Frames of Reference Flashcards
Applied Behavioral FOR
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.
Anne Mosey
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.
Neuromotor
to include sensory motor, neuromuscular, and motor
Cognitive
to include level of arousal, memory, problem solving, generalization of learning, attention
Psychological
to include roles, routines, habits, values/beliefs, self-concept
Social
to include social conduct, self-expression, self-management, self-control, coping skills, time management
Writing behavioral goals and objectives for applied behavioral FOR
- Behavioral task: specifies the behavior or task that is to be learned. It needs to be written in positive and observable terms.
- Condition of Performance: outlines what, where, and how an individual will demonstrate attainment of the objective.
- Frequency/Duration: specifies how often or how long the behavior has to occur.
- Criteria for moving to the next level: determines what steps must be completed before the next behavior or objective can be performed.
- Timeframe: determines when behavior should be performed; state actual date (month/day/year) behavioral task should be completed.
Example of goal and objective for applied behavioral FOR
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)
Shaping and chaining in Applied Behavioral FOR
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.
Prompting, scaffolding, and fading in Applied Behavioral FOR
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”
Cognitive Behavioral FOR
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.
Describe the 3 waves of behavioral theories
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.
Social cognition and 3rd wave cognitive FOR
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.
5 basic assumptions of social cognitive theory
- People learn by observing others
- Learning is an internal process
- People are motivated to achieve goals
- People regulate and adjust their own behavior
- Positive and negative reinforcement may have an indirect effect on behavior
Concepts from 3rd wave cognitive behavioral theory
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
Biomechanical FOR
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.
Rehabilitative FOR
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.
Allen’s Cognitive Levels FOR
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.
What are the 6 ACLs?
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.
Toglia’s Dynamic Interactional Approach
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.
Ayers’ Sensory Integration FOR
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.
5 basic assumptions that form the basis of Ayers’ SI theory
- The CNS is plastic
- SI develops in stages
- The brain works as an integrated whole
- Adaptive interactions are critical to SI
- People have an inner drive to develop SI through participation in sensorimotor activities
Sensory motor and processing frames
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.
Motor Control FOR
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.
