Occupational Therapy professionals use “theory” to guide their practice. A Theory is the base of any profession in which construction or modification can be done with valid reasoning. Generally, theories can be made by the experts of the particular fields. Theories are, in general, may be a belief, policy or procedure proposed or followed as the basis of action.
Theories are not always vast and complex, but most people avoid to read theories and postulates. Theories are based on research, thoughts or observation of phenomena. Research-based theories are better to believe because they have some valid reasoning and reference.
A Frame of reference uses pieces of one or more theories and makes them practical and useful. (Kramer)
In the Occupational Therapy, a frame of reference is used as a baseline for practical application. A frame of reference uses theories to guide evaluation and assessment and application to the practice.
The frame of reference provides a structure for identifying relevant theories and then based on this information, outlines guidelines that occupational therapists use when assessing and providing intervention.
Mosey’s structural components for a frame of reference are used as an organizational scheme for all frames of reference. They are—
1. Theoretical base
2. Function- Dysfunction continua (areas of concern)
3. Evaluation
4. Postulates regarding Change (link between present problems and goals)
5. Postulates regarding Intervention (link between goals and treatment)
Theoretical Base – Occupational therapist use theory base in intervention to understand the future result she may notice after intervention. The theoretical base provides the foundation of the entire frame of reference. A theoretical base may draw from one or more theories. It includes Assumptions, Concepts, Definition, Postulates, and the relationship between them.
Function – Dysfunction Continua – This part of occupational therapy frames of reference specifically focus on “Concern/ Problem Areas” . After setting a theoretical base a therapist should be able to identify the specific areas of performance important to the individual’s skills and abilities. The functional end of the continuum represents, what the therapist expects from a client to be able to do ( Abilities ), whereas the dysfunctional end of the continuum represents Disabilities . Generally, a single frame of reference consists of several function- dysfunction continua.
Guide for Evaluation – Evaluation makes a baseline to the intervention. The evaluation should relate the indicators of function- dysfunction. Specific assessment tools / scales or specified protocol may be applied during the evaluation. The Occupational therapist uses tools, either standardized or nonstandardized, that will provide an appropriate baseline of performance and assist in developing a meaningful plan for intervention.
Postulates regarding Change –
Postulates regarding change, provides more concrete structure to the OT frames of reference. In this step, we can see the “Cause-Effect” phenomenon. It guides the therapist about the changes seen after applying the action. Postulates regarding change, transform abstract material stated in the theoretical base into practical actions that need to be taken by the therapists to facilitate change in the client.
Postulates regarding Intervention-
Postulates regarding intervention are guided by the postulates regarding change, which describe how an occupational therapist puts theory into action to facilitate change in the client. After an assessment, the therapist can plan out the media and modalities according to the frame of reference.
This postulate helps the therapist to set client-oriented goals and implementation of different techniques to achieve those goals. This postulate also guides how to use the specific techniques and modalities according to the theory.
An effective practice involves a therapist’s ability to match a client with the most appropriate frame of reference within the context of his or her life. After a patient is referred to occupational therapy, the therapist does a preliminary screening. The therapist looks at the person needs, strength, limitations, and environments.
After understanding all the above-mentioned things, a therapist chooses the most appropriate method for evaluation and intervention. Sometimes, this can be one specific OT frame of reference, but at other times, one is not adequate enough to deal with the complexity of the problems presented by the patient.
Eleven frames of reference currently used in occupational therapy practice are mentioned below-
Behavioral Frame of Reference
Cognitive disability Frame of Reference
Neurodevelopmental Frame of Reference
Sensory Integration Frame of Reference
Spatiotemporal Adaptation Frame of Reference
Occupational Adaptation Frame of Reference
Many therapists read about the OT frames of reference, but they don’t know how to apply the principles of frames of reference in clinical practice.
No doubt, OT Frames of reference are quite theoretical and even if therapists understand the principles of particular frames of reference, it’s difficult to apply it to a patient.
A therapist must understand what he/she is doing and why he/ she is doing it. A therapist also needs to be able to explain this rationale to patients, observers, and other professionals. This will improve his /her confidence during a therapy session.
A therapist can learn from the trial and error method initially if there is no senior or expert available to guide the expertise knowledge about the particular frame of reference.
A therapist needs to improve his/ her knowledge about the frame of reference, he/ she may use different frames of reference in a single patient, but it’s crucial to know the after effects and why he/she is using them.
For example, a physician should not prescribe medication without knowing its possible consequences; similarly, a therapist should not use a procedure without understanding its potential effects. On the basis of a client’s presenting problems, a therapist selects a frame of reference to specify changes or outcomes that she or he would like to promote.
Initially, Young occupational therapists are not having that much of knowledge to apply multiple frames of reference in one patient. They should focus on one frame of reference at a time, after mastering one; they can apply other frames of reference in a patient. Some patient needs one frame of reference, but many patients need multiple frames of reference.
Lets’ have an example of single OT frame of reference, a child having Sensory Processing Disorder, Occupational therapist prefers to apply single frame i.e. “sensory integration frame of reference”.
Now, consider a case of cerebral palsy, Occupational therapist may use multiple frames of reference, like developmental frame of reference, Neuro-developmental frame of reference, and Biomechanical frame of reference.
Frames of reference can be used in sequence or in parallel by the therapist, according to the need of a patient.
Frames of reference can be used in sequence—that is, one frame of reference is used primarily while another is applied for a separate problem.
For example, a child who has cerebral palsy may be treated first with the Neuro- Developmental frame of reference. After seeing the child for several months, the therapist might observe that the child also appears to be having cognitive problems. The therapist then evaluates the child based on the cognitive frame of reference. In this situation, the therapist decides to continue with the Neuro-Developmental Treatment frame, but also decides to use the cognitive frame of reference.
Frames of reference can also be used in parallel. In this situation, two frames of reference are used at the same time to address similar or related problems from different perspectives.
For example, A therapist may treat a child who has cerebral palsy by first using the Neuro-Developmental Treatment frame of reference for handling purpose. Along with this, therapist simultaneously uses the biomechanical frame of reference to enhance the child’s movement abilities and to assist him or her in developing as many normal patterns as possible.
Summary –
Occupational therapists use frames of reference to guide their practice and clinical knowledge. OT Frame of reference has a specific structure, from theory to intervention. Many frames of reference are available for occupational therapy practitioners. Multiple frames of reference can be used in sequence or in parallel.
References-
1. Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction
2. Willard and Spackman’s Occupational Therapy
3. Frames of Reference for Pediatric Occupational Therapy by Paula Kramer
