Frames of Reference

Question 1

What are musculoskeletal FOR?

Answer 1

• Biomechanical/Biomedical
• Rehabilitative
• Occupation-based focus
• • PEOP
• • MOHO
• • Occupational science
• • EHP

Question 2

What is the biomechanical/biomedical approach?

Answer 2

• Approach in treatment of physical dysfunction employing principles of fixing the physical impairments of the person. This approach looks at physics related forces, levers and torque, and involves assessment of both static and dynamic movement. It applies principles of human movement to occupational performance

Question 3

How does the biomechanical/biomedical approach relate to occupational therapy FOR and intervention approaches?

Answer 3

• Primary focus is on remediation. Establish and restore function
• Change client variables to establish a skill or ability that has not yet developed or to restore a skill or ability that has been impaired
• Variables include: ROM, muscle strength, etc.

Question 4

What does the biomechanical/biomedical approach use when focusing on deficits?

Answer 4

• Decreased ROM
• Decreased strength
• Decreased sensation
• Decreased postural stability
• Increased swelling causing decreased motion and pain

Question 5

How does the biomechanical/biomedical approach relate to occupational performance?

Answer 5

• Directed towards the restoration of motor function
• Usually seen as adjunctive, enabling, or preparatory in nature
• Interventions should be related to the individual’s occupational goals

Question 6

What is the rehabilitative approach?

Answer 6

• This approach seeks to promote independence despite impairment
• What intervention can be done now in order to increase independence or to “restore identity”
• Restore identity by providing opportunities

Question 7

What are interventions under the rehabilitative FOR within the OT framework?

Answer 7

• Modification/adaptation (i.e. built up handles, pen grips, button hooks, jar openers)
• Create/prevent (i.e. patient education, community education, sensory rich environments
• Maintain (patient, family, and community education)

Question 8

What are examples of the rehabilitative approach?

Answer 8

• Wheelchair selection: to prevent decubitus ulcers and to allow someone to self-propel
• Technology adaptations
• Environmental changes: moving items to a lower level, elevated toilet seats, grab bars
• Adaptation to task performance: if pt cannot do task standing, can they do the task sitting?

Question 9

What are socioeconomic and cultural considerations that should be made when treating patients?

Answer 9

• Access to services: lack of insurance or co-pays can interfere with access to OT services
• Personal beliefs about adaptive equipment and orthotics
• Language or communication barriers in outpatient settings
• Cultural beliefs regarding healthcare, interventions, and service delivery
• Cultural beliefs regarding pain: if the pt is safe to move, reassure pt that moving will not increase damage
• Consider cultural routines and rituals when developing occupation-based goals (i.e. be aware of prayer times when scheduling therapy)
• Consider cost-effective alternatives for treatment interventions

Question 10

How do reimbursement trends effect service delivery?

Answer 10

• Rationing of health care in order to decrease expenditures
• Emphasis on wellness/prevention
• Emphasis on outcomes
• Pt caretakers assume increased responsibility
• Network of providers determines coverage of services
• Managed care (trying to limit care)
• Workers comp (individual has a case manager in addition to network of health care professionals)
• Medicare (part B cap - no longer active but there is still a threshold that can be modified using a specific code)
• Emphasis on functional activity

Question 11

When does home program education and d/c planning occur?

Answer 11

On the first day of treatment!