OCTH 611 (Theory & Philosophy) Flashcards
Types of knowledge:
Propositional
Professional craft knowledge
Personal knowledge
Propositional Knowledge:
Set of assertions or assumptions that can be
explained studied and transmitted
Generalizable; universal principles
Purely intellectual – associated with Theory
Professional Craft Knowledge:
More than “application of theory”
Context-specific
Personal Knowledge:
Personal worldview; morals; experiences
Theory Defined:
“A a set of interrelated assumptions, concepts, and
definitions that presents a systematic view of phenomena by specifying relationships among
variables, with the purpose of explaining and predicting the phenomena.”
Theory Defined:
“Theory is a way to increase understanding by bridging the gap between concrete experience in the world of observed events, such as falling apples, and the imagined world of hypothetical concepts, such as gravity.”
Theory Construction:
- Philosophical assumptions
- Concepts and constructs
- Principles and postulates
- Theory/framework/model creation
beliefs that are the essence of a culture,
society, discipline, or movement and which supports its decision-making.
Philosophical Assumptions
CONCEPTS AND CONSTRUCTS:
- Concept
Observable characteristics or
structural features or objects - Construct
Abstract, intangible
characteristics that
characterize observations
PRINCIPLES AND POSTULATES:
Relationships between identified concepts and
constructs
REASONS TO STUDY THEORY:
- To validate and guide practice
- To justify reimbursement
- To clarify specialization items
- To enhance the growth of the
profession and the professionalism of
its members - To educate competent practitioners
- To meet accreditation counsel for OT
education (ACOTE) standards
BARRIERS TO USING THEORY IN PRACTICE:
- Ever-increasing pace of change
- Demands on healthcare workers
- Lack of time to explore theoretical ideas in
practice - Minimal exposure to theory during
fieldwork
Philosophy defined:
Concerned “with the meaning of life and
the significance of the world in which humans find
themselves.”
Professional philosophy:
“The system of beliefs and values unique to
each profession, which provides its
members with a sense of identity and
exerts control over theory and practice.”
PHILOSOPHY OF OT:
Represents the profession’s view of the nature and
existence and gives meaning to and guides the actions of the profession. It also provides the fundamental set of values, beliefs, truths, and principles that guide the actions of the
profession’s practitioners
SCHOOLS OF PHILOSOPHY:
- PRAGMATISM
- EXISTENTIALISM
- HUMANISM
- ASCETICISM
“A method or tendency in philosophy…which
determines the meaning of all concepts and tests
their validity by their practical results.”
- Based on the notion that an idea is only true if it
works or “tests out” in real life - Primary author – William James
- Also known as “results-driven” philosophy
Pragmatism (20th centry)
Pragmatism (20th century):
Pragmatists say that life is a process of
discovering the truths of how our actions
work for us. Their question is not so much
“what is true?” or “what ought we to
believe?” but instead “what, if we believe
it, will work best for us?”
Pragmatism:
“Holds that humans’ development proceeds through experience in life with objects and individuals in the environment. Knowledge and
truth are constantly being revised, and interpretation or reality is influenced by individual and collaborative experience.”
A philosophy and literary movement, variously
religious and atheistic“… based on the doctrine that
existence takes precedence over essence and holds that man is totally free and responsible for his acts, and that this responsibility is the source of the dread and anguish that encompasses him.”
Existentialism
Existentialism:
- Less concerned about scientific truths
and more focused on the experience of
the person (e.g., beliefs and feelings) - What is the meaning or purpose of
life? - Kierkegaard – the father of
existentialism; also espoused by Sartre
and Nietzsche - Focus on freedom and responsibility –
humans are ultimately free to do
whatever they choose, but are also,
ultimately, responsible for their choices
“Any system of thought or action-based
on the nature, dignity, interests, and
ideals of man…modern, nontheistic,
rationalist movement that holds that
man is capable of self-fulfillment [and]
ethical conduct…without recourse to
supernaturalism.”
Humanism
Humanism:
- Concerned primarily with the ideas, thoughts, beliefs, values, and concerns of humans.
- Emphasis on humans’ ability and responsibility
to lead lives that are ethical, personally fulfilling, and good for all of humanity.
A philosophy that “exults
work and seriousness at the expense of
leisure and enjoyment.”
Asceticism
Asceticism:
“The religious doctrine that one can
reach a higher spiritual state by rigorous self-discipline and self-denial.”
Asceticism:
- Renouncing worldly pleasures, typically in order
to pursue a spiritual goal, but may apply to other goals - Restraint is a virtue
- Max Weber was a proponent, as were Buddha and Gandhi
WHY STUDY PHILOSOPHY?
“Through understanding the philosophical foundation of occupational therapy, one is likely
TO BE BETTER ABLE TO UNDERSTAND the profession and its relationship to clients,
to colleagues in other areas of specialization or other professions, and to society to which is it responsible.”
Mental Hygiene Movement:
Included the view that idleness contributes to
mental illness
Slagle, Tracy, and Johnson championed involving
individuals in healthy daily routines
Tasks were graded and environments structured for healthy engagement in occupation
Arts and Crafts Movement:
Based on an appreciation of skilled craftsmen
versus industrialization
Preserving tools and traditions
Hull House in Chicago and the Guildhall in
London
Barton, Tracy, and Slagle emphasized crafts in
OT
represents the knowledge base, values, and worldview upon which occupational therapists can agree through shared experience and that provides a basis for OT practice.
Paradigm
Dunton’s Foundational Assumptions:
- “Occupation is as necessary
to human life as food and
drink.” - “Every human being should
have both physical and
mental occupation.” - “Sick minds, sick bodies, and
sick souls may be healed
through occupations.”
Paradigm of Occupation (1900s-1940s):
Dunton’s foundational notion of occupation as paramount to health and
well-being
Mechanistic Paradigm/Medical Model (1950s-1970s):
◦ Calling for scientific evidence to support the emerging medical model
◦ OT adopts a biomedical worldview at the expense of holism (e.g., man is a
machine, just fix the parts)
◦ OT fragmented by specializations; managed care complicates reimbursement
New Emerging Paradigm (1980s onward):
◦ Return to foundational focus on meaningful occupations as central to well-being and health
◦ Occupation-based models emerge
The Paradigm of Occupation- 1920s:
Habit Training and Reconstruction
Rapid growth in hospitals
More OTs in the field
Slagle and Meyer develop habit training
Reconstruction offered to WWI veterans and to factory workers with industrial accidents
Emergence of rehabilitation focus and the biomechanical model, with activity analysis applied to ADLs and re-entrance to the workforce
1930s: Biomechanical and Behavior
Modification Frames of Reference (FOR):
Scientific influence plus arts and crafts
◦ Use of adapted tasks in handcrafts
OTs able to work in institutions
◦ Respected centers of the latest care
Scientists studying human behavior
◦ Pavlov, Watson, and Skinner
◦ Positive and negative reinforcements
Declining interest in psychoanalysis
1940s: Vocational Training, Activity Analysis, and Rehab:
Vocational rehab needed again after WWII
Social Security (New Deal provision of income for the disabled)
GI Bill (funding for vocational retraining)
◦ For people with physical and mental needs
◦ Sheltered workshops emerge
Physical Dysfunction Models
◦ Kinetic Model (Licht, 1947)
◦ Rehabilitation Model (Spackman, 1947)
1950s: Psychoanalytic and Sensory Motor FOR:
Psychopharmacological advances
◦ Thorazine and Librium
◦ Increased patients’ ability to participate in
OT
Re-emergence of interest in psychoanalytic
application of tasks
Freudian-influenced Object Relations Theory
advocated the “therapeutic use of self”
Neurological advances
◦ Rood, Ayers, and Bobath’s methods for
facilitating motor development
1960s: Social Reform:
Questioning of authority and demonstrations
Deinstitutionalization
◦ Goffman’s 1961 exposé of asylums
◦ Medications to prevent, cure, and manage chronic
conditions
◦ Resocialization (IADL training and opportunity for OT groups)
discussed in publications by Fidler and Mosey
Therapeutic milieu
◦ Community Approach
◦ Collaborative effort between therapist and client
Community Mental Health Act of 1963
Sensory Integration (Ayers, 1968)
1970s: Identity Crisis:
Specialties made it hard to find an OT frame
of reference
◦ Psychosocial
◦ Physical disabilities
◦ Hand therapy
◦ Pediatrics
◦ Geriatrics
AOTA established the Representative Assembly
who published the “Uniform Terminology”
document in 1979
1970s: Emergence of Various Frames of Reference:
Mosey (1970) – 3 Frames of Reference for
Mental Health
◦ Acquisitional: behavior/learning theory
◦ Psychoanalytic: object relations
◦ Developmental: recapitulation of ontogenesis
Llorens (1970) – Facilitating Growth and
Development
◦ Based on a review of contemporary theories of
human development
1970s: More Emerging Models:
- Ruth Weimer (1972) – Prevention Model
- Mosey (1973) – Activity Therapy
- Fidlers (1978) – Doing and Becoming
- Kielhofner (1977) – Temporal Adaptation
- Lorna Jean King (1978) – Individual Adaptation 6. Model (use of sensory integration with adults)
1980s: Standardized Assessments:
Accountability
◦ Pressure to show evidence for
interventions before receiving
reimbursement
◦ Exacerbated by lack of standardized
assessments
Manpower shortage
◦ Education of All Handicapped Children
Act of 1975
Lack of unified theoretical base
Lack of research to validate practice
1980s: Standardized Assessments
AOTF offers grants for research
Movement towards state licensure
Proliferation of models, theories, and frames of
reference continued
Academic programs had a difficult time keeping
up with the changes being made in the
profession
1980s: Emerging Models:
Gilfoyle & Grady (1981) - Spatiotemporal
Adaptation (pediatrics)
Ross & Burdick (1981) - Sensory Integration
Groups for Adults
Howe & Briggs (1982) - Ecological Systems
Model
Townsend (1988) - Client-Centered Task Force
in Canada
Allen (1982) - Cognitive Disabilities
1980s: Fundamental Theoretical Developments:
Reilly (1958) - Occupational Behavior
Kielhofner & Burke (1980) - Model of Human Occupation
◦ 1st occupation-based model
◦ Reilly was their mentor
Mattingly & Fleming (1994) - Emergence of Clinical Reasoning
Activities that occupy a person’s time, involve achievement and address the economic realities of life.
Occupational Behavior
Occupational Behavior (Mary Reilly):
◦ Gave the 1961 Eleanor Clark Slagle Lecture, OT
Can Be One of the Great Ideas of the 20th
Century Medicine
◦ Believed strongly that OT needed a unifying
theory base
◦ Kielhofner, her mentee, credited her with the
shift in focus back to the occupation
Occupational Behavior: Reilly’s Influence:
OT had been reducing practice to “fixing the problem” with modalities and techniques
Reilly urged OT to recall the purpose of OT as defined by Meyer and Slagle - to “prevent and reduce the incapacities resulting from illness”
Focus on the disruption in function rather than the medical diagnosis
Kielhofner and Burke, two of her students,
incorporated her ideas of occupational
behavior into a model of practice that they
called the Model of Human Occupation
Reilly stressed the importance of childhood
play had on the normal, adaptive
development of productive activity in
adulthood
Occupational Behavior Model:
Introduced in 1969
Focused on the prevention and reduction of dysfunction that results from injury and illness
Emphasized a balance of self-care, work, and play/leisure
Occupational Behavior: Assumptions
Man has a need to master, alter, and improve his environment.
Occupation is intrinsically motivating, and people engage in occupation for its own sake to experience learning, control, and mastery that occurs during performance.
Humans have a psychological need for occupation, and when they lack
occupation, they suffer.
Society and culture highly influence the specific occupations chosen by
a person.
Health is realized in the rhythm of activity and rest and includes the need for balance and habits.
OB includes both physical and visible forms as well as a subjective and affective experience for the person
Occupational Behavior: Research and Future Directions:
Model was criticized by OTs for difficulty in
clinical application and lack of research
Several case studies have been published
(Line, 1969; Reilly, 1969)
Served as the “conceptual inspiration” for
other occupation-based models such as…
Model of Human Occupation:
Kielhofner and Burke reviewed the conceptual history of OT and proposed the MOHO in the 1980s
Called for reclaiming of the original concepts of the founders
Sought to understand and explain human occupation
Clinical Reasoning:
Initially a concept introduced by Rogers in her 1983
Slagle lecture
“The thinking process that expert OTs use during
treatment and interactions with clients” (p. 17)
Rerouting mechanistic OT back to its holistic roots
Mattingly & Fleming’s qualitative research (1994)
identified three types of reasoning
◦ Procedural reasoning: specific interventions
◦ Interactive reasoning: collaborative communication
◦ Conditional reasoning: connecting culturally
Occupational Science:
- Founded in 1989 by Yerxa and colleagues at USC
- Defined as “the study of the form, function, and meaning of human occupation”
- A controversial topic that has been agreed upon to be used to inform current practice
- Considered a separate academic discipline from OT with separate research methods
1990s: Decade of the Brain and Growth
of Occupational Performance Models:
- Christiansen & Baum (1991) – Person Environment Occupation Performance Model
- Schkade & Schultz (1992) – Occupational Adaptation Model
- Dunn, Brown, & McGuigan (1994) – Ecology of Human Performance Model
- Law et al. (1996) – Person Environment Occupation Model
- CAOT (1997) – Canadian Model of Occupational Performance
◦ Revised by Polatajko, Townsend, & Craik (2007) as Canadian Model of Occupational Performance and Engagement
1990s: Research and Education:
ADA of 1990
Change in requirement for MS degree
Many master’s and doctoral OT students doing
research
Well Elderly Study (Clark et al., 1997)
◦ Randomized control trial of OT’s influence on
independent living in older adults
◦ Published in JAMA
Major Trends in OT Theory Development:
- Moving away from the medical model
- Moving toward a holistic approach
- Expanding the definition of occupation
- Understanding cognition, sensation, and neuroscience
- Embracing occupational science
- Building an evidence-based practice
- Human adaptation in the context of culture and community
- Putting the client first
Phillippe Pinel (1745-1826):
- Medical director of a hospital in Paris
- Credited with “removing the chains”
- Champions “activities as a means of securing good morale and discipline” in his 1801 book advocating occupational treatment – rather than restraint – for those with mental health illnesses
- Influenced others in Europe
Phillippe Pinel:
forbids the use of chains and shackles
removed patients from dungeons and provided them with sunny rooms and allowed them to exercise on grounds
Samuel Tuke (1784-1857):
- Grandson of Quaker William Tuke, who
established The York Retreat in England in
1796 - “Retreat” versus “asylum”
- Activities and occupations used to
promote self-control and habit training - No chains or physical punishment
- The Retreat York
Benjamin Rush (1746-1813):
- American physician and Physician General
of the Military Hospital, signer of the
Declaration of Independence, and
politically influential - Known as a “Father of Psychiatry” in
America and known for making a change
in the approach to treating the mentally ill
with activities and incentives - Established first humane hospital and The
Brattleboro Retreat in USA
Dorothea Dix (1802-1887):
- Difficult childhood led her to education, jail, and
social reforms at an early age - Inspired by Rush and Pinel; met with Tuke
- Began a crusade to reform mental health care,
which led to Europe and an audience with the
Queen and the Pope - Had a “nervous breakdown” herself in 1836 and
was hospitalized in the York Retreat in England - Was so impressed with their philosophy
that she brought those methods to the USA - Meeting with Moses Sheppard in 1851
Clifford Whittingham Beers (1876-1943):
- Yale graduate and a financier
- Experienced bipolar disorder, suicide attempt
and hospitalization - Wrote about his experience in “A Mind That
Found Itself,” exposing the deplorable
conditions in asylums - Devoted himself to improving the mental
health system and sparked the founding of the
modern mental hygiene movement - Founded Mental Health America
Early Advocates of OT:
Dr. Herbert James Hall
Susan Tracy
Eleanor Clarke Slagle
George Edward Barton
Dr. William Rush Dunton Jr.
Dr. Adolph Meyer
Dr. Herber James Hall (1870-1923):
- Harvard grant in 1905 to study occupation’s
therapeutic use - Set up arts and craft workshops (called them
“sanatoriums”) - Demonstrated that “physical, mental, and moral
health could be restored and maintained through
occupation” (Quiroga, as cited in Kielhofner, 2009, p.
16) - Pioneer of sorting, adapting, and grading tasks
by activity analysis - Engagement in manual occupation addressed
issues of failure, boredom, cognition, and
thought diversion - President of AOTA* in 1921
Susan E. Tracy (1878-1928):
- Observed that those who were active had
better outcomes which led to her to the
use of “occupation” as a private nurse - As nursing school administrator, she
integrated occupation courses into
nursing curriculum - Considered one of the first Ots
- Eventually shifted her emphasis to
instruction in “occupational therapy” - Authored Studies in Invalid Occupation
- Was invited to the 1917 founder’s
meeting but was unable to attend and
sign - Listed as a founder and elected to the
Board of Management
William Rush Dunton, Jr. (1868-1966):
- Physician working at Sheppard Asylum
(SA) - Influenced by Tuke’s integration of
occupation and moral treatment - 1896 – collaboration with Meyer at
Hopkins’ psychiatric clinic - 1912 – director of occupation at SA
- 1915 – published Occupational
Therapy: A Manual for Nurses - Was a founder and became president
of the NSPOT - Was the editor of the first professional
journal, Occupational Therapy and
Rehabilitation (1939)
Eleanor Clarke Slagle (1871-1942)
- 1911 – took a course in
“Amusements and Occupation” at Hull House in Chicago School of Civics and Philanthropy (influenced
by Adolph Meyer) - 1912 - director of OT at Phipps Clinic; then returned to teaching in Chicago to become primary early educator of OT
- Studied music in private school in NY
- Was a caregiver for family members (father with Civil War gunshot wound, brother with TB, nephew with polio)
- Implemented “habit and moral training”
Eleanor Slagle (Habit Training):
- Structure of self-care, occupations, walks,
meals, recreation, and exercise for those
with chronic and severe mental illness - Based on ideas of Meyer, who felt that
disorganized habits were linked with mental
illness
Slagle – Later Years:
- WWI – asked by Red Cross to direct a six-week training
program for reconstruction aide volunteers working
with returning soldiers - Appointed by US Surgeon General as a consultant to
the US Army for training these aides (up to 4000
therapists) - Was a founder and elected the first VP of the NSPOT,
then elected president; later served as Executive
Secretary for AOTA - First Eleanor Clarke Slagle Lecture given in her honor
at the 1955 annual AOTA conference
George Edward Barton (1871-1923):
- Trained as an architect, but after
some medical issues he became
inspired to use his interests in
manual arts for his own recovery to
help others - Established Consolation House in
Clifton Springs, NY in 1914 as a
workshop for recovering patients - Became interested in getting like-
minded people to establish an
organization - First to use the term “occupational
therapy”
Adolph Meyer (1866-1950):
- Received his MD in Switzerland
with a focus on neurology - Emigrated to Chicago in 1892 and
worked in a state hospital as a
pathologist - Influenced by his mother’s mental
illness, he became interested in
psychiatry - Became director of Henry Phipps
Psychiatric Clinic at Johns
Hopkins Hospital - Contact with Dunton at SP and
later collaborated with Slagle to
develop OT
Meyer – Assumptions:
* In care of the mentally ill, it is important to
* “…support development of a regime of work, rest,
play and socialization” (Meyer, 1931, p. 170)
* “…do work that is meaningful to them” (Winters,
1952, as cited in Kielhofner, p. 33
- In care of the mentally ill, it is important to
- “…support development of a regime of work, rest,
play and socialization” (Meyer, 1931, p. 170) - “…do work that is meaningful to them” (Winters,
1952, as cited in Kielhofner, p. 33)
AOTA’s Beginnings: Clifton Springs Delegation 1917:
- William Dunton
- Isabel Newton
- Thomas Kidner
- Susan Johnson
- George Barton
- Eleanor Clarke Slagle
process of self-reflection to understand oneself and others to build trustworthy relationships
cultural humility
Cultural Humility:
Ongoing process of examining ones own cultural identity and beliefs
Adopted by therapist to increase quality of patient interactions
Different parts of the world are becoming increasingly diverse
We must approach environmental and cultural contexts that contribute to
health disparities
Cultural Competence vs. Cultural
Humility:
Cultural competency
Building an understanding and knowledge of
other cultures
The clinician becomes an expert on culture
Cultural humility
The patient is the expert on their culture
Builds client-centered care
Why is cultural humility important?:
Philosophical assumptions
“Each individual is able to be understood only
within the context of his or her
environment of family, community, and cultural
group.” (Mosey, as cited in Ludwig, 1993, p. 52)
“Choice and control extend to decisions about
Intervention, thus identifying
occupational therapy as a collaborative process
between the therapist and the
recipient of care. In this collaboration, patient’s
values are respected.” (Christiansen & Baum,
1997, p. 36)
How did our OT roots and founders account for or attend to culture?
When is it important to be culturally humble?:
Refugees
Socioeconomic status
Minority groups
Stigma
Language
Age
Disability
Health literacy
How are we to be culturally humble as
OTs?:
“Are we equipped (theoretical frameworks, interventions tools and guidelines) to provide a culturally appropriate response to disability
management, return-to-work or work rehabilitation in regard to the diversity of workforce?”
Is it part of our academic training?
Is it encouraged in the workplace between staff members?
Is it maintained with all patient populations?
If not, how could it be incorporated?
Applied Systems Theories in OT:
“The whole is more than the sum of its parts.”
-Aristotle
The Reductionistic Paradigm:
Contributing Ideas of the 17th
Century
René Descartes (1659-1650) - French
philosopher; proposed separation of
body and spirit (observable would be
studied by science, the ephemeral by
the church); This philosophy was
widely embraced and persists today
Influences of Systems Theories:
Late 20th century paradigm shift out of
mechanistic and reductionist ways of
thinking.
Kielhofner introduced it as counter
approach to reductionist specializations
in OT.
Valued holistic approach to assessment
and intervention.
OTPF, MOHO, EHP, OA, and PEOP (and
others) all use concepts from systems
theories.
Origins of Systems Theories:
Ludwig von Bertalanff y (1901-1972)
Hungarian biologist who introduced the
idea of Systems Theory in 1948
“A whole that functions as a whole by
virtue of the interaction of its parts”
“An entity that is greater than the sum
of its parts because it consist:
1) parts
2) the way they work together
3) the qualities that emerge from
these relationships”
Kielhofner’s Contributions:
AJOT article titled “General
systems theory: Implications for
theory and action in occupational
therapy” (1978)
Identifi ed ST as “the emerging
paradigm that will transform…
reductionism”
The MOHO was published two years
later with Burke and used ST as its
foundational framework
OTPF embraced and embedded ST
constructs
Systems Theories: Main Ideas
Scientifically, it takes the
conversation away from the level
of waves and particles to the level
of relationships
“Looking for patterns behind
patterns and for processes beneath
structures.”
Fritjof Capra
“…to see the universe not as a
collection of physical objects,
but rather as a complicated
web of relations between the
various parts of a unified
whole.”
-Fritjof Capra
Chaos Theory:
- Systems are self-organizing
- Even chaos has underlying,
inherent order - “Some systems are so complex
that prediction is not possible
due to multiple potential
interactions between multiple
variables - Exact weather prediction (e.g.,
Lorenz’s “butterfly effect”
Gregory Bateson (1904-1980):
Father was a pioneer of genetics
Degree in Anthropology from
Cambridge
Traveled to New Guinea to study
Met his wife, anthropologist
Margaret Mead
Studied zoology, psychology,
anthropology, and ethology
Bateson: The Pattern Which Connects:
Central message is the shift
from objects to relationships
“What pattern connects the
crab to the lobster and the
orchid to the primrose and all
four of them to me? And me
to you?”
Metaphor versus logic as a
means of understanding
nature
Bateson: Relationships
Things are comprised of
relationships, not parts
Stories are a means of
describing things in terms
of relationships, rather than
simply a description of the
elements of the story
The more complex the
relationships, the “prettier”
Margaret Mead (1901-1978):
Mead was born in
Philadelphia
Progressive and
controversial anthropologist
who became very well know
as someone who translates
other cultures for Americans
Bateson was her 3rd
husband
Named “Mother of the
World” by Time Magazine in
1969
Margaret Mead:
“Never doubt that a small group
of thoughtful people could
change the world. Indeed, it
is the only thing that ever
has.”
“Always remember that you are
absolutely unique, just like
everybody else.”
Mary Catherine Bateson (born 1939):
Only child of Mead and
Bateson
Anthropologist
Authored the first chapter in
Zemke and Clark’s
“Occupational Science: The
Evolving Discipline”
textbook
Participant in a USC
Occupational Science
Annual Symposium
Impact on OT:
World Health Organization recognizes life as an
ecological system in which health falls along a
spectrum
OT models incorporate its assumptions
OTPF
1. Describes contexts as “a variety of interrelated
conditions within and surrounding the client that
influence performance” (AOTA, 2002, p. 623)
2. Physical, Social, Cultural, Spiritual, Personal,
Temporal, and Virtual
WHAT IS A FRAME OF REFERENCE?
- Tend to be more focused than a theory
- A template rather than a protocol used to structure interventions
- Customizable
- Applicable
- Foster clinical reasoning
- Meant to be used in conjunction with other frames of reference
“The purpose…is to…link theory to intervention strategies and to apply clinical reasoning to the chosen
intervention methods”
BIOMECHANICAL FRAME OF REFERENCE:
- Kinematics and kinesiology
- Assessment of the physics (e.g., torque, force, leverage) of movement
- Interventions include (but are not limited to) exercise and splinting
- Lower motor neuron and orthopedic diagnoses
- Interventions to improve strength, range of motion, and endurance
- Focus on physiological factors (e.g., activity analysis) as the means to achieve a functional outcome
- Motivated by a goal in which “the outcome must reflect engagement in occupation” (Schultz-Krohn
& Pendleton, 2001, p. 39) - Trombly and Scott published Occupational Therapy for Physical Dysfunction in 1977
(Schultz-Krohn & Pendleton, 2001; Breines, 2001)
BIOLOGICAL THEORIES OF AGING:
- Cellular theories
- Free radicals disrupt cellular balance at a rate affected by internal (e.g., biological
processes) and external (e.g., radiation exposure) factors as well as a “decreased expression
of…mixed function oxidases” (p. 32) - Genetic theories
- Stochastic theory: delayed outcome of decreased replication ability of non-repeating DNA
sequences - Control theories
- Natural decrease in the “function of specific physiologic systems known to be vital for the
maintenance of homeostatic equilibrium”
REHABILITATION MODEL:
- Initiated in response to the heightened need for medical care for wounded WWII
soldiers and veterans - Physical medicine and rehabilitation programs created within Veterans Administration hospital
systems - Government programs and funding
- Addressed needs of chronically ill populations
- Hill-Burton Act of 1946 “provided federal aid for the construction of rehabilitation centers”
(p. 19) - In 1965, Medicare and Medicaid were initiated to ensure access to rehabilitative services for
the chronically ill, the community, and the institutionalized
REHABILITATION FRAME OF REFERENCE:
- Goal of “return[ing] to the fullest physical, mental, social, vocational, and economic
functioning as possible” (p. 39) - Interventions increase a client’s abilities by:
- Facilitating participation in tasks with assistive devices and technologies
- Education on compensation (e.g., sock aid for lower body dressing, coping strategies to counter
obsessive-compulsive disorder symptoms) - Remaining focused on meaningful occupational outcomes
“engagement in occupation through alternative means” (p. 39)
What’s the difference between biomechanical and rehabilitative?:
The biomechanical FOR focuses on the physical state of a person and their sometimes immutable biological processes. The rehabilitative FOR takes
biological aspects into account, but focuses more on adapting and restoring function than addressing physical processes.
However, because both are closely related - in that they both account for biological processes and have goals of addressing functional outcomes - they are often used in conjunction in research.
Pros… and Cons of the Biomechanical & Rehabilitation Model:
Pros…
* Easier to gather quantitative data
* Support from medical community
* More research on physical
rehabilitation
* Reimbursement favors measurable
results
…and Cons
* Tend to focus less holistically
* More medical model, less focus on function
* Addresses symptoms rather than whole the
person or situation
FUTURE RESEARCH AND IMPLICATIONS of the Rehabilitative & Biomechanical Model:
- Is effectiveness increased when these FORs are coupled with other models?
- Would there be increased support for OT in the medical community
because of easier-to-present data? - Is this the only concrete means of justifying reimbursement?
