Rehabilitative Frame of Reference

Rehabilitation is the action of restoring someone’s health or normal life through training and therapy after an illness. Before going into the deep of rehabilitative frame of reference A.K.A rehabilitation frame of reference, it’s important to understand the meaning of rehabilitation.

The term rehabilitation means a return to ability, that is, the return to the fullest physical, mental, social, vocational, and economic usefulness that is possible for the individual. It means the ability to live and work with remaining capabilities. Therefore the focus in the treatment program is on abilities rather than on disabilities. (Hopkins)

An Aim of rehabilitation is to regain the function of an individual or to compensate the deficits. For rehabilitation of a person, many different types of approaches can be used by the therapist like biomechanical frame of reference, developmental frame of reference, etc.,

Now, come back to the main topic, i.e rehabilitative frame of reference in occupational therapy. In Occupational therapy point of view, “rehabilitation is to compensate for underlying deficit that cannot be remediated in a daily routine task and in occupation.

The rehabilitative frame of reference requires that the client must be the part of the rehabilitation team. Rehabilitation programs must be preferred in the environment that is most natural to the client. The therapist must be creative when coming up with compensatory strategies and environmental modification.

In the rehabilitation frame of reference, theories suggest many assumptions which form the base of frame of reference.

#1 – person can regain independence through compensation.

#2 – motivation is a basic requirement for the independence. Motivation is based on values, role, and interest.

#3 – environmental factors also plays important roles in independence/rehab.

For ex. Financial status, family support, etc.,

#4 – minimum of emotional and cognitive prerequisite skills are needed to make independence possible.

Function – dysfunction continua (domains of concern)

In this approach, an occupational therapist focuses on performance areas more than on performance components. The aim of the occupational therapy program is to minimize disability barriers to role performance. From the Occupational Therapy perspective, activities of daily living ( ADL), work and leisure, are the basic and most important domains, where OT should focus and bring independence in those areas to successfully rehabilitate a patient.

ADL – it can be divided into two main parts, i.e. self-care and home care. A wide range of skills is required to perform ADL activities like eating, dressing, bathing, homemaking, child care etc.

Work tasks depend on the nature of occupational roles.

Leisure activities like watching TV, gardening, playing guitar, piano, etc. can also need independence. So, a person can take a leisure break when he /she need it without any help from others.

Behavior indicative of function dysfunction (Assessment) –

The occupational therapist must assess the patient’s capabilities and determine how to overcome the effects of disability. Many assessment tools are available to assess the level of assistance needed while performing an activity. The level of assistance is generally labeled as minimum, moderate, and maximum assistance. Assistance may need at during different activities like bed mobility, bowel-bladder control, skin care, communication etc.,

In work evaluation, work behavior like work tolerance, work conditioning, grip strength etc. evaluated and noted. Similarly, leisure skills are noted down by implementing different interest checklists for adults and play evaluate for children.

This postulate identify links between present problems and functional outcomes.

Rehabilitative frame of reference example,

It is essential to identify the stage-specific cause of the dysfunction.

It will help the therapist to decide better rehabilitation approach.

Postulates regarding change and intervention –

This postulate creates links between functional outcomes and specific adaptive devices, modification and procedure.

Frequently the methods of the rehabilitation approach are used in combination with biomechanical or sensorimotor approaches. First, biomechanical or sensorimotor principles can be applied during rehabilitation activities to enhance and reinforce the restoration of the sensorimotor and cognitive components. Second, the treatment program often focuses on performance areas and performance components simultaneously. Thus the restoration of sensorimotor, cognitive, and psychosocial functions are combined to improve functioning in the performance areas.

The treatment methods of the rehabilitation approach include modalities such as the following –

# Self-care evaluation and training

# Acquisition and training in Assistive devices

# Homemaking and child care

# Work simplification and energy conservation,

# work related activities,

# Orthotics and prosthetic training,

# Wheelchair modification and management,

# adapted procedure and safety education (Dutton)

References-
1. Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction
2. Willard and Spackman’s Occupational Therapy