Frames of References

Model of human occupation

● Volition - the process by which a person are motivated towards and choose what they do.
● Habituation - the process by which doing is organized into patterns and routines
● Performance capacity - the physical and mental abilities of an individual that shapes performance
● environment -sole external or extrinsic factor that can influence the performance positively or negatively

Intrinsic/internal factors - volition, habituation, performance capcity

When the client falls to dysfunction, we are targetting issues present in any fundamental concepts through engagement and repetition of said tasks or
occupations in a facilitating environment where these tasks can be performed.

We are changing the targetted issue in order to increase participation from the end of the client while doing it in a facilitating or doing it in an
environment that positively influences the individual to increase his or her occupational participation or performance.

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Ecology of human performance

● focuses on the ecology or the interaction between the person and their context where they perform their identified meaningful tasks or
occupations

Performance range
● refers to the task that are available to the person which are all facilitated by a supporting context or environment, and the inherent capbilities of
a person.
● If any of the components becomes affected by a disability or limitation, this range will decrease thus resulting to a person becoming limited or
dependent towards the activities s/he previously participates in.

Approaches
● increase the range of performance of a person by selecting what appropriate approaches should be given to a client during formulation and
implementation of intervention plans
● Be careful in selecting as some approaches is only used for a specific component of this model.
 ○ Establish/restore - used to a person, not the environment
○ Alter, adapt/modify - context/environment, and task
○ Prevent - used in all components

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PEO Model
● Find the match between the intrinsic and extrinsic factor in order to promote occupational performance and participation by promoting change
on the problematic issues on the person and on the environment in order for us to find the perfect match so what we do here is we only focus on
identifying what are the issue on both the person and environment, and after we found the issues, we try to change them to get back to
functioning while assessing also the environment if the environment is positively or negatively influencing the performance or participation of the
person
○ If it is negatively influencing, we provide change to the environment, at the same time to further improve the occupational performance of
the client

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CMOP-E
● Spirituality -
○ not associated with religion,
○ refers to the truest form of self.
○ The person factor in other models
○ it is in the constant interaction with the environment through participation or participating various
● occupations
○ anything that people do to occupy time
○ Self care
○ productivity
○ leisure

Once the client fall on dysfunction, our main focus is to facilitate the client to get back to functioning, or to get back to his or her occupations to bring
change into the person

COPM
 ● Areas of occupation: Self-care, productivity, leisure
● assessment happens as the client is expected to enumerate or list down activities for each occupations and rate performance and satisfaction
on each identified activities or task

Rehabilitation approaches

Biomechanical FOR
● bottom-up approach:
○ adheres to teh traditional way of targetting problems in a person.
○ Finding puzzle pieces to complete the picture of what we want to happen
○ Remediating or restoring specific client factors or performance skills required in order to promote occupational performance or
participation
○ If restoration is not effective in the acute phases of recovery, we can still apply this FOR by focusing or maintaining the current skills or
client factors to somehow maintain level of performance on our client
○ In order for a person to increase performance in their meaningful occupations, one must gain first the skill and the abilities needed for
these tasks.
○ Ex: Bathing - increase ROM and strength of the client in order to manipulate task objects required for bathing.
○ improving client factors affected by acquired injury will be his stepping stone to better his performance in the identified occupation
● Assumption
○ use of purposeful tasks -
◆ during intervention to increase moderate retention of training
◆ Ex: ROM - not giving stretching and ROM exercises, instead we provide occupation based activities (e.g. transferring activities)
● Rest and stress principle -
○ in the acute phases of rehabilitation, wherein we let the individual rest first to prevent secondary complications from the exercises that will
be given
○ once the client enters the recovery phase, we apply the stress technique to maximize the capability of the person to recover.
○ originally Exclusive to trauma and injury, no neurologic in nature as interventions in this FOR do not address tonal problems which are
typically of neurologic impairments.

Treatment principles
● focuses on the remediation, if not, the maintenance of the biomechanical components of a person in order to increase the change or chance that
the person can still function and perform on his own.
Intervention: postural instability
● resting of equilibrium between two opossing muscles acting on each other
● A muscle imbalance or problems in alignment happens when their is release of a specific muscle while or during its volitional movement thus
leading to ineffective movement patterns
● if the goal is to temporarily immobilize a certain part to heal, we provide orthosis such as resting hand splints, casts, wrist splints. Devices such
as lapboards, wheelchairs to help the client to immobilize that specific part to promote healing.
● If the goal is to facilitate movement in stability, we provide positioning for preparation for mobility. Positioning could be static or dynamic.
Provision of weight-bearing exercises, at the same time we provide weightshifting exercises.

Intervention: Scar formation

● Inflammation phase
○ Goal: decrease the inflammation, joint pain, and tenderness
○ Static splints to protect the healing structures
● Recovery phase
○ Goal: elongate the tissue length
○ we can now mobilize the specific structures that are already healed
○ Scar mobilization - application of controlled tension in the scars as we do not want the scar the become non-flexible or unflexible because
if the scar would become non-elastic it could lead to what we call contracture which could become a hindrance during movement thus
resulting to limitation of motion

Intervention: Edema
● Happens when an excess fluid is trapped in a body tissue due to leage found in a blood vessel secondary to sitting or staying in one position for
too long.
● Goal: reduce pooling of fluid in the affected limb

Intervention: Retrograde massage

● use lubrication to make stroking easier and prevent inflicting pain on the end of the client as most time edematous extremities is painful to touch
and movement.
● Elevated so that luid is pooled back tot he lympatics

Intervention: contrast bath

● activates the lymp and blood vessels to dilate and contract thus facilitating motion of fluids back to the lymph.
intervention: LOM
● choosing a strategy will depend on the intervention process
● PROMEs - for no active movement at the start of our program
● AAROMEs - once the muscle produce contraction or movement after PROMEs
● Stretching - going a few degrees past the point of restriction and discomfort.
● Skateboard - shoulder horizontal abduction and adduction

Intervention strategies: muscle weakness

● Strength - power of the muscle to resist movement (hence use resistive exercises)
● Before proceeding to resistive exercises, do first AROM exercises because we want our client first to achieve functional range of motion
○ Provide mildy resistive exercise by asking the client to perform movement against gravity since ti si a force
● If the client is able to tolerate it, provide resistive exeercises
○ Progressive resisitve exercises - low intensity to high intensity
○ Regressive resistive exercises 9oxford method) - high intesity going to low.
● Grading: modify the components
○ Duration - time component
○ frequency - repetition component
○ intensity - how much wieght will the client tolerate while he or she is doing th exercise

Intervention: endurance
● provide it depending on the current status of the client to condition him or her before progressing to a more tiring sets of activities
● high-impact aerobic activities: more complex and tiring activity
● Tai chi
● standing and sitting

Rehabilitative FOR
● Top-down approach: we focus on the aspect of thaving the client perform his or her identified occupations regardless of limitations that are
brought by their injury or disability

● A more immediate resolution to functional problems by provindg compensatory techniques for the client to promote independence or what we
call modified independence
One-hand technique: Brassiere
● First, place the bra around your waist with its back in front of you
● Hold the bra on your weak side with the weight of your affected arms
● Use a clip to maintain the bra in its position then use the strong hand to fasten the hooks
● Turn the bra into the correct position
● Place the weak hand into the strap of the strong hand, still using the strong hand pull the strap of the bra over the elbow
● Place your strong hand into the other strap and pull it over your strong shoulder
● Use the strong hand to pull the strap on the shoulder of the weak arm then tighten the bra.

One hand technique: Upper body dressing

● weak hand should go first before the strong hand
● spread the shirt on your lap with the inside facing up and the collar away from the body
● Locate the arm hole for the affected side using the strong hand to prevent difficulty in navigating the armhole.
● With the assistance from the strong hand, try to place or shoot the weak hand into the arm hole and pull it up to the elbow level
● Maintain or hold the clothes or armhole using the affected extremity while simultaneously inserting the strong hand into the arm hole.
● Up to the elbow level again, and trey to lift up the sleeve hole of the affected arm
● Using the strong hand, insert your head into the neck hole
● Pull down the head line of the shirt using the strong hand
● Tidy the shirt
● Given to clients with LOM or strength problems
● If the client wants to perform immediate dressing despite condition

Perform when it is fresh

One hand technique: Lower body garment

● Weak leg should go first before the strong leg
● Sit on a chair or side of the bed
● Cross your weak leg over the strong leg
● Start with the weak leg, insert the leg into the leg hole with the assistance coming from your strong hand
● Proceed to the strong leg the pull it up to the waist level
● Use the strong hands to fasten the lower body garment (same goes for doffing strategy: start with the weak leg before the strong leg)
One hand technique: Shoe tying
. Make a cross out of the string, try to maintain the other string using the strong leg.
. Once stabilized, make a knot on one end of the shoe string. This will give the shoe a knotted end on the lowest islet or hole.
. With the top iselt, feed the end of the shoelace from outside to inside. Throw the end over the top of the laces
. Make a loop on the free end of the shoe lace, and pull a loop within a loopp.
. Pull the lace tight being careful not to pull the free end being pulled all the way through
. To untie the shoelace, just pull the free end

Intervention: Adapted task - objects (wala nang chance to recover)

● Plate guards - prevent the food from spilling when we are scooping or during scooping or stabbing of food using fork or spoon
● Universal cuff - if the client has problems with gripping the task objects., Insert the spoon and fork in the universal hand cuff.
● Universal built up - to make the handles of these task objects larger
● Long handled sponge - for problems with ROM during bathing for hard areas to reach.
● BUtton hook - for the client no longer required to do in hand manipulation
● Mouth stick - for clients with bilateral deficits or problems with movement. Example for typing

Intervention: environmental modification

● grab bars - to prevent falls or for clients with problems in maintaining balance
● ramps - wheel chairs
● skid mats - for balance
● Decluttering of task environment - cooking for the client to becoming independent.

intervention: Client/caregiver education

Integration of mode and FOR to practice

● one model and for but not limited that
● eclectic approach (several models and approaches)
● Intervention process is dynamic