Rehabilitative Frame of Reference Biomechanical Approach

OT 606 Spring 2004

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.

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

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.

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 teachinglearning 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.

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

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)

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.

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

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

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

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

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).

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.

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

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

Rehabilitative Frame of Reference Biomechanical Approach

Whose Life is it Anyway?

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?