Frames of Reference

Question 1

Applied Behavioral FOR

Answer 1

The behavioral FOR is on a continuum. It spans from behavioral modification to cognitive behavioral therapies and ends with social cognitive theories of learning.
The behavioral FOR comes to us from psychology theories. Pavlov, Skinner, and Bandura are widely know for their contributions to behaviorism.
Common terms: shaping, chaining, scaffolding, prompting
It promotes the learning of skills of occupational performance without regard to sequence or developmental stage.
This FOR is useful for anyone wishing to form a new habit or to break a bad (maladaptive) one.

Question 2

Anne Mosey

Answer 2

She adapted the behavioral principles when defining the acquisitional frame of reference. The idea was based on “action – consequence.” The principles of repetition, practice, and reinforcement are key. The principles are applied through self-management or self-regulation strategies.
We (OT) apply this within the context of everyday tasks.
The big idea…When considering independent living skill acquisition, know that performance (neuromotor, cognitive, psychological and social) skills are necessary.

Question 3

Neuromotor

Answer 3

to include sensory motor, neuromuscular, and motor

Question 4

Cognitive

Answer 4

to include level of arousal, memory, problem solving, generalization of learning, attention

Question 5

Psychological

Answer 5

to include roles, routines, habits, values/beliefs, self-concept

Question 6

Social

Answer 6

to include social conduct, self-expression, self-management, self-control, coping skills, time management

Question 7

Writing behavioral goals and objectives for applied behavioral FOR

Answer 7

1. Behavioral task: specifies the behavior or task that is to be learned. It needs to be written in positive and observable terms.
2. Condition of Performance: outlines what, where, and how an individual will demonstrate attainment of the objective.
3. Frequency/Duration: specifies how often or how long the behavior has to occur.
4. Criteria for moving to the next level: determines what steps must be completed before the next behavior or objective can be performed.
5. Timeframe: determines when behavior should be performed; state actual date (month/day/year) behavioral task should be completed.

Question 8

Example of goal and objective for applied behavioral FOR

Answer 8

Goal: To improve study skills

Objective:
1. Behavioral task: Client will verbalize study habit strengths (assets) and weaknesses (deficits).
2. Condition of performance: within the academic environment/school setting.
3. Frequency or duration: 1 time per week.
4. Criteria for moving to the next level: for six out of twelve sessions (50% of the time)
5. Time frame: by 16 weeks (Spring semester, May 2023)

Question 9

Shaping and chaining in Applied Behavioral FOR

Answer 9

Shaping and chaining, an outgrowth of operant conditioning, can guide the learning of occupational skills.
Skinner demonstrated these principles by teaching a pigeon to turn around. Each time the bird turned in the desired direction, it was given a morsel of food (shaping). Eventually, the bird turned all the way around (chaining) and learned that repeating this behavior brought continued reinforcement.

Question 10

Prompting, scaffolding, and fading in Applied Behavioral FOR

Answer 10

While a client performs a sequence of steps, the occupational therapist may either visually or verbally prompt the client to remind him or her what needs to happen next.
Scaffolding is “a method of grading an activity by providing assistance to the client at times that he or she might struggle or be unable to successfully complete a step.”
Removing such assistance when it is no longer needed is called fading. Fading “occurs when prompts or cues that guide the performance of a complex behavior are gradually withdrawn”

Question 11

Cognitive Behavioral FOR

Answer 11

Cognitive behaviorism incorporates complex systems and nonlinear science.
Occupational therapists should consider this FOR whenever psychological barriers to activity engagement are encountered.
This frame of reference has been identified as the one most often used in behavioral health settings because it is especially effective in dealing with issues of motivation and emotion.
Used with OCD
Functional individuals can control and manage their own thoughts, feelings, and behavior to cope with stress, manage time, and balance their life roles and occupations.

Question 12

Describe the 3 waves of behavioral theories

Answer 12

The first wave covered early behaviorismfor which human behavior was analyzed using the scientific method.
In the second wave, cognition was added as a “behavior” that could be measured using self-report and the use of language.
The third wave widened the scope of focus to target problem behaviors and address valued life activities.

Question 12

Social cognition and 3rd wave cognitive FOR

Answer 12

We define social cognitive theory as an FOR intended for OTs treating mental health populations. Its focus, however, is on thought processes, self-determination, and social participation (roles, relationships, identity, and support).
This approach is especially useful for occupational therapy individual and group interventions for populations with mental health issues.
Functional persons can exercise personal and proxy agency by self-directing their own life roles, choosing supportive relationships and environments, and seeking out the help and resources they need to pursue a meaningful and fulfilling life.

Question 13

5 basic assumptions of social cognitive theory

Answer 13

1. People learn by observing others
2. Learning is an internal process
3. People are motivated to achieve goals
4. People regulate and adjust their own behavior
5. Positive and negative reinforcement may have an indirect effect on behavior

Question 14

Concepts from 3rd wave cognitive behavioral theory

Answer 14

Holism: acknowledge’s the interconnections of mind body, and spirit; as well as the brain’s ability to self-organize

Functional contextualism: focus on the whole event, sensitivity to the role of context in understanding the nature and function of an event, emphasis on a pragmatic truth criterion, and specific scientific goals against which to apply that truth criterion

Constructivism: to build, organize, or create order

Relational frame theory: comes from basic research about the way language and cognition interact, acknowledging the brain’s natural tendency to categorize and relate things and ideas to one another

Cognitive fusion and diffusion: (fusion) the building of relational frames by associating the various aspects of events in memory; (diffusion) focuses on nonlinear use of language

Pragmatism: focuses on the relationship among individuals, their artifacts and environments, and their societies, as represented by their actions in personal and interpersonal well-being

Mindfulness: full awareness of events in the here and now, suspending judgement or evaluation

Question 15

Biomechanical FOR

Answer 15

The biomechanical frame of reference applies the principles of physics to human movement and posture with respect to the forces of gravity.
life. In occupational therapy, the principles of movement, including range of motion (ROM), strength, endurance, ergonomics, and the effects or avoidance of pain, must be considered within the context of occupation.

Question 16

Rehabilitative FOR

Answer 16

Rehabilitation approaches include the concepts of adaptation, compensation, and environmental modifications with a goal of maximizing client strengths and independence.
Function involves maintaining strength, endurance, and ROM within normal limits for one’s age, gender, and physical characteristics. Function may also relate to the knowledge and use of good body mechanics and ergonomics in one’s daily occupations to prevent the likelihood of injury or cumulative stress syndrome.
Methods of intervention include activity adaptation, application of compensatory strategies or technologies, and physical reconditioning.

Question 17

Allen’s Cognitive Levels FOR

Answer 17

The six clinically defined cognitive levels and 52 cognitive modes offer occupational therapists some of the best detailed guidelines for assessing, assisting, and adapting environments for persons with cognitive disabilities.
This frame of reference focuses on the role of cognition (a process skill), the role of habits and routines, the effect of physical and social contexts, and the analysis of activity demand. Types of health conditions that include cognitive deficits are dementias, acquired head injuries, chronic mental illness, chronic diseases affecting the nervous system, and developmental disabilities.
Below level 1 is basically comatose, and above level 6 is considered normal functioning. Allen (1999) has identified ACL 4.6 as minimal for living independently, with the condition that dangerous items in the environment are removed or disabled and some supervision is available.

Question 18

What are the 6 ACLs?

Answer 18

Level 1: Automatic Actions
- ACL 1.0: withdrawing from stimuli: edge of consciousness
- ACL 1.2: responding to stimuli
- ACL 1.4: locating stimuli
- ACL 1.6: moving in bed
- ACL 1.8: raising body parts

Level 2: Postural Actions
- ACL 2.0: overcoming gravity
- ACL 2.2: standing and using righting reactions
- ACL 2.4: walking ACL
- 2.6: walking to identified location
- ACL 2.8: using railings and grabbing bars for support

Level 3: Manual Actions
- ACL 3.0: grasping objects
- ACL 3.2: distinguishing among objects
- ACL 3.4: sustaining acts on objects
- ACL 3.6: noting the effects of actions on objects ACL
- 3.8: using all objects and sensing completion of an activity

Level 4: Goal-Directed Actions
- ACL 4.0: sequencing self through steps of an activity
- ACL 4.2: differencing among parts of an activity
- ACL 4.4: completing a goal
- ACL 4.6: scanning the environment
- ACL 4.8: memorizing new steps

Level 5: Exploratory Actions
- ACL 5.0: learning to improve effects of actions
- ACL 5.2: improving the fine details of actions
- ACL 5.4: engaging in self-directed learning
- ACL 5.6: considering social standards
- ACL 5.8: consulting with other people

Level 6: Planned Actions
- Deductive thinking and trial and error allows them to anticipate problems and to take steps to avoid them.

Question 19

Toglia’s Dynamic Interactional Approach

Answer 19

This approach has been used with all types of acquired brain injury, including trauma and stroke, as well as some mental health and developmental disability populations.
The goal is to restore functional occupational performance for persons with cognitive dysfunction.
Domains of concern have previously been identified as orientation, attention, visual processing, motor planning, cognition, occupational behaviors, and effort.
The key features are self-awareness and the creation and use of cognitive strategies.
Cognitive functioning requires the ability to receive, elaborate, and monitor incoming information and the flexibility to use and apply one’s analysis of information across task boundaries.
Traditional occupational therapy interventions address attention, memory, and perception.

Question 20

Ayers’ Sensory Integration FOR

Answer 20

SI affects all of the occupations people undertake and, to a large extent, determines the effectiveness of occupational performance.
Ayres used the term sensory integrative dysfunction to describe the focus of occupational therapy intervention.
Disorders of attention, hypersensitivity to sensory stimuli, poor postural control and balance, apraxia, tactile defensiveness, and inefficient cognitive processing are some of the many difficulties that have been addressed successfully using SI strategies.
Neuroscientists define SI as the brain’s ability to organize sensory information received from the body and environment and to produce an adaptive response.
Children are functioning when they are able to integrate sensations within the process of engaging in their age appropriate occupations, such as playing, learning (education), self-care, rest and sleep, and social participation.
The SIPT battery has been called the “gold standard” for evaluating SI and praxis.

Question 21

5 basic assumptions that form the basis of Ayers’ SI theory

Answer 21

1. The CNS is plastic
2. SI develops in stages
3. The brain works as an integrated whole
4. Adaptive interactions are critical to SI
5. People have an inner drive to develop SI through participation in sensorimotor activities

Question 22

Sensory motor and processing frames

Answer 22

Sensory modulation difficulties in adulthood often interfere with their ability to work, socialize, or participate in other occupations of daily life.
Sensory motor functioning must be adequate for a client’s occupational performance and participation goals. This includes the ability to modulate sensory input and to self-direct attention to relevant internal and environmental sensory dimensions of a specified occupation, activity, or task.
People with normal sensory processing and integration ability can perform their daily occupations without becoming distracted or side-tracked by extraneous sensory input; they can also seek and incorporate sensations that facilitate their occupational objectives.
Dysfunction occurs when sensory systems cannot be controlled internally or automatically.
The occupational therapist’s role in this frame of reference is to identify activities within the client’s social and occupational roles that involve the type and intensity of sensation clients need to normalize their sensory processing and produce adaptive responses.

Question 23

Motor Control FOR

Answer 23

Karel (a psychiatrist) and Berta (a physical therapist) Bobath developed NDT

The focus of the NDT frame of reference is the restoration of skilled voluntary movement for both children and adults with either developmental or acquired neurological health conditions.
The focus of the NDT frame of reference is the restoration of skilled voluntary movement for both children and adults with either developmental or acquired neurological health conditions.
Most of the traditional motor control theories, including NDT (neurodevelopmental therapy), have their basis in reductionism.
Functional motor control refers to the capacity to perform voluntary skilled movements needed for everyday life.
The initial goals vary according to client condition, motivation, and occupational preferences.

Question 24

Motor Learning and Task-Oriented Frames

Answer 24

General rehabilitative approach to all forms of movement abnormalities and disorders.
Motor learning theories currently provide guidelines for restoring functional movement with clients having a broad range of health conditions.
This frame of reference incorporates the concepts of nonlinear science and depends upon neuroplasticity and brain self-organization as targets of therapeutic change.
Motor learning is defined as “a set of processes associated with practice or experience Motor learning is defined as “a set of processes associated with practice or experience define motor control as “the ability to regulate or direct the mechanisms essential to movement”
Functioning is defined within the context of specific tasks. Acquisition of skills for doing a task may be separated into early (experimental) or late (refinement) stages of motor learning.
With specific task accomplishment as the goal, intervention would focus on assisting clients in developing the optimal motor and cognitive strategies for achieving functional goals.

Question 25

Learning Theory

Answer 25

Procedural learning refers to learning tasks that can be performed without attention or conscious thought. Procedural learning develops slowly through many repetitions and eventually becomes habitual.
Declarative learning, in contrast, results in knowledge that can be consciously recalled and thus requires awareness, attention, and reflection. This type of motor learning allows individuals to mentally practice a movement sequence before performing it. For example, learning to ski requires the conscious application of strategies and techniques
Declarative learning, in contrast, results in knowledge that can be consciously recalled and thus requires awareness, attention, and reflection. This type of motor learning allows individuals to mentally practice a movement sequence before performing it. For example, learning to ski requires the conscious application of strategies and techniques

Habituation refers to a decrease in responsiveness (or desensitization) that results from repeated exposure to a nonpainful stimulus.
Sensitization is an increased responsiveness following threatening or noxious stimuli.

Question 26

Psychoanalytic Frames

Answer 26

The psychoanalytic frame of reference offers both insight and effective strategies to guide occupational therapists in dealing with our clients’ emotional issues and barriers.
The focus of this frame of reference, in a broader scope of practice, may target the following life dimensions: social participation, emotional expression and motivation, self-awareness, defensive behaviors, and projective arts and activities.
Freud suggests three ways by which observation of unconscious content is possible: projections (drawings, music, drama, and creative writing), dreams (symbols and their meaning), and free association (spontaneous connections of objects, symbols, and emotions).
Psychoanalytic theory provides an explanation for many of the irrational, even bizarre behaviors we observe in persons with a variety of illnesses, such as suicide attempts and paranoia.
A balance exists in the functioning individual that allows the psychic energy to flow freely between the id, ego, and superego. A functioning adult is free from conflicts and fixations and is able to satisfy his or her needs and direct his or her drives in ways that fit in with the social environment and culture.

Question 27

Psychodynamic-Ego Adaptive Frames

Answer 27

The psychodynamic frames of reference are some of the most relevant for occupational therapy because they focus on the person’s inner drive toward growth, development, and mastery and incorporate the role of doing, or occupation, in a person’s self and social identities.
This frame of reference for occupational therapy most often targets the following: self-identity, self-direction and motivation, self-awareness, self-management, and social identity and relationships.
A healthy ego is synonymous with a strong sense of self; body image, self-identity, and self-esteem are realistic and can serve as the basis of adaptive function. The ego is in control and defense mechanisms are not exaggerated so that the individual with a healthy ego can use most of his or her energy to grow and develop and interact effectively with others.