The theoretical base of biomechanical frame of reference (FOR) is considered as a remedial approach focusing on impairments that limit occupational performance. This FOR assumes clients are able to acquire the voluntary motor skills necessary to perform the desired human occupation, meaning that the underlying impairment is amenable to remediation. It also assumes that engaging in occupation and therapeutic activities has the potential to remediate the underlying impairment, and results in improvement in occupational performance. The goals are to prevent deterioration and maintain existing movements for occupational performance, to restore movements for occupational performance, and to compensate/adapt for loss of movements in occupational performance. Individuals who have limitations in performing occupations due to limitations in movements, inadequate muscle strength, loss of endurance, or other biomedical conditions are suitable to use this FOR. The goals are to prevent limitation of range of motion, to move the target body part through full range of motion, either passively or actively appropriately, and to position the body to prevent contractures and edema. Assessment includes assessing the performance components on movements, strength and endurance. Some assessments associated with this FOR include standardized objective tests of occupational performance, pain scales, examination of skin/wounds, sensory testing, etc. Interventions associated with this FOR include ADL retraining, work hardening, static and dynamic orthoses, active, active assistive, passive range of motion exercises, nerve gliding, etc. The variety of interventions aims to amend underlying impairment and result in enhanced occupational performance in desired occupations.
Frame of reference
Domain of occupation
It targets remediate amendable impairments that are influencing occupational performance in desired occupation.
McMillan, I. R. (2011). The biomechanical frame of reference in occupational therapy. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (5th ed., pp. 179-194). Edinburgh: Churchill Livingstone.
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.
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.
The Conceptual Model for Performance in Handwriting views that handwriting is important for one’s work and/or education domains of occupations. It considers the performance components, performance areas (functional performance), performance contexts, and the interactive relationship among them. Prerequisites to handwriting include performance components in sensory, perceptual, motor cognitive, and language functions, as well as integrations of these components.
The Framework of Occupational Gradation (FOG) focuses on one’s active movements with the more involved upper extremity. There are two versions of FOG, one for young children (C-FOG) and one for older children and adults (A-FOG). Both aim to provide occupational ideas in preventing learned non-use of the more involved upper extremity for clients with neurological impairment. These ideas can be incorporated into daily lives to increase use of the extremity. Appropriateness of task for each client is determined by hand dominance and perceived meaningfulness.
Rehabilitative frame of reference (FOR) considers rehabilitation as the process of facilitating patients in fulfilling daily activities and social roles with competence. This FOR is used with clients whose underlying impairments are unlikely to remediate and be considerable permanent, or the clients who lack motivation to participate in remediation. The theoretical basis of this FOR is that the client must focus on the remaining abilities, despite of any disabilities, to attain his/her highest level of functioning in the desired occupational performance.