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The Rehabilitative Frame of Reference

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Caitlyn Witherspoon

on 25 September 2014

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Transcript of The Rehabilitative Frame of Reference

Rehabilitation Hospitals
Intervention between the hospital and home
Team Approach
3 hrs/day, 5 days/week
Pre-WWII Rehabilitation
Early 19th century - familial, in-home care
Those with disabilities: isolated and tucked away from society
Shift from family care to rehabilitation institutions (once women entered work force)
Vocational rehabilitation received first funding (between 1918 and 1920)
Key Contributors
Rebecca Dutton, MS, OTS/L
Purposeful activities - practice the exact skill used for work or leisure (~1990s)
The Rehabilitative Frame of Reference
Where did
Rehabilitation begin?
Based in medicine
To better understand how pathological processes influence function
Based in physical sciences
To better understand human movement
The Rehabilitative Frame of Reference
Requires that the client be part of the rehabilitation team
Treatment programs will occur in the environment that is most natural to the client
The therapist must be creative when coming up with compensatory strategies and environmental modifications
Teaching/Learning process
Rehabilitation IS
Being able to live and work with one's remaining capabilities.
Rehabilitation
IS NOT
Meant to cure an illness or regain a lost movement
Rehabilitation IS
The use of assistive devices, adaptive techniques, environmental modifications, and compensatory strategies
Rehabilitation
IS NOT
Focusing on the disabilities; rather, emphasis is placed on the client's strengths and abilities
Rehabilitation IS
For clients whose impairments are considered permanent (i.e. not expected to improve). Permanence can be both static or progressive.
What is Rehabilitation?
Rehabilitation is "the process of restoring an individual's capacity to participate in functional activities when this capacity has been altered or limited by a physical or mental impairment" (Siedel, 2003, p. 235)
Pedretti, L. W. & Zoltran, B. (1990).
Occupational therapy practice skills for dysfunction (3rd ed., pp. 8-10)
. St. Louis: The C.V. Mosby Company.
Seidel, A. C. (2003). Theories derived from rehabilitation perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
Seidel, A. C. (2003). Theories derived from rehabilitation perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
Gillen, G. (2014). Motor function and occupational performance. In Schell, B. A., Gillen, G., and Scaffa, M. E. (Eds.),
Willard and Spackman’s occupational therapy (12th ed., pp. 753-756, 758)
. Philadelphia: Lippincott Williams and Wilkins.
Gillen, G. (2014). Motor function and occupational performance. In Schell, B. A., Gillen, G., and Scaffa, M. E. (Eds.),
Willard and Spackman’s occupational therapy (12th ed., pp. 753-756, 758)
. Philadelphia: Lippincott Williams and Wilkins.
Hopkins, H. L. & Smith, H. D. (1988).
Willard and Spackman’s occupational therapy (7th ed., p.41)
. Philadelphia: J. B. Lippincott Company.
Seidel, A. C. (2003). Theories derived from rehabilitation perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
1942 - 1954
Occupational therapists joined the rehabilitation movement
OTs already knew to treat mentally ill, but now they were treating the physically disabled (war veterans)
Emphasis was placed upon acquiring techniques
:
Prosthetic training
Progressive resistive exercises
1943
: Legislation amendment included psychiatric and medical rehabilitation services in its funding

1954-1960
Legislation amendments in 1954 and 1963
:
Concept of rehabilitation moved from biomechanical to a social rehabilitation model
"...restoration of individuals to their fullest potential as participants of family and community groups" (Seidel, 2003, p. 237)
Resulted in federal funds
: training rehabilitation personnel (OTs) and funding research
1960-1990
Rehabilitation was emerging as a medical standard
Social movement toward civil rights
: de-institutionalization of the mentally impaired influenced rehabilitation movement
Began advocating for community reintegration
Community-based programs
Assisted-living apartments
Wheelchair repair shops
1990 - present
More obvious advocacy for the inclusion of the physically disabled in a "mainstream" life
American Disabilities Act (1990)
:
Rights for the physically disabled for full participation in society
ADA Amendments Act of 2008 (ADAAA)
- broadened the definition of "disability"
Focus on "Quality of Life"
The Rehabilitation Movement: Post WWII
Advantage
: proficiency in use of treatment techniques
Disadvantage
: no theoretical/philosophical base and no integration of purposeful activities

References (timeline)
United States Department of Justice Civil Rights Division. (n.d.) Retrieved from http://www.ada.gov/2010_regs.htm.

Pedretti, L. W. & Zoltran, B. (1990).
Occupational therapy practice skills for dysfunction (3rd ed., pp. 8-10)
. St. Louis: The C.V. Mosby Company.

Seidel, A. C. (2003). Theories derived from rehabilitation perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
Assumption #5
"Clinical reasoning, used by the practitioner, begins with the individual's goals and functional capabilities, moves to the environments in which the person will function, and then to the types of compensatory strategies the person needs to use his or her capabilities."
Assumption #4
"Rehabilitation involves the teaching-learning process; therefore, the person needs sufficient cognitive skills to learn and to apply compensatory methods. Motivation enables the individual to participate fully in the teaching-learning process."
Assumption #3
"Environments in which a person performs influence his or her motivation for independence."
Assumption #2
"A person's level of motivation affects the extent to which and individual will regain independence."
Assumption #1
"With compensation strategies and techniques, an individual can restore independence when the underlying impairment cannot be remediated."
The 5 Assumptions
Rebecca Dutton, in 1995, identified 5 assumptions of the Rehabilitative Frame of Reference
Major Assumptions
Gillen, G. (2014). Motor function and occupational performance. In Schell, B. A., Gillen, G., and Scaffa, M. E. (Eds.),
Willard and Spackman’s occupational therapy (12th ed., pp. 753-756, 758)
. Philadelphia: Lippincott Williams and Wilkins.
Anne G. Fisher, ScD, OT, FAOTA
Use of adaptive occupations to compensate for client's ineffectiveness
Assistive devices and environmental modifications (~1970s-1980s)
Fisher, A. G. (1998). Uniting practice and theory in an occupational therapy framework.
American Journal of Occupational Therapy, 52
(7), 509-521.
References (Key Contributors)
Dutton, R. (1989). Guidelines for using both activity and exercise.
American Journal of Occupational Therapy, 43
(9), 573-580.
William Rush Dunton, Jr., George Barton, Thomas Kidner
Early founders of AOTA
Catherine A. Trombly, ScD, OTR, FAOTA
meaning must be present for motivation and purpose (~1990s)
Trombly, C. A. (1995). Occupation: Purposefulness and meaningfulness as therapeutic mechanisms. 1995 Eleanor Slagle Lecture.
American Journal of Occupational Therapy, 49
, 960-972.
Seidel, A. C. (2003). Theories derived from rehabilitation perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
How is the rehabilitative frame of reference used in OT?
Restore the client's ability to function independently and perform activities
"Compensate for disability by learning to live with one's capabilities in all aspects of life; adapt environment to obtain independence" (Dutton, Levy, & Simon, 1993)
Compensatory Strategies & Adaptive Devices
One-handed dressing/shoe tying
Prosthetics
Orthotics
Assistive devices
Home modifications
Populations
Physical Impairments:
Stroke, TBI, Total-Hip or Knee Replacements
Not used with only cognitive impairments
The Therapist
Collaborates with client to determine ADLs, work, and leisure activites
Must be creative!
Evaluations
COPM
Observations during activities
Self-reporting from the client
Interviewing the client to determine valued occupations
Case Study
Strengths of the Rehabilitative Frame of Reference
This frame of reference focuses on the core values of occupational therapy.
It gives the therapist a holistic perspective on the client.
There is collaboration between the therapist and client.
This frame of reference is a
goal-based intervention.
Weaknesses of the Rehabilitative Frame of Reference
The client must be motivated and committed to improve their independence.
There are no alternatives to therapy if these compensatory methods fail to work.
It is designed to
be used with
physical impairments.
You must have the proper equipment and environment to teach the skills.
Reference
(Strengths and Weaknesses)
Seidel, A. C. (2003). Theories derived from rehabilitation
perspectives. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.),
Willard & Spackman’s occupational therapy (10th ed., pp. 235-240)
. Philadelphia: Lippincott Williams & Wilkins.
Single Hand Cook
[Photograph]. Retrieved from http://www.yankodesign.com/2009/09/07/single-hand-cook/
Good Grips Button Hook
[Photograph]. Retrieved from http://www.mobility-uk-equipment.co.uk/good-grips-button-hook-504-p.asp

Zipper Pull
[Photograph]. Retrieved from http://www.tested.com/art/makers/458862-magzip-just-solved-one-lifes-greatest-challenges-one-handed-zipping/
Walker [Photograph]. Retrieved from http://www.mobility-uk-equipment.co.uk/good-grips-button-hook-504-p.asp
Hands Free Hair Dryer Holder
[Photograph]. Retrieved from http://www.amazon.com/HANDS-FREE-HAIR-DRYER-HOLDER/dp/B005IH0KDC/?keywords=hands+free+hair+dryer&qid=1346009754&ref=sr_1_2&ie=UTF8&sr=8-2.
Hemiplegic Dressing [Photograph]. Retrieved from http://therapylibrary.com/index.php?option=com_content&view=article&id=123&Itemid=2946
30 year old female
Valued Occupations: Mother (3 yr old son), Wife, Blogger, Home Caretaker
Right MCA Ischemic Stroke
Goals for Therapy
Adaptive Devices
Intagliata, S. (1993)
Rehabilitation centers
. In H. L. Hopkins, H. D. Smith (Eds.), Willard & Spackman’s occupational therapy (8th ed., pp. 784-789). Philadelphia: Lippincott Williams & Wilkins.
References
Seidel, A. C. (2003).
Theories derived from rehabilitation perspectives
. In E. B. Crepeau, E. S. Cohn, and B. A. B. Schell (Eds.), Willard & Spackman’s occupational therapy (10th ed., pp. 235-240). Philadelphia: Lippincott Williams & Wilkins.

Dutton, R., Levy, L. L., Simon, C. J. (1993)
Frames of reference in occupational therapy: introduction.
In H. L. Hopkins, H. D. Smith (Eds.), Willard & Spackman’s occupational therapy (8th ed., pp. 784-789). Philadelphia: Lippincott Williams & Wilkins.
Full transcript