Understanding Rehabilitative and Compensatory Therapy

Welcome to another lecture. In this lecture I'm going to discuss the Rehabilitative Frame of Reference and the Compensatory Frame of Reference. These are frames of reference that we use in occupational therapy and what I'm going to present here is based on my own research in terms of these two frames of reference. They are very similar but I'm just going to put them. head to head and then I'll leave you to make your final conclusion at the end of it. So starting with the rehabilitative frame of reference, some authors actually believe that the rehabilitative frame of reference can be used when the use of the biomechanical frame of reference has reached a plateau or there's no further progress. Maybe you might have started using the biomechanical frame of reference trying to bring full restoration of function And then you realize that the service user has actually reached a plateau There is no further gains in terms of your interventions Then you can then switch on to use the rehabilitative frame of reference. So that's what other authors say Others also believe that the biomechanical frame of reference already addresses the compensatory aspect. So there might be no need to say we're actually bringing in a rehabilitative frame of reference. Okay. So the rehabilitative frame of reference can be used to restore occupational performance or when returned to premorbid functional levels is not possible. And it has got the following assumptions. The first one, independence, it assumes that independence can be restored. through compensatory strategies and techniques. And the second one is that a person's motivation affects the extent to which they regain their occupational performance. And then lastly, the third assumption is that rehabilitation involves teaching and learning, therefore a person needs to have a certain level of cognitive abilities in order for them to actually learn as rehabilitation evolves. learning and teaching. And they also need to be motivated to learn as an individual. The aims for the Rehabilitative Frame of Reference is to aim, we use it in occupational therapy when we are aiming to restore functional ability to previous levels and sometimes we use it, in fact most of the times we use it when we are not able to restore function to the previous functional level. but the rehabilitative frame of reference helps us to achieve the highest possible given the circumstances or given one's circumstances. This frame of reference also combined and coordinated uses combined and coordinated use of medical, social, educational and vocational measures. So there's a bit of teaching, there's a bit of education for our service user in terms of their occupational participation or occupational engagement. This frame of reference focuses more on performance areas rather than performance components. So performance components, these are aspects like joint range of motion, muscle strength, those are performance components. So when we're using the rehabilitative frame of reference, it focuses more on the performance areas like the actual occupation, self-care occupations, productivity occupations, and leisure occupations. the way in which a person executes those occupations. That's what this frame of reference helps us to focus. It helps us to focus more on that rather than the building blocks or the performance components. The good thing with this frame of reference is that we can use the rehabilitative frame of reference with people who are having physical impairments as well as cognitive impairments. That's a good thing about this frame of reference in occupational therapy. The ideas of strategies to compensate for the impairment or permanent conditions, it actually allows us to enable the service users to perform their desired occupation, meaningful occupations. There are some merits for this frame of reference. It uses the holistic perspective of the client, so it's not reductionist. You know, when we discuss the biomechanical frame of reference, we're saying to some extent it actually can be really reductionist. But with this one, it takes a holistic perspective of the client. It uses a collaborative process together with the client. And then it also uses goal-based interventions where we're looking at what is the goal in terms of occupational performance or occupational engagement. And then the interventions are targeted towards that. It can also be used to meet short-term needs or compensate for long-term loss. So we can use it for achieving short-term goals and we can also use it for achieving long-term goals. in relation to occupational performance. It aligns very well with the OT philosophy or OT paradigm. However, it also has its limitations. For example, it's very much dependent on the client's motivation. So if the client is not motivated, we might not be able to go anywhere with this frame of reference. Just think of if a service user, for example, requires equipment. and then the service user is not keen on using that equipment, then it means the framework of reference is not going to be effective in that situation. So it requires client's motivation. And there are usually no therapy alternatives if the compensatory approach fails. So it's using compensatory approaches in the rehabilitative framework of reference. But if we fail with this approach, then usually we don't have anything else that we could possibly do. The other limitation is that it requires proper equipment and environment to teach the clients the adaptive technique. So it's also dependent on what resources are available. Now moving on to the compensatory frame of reference. So that was the rehabilitative frame of reference. Moving on to the compensatory frame of reference. It says there are benefits in improving occupational performance despite ongoing physical, cognitive, psychological or social dysfunction. So there are benefits despite an individual having a permanent condition. There are benefits of actually improving their occupational performance. The successful completion of an occupation rather than a specific change in anatomical, physiological or psychological attributes is the primary goal. So the main goal when we're using the compensatory frame of reference is actually on successful completion of occupations, whether they are impairments that are temporary or impairments that are permanent. Compensation can be done through three ways. The first one, using and adapting of remaining abilities and strengths or adapting the occupation or the activity itself. or provision of external compensatory means that could be our assistive technology and things like that. So for the compensatory frame of reference, the basic assumptions are that completion of daily raw activities is a basic human need, and individuals with permanent disabilities, whether physical or cognitive, can benefit from learning alternative methods of performing those daily occupations. The other assumption is that people suffer short and long-term dysfunction, which cannot be immediately or significantly improved by therapeutic methods. So there is need to actually use a compensatory approach to compensate for the lost or limited abilities. So that we can use still use the compensatory frame of reference whether there is a short-term or long-term dysfunction, which is very similar to what the rehabilitative frame of reference. covers as well. Residual capabilities can be supplemented by external aids, very similar to what the Rehabilitative, literature on the Rehabilitative Frame of Reference says. The client's involvement in choosing an appropriate method can actually promote well-being. So we are also seeing that aspect of collaboration with the client, similar, very similar to the Rehabilitative Frame of Reference. The advantages, Just like the rehabilitative frame of reference, the compensatory frame of reference also uses a holistic view. It takes a holistic view when working with clients. Many therapists are generally familiar with the strategies that are used in the compensatory frame of reference. It's also easy to explain and to understand for the service user. If the service user says, I'm not able to perform this occupation, and then the therapist says, I can give you this. I can give you this equipment to enable you to do that. It becomes easy to explain. It can be used to meet short-term, short-term needs also long-term loss, just like the rehabilitative frame of reference, can bring speedy achievement of occupational goals. A person is not able to perform in occupation, they are provided with equipment or assistive technology, and they are able to actually execute the goal of performing that particular occupation, which can be speedy compared to... functional retraining where the person is actually being retrained to be able to get back to performing that particular occupation without any assistive technology. So this compositional frame of reference can actually be a quick way of doing that. It allows for flexibility, creativity and problem solving with no rigid structures and sequences in terms of its steps, so very much dependent on the creativity of the therapist. The composite form of reference has got its own limitations. The first one is that it may have a negative effect on the client because we're using equipment and assistive technology. Those things, some authors actually argue that they serve as a reminder to the service user that they've got a permanent loss of their previous function. So that might be problematic sometimes. Compensation may be used as a quickest or cheapest option, thereby denying the personal choice for being retrained to actually perform an occupation. So that could be another limitation as well, where this frame of reference can be used as a shortcut to just quickly provide equipment, yet there could be other frames of reference that could actually promote or facilitate recovery or improvement. So those are the limitations of the compensatory frame of reference. In this table here, I've put the Rehabilitative Frame of Reference and the Compensatory Frame of Reference head to head, looking at the main goals, the focus, the strategies, the outcomes and the types of clients that we usually use. So for the Rehabilitative Frame of Reference, the main goal is on restoring the client's ability to the highest possible level, despite any residual impairment. And for the Compensatory Frame of Reference, the literature says to maximize participation in occupational engagement so we know that occupational engagement can actually take place in the absence of the actual occupational performance or the doing but that also is considered to be the main goal for the compensatory frame of reference despite any permanent loss of function and then in terms of the focus the rehabilitative frame of reference generally focuses on regaining abilities or preventing further deterioration to enable occupational performance while the compositor frame of reference uses alternative strategies and assistive technology to enable occupational performance or engagement on the strategies used when we are using these two frames of reference also very similar with the rehabilitative frame of reference it's about making changes to the environment to reduce the task demands and facilitate participation it also uses therapeutic therapeutic activities when we are using the Rehabilitative frame of reference whereas the compensatory frame of reference. It's mainly focusing on assistive technology Compensatory techniques environmental modifications and again very similar to what we would do if we are using the rehabilitative frame of reference The outcomes for the rehabilitative frame of reference is looking at increased functional ability and improved occupational performance and the compensatory frame of reference is looking at increased participation and more quality of life despite the limitations and then the types of client that would use the rehabilitative frame of reference with generally the rehabilitative frame of reference is used when there is some potential for improvement in terms of the person's occupational performance and then the compensatory frame of reference generally this is where We use it with clients who have got limitations that we know these are permanent limitations or conditions that we know these are progressive conditions. However, I need to clarify that the strategies that we're using when using these frames of reference, they are more or less the same strategies. So it doesn't necessarily mean that if a person is having a progressive condition, we cannot say we're using the rehabilitative frame of reference. We can. And it doesn't necessarily mean that if a person has got. a condition that is just permanent which may not be progressive we can't use the compensatory frame of reference we can so these two frames of reference they are really really very close um according to what i've found out what has been written on these two frames of reference so for both of these frames of reference the reasoning pathway when using them is generally the same you are starting at working out the individual's goals in terms of their occupation participation or occupational engagement and also looking at their abilities and then after that we then assess the environment in which the person is going to be functioning the context and the environment physical environment all those aspects of the environment and then we then work out the compensatory strategies that the person needs in order to support their their abilities it both of these frames of reference definitely they require creativity on the part of the therapist moving on to the Assessments commonly used both of the frames of reference, the rehabilitative and the compensatory frame of reference, they use a top-down approach and the assessments that we use there is hardly any distinction in terms of the assessments that we'll use. Observations, interviews, we can use self-reporting assessments, the COPAM, Mohost, environmental assessment, assessment of the level of assistance required. available for the service user. We can also be assessing them for equipment and assistive technology. Coming to the interventions, both the Rehabilitative Frame of Reference and when we're using the Compensatory Frame of Reference, these are some of the interventions that would commonly use in occupational therapy. And these are around provision of assistive technology or equipment, energy conservation techniques, sort of like compensatory techniques. teaching adaptive techniques, development of alternative skills for occupational performance or engagement. We might also look at care support packages, maybe we're working with somebody who has got a progressive condition and maybe they are receiving palliative care, we're actually looking into that. Environmental adaptation or home modifications for example, we're also using compensatory strategies for cognitive. functions like memory aids, cue cards, all those strategies to help in terms of occupational engagement and quality of life. If we think of the conceptual models that we can use when we are using either the rehabilitative frame of reference or the compensatory frame of reference, many of our conceptual models you can actually use together with these. with these two frames of reference. So for me, really, there isn't much difference in terms of you're using rehabilitative or you're using compensatory, but the call is on you to select what you want to use and be able to justify it. But we can't say really in practice, we are using a combination of two frames of reference when we say we're using rehabilitative frame of reference and compensatory frame of reference. To me, based on what I've researched, these two are basically the same. the same thing because the assessment that we're using they are the same the interventions that we're using they are the same but it's up to you to make your decisions based on the evidence that you have so when we're working with clients these sort of some of the things that you come across or that you use in your interventions if you are using the rehabilitative frame of reference or the compensatory frame of reference where we are using adaptations, assistive technology, different devices, different equipment. That's another one again with some examples of what we will do if we are using the Rehabilitative Frame of Reference or the Compensatory Frame of Reference. Important to remember is that for both the Rehabilitative Frame of Reference and the Compensatory Frame of Reference, we can use them whether people are having physical conditions or they are having conditions affecting their cognition or conditions that are linked to mental ill health we can also be able to use these these two frames of reference as long as the service user that we are working with requires compensatory strategies in order to enable them to participate in occupations or in order to enable occupational engagement These are the references that I've used and thank you very much for your time.

So starting with the rehabilitative frame of reference, some authors actually believe that the rehabilitative frame of reference can be used when the use of the biomechanical frame of reference has reached a plateau or there's no further progress. Maybe you might have started using the biomechanical frame of reference trying to bring full restoration of function And then you realize that the service user has actually reached a plateau There is no further gains in terms of your interventions Then you can then switch on to use the rehabilitative frame of reference. So that's what other authors say Others also believe that the biomechanical frame of reference already addresses the compensatory aspect. So there might be no need to say we're actually bringing in a rehabilitative frame of reference. Okay.

So the rehabilitative frame of reference can be used to restore occupational performance or when returned to premorbid functional levels is not possible. And it has got the following assumptions. The first one, independence, it assumes that independence can be restored. through compensatory strategies and techniques.

And the second one is that a person's motivation affects the extent to which they regain their occupational performance. And then lastly, the third assumption is that rehabilitation involves teaching and learning, therefore a person needs to have a certain level of cognitive abilities in order for them to actually learn as rehabilitation evolves. learning and teaching.

And they also need to be motivated to learn as an individual. The aims for the Rehabilitative Frame of Reference is to aim, we use it in occupational therapy when we are aiming to restore functional ability to previous levels and sometimes we use it, in fact most of the times we use it when we are not able to restore function to the previous functional level. but the rehabilitative frame of reference helps us to achieve the highest possible given the circumstances or given one's circumstances. This frame of reference also combined and coordinated uses combined and coordinated use of medical, social, educational and vocational measures. So there's a bit of teaching, there's a bit of education for our service user in terms of their occupational participation or occupational engagement.

This frame of reference focuses more on performance areas rather than performance components. So performance components, these are aspects like joint range of motion, muscle strength, those are performance components. So when we're using the rehabilitative frame of reference, it focuses more on the performance areas like the actual occupation, self-care occupations, productivity occupations, and leisure occupations.

the way in which a person executes those occupations. That's what this frame of reference helps us to focus. It helps us to focus more on that rather than the building blocks or the performance components.

The good thing with this frame of reference is that we can use the rehabilitative frame of reference with people who are having physical impairments as well as cognitive impairments. That's a good thing about this frame of reference in occupational therapy. The ideas of strategies to compensate for the impairment or permanent conditions, it actually allows us to enable the service users to perform their desired occupation, meaningful occupations.

There are some merits for this frame of reference. It uses the holistic perspective of the client, so it's not reductionist. You know, when we discuss the biomechanical frame of reference, we're saying to some extent it actually can be really reductionist.

But with this one, it takes a holistic perspective of the client. It uses a collaborative process together with the client. And then it also uses goal-based interventions where we're looking at what is the goal in terms of occupational performance or occupational engagement.

And then the interventions are targeted towards that. It can also be used to meet short-term needs or compensate for long-term loss. So we can use it for achieving short-term goals and we can also use it for achieving long-term goals.

in relation to occupational performance. It aligns very well with the OT philosophy or OT paradigm. However, it also has its limitations.

For example, it's very much dependent on the client's motivation. So if the client is not motivated, we might not be able to go anywhere with this frame of reference. Just think of if a service user, for example, requires equipment.

and then the service user is not keen on using that equipment, then it means the framework of reference is not going to be effective in that situation. So it requires client's motivation. And there are usually no therapy alternatives if the compensatory approach fails. So it's using compensatory approaches in the rehabilitative framework of reference.

But if we fail with this approach, then usually we don't have anything else that we could possibly do. The other limitation is that it requires proper equipment and environment to teach the clients the adaptive technique. So it's also dependent on what resources are available.

Now moving on to the compensatory frame of reference. So that was the rehabilitative frame of reference. Moving on to the compensatory frame of reference.

It says there are benefits in improving occupational performance despite ongoing physical, cognitive, psychological or social dysfunction. So there are benefits despite an individual having a permanent condition. There are benefits of actually improving their occupational performance. The successful completion of an occupation rather than a specific change in anatomical, physiological or psychological attributes is the primary goal. So the main goal when we're using the compensatory frame of reference is actually on successful completion of occupations, whether they are impairments that are temporary or impairments that are permanent.

Compensation can be done through three ways. The first one, using and adapting of remaining abilities and strengths or adapting the occupation or the activity itself. or provision of external compensatory means that could be our assistive technology and things like that. So for the compensatory frame of reference, the basic assumptions are that completion of daily raw activities is a basic human need, and individuals with permanent disabilities, whether physical or cognitive, can benefit from learning alternative methods of performing those daily occupations.

The other assumption is that people suffer short and long-term dysfunction, which cannot be immediately or significantly improved by therapeutic methods. So there is need to actually use a compensatory approach to compensate for the lost or limited abilities. So that we can use still use the compensatory frame of reference whether there is a short-term or long-term dysfunction, which is very similar to what the rehabilitative frame of reference.

covers as well. Residual capabilities can be supplemented by external aids, very similar to what the Rehabilitative, literature on the Rehabilitative Frame of Reference says. The client's involvement in choosing an appropriate method can actually promote well-being.

So we are also seeing that aspect of collaboration with the client, similar, very similar to the Rehabilitative Frame of Reference. The advantages, Just like the rehabilitative frame of reference, the compensatory frame of reference also uses a holistic view. It takes a holistic view when working with clients.

Many therapists are generally familiar with the strategies that are used in the compensatory frame of reference. It's also easy to explain and to understand for the service user. If the service user says, I'm not able to perform this occupation, and then the therapist says, I can give you this.

I can give you this equipment to enable you to do that. It becomes easy to explain. It can be used to meet short-term, short-term needs also long-term loss, just like the rehabilitative frame of reference, can bring speedy achievement of occupational goals. A person is not able to perform in occupation, they are provided with equipment or assistive technology, and they are able to actually execute the goal of performing that particular occupation, which can be speedy compared to... functional retraining where the person is actually being retrained to be able to get back to performing that particular occupation without any assistive technology.

So this compositional frame of reference can actually be a quick way of doing that. It allows for flexibility, creativity and problem solving with no rigid structures and sequences in terms of its steps, so very much dependent on the creativity of the therapist. The composite form of reference has got its own limitations.

The first one is that it may have a negative effect on the client because we're using equipment and assistive technology. Those things, some authors actually argue that they serve as a reminder to the service user that they've got a permanent loss of their previous function. So that might be problematic sometimes.

Compensation may be used as a quickest or cheapest option, thereby denying the personal choice for being retrained to actually perform an occupation. So that could be another limitation as well, where this frame of reference can be used as a shortcut to just quickly provide equipment, yet there could be other frames of reference that could actually promote or facilitate recovery or improvement. So those are the limitations of the compensatory frame of reference.

In this table here, I've put the Rehabilitative Frame of Reference and the Compensatory Frame of Reference head to head, looking at the main goals, the focus, the strategies, the outcomes and the types of clients that we usually use. So for the Rehabilitative Frame of Reference, the main goal is on restoring the client's ability to the highest possible level, despite any residual impairment. And for the Compensatory Frame of Reference, the literature says to maximize participation in occupational engagement so we know that occupational engagement can actually take place in the absence of the actual occupational performance or the doing but that also is considered to be the main goal for the compensatory frame of reference despite any permanent loss of function and then in terms of the focus the rehabilitative frame of reference generally focuses on regaining abilities or preventing further deterioration to enable occupational performance while the compositor frame of reference uses alternative strategies and assistive technology to enable occupational performance or engagement on the strategies used when we are using these two frames of reference also very similar with the rehabilitative frame of reference it's about making changes to the environment to reduce the task demands and facilitate participation it also uses therapeutic therapeutic activities when we are using the Rehabilitative frame of reference whereas the compensatory frame of reference.

It's mainly focusing on assistive technology Compensatory techniques environmental modifications and again very similar to what we would do if we are using the rehabilitative frame of reference The outcomes for the rehabilitative frame of reference is looking at increased functional ability and improved occupational performance and the compensatory frame of reference is looking at increased participation and more quality of life despite the limitations and then the types of client that would use the rehabilitative frame of reference with generally the rehabilitative frame of reference is used when there is some potential for improvement in terms of the person's occupational performance and then the compensatory frame of reference generally this is where We use it with clients who have got limitations that we know these are permanent limitations or conditions that we know these are progressive conditions. However, I need to clarify that the strategies that we're using when using these frames of reference, they are more or less the same strategies. So it doesn't necessarily mean that if a person is having a progressive condition, we cannot say we're using the rehabilitative frame of reference. We can.

And it doesn't necessarily mean that if a person has got. a condition that is just permanent which may not be progressive we can't use the compensatory frame of reference we can so these two frames of reference they are really really very close um according to what i've found out what has been written on these two frames of reference so for both of these frames of reference the reasoning pathway when using them is generally the same you are starting at working out the individual's goals in terms of their occupation participation or occupational engagement and also looking at their abilities and then after that we then assess the environment in which the person is going to be functioning the context and the environment physical environment all those aspects of the environment and then we then work out the compensatory strategies that the person needs in order to support their their abilities it both of these frames of reference definitely they require creativity on the part of the therapist moving on to the Assessments commonly used both of the frames of reference, the rehabilitative and the compensatory frame of reference, they use a top-down approach and the assessments that we use there is hardly any distinction in terms of the assessments that we'll use. Observations, interviews, we can use self-reporting assessments, the COPAM, Mohost, environmental assessment, assessment of the level of assistance required. available for the service user.

We can also be assessing them for equipment and assistive technology. Coming to the interventions, both the Rehabilitative Frame of Reference and when we're using the Compensatory Frame of Reference, these are some of the interventions that would commonly use in occupational therapy. And these are around provision of assistive technology or equipment, energy conservation techniques, sort of like compensatory techniques.

teaching adaptive techniques, development of alternative skills for occupational performance or engagement. We might also look at care support packages, maybe we're working with somebody who has got a progressive condition and maybe they are receiving palliative care, we're actually looking into that. Environmental adaptation or home modifications for example, we're also using compensatory strategies for cognitive.

functions like memory aids, cue cards, all those strategies to help in terms of occupational engagement and quality of life. If we think of the conceptual models that we can use when we are using either the rehabilitative frame of reference or the compensatory frame of reference, many of our conceptual models you can actually use together with these. with these two frames of reference.

So for me, really, there isn't much difference in terms of you're using rehabilitative or you're using compensatory, but the call is on you to select what you want to use and be able to justify it. But we can't say really in practice, we are using a combination of two frames of reference when we say we're using rehabilitative frame of reference and compensatory frame of reference. To me, based on what I've researched, these two are basically the same. the same thing because the assessment that we're using they are the same the interventions that we're using they are the same but it's up to you to make your decisions based on the evidence that you have so when we're working with clients these sort of some of the things that you come across or that you use in your interventions if you are using the rehabilitative frame of reference or the compensatory frame of reference where we are using adaptations, assistive technology, different devices, different equipment. That's another one again with some examples of what we will do if we are using the Rehabilitative Frame of Reference or the Compensatory Frame of Reference.

Important to remember is that for both the Rehabilitative Frame of Reference and the Compensatory Frame of Reference, we can use them whether people are having physical conditions or they are having conditions affecting their cognition or conditions that are linked to mental ill health we can also be able to use these these two frames of reference as long as the service user that we are working with requires compensatory strategies in order to enable them to participate in occupations or in order to enable occupational engagement These are the references that I've used and thank you very much for your time.

Transcript for:Understanding Rehabilitative and Compensatory Therapy

Transcript for:
Understanding Rehabilitative and Compensatory Therapy