Balance Scale Model

  • This model aims to assist practitioners in understanding decision-making process of people with stroke in community participation. It is depicted as a scale with the fulcrum in the middle, with the facilitators and barriers placed on either end with different amount of the impacts (factors placed further from center represents higher impact on decision making). The balance scale represents the concept of weighting thought, desire, or request for going out into the community that from oneself, caregiver, or significant others. Left side of the fulcrum, supporting community participation, includes personal contextual and environmental facilitators. These factors are weighted against the right side of the fulcrum, barriers to community participation, which includes environmental and personal barriers, impairments in body function and structures, and activity limitations including dependence factors. When the factors on the left side of the fulcrum outweigh the factors on the right side, the client decides to go out into the community. Personal facilitators, e.g., the feeling of well-being during engagement in community activities or continuance of a social role/activity, positively affect the decision making more than environmental facilitators, e.g., wheelchair accessibility. As the clients usually adjust their participation in places with fewer environmental and personal barriers, this factor is placed nearer to the center than other factors. Impairment in body function and structure, such as altered body functions, perceptual deficit, decreased sitting tolerance, would weigh heavily against community participation if the anticipated trip requires long time or effort. Dependence issues, due to activity limitation, are positioned farthest away from the fulcrum, as the clients are conscious that going out increases caregiver burden. Occupational therapists, and other health professionals, prescribe wheelchair, and powered mobility devices to facilitate community participation, and to increase independence, freedom, and continuity of life for people with stroke.

Summarized by

  • Macey Cho

Type

  • Model (conceptual)

Population

  • Adult
  • Elderly

Disability

  • Neurological disorder

Domain of occupation

  • IADL
  • Work
  • Leisure

Application Note

  • This model aims to facilitate practitioners’ understanding in factors affecting community participation among stroke survivors.

Key Reference

  • Barker, D., Reid, D., & Cott, C. (2006). The experience of senior stroke survivors: Factors in community participation among wheelchair users. Canadian Journal of Occupational Therapy, 73(1), 18-25.

Year Published

  • 2006

Primary Developer

  • Donna J. Barker

Primary Developer Email

  • donna.barker@utoronto.ca

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Model Type

Population

Disability

Domain of Occupation

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