The practice of occupational therapy means the therapeutic use of everyday life occupations with
persons, groups, or populations (clients) to support occupational performance and participation.
Occupational therapy practice includes clinical reasoning and professional judgment to evaluate,
analyze, and diagnose occupational challenges (e.g., issues with client factors, performance patterns,
and performance skills) and provide occupation-based interventions to address them. Occupational
therapy services include habilitation, rehabilitation, and the promotion of physical and mental health
and wellness for clients with all levels of ability- related needs. These services are provided for
clients who have or are at risk for developing an illness, injury, disease, disorder, condition,
impairment, disability, activity limitation, or participation restriction. Through the provision of skilled
services and engagement in everyday activities, occupational therapy promotes physical and mental
health and well-being by supporting occupational performance in people with, or at risk of
experiencing, a range of developmental, physical, and mental health disorders.
Approaches
In Occupational Therapy the mode of treatment is via Frame of references or Approaches. There are
several approaches as follows:
Model of Human Occupations (MOHO) Frame of Reference
This makes sense since it is filled with intervention and evaluation techniques that are of the
most used among therapists today.
Humans are considered open systems that go through growth and development through ongoing
interaction with their environment.
This interaction is broken down into 4 phases: input, throughput, output, and feedback. Through
these phases come self-maintenance and change. This open system also includes 3 subsystems:
volition, habituation, and performance.
Sensory Integration Frame of Reference
The Sensory Integration Frame of Reference, originating from the work of Dr. Jean Ayers, focuses on
how individuals’ sensory systems (auditory, visual, gustatory, interoceptive, tactile, vestibular,
proprioceptive) interact with and integration information from the environment. Sensory integration
is broken down into abilities such as sensory modulation, sensory discrimination, sequencing, self-
regulation, postural and ocular control, and praxis.
Desired outcomes of intervention include the individual successfully participating in meaningful daily
tasks. SI requires a particularly structured therapeutic environment in order to grade sensory input
intensity dependent on the unique needs of each client (typically children).
Biomechanical Frame of Reference
The Biomechanical Frame of Reference is a remedial approach to intervention that focuses on
impairments that inhibit functional performance. Goals include using therapeutic and occupation-
based activities such as ADL training to remediate existing impairments (i.e. movement-related), to
prevent further deterioration (i.e contractures, muscle atrophy), and to provide
compensatory/adaptive strategies for loss of movement.
Impairments that affect functional movement and joint range of motion may include reduced
muscle strength or decreased muscle endurance due to multiple medication conditions (i.e. stroke,
injury, etc.). From the Biomechanical frame of reference emerges assessments and interventions for
static and dynamic orthoses, passive/active range-of-motion, ADL performance, work hardening,
and nerve gliding.
Biomechanical Frame of Reference for Positioning Children for Function
The overall intent of this frame of reference is to assist the development of postural reactions in
individuals who are unable to maintain typical postural alignment via automatic muscle activity. The
underlying theory is that sensory stimulations develop from interaction with the environment and
that autonomic motor responses, such as equilibrium, are needed for typical posture.
Intervention techniques may include gravity-eliminating activities, using external supports, and
providing proximal body stability to improve distal participation with the use of prescribed assistive
devices. The overall goals of intervention are to improve client’s participation in functional daily
activities.
Behavioural Frame of Reference
The main feature of this model is the use of behavioral modification, a technique used to shape
behaviors, to increase adaptive behaviors, and to reduce maladaptive behaviors. OTs who use
behavior modification in practice generally target persons who need social skills training, so children
and individuals with psychiatric disorders.
This frame of reference uses elements such as stimuli (unconditioned, conditioned), reinforcement,
extinction, backward chaining, systematic desensitization, and token economy as forms of
intervention to achieve target behaviors that improve performance.
Psychoanalytic Frame of Reference
Not to be confused with the Psychodynamic Frame of Reference, the Psychoanalytic Frame of
Reference is based on the Vivaio model (MOVI) which emphasizes recognizing constant emotions
that exist in the relationship between the patient, therapist, and “doing”. Each of these three
elements communicate and effect each other to create what is referred to as a dynamic
transference or unconscious connection with past or present relationships).
MOVI is comprised of 7 interconnected components: Evaluation, the interaction process, the space
and time settings, choice and play, materials and transformations, sensory experience and though,
and nonhuman environment. OTs benefit from this FOR by using it as a means to assess the meaning
of “doing” and the unconscious elements of the therapeutic relationship.
Psychodynamic Frame of Reference
The Psychodynamic Frame of Reference has its roots in Freud’s theories of ego and its roles in
developing and maintaining healthy relationships. Conflicts occur when there is a breakdown in the
ego defense mechanism. Therapy focuses on two approaches: explorative and supportive.
Explorative interventions aide in surfacing conflicts from the unconscious mind to the conscious min
in order to resolve the issues and to promote expression of feelings. Supportive interventions keep
conflicts hidden in the unconscious while strengthening the ego defense mechanism. The goal of
both approaches is to enhance typical psychosocial development and social interaction.
Cognitive-Behavioural Frame of Reference
This frame of reference focuses on five interrelated aspects of life experience: behaviors, thoughts,
emotion, physiological responses, and the environment (social and physical).
Interventions that stem from the Cognitive-Behavioral FOR include cognitive behavior techniques
such as deep breathing, systematic desensitization, activity diaries, and graded activity scheduling
for person’s with impacted cognitive function (i.e. anxiety, phobias, etc.). Often times, this FOR is
used in conjunction with other occupation-based models to further establish details about a
client’s/patient’s functional needs.
Frame of Reference for Neuro-Developmental Treatment (NDT)
The Neuro-Developmental Frame of Reference is used by therapists to treat posture and movement-
related impairments commonly seen in cerebral palsy and post-stroke. Its intervention approaches
are rooted in kinesiology and biomechanics. Key elements of the NDT frame of reference include:
alignment, planes of movement, range of motion, base of support, postural control, weight shift,
mobility, and muscle strength.
As opposed to compensatory ideologies, NDT postulates that impairments to function can be
changed or remediated. There are no current standardized tools stemming from this FOR since
evaluation of each person is particularly unique.
Intervention strategies include therapeutic handling, graded application of manual forces, and
directional cueing to promote newly learned movements. Learning new movements in therapy is for
the purpose of enhancing participation in functional tasks.
Social Participation Frame of Reference
The Social Participation Frame of Reference emphasizes the power of emotion and its purpose to
motivate children in social engagement. Children adoptive and regulate emotions in response to
what they have learned interacting with parents and/or caregivers from an early age.
The social participation FOR has seven areas of social functioning: temperament adaptation,
emotional regulation, family habits and routines, environmental supports, social participation in
school, environment for peer interaction, and peer interaction.
Rehabilitative Frame of Reference
The Rehabilitative Frame of Reference focuses on facilitating patients to fulfill meaningful activities
and social roles in a competent manner.
The clients are encouraged to focus on abilities that remain and to attain their highest level of
function through adaptation, compensation, and environmental modifications. Interventions that
stem from this FOR include energy conservation, work simplification, and home modifications.
Frame of Reference for Motor Skill Acquisition
Based on key principles for the learning theory, this frame of reference focuses on helping learners
acquire motor skills for functional participation. Primary terms include ability, characteristics of the
task, required skills, the environment, and regulatory conditions (from which emerges the
continuum between closed and open tasks).
Closed tasks are performed in environments that are stagnant with little variability such as brushing
one’s hair or teeth. Open tasks are performed in environments that are in motion and that require
variability in movement with each demand (i.e. competing in an athletic sport like football or
basketball). Acquiring a motor skill involves active problem-solving, self-evaluation, and planning
based on the therapist’s (or facilitator’s) feedback.
Brunnstrom Frame of Reference
The Brunnstrom Frame of Reference, or Movement Therapy, is considered the opposite of NDT. The
approach uses primitive synergistic patterns in order to improve motor control, posing that damage
to the central nervous system causes a person to regress to less mature movement patterns.
Therapists teach the patient to voluntarily control motor patterns during recovery using limb
synergies.
The process of recovery includes 7 stages: flaccidity, spasticity, gained voluntary control through
synergies (increased spasticity), patterns outside of synergy develop (decreased spasticity), complex
movement combinations form (further decreased spasticity), disappearance of spasticity, normal
function in restored.
Roods Approach
The Rood Approach, theoretically based on the Reflex and Hierarchical Model of Motor Control,
developed by Margaret Rood in the 1950s, provides the origin for many of the facilitation techniques
used today in neurological rehabilitation today. Rood developed a system of therapeutic exercises
enhanced by cutaneous stimulation for patients with neuromuscular dysfunctions. In addition to
proprioceptive maneuvres such as positioning, joint compression, joint distraction and the general
use of reflexes, stretch, and resistance, the greatest emphasis is given on exteroceptive applications
such as stroking, brushing, icing, warmth, pressure, and vibration in order to achieve optimal
muscular action.
Conditions
Autism
Autism is described as a life-long condition that affects a child’s ability to communicate and interact
with the people and world around them.
A child with Autism Spectrum Disorder is less able to interact with the world around them than their
peers. They may have difficulty in understanding and using language and will often find social
interactions challenging.
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is a condition that may cause children to struggle
with school, social and home activities.
ADHD or ADD (Attention Deficit Disorder) is a condition that appears in early childhood and is
defined by a cluster of behaviours causing a child to be inattentive, impulsive or hyperactive.
Down’s Syndrome
Down’s Syndrome is a genetic condition that causes varying degrees of learning disability and some
characteristic physical features. Children with Down’s Syndrome may struggle to develop their
independence and self-care skills at the same stage as their peers.
Down’s Syndrome is developed at conception due to an additional chromosome. Children with
Down’s Syndrome have 47 chromosomes in their cells instead of 46. They also have an extra
chromosome 21, which is why Down’s Syndrome is also called Trisomy 21
Dyspraxia
Dyspraxia is the word used to describe difficulties associated with movement and coordination. It is
a common childhood condition that affects both gross and fine motor movements.
DCD relates to a lack of fluid, controlled and coordinated movement often causing difficulties with
day-to-day activities such as movement, sports or dressing.
The brain of a child with Dyspraxia does not process information in the way that allows the full
transmission of neural messages. A child with DCD or Dyspraxia will find it hard to plan what to do
and how to do it.
Learning difficulties
A child with learning difficulties can benefit from being given the tools they need to unlock their
potential. Our team of experienced children’s occupational therapists assess, treat and advise
children and their families or schools on how to best achieve this.
A learning difficulty can be described as a neurological difficulty with processing certain forms of
information. Some learning difficulties are seen in isolation and others alongside each other, for
example Dyslexia and Dyspraxia are often seen together.
Learning difficulties is an umbrella term used to describe some of the most frequently occurring
conditions such as, Dyspraxia, Dyslexia or Attention Deficit Hyperactivity Disorder (ADHD).
Asperger Syndrome
Children with Asperger Syndrome are often above average in intelligence but struggle to
appropriately interact with the world around them.
Social interactions tend to be particularly difficult for those with Asperger Syndrome and although
they often have strong language skills it is the interpretation of others’ communication both verbal
and non-verbal that can be difficult.
Sensory Processing Disorder
How a child processes and responds to sensory information – sight, sound, smell, taste and touch –
can be reflected in their emotional reactions. Some children find everyday activities such as dressing
themselves, overwhelming and distressing.
Tactile difficulties (touch)
These may be displayed through an aversion to sticky or dirty hands, not wanting to wear shoes or
socks, finding clothes itchy, an interest in touching certain surfaces and fabrics, not liking having
their hair washed or brushed, or not liking textured food, resulting in a fussy or picky eater.
Proprioceptive difficulties (where they are in space)
This may present itself through a child seeking out heavy items to cuddle up under such as heavy
clothing or coats. They may appear fidgety in class and constantly moving to seek input.
Vestibular difficulties (movement)
They may avoid movement such as spinning or swinging or have a fear of heights, or they may be
completely opposite to this and crave these sensations and engage in these activities at every
opportunity.
Proprioception (body awareness)
Within our joints and muscles are receptors that tell our brain where our limbs are positioned in
space.
Vestibular (movement)
Vestibular receptors, located in the inner ear provide the brain with information about the body’s
movement.
Stroke
Strokes will affect each client uniquely, our rehabilitation and support services following a stroke are
bespoke, and we provide one-to-one neurological occupational therapy, in your own home, for as
long as you need us.
Hemiplegia refers to a total paralysis of the arm, leg, and trunk on one side of the body, while
hemiparesis is a muscle weakness (or partial paralysis) of one side of the body. Although not
identical, both these terms have been used interchangeably in the following text unless specified
otherwise. It is not a disease, but rather a nonspecific response of the central nervous system.
Developmental delay
Babies and children learn and develop important skills known as ‘developmental milestones’. These
milestones usually occur during the first five years of life and are fairly predictable. When a child is
not reaching these milestones, their development may be termed as ‘delayed’.
Every child develops at different rates:
By 3 to 4 months, your child should be starting to…
Motor skills – reach, grasp and hold objects, support their head well, bring objects to their mouth
and push down with their legs when their feet are placed on a firm surface
Personal / social skills – smile at people and pay attention to new faces
Communication skills – respond to loud noises, babble and imitate sounds
By 7 months, your child should be starting to…
Motor skills – reach with one hand, take objects to their mouth, roll over in either direction, sit up
without help and weight bear through their legs when you pull them up to a standing position
Personal / social skills – enjoy cuddles, show affection for parents, show enjoyment around people,
be comforted at night, smile without prompting, laugh or squeal, and take interest in games of peek-
a-boo
Communication skills – respond to sounds
By 1 year, your child should be starting to…
Motor skills – crawl, drag one side of their body while crawling, and stand when supported
Personal / social skills – show back-and-forth sharing of sounds, smiles, or facial expressions and
show back-and-forth gestures, such as waving, reaching, or pointing
Communication – use single words (like “mama”)
Thinking – Search for objects that are hidden while they watch, use gestures, such as waving and
point to objects or pictures
By 2 years, your child should be starting to…
Motor skills – walk and specifically develop a heel-to-toe walking pattern or be able to push a
wheeled toy
Communication -speak at least 15 words, use two-word phrases, and use speech to communicate
more than immediate needs
Thinking – know the function of common objects, such as a hairbrush, telephone or spoon, follow
simple instructions and imitate actions or words.
Conclusion
Our team of expert paediatric occupational therapists are skilled at working with children with above
mentioned conditions and those who are involved in the child’s life. We aim to identify day-to-day
difficulties and provide treatment and techniques to manage them.
Occupational therapists work to promote, maintain, and develop the skills needed by students to be
functional in a school setting and beyond.
For example:
self-care (e.g. dressing, eating a meal, managing toileting needs and managing personal hygiene)
productivity (e.g. emotional regulation, levels of alertness, participation, hand writing and
organisational skills)
leisure (e.g. socialising with friends, belonging to a group, participating in hobbies/play and motor
skills for PE).
Every child will have a unique set of sensory needs and these needs will alter depending on mood,
environment and therapeutic intervention.
An occupational therapist works to develop skills for handwriting, fine motor skills and daily living
skills. However, the most essential role is also to assess and target the child’s sensory processing
differences. This is beneficial to remove barriers to learning and help the students become calmer
and more focused.