Theories (in a nutshell) Assignment Name: TaraJane House

 
Theories   Typical Key Concepts/Terms  
Population(s)  
Occupational Behavior   All ages and all    The focus is to “prevent and reduce the disruptions
(Mary Reilly)   abilities and incapacities in occupational behavior that result
from injury and illness” (Cole and Tufano, p. 89).
 Clearly describes domains of work and play, possibly
self-care as well.
 Functioning is defined as when a person is “capable
of seeking, undertaking, and adapting occupations”
to meet their own needs and social needs (p. 91).
 Disability describes when someone suffers from
a”lack of occupational fulfillment, competency, or
achievement” (p. 91). They may also feel
incompetent and feel like they cannot fulfill their
roles.
 Change occurs when someone is intrinsically
motivated to alter their occupations.
 Interventions in OT are when we use occupations to
“promote adaptation and life satisfaction.” Ex:
Enhance strengths to promote competence and
sense of achievement.

Model of Human Occupation     Used for clients   Person has volition, habituation, and
(Kielhofner and Burke) with physical, performance capacity.
mental, cognitive,  The MOHO is client-centered, theory-driven,
or sensory occupation-focused, and evidence based way of
impairments practicing OT that address how occupations are
throughout life. chosen, patterned, and performed.
 Helps therapists “identify client’s occupational
strengths and limitations” and determine course of
therapy. MOHO wanted to encompass other factors
along with impairment that affect occupation.
 Integrates framework domains, especially how client
factors and environment affect performance skills.
 Change is driven by a client’s occupational
engagement.
 Strategies include Therapeutic reasoning process
and questions.

Occupational Adaptation     This applies to all    OA focuses on occupational engagement and
(Schkade and Schultz) people, ages, person-environment relationship.
conditions,
although  Change occurs as people adapt their occupational
intervention responses to the challenges, roles, and role
 occurs when expectations they face, which involves adjusting
illness, disease, cognitive, psychosocial, and sensorimotor systems
disability, major (gestalt) to allow competence.
life transitions, or
a-typical o Client is agent of change.
development lead
to dysadaptation.  The goal of OA theory is to understand the natural
occupational adaptation process in people and to
use intervention to facilitate this process.

o When client can adapt to overcome

challenges and can transfer skills to other
settings/challenges, then their relative
mastery and their adaptive capacity have
been increased
 Five Strategies
o A holistic approach and participation
approach to assessment
o Reestablish important occupational roles
o Client is agent of change
o Occupations are central in eliciting adaptive
responses
o Increase relative mastery and adaptive
capacity
Ecological Models     All people,    Person both affects and is affected by their
-EHP   ages, and environment.
-PEO   abilities  Environment is the physical, cultural, social, even
-PEOP   temporal or institutional space. The environment
-CMOP-E   can inhibit or enhance occupational performance.
 Occupations are made up of tasks grouped into
activities.
 Goal is to increase Occupational Performance- the
interaction between person, environment, and
occupation factors determined by performance
range, which intervention aims to widen. Ideally
change environment first.

 Interventions
o Establish/restore
o Adapt/modify
o Alter
o Prevent
o Create
Biomechanical (Colangelo, for clients with   Biomechanical Frame focuses on remediation of body
Pedretti, and Trombley) & ongoing functions (improving strength, ROM, and endurance).
Rehabilitative Frames (Trombley disability, The Rehabilitative approach focuses more on
and Mosey)  musculoskeletal environment and task adaptation and compensation.
d/o, cumulative
trauma (e.g. Base in physics- ROM, kinematics, Torque, strength,
carpal tunnel), and endurance.
hand injuries,
work garnering, Functioning is maintaining strength, endurance, and
ergonomics, and ROM within normal limits for one’s age, gender, and
prevention. physical characteristics and disability is a restriction in
these that interferes with occupations (Cole and
Tufano, 2017, p. 167).

Change occurs by maintaining and increasing ROM,

strength, and endurance. (And PAM).

Interventions include:
Activity adaptation, energy conservation techniques,
work hardening, ergonomics and prevention, and
rehabilitation.

Allens Cognitive Levels Frame   People with   Functioning and disability determined by an
(Claudia Allen) cognitive deficits individual’s ability to respond and act within
(dimensions, environment and defined in terms of cognitive levels 1-
 developmental 6 with 52 modes. Below level one is comatose.
disabilities, head
injuries) but can Level 1- only automatic actions
describe Level 2- postural actions
activities or Level 3-manual actions
functioning for Level 4- goal-directed actions
anyone. Level 5- exploratory actions
Level six+ is considered normal functioning.

Change occurs in brain, and OTs can help through

instructions, assistances, and adapting task
environment.

Intervention and assessment intertwined and based on

ACL:
1-sensory stimulation
2-simple repetitive like dancing, tossing ball, raising
spoon, rocking
3-activities that focus on following steps and detecting
errors
4-activities with steps, visible goal, tools in sight
5-activities with verbal instructions and some thinking
ahead
6- activities with plan ahead and consider
consequences

Plus environmental adaptations.

Lifespan Development Frames   People in all   Focuses on how people develop and function within
(Piaget, Freud, Erikson, ages and stages different stages. OTs will focus on establishing age-
Kohlberg+Wilcox, Llorens, and appropriate occupations within continued life roles
Levinson)  throughout life span.

Function occurs when there is a match between client’s

age/stage and heir mastery of typical skills.

Disability is ineffective or unsatisfying interaction with

environment due to loss or failure to develop skills of a
specific stage.

Change occur by learning new skills in a growth-

 promoting environment and is driven by internal need
for mastery that stems from our biological clock and
our environment.

Intervention focuses on creating a growth-facilitating

environment to encourage age/stage- appropriate
behaviors and skill learning so their clients can master
skills related to their continuing or changing life roles as
identified through the life-stage discussion and
observation.

Learning & Behavior-    1. Behaviorist-learning through association

-Behaviorist   Provides guidelines for behaviors modification
-Social Cognitive  assessment and treatment including assessing
-Constructivist  baseline; using reinforcement, punishment/neglect,
-Self-Efficacy  fading, shaping, and chaining.
-Motivational 
Also helps OTs analyze and sequence behavior and
behavior triggers (stimuli).

2. Social Cognitive- learning through observation and

relationship; internal cognitive change over time
due to feedback from self and others; modeling,
demonstration, role-play, and peers/groups.

3. Constructivist- learning through exploration or

active construction of information into our view of
the world; client guides and determines own
learning strategies.

4. Self-efficacy- learning/change driven by belief in

one’s ability to succeed based on past experiences;
motivational; builds persistence; can be developed
by practicing, beginning with small obtainable
goals, and rough vicarious experience.

5. Motivational- learning/change driven by internal

motivation; motivational interviewing an
communication.
Sensory Integration &   All ages for   Focuses on sensory perception and response to
Processing  (Ayres-sensory disorders of environment that affect occupational and social
integration; Dunn- sensory attention, participation, often for children or adults with
processing model) hypersensitivity, disabilities, such as ASD.
 posture control,
balance, apraxia, Goals focus on sensory development, handwriting,
and cognition. skilled movement, and learning disability.

Function occurs when one can organize sensory input

and react in an adaptive way.
Disability is sensory integrative dysfunction and can
cause deficits in visual, somatosensory, bilateral
integration, and sequencing.

Change occurs when people seek the amount and type

of input they need and the goal is to find available and
appropriate ways to meet those needs.

Interventions include sensory diet, equipment that

provides sensory input, group interventions, adapting
sensory environment.

Four sensory styles:

1. Seeking
2. Avoidant
3. Sensitive
4. Registration/Bystander

Motor Control & Motor   Children and   Focus is on (re)/learning voluntary functional
Learning Frames  (Roods and adults with movement.
Carr and Shepherd) health
conditions that Function is measured by increased degree of voluntary
affect motor movement and ability to use functional skills to engage
control (e.g. in occupations, particularly ADLs.
strokes or CP)
NDT
 looks for flaccidity or spasticity
 Uses handling, placement, inhibition,
facilitation, and reflexi inhibiting postures to
help client use normal movements
 Discourages adaptation and compensation with
unaffected side/body parts

Motor Learning etc

 Early-learning motor strategies through trial and
error
 Late- through practicing and refining skilled
movements.
  Intervention includes remediation, adaptation,
and compensation
 Goal is to develop motor strategies to engage in
chosen occupations
 Can include stretching, supporting, splinting,
constraining.

Psychodynamic   Primarily for   Focus areas that OTs can address

Frames*  (Freud-1900s, Fidler- people with 1. Social participation and relationships
1950s, Mosey, Llorens-1970s) mental illness or 2. Emotional expression and motivation
emotional 3. Self-awareness through reality testing and
response to feedback from others
illness. 4. Defense mechanisms (e.g. denial, projection,
sublimation) through symbolism of activities and
occupations
5. Projective activities such as communication and
clarification of occupational goals and priorities;
like through art and activities.

Function looks like a strong sense of self with realistic

body image, self-identity, and self-esteem that can serve
as the basis for adaptive function.

Disability looks like unresolved conflicts and fixations

and an imbalanced psychic energy between ego,
superego, and id.

Change is a process of “working through” that leads to

insight and adequate ego functions.

Interventions include using activities to test reality,

using symbolic and transitional objects such as using
activities like dance and art for self-expression of
feelings, group activities, pet therapy, and creating
symbolic legacies.

Occupational Justice* (Elizabeth  Occupational  Foundation: If health is a human right and occupations

Townsend and Anne Wilcock) justice for all, lead to health, then occupational engagement is a
people human right.
experiencing Problems of justice are often problem of occupation
inequity. such that they limit occupational opportunities and
participation.

Justice is a core AOTA value.

 Change occurs through equitable changes in society
that open doors for occupational engagement as well
as changes in an individual that give them greater
ability/opportunity to enjoy their human rights.

Action: Leads to advocacy, community change, and

policy-making side of OT. It also looks like daily practice,
because occupations are political by nature and every
time someone is able to engage in occupations that
were once unavailable to them, new doors open to
them. Consider the effect that the opportunity to
participate in education gave to minority groups and
women in the United States.