Occupational therapists can base this psychodynamic FOR to help treat the dysfunction using two main approaches including explorative and supportive approach.

The Sensory Integration (SI) frame of reference focuses on how the interaction between the sensory systems including auditory, vestibular, proprioceptive, tactile, and visual systems, provides integrated information that contributes to a child’s learning and adaptive behaviors. The key consideration is that children have the abilities to make adaptive responses to constantly changing sensory environments. The sensory integrative abilities include sensory modulation, sensory discrimination, postural-ocular control, praxis, bilateral integration, and sequencing.