Reference: Duncan
Biomechanical FOR in occupational therapy
Occupation (Kielhofner 1997, Canadian Association
of Occupational Therapists 2002), within the context
of occupational therapy, is part of the human
condition, is necessary to society and culture, is
required for physical and psychological well-being,
entails underlying performance components and is a
determinant and product of human development.
The intrinsic vales of occupational therapy as a
practice grounded in humanism affirm the:
 Dignity and worth if individuals
 The participation in occupation
 Self-determination
 Freedom and independence
 Latent capacity
 Caring and the interpersonal elements of
therapy
 Human uniqueness and subjectivity
 Mutual cooperation in the therapeutic
processes
o Occupation and occupational performance are
usually expressed in terms of self-care/daily living
tasks, work/productivity and leisure/play (Kielhofner
1997, Canadian Association of Occupational
Therapists 2002). This infers that studying and
considering human occupation is most important
and is the core business of OTs
o Majority of clients seen by an occupational therapist
will have problems of ‘body and mind’ (irrespective
of diagnostic labels), which can only be discerned
within the context of that individual’s environment,
perspectives and value system
Improve Client’s
 Range of motion
 Muscle Strength
 Sensory Awareness
 Endurance
o In order to understand an individual’s specific
occupational performance problems, it is also
necessary to analyse and understand their
performance capacities.
Performance capacities – refer to cognition,
behavior, neural development, personal interactions,
and most importantly for this model, movement.
This model is called…
o Baldwin’s reconstruction approach 1919
o Taylor’s orthopaedic approach 1934
o Licht’s kinetic approach 1957 (Turner et al
2002)
 Occupation can be analysed to regarding its content
and meaning for the individual to determine
‘dysfunctional elements’ that may occur because of
disease or injury.
 Top down approach – using an occupational
therapy conceptual model of practice to appreciate
the significance of an individual’s occupational
performance problems and then using the
biomechanical FOR and others to appreciate the
performance capacity issues.
o The beliefs and values inherent in occupation
paradigm imply that OTs need to view their clients
as occupational beings. Therefore, we need to
choose conceptual models of practice that focus on
describing the occupational nature of the client,
such as MOHO, CMOP, and PEOP.
The focus of biomechanical FOR is the
musculoskeletal capacity to create movement (ROM),
strength and endurance in order to carry out
meaningful occupations.
Criteria when using the technology of
biomechanical FOR to enrich practice
1. Person’s occupational performance. The
primary concern here is understanding how the
phenomena from the biomechanical FOR (movement,
strength, and endurance) influence the person’s
performance of their occupational roles.
2. Assess through occupation. Analyse and assess
the phenomena from the biomechanical FOR
(movement, strength, and endurance) within the
context of the person’s performance of their
occupational roles.
3. Occupation restores/maintains. This reinforces
the person’s performance of occupational roles during
the restoration and/or maintenance and/or
compensation of movement, strength, and endurance
4. The outcome of occupational therapy is
satisfying/meaningful performance in occupations.
OTs ought to view the satisfying, meaningful
performance of occupation as the primary outcome of
therapy.
o Using the top down approach above means the
biomechanical FOR used by OTs will be different
from the biomechanical FOR used by other health
professionals.
o Biomechanical FOR is focused on the individual’s
motion during occupations. Motion refers to
capacity for movement, muscle strength and
endurance (ability to resist fatigue)
o An individual’s quality of motion may be
compromised due to injury of disease, thus affecting
their occupations. These effects may compromise
specific body systems and structures (bones and
joints) that help create motion seen during
occupational performance.
Biomechanical FOR objectives
 prevent deterioration and maintain existing
movement for occupational performance
 restore movement for occupational
performance, if possible
 compensate/adapt for loss of movement in
occupational performance
 Reference: Duncan
Limitations in movement during occupations
- capacity of the person to use their muscles in
conjunction with bones and joints to move freely
when engaging in occupations. This is usually due
to:
 shortening(contracture) of soft tissues, i.e.
muscle tissue, muscle connective tissues,
tendons, ligaments, fibrous capsules and skin
 the presence of inflammation, edema or
hematoma
 localized destruction of bone (rheumatoid
arthritis, osteoarthritis)
 amputation
 congenital abnormalities
 acute and chronic pain
 maladaptive environmental conditions
Inadequate muscle strength for use in
occupations
- capacity of person to initiate and maintain muscle
strength during their occupations. Inability may be
due to
 limitations in movement
 disuse or atrophy of muscle (post fracture
immobilization)
 primary muscle pathology (motor neurone
disease)
 peripheral neuropathy (diabetes)
 peripheral nerve damage (mononeuropathy of
the medial nerve)
 acute and chronic pain
 maladaptive environmental conditions
Loss of endurance in occupations
- ability of a person to resist subjective fatigue and
therefore sustain their occupations over time and
distance to their satisfaction. Issues are usually
due to:
 limitations in movement
 inadequate muscle strength
 compromised cardiovascular and/or
respiratory function
 acute and chronic pain
 maladaptive environmental conditions
Biomechanical conditions
- people who experience limitations in movement,
inadequate muscle strength and loss of
endurance whilst engaging in their occupations
may have a diagnosis of one or more of the
following biomechanical conditions:
 rheumatoid arthritis, osteoarthritis,
combination of the two, or the individual may
have experienced surgical arthroplasty
 amputations, burns and other soft-tissue
damage frequently seen in hand and limb
injuries
 fractures and various orthopedic conditions
 Guillain-Barre syndrome, muscular dystrophy,
motor neurone disease and the long-term
effects of poliomyelitis (post-polio syndrome)
 Peripheral neuropathy, mononeuropathy,
brachial plexus lesions
 Cardiac problems in the form of ischaemic
heart disease, cardiac failure or the effects of
bypass surgery
 Respiratory problems in the form of various
obstructive airway diseases
 Chronic pain due to occupational overuse
syndrome (OOS), back injuries, neck injuries
or pain associated with any of the conditions
outlined above.
Understanding
- the biomechanical basis of movement includes
knowing the locomotor system (how bones and joints
perform together, especially in relation to the
appendicular skeleton), active and passive joint range
of motion, the function of skeletal muscle, types of
muscle work (concentric and eccentric, isotonic and
isometric contraction), muscle architecture and role,
the peripheral nervous system (motor, sensory and
autonomic) and the relationship between the
peripheral nervous system (synaptic transmission and
innervation) and muscles (sliding filament theory).
Biomechanical basis of movement includes
understanding concepts of
 Force
 Gravity
 Friction
 Resistance
 Leverage
 Stability and equilibrium
 How these elements interact to affect the
nature of motion in human beings
- In summary, the capacity for movement and
occupational performance is a synthesis of forces (the
musculoskeletal system and nervous system
coordinating the works of groups of muscles to
produce movements and stabilize joints) acting on the
body.
Endurance–(ability to sustain occupational
performance)
- It is predominantly a function of muscle physiology
and the ability of the body systems to transport the
required material towards, and waste materials away
from, the muscle tissues.
- Individuals’ problems that can be addressed through
biomechanical FOR should have an intact CNS.
Because in some cases, when having CNS damage
and applying biomechanical FOR, we could achieve
the opposite effect. There are some exceptions to
individuals with CNS damage in the form of stroke,
multiple sclerosis, and so on. This is because they
a lose control of movement in various parts of their
body, and the long-term compensating for this loss of
motion in occupational performance is required.
- OTs frequently use tests of function. These tests
tend to examine performance components related to
upper limb and especially power and precision grips
of the hand.
 Bennett Hand Tool Test
 Jebsen-Taylor Hand Function Test
 Moberg Pick Up Test
 Valpar Work Samples
 Reference: Duncan

Movement
Range of Motion Observation
Goniometry
Odstock Method
Strength
Muscle Power Oxford Rating Scale
Other Scales
Grip strength in the Dynamometer
hand
Pinch strength in the Pinch meter
fingers
Muscle bulk Observation
Tape measure
Presence of swelling in Observation
limbs Tape measure
Volumeter
Endurance Observation
Cardiorespiratory
Functional
Sensation Light touch and pressure
Weinstein monofilament
Thermal Sensation
Pain

Practice settings:
 Amputation and amputee problems
 Assistive technology (wheelchairs, orthotics
and other devices for home and personal
use)
 Burns and plastic surgery
 Cardiac rehabilitation
 General medical problems
 Hand therapy
 Housing (ergonomic) modifications in the
community
 Older people (usually problems with falls,
stability and mobility)
 Orthopedics
 Orthotics and prosthetics
 Pain management
 Spinal cord injury
 Work rehabilitation
 Worksite modification

o All of the above may take place in hospital or

community setting.

o Though biomechanical model is sometimes viewed

as bottom-up approach, trying to fix problems of
movement. However, the theoretical base does not
necessarily make it narrow in application, but one’s
view of the world as an occupational therapist and
how different conceptual models of practice/frames
of reference are used.