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. Activities are provided in various levels under this framework. The person, task or object properties, and environment can each be manipulated by occupational therapists, to optimize or challenge a client’s performance on each level. The personal factor can be manipulated by reducing the degrees of freedom using splinting or positioning. For example, a thumb splint may stabilize the thumb and improve prehension movements in children with spastic hemiplegic cerebral palsy. Manipulation on tasks and/or objects factors can also determine the speed, smoothness, force, and accuracy of movement. Properties of objects such as weight, size, shape, and nature of task, like eating with different utensils can be manipulated. The environment can also be manipulated with the object’s orientation, use of stationary/mobile objects, height of task (against gravity/gravity assisted, etc.), to reduce or increase degrees of freedom of movement requirements. In designing the intervention, firstly, the therapists consider both person and family goals and the person factors. From that, the therapists select meaningful tasks from the FOG, and manipulate factors in person, task, and environment to level the task suitably. With mass and organized practice in context and feedback (intrinsic and extrinsic), the final goal is to improve motor control and occupational performance that can be generalized to performing environments.
Domain of occupation
Combination of this approach with compensation/adaptation may be optimal for intervention.
Poole, J. L., Burtner, P. A., & Stockman, G. (2009). The Framework of Occupational Gradation (FOG) to treat upper extremity impairments in persons with central nervous system impairments. Occupational Therapy In Health Care, 23, 40-59.
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 Children’s Hand Skills Framework (CHSF) is used as a conceptual guide to analyze and describe children’s hand skills in the assessment and intervention process. The CHSF divides children’s hand skill use into six major categories, based on the extent to which the hands contact objects/parts of the body or not. The first two categories are manual gesture and body contact hand skills that do not contact specific objects.
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 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 clinical reasoning framework aims to guide practitioners in selecting strategies in approaching sensory challenges in order to optimize participation of children with autism spectrum disorder. Several clinical reasoning considerations are based on this framework, and these include research evidence, client- and family-centeredness, practice contexts, occupation-centeredness, and risks. This framework emphasizes on the use of mutual information-sharing and coaching to empower families or teachers and develop their own solutions to supporting children’s participation.