Biomechanical Frame of Reference for Positioning Children for Function
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 focuses on static position instead of transitional movements. The developmental sequence of motor behaviors is required to understand dysfunction and immature motor patterns. It assumes that motor patterns are developed from sensory stimulations from the environment, and autonomic motor responses (includes righting and equilibrium reactions) are required for maintaining postures. Motor behaviors are reflexive in infancy, and are developed and modified by sensory input from the environment. This frame of reference identifies function and dysfunction in the areas of range of motion, head control, trunk control, control of arm movement, mobility, and positions that are related to participation in daily activities like self-feeding and toileting. In evaluation, postural components of dysfunction are assessed and identified for intervention planning. Some critical areas of assessments are range of movement against gravity, right reactions of head and trunk, positioning of hands, mobilization of limbs to get to desired goal by walking or creeping, etc. Interventions mainly include translating therapeutic interventions by prescribing assistive devices in order to enhance proximal stability and posture in functional activities. Eventually this will enhance participation in the client’s home, school, and community.
Frame of reference
Domain of occupation
Combined with other frames of reference to maximize individual’s potential for movement and function
Colangelo, C. A., & Shea, M. (2010). A biomechanical frame of reference for positioning children for functioning. In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (3rd ed., pp. 489-567). Philadelphia: Lippincott Williams & Wilkins.
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 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 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.
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.
Sensory Integration Theory aims to explain behaviors, plan intervention, and predict behavioral change through intervention, and provide specific intervention strategies to remediate the underlying sensory issues that affect functional performance. It purposes therapeutic interventions that incorporate sensation to affect multi-sensory perception to influence learning and behavior, as the central nervous system does not process sensory information in isolation.