Rehabilitative Frame of Reference Biomechanical Approach

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Rehabilitative Frame of ReferenceBiomechanical
Approach

• OT 606
• Spring 2004

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Rehabilitative Frame of Reference

• Philosophy To enable a person with a physical or
  mental disability or chronic illness to achieve
  maximum function in the performance of his or her
  daily activities (p.538)
• Based on medical sciences, physical sciences,
  social sciences.

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Rehabilitation Frame of Reference

• Rehabilitation The process of helping a person
  perform competently in his or her social roles
  and daily activities (p.538).
• Focus compensatory techniques,
  adaptive/assistive devices, environmental
  modifications

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Rehabilitative Frame of Reference Assumptions

• 1. Through the use of compensation strategies and
  techniques an individual can restore independence
  when the underlying impairment cannot be
  remediated.
• 2. A persons level of motivation affects the
  extent to which an individual regains
  independence
• 3. Environments in which daily activities are
  performed influence a persons motivation for
  independence.

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Rehabilitative Frame of Reference Assumptions

• 4. Rehabilitation involves the teaching-learning
  process. Therefore, cognitive skills are needed
  to learn and apply compensatory strategies.
  Motivation enables the person to participate
  fully in the teaching-learning process.
• 5. Clinical reasoning, used by the practitioner,
  begins with the individual's functional
  capabilities, then moves to the environments in
  which the person will function, and then to the
  types of compensatory strategies the person needs
  to use his or her capacities.

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Rehabilitative Frame of Reference Evaluation

• Evaluation assesses clients functioning in self
  care, work, and leisure.
• Evaluation involves
• Observation
• Interviews of clients daily living priorities
• Client self-report re ability to perform tasks

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Rehabilitative Frame of Reference Evaluation

• Therapist focuses on
• 1. characteristics of environments in which
  client functions
• 2. equipment and clients economic resources
• 3. level of assistance/supervision available for
  client
• 4. developmental expectations for client
  performance
• 5. absent or limited performance components
  (skills abilities). (p.539)

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Rehabilitative Frame of Reference Mechanisms for
Change

• Assumption is that clients impairment is stable
• Can alter function through compensatory
  strategies and adaptive equipment
• Therapist teaches client new ways to perform
  ADLs.

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Rehabilitative Frame of Reference Change in
Function

• Client must
• Be motivated
• Be able to use compensatory strategies and
• have underlying perception/cognition to do that
• Environment must
• Have necessary
• equipment
• Objects
• Support and feedback systems

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Rehabilitative Frame of Reference Treatment

• Includes purposeful activities
• Daily living
• Work
• Leisure
• Compensatory strategies
• Practice of these tasks and strategies
• Collaboration with client important
• Client must cooperate
• Therapist must be creative in problem-solving

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Rehabilitative Frame of Reference Strengths and
Limitations

• Strengths
• Long successful history
• Focus on client capabilities, and important ADLs
• Client centered
• Evaluates Clients interests, roles, resources,
  environments, support systems
• Holistic perspective

• Weaknesses
• Some ADL instruments lack validity/reliability
  testing outcomes research is limited
• Does not address unmotivated client
• Does not offer alternative approaches if
  compensatory strategies ineffective or client
  unable to learn new ways of doing
• Does not address psychosocial needs of clients
• Linked to medical model

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Biomechanical Frame of Reference Domains of
concern

• 1. Structural stability
• 2. low-level endurance
• 3. Edema control
• 4. Passive range of motion (PROM)
• 5. Strength
• 6. High-level endurance

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Biomechanical Frame of Reference Assumptions

• 1. purposeful activities can be used to treat
  loss of ROM, strength, and endurance
• 2. After ROM, strength, and endurance are
  regained, the client will automatically regain
  function.
• 3. The principle of rest and stress first the
  body must rest to heal itself then structures
  must be stressed to regain range, strength,
  endurance
• 4. The biomechanical frame of reference is best
  suited for clients with an intact central nervous
  system because clients must be able to perform
  smooth, isolated movements (p.541).

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Biomechanical Frame of Reference - Evaluation

• Domains of concern
• 1. Structural stability
• 2. low-level endurance
• 3. Edema control
• 4. Passive range of motion (PROM)
• 5. Strength
• 6. High-level endurance

• Evaluations
• 1. X-ray (Physician)
• 2. Cardiac step charts, recording time pt can
  tolerate sedentary activity
• 3. Volumetry
• 4. Goniometry
• 5. Manual muscle tests, palpation, clinical
  observation
• 6. Number of reps or duration pt. can perform
  activity.

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Biomechanical Frame of Reference Client
Practitioner Interaction

• Therapist must explain connection between
  clients deficit and biomechanical goal and
  functional outcome.
• in writing for reimbursement purposes and
• verbally to client because treatment can be
  painful

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Biomechanical Approach -Strengths and Limitations

• Strengths
• Easy to write measurable goals quantifiable
• Oldest form of treatment for physical
  disabilities

• Weaknesses
• Purposeful activities much more effective than
  rote exercise
• Does not address pain, loss of sensation,
  incoordination

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Rehabilitative Frame of ReferenceBiomechanical
Approach

• Whose Life is it Anyway?

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Questions for Whose Life is it Anyway?

• 1. Which approach is more appropriate for the
  main character rehabilitative or biomechanical?
• 2. What would you suggest an OT do to help this
  person transition from hospital to home
  environment?
• 3. Treatment activities would you suggest?
• 4. What are some barriers to treatment being
  successful?
• 5. What are some resources the main charcater
  has?
• 6. If the main character had more use of his
  upper extremities and trunk, what else could you
  have him do? Which approach would you use?