Lecture Notes: Biomechanical Frame of Reference in Occupational Therapy
Introduction
The biomechanical frame of reference is commonly used in occupational therapy.
It provides guidelines on how to do what we do, focusing on the mechanical aspects of human motion.
This frame of reference is based on kinematics (study of motion) and kinetics (study of forces).
Key Focus Areas
Musculoskeletal Capacity: Includes joint range of motion, muscle strength, and endurance.
Joint Range of Motion: Extent and direction of joint movement.
Muscle Strength: Force generated by muscle contraction.
Endurance: Ability to sustain activity or repeated muscle contractions.
Secondary aspects include balance, joint stability, and joint mobility.
Goals and Applications
Aims to increase/restore joint range of motion, muscle strength, physical endurance.
Can prevent or decrease deformities.
Suitable for clients with intact central nervous systems, often not ideal for conditions affecting the CNS (e.g., stroke).
Commonly used in settings such as falls prevention, pain management, hand therapy, etc.
Assessments
Performance Components
Joint Range of Motion: Assessed using goniometers (manual or electronic).
Dexterity: Tests like Nine-Hole Peg Test and Box and Block Test.
Muscle Strength: Measured by Manual Muscle Testing (MMT) and dynamometers.
Endurance: Measured through functional endurance and cardiopulmonary endurance.
Edema: Observed, measured by tape, or using a volumeter.
Sensation: Tested for light touch, pressure, thermal, and pain.
Occupational-Based Assessments
Canadian Occupational Performance Measure (COPM): Assesses occupational importance and satisfaction.
Barthel Index: Evaluates self-care activities.
DASH/QuickDASH: Measures disabilities of the arm, shoulder, and hand.
Occupational Self Assessment: Self-reported assessments and functional assessments observed by therapists.
Environmental Assessments: Home or work assessments.
Interventions
Occupation-Based Interventions: Focus on meaningful occupations using assistive tech, environmental adaptations, etc.
Therapeutic Exercise: Used especially in hand therapy, focusing on grading principles.
Grading Principles: Adjusting complexity, resistance, time, and distance to challenge the service user appropriately.
Limitations
May not automatically provide client-centered practice.
Can be reductionistic and not fully holistic.
Often used in conjunction with other references to address these limitations.
Benefits
Attractive to occupational therapists in acute settings.
Facilitates communication with other healthcare team members.
Can be used to achieve occupation as an end or a means, requiring an occupational filter for creativity.
Common Conceptual Models
Used with models like CMOP-E and PEOP, among others.
Conclusion
The biomechanical frame of reference is a valuable tool in occupational therapy but must be used thoughtfully, often in combination with other frameworks.