Physical Dysfunction oYou don’t work directly on the occupation or

activity, you look into the impairment level

 Rehabilitation
with assumption that they could participate
o Pedretti, Trombly *
afterwards
o Dr. Dunton (1919) and Dr. Rusk (1949)
 Motor (Re)Learning
o Compensatory techniques: Compensation
o Carr and Shepherd*
o 5 Theoretical Base
o Gentile
▪ A person regains independence through
o Uses more contemporary approach
compensation
o Theoretical Base
▪ Motivation for independence cannot be
▪ Dynamic Systems Theory vs. Traditional
separated from environmental context
reflex hierarchical
▪ A minimum of emotional and cognitive
• Traditional reflex hierarchical (Bobath)
prerequisite skills are needed to make
o assumes that motor control
independence possible
difficulties are caused by problems
▪ Clinical reasoning should take top-down
in central nervous system
approach; looking at patient’s needs then
o developmental sequence is seen as
providing solutions to it; not having a
necessary for normal
general solution then thinking about the
development, and the central
patient afterwards
nervous system is viewed as
o e.g. Usage of Wheelchair, Assistive Devices,
hierarchical with “higher” centers
Commode, universal cuff
controlling “lower” centers.
 Biomechanical
• Dynamic Systems
o Trombly, Pedretti*
o views movement as emerging
o Theoretical Base
interaction of many systems: task,
▪ Physical Science
person and environment
▪ Kinetics
o Subsystems within the person can
▪ Anatomy
include emotional, cognitive,
▪ Physiology
perceptual, sensory, motor and
▪ Kinematics
other physical systems such as
▪ Medicine
cardiovascular, musculoskeletal
o Assumptions
and neurological. Systems outside
▪ Purposeful activities can be used to treat
of the person that influence motor
loss of range of motion, strength and
performance and skill acquisition
endurance
(e.g. characteristics and complexity
▪ After ROM and endurance are regained,
of the task and the environment in
the patient automatically regains function
which it must be performed) are
▪ Principle of rest and stress
also considered.
▪ Best suited for patients with intact CNS
• *Heterarchical view: subsystems in
(e.g. Orthopedic or Cardiopulmonary
charge will vary with specific task
cases)
requirements and environmental
o E.g. Thera-putty, Thera-band, Use of Splint,
demands; no one system has logical
Feeding seat(puts them in 90 degrees position
priority for directing or influencing the
for them to be able to swallow)
others
▪ Principles of Learning Theory
• practice, experimentation,
Muscle Physical variation, instruction and feedback
Strength Endurance Biomechanical
o Motor Re-learning-adults
Model
o Motor Skill Acquisition Frame of Reference-
Joint Range child
of Motion
 Neuro-Developmental ▪ For integration to occur, meaningful
o Bobath* registration of sensory input is required.
o Carr and Shepherd (MRP)* ▪ When the child makes an appropriate
o Voss, Knott, Kabat (PNF) adaptive response, this contributes further
o Brunnstrom to the development of general sensory
o Looks into movement as key problem integrative abilities
o Assumptions ▪ The child needs to be self-directed to act on
▪ It is important to remediate foundation the environment
skills that make normal skill acquisition ▪ adaptive responses that are within the
possible child’s abilities should be used
▪ Normal movement is learned by ▪ Intervention is specific to the underlying
experiencing what is normal movement deficits, it not specific to behaviors.
feels like ▪ Sensory integration difficulties may arise
▪ Posture control is essential for limb control from problems in 2 distinct areas: sensory
▪ You cannot impose normal movement on system modulation levels and functional
abnormal tone support capabilities
▪ Plasticity of the brain ▪ The child’s behavior can be modified thru
o Muscle Tone. Muscle patterns and synergies, appropriate sensory inputs
Postural reflexes and reactions ▪ Input from several sensory systems may be
o E.g. Stroke, Cerebral Palsy (kids) needed to achieve the
▪ registration level or integration level

Postural Muscle
Reflexes and Patterns and
Reactions Synergies Neuro-
Developmental
Treatment Model
Muscle Tone

 Sensory Integration
o Jean Ayres* o Senses have to be integrated in order to have
o Pat Wilbarger, Margaret Rood, LJ King motor planning, body scheme necessary for
o Theoretical Base attention, coordination, perception, academic,
▪ Convergence of sensory information that self- care and behavior
comes from many sources to the brain stem o Always in context of play ── usually for children
and thalamus suggests integration of input
at that level. The brain’s ability to filter,
organize and integrate masses of sensory
information is critical to learning
Vestibular Tactile
o Postulates
(gravity and
▪ Integration of sensory input is holistic. (touch)
movement) Sensory Integration
▪ The child’s behavior are influence by the
state of the CNS. Proprioception
▪ The functioning of the underlying sensory (muscles and
systems determines the quality of adaptive joints)
responses
PSYCHOSOCIAL DYSFUNCTION defend itself against the anxiety that
accompanies them
 Psychoanalytic/ Object Relations
o Functions of Activities
o Theoretical approach that views persons, media
▪ Provide an opportunity for trying out new
and activities as objects invested with psychic
roles or gaining confidences with already
energy
established roles
o Interaction with these objects is necessary to
▪ Provide a vehicle for learning more about
understand personal needs
one’s self and one’s relationship to others
o Meaning of activities to people
▪ Provide a means toward increased self-
o Theoretical Development
acceptance
▪ Outgrowth of psychoanalytical and
▪ Facilitate movement toward flexibility on
communication process approaches
approaching life tasks
▪ 1970 –Ann Mosey* coined the term object
relations
 Behavioral
o Relationship with object is an interpretation of
o Used often for children and adults, mostly for
Sigmund Freud psychoanalytic FOR
children
o Releasing psychic energy, facilitating emotional
o Changing behavior requires reinforcement
experiences leading to understanding of
o Ivan Pavlov
patient’s needs
▪ Classic Conditiong/ Respondent
o Activities are selected based on:
Conditioning
▪ Ability in enhancing interpersonal
• A neutral stimulus is paired with an
communication
unconditioned stimulus a number of
▪ Facilitating healthy emotional experiences
times until it is capable of times until it
▪ Designed to lead to an understanding of
is capable of bringing about a
patient’s needs, conflicts, feelings and
previously unconditioned response
behavior
• E.g. ringing of bell and salivation of dog
o Sigmund Freud*
for time of meal
▪ Psychosexual Stages of Development
o B.F. Skinner
• Oral Phase (First 18 mos)
▪ Operant Conditioning/ Instrumental
o Mouth: Erogenous
Conditioning
o Fixation: Dependency
• Building on a behavior
• Anal Phase (1.5-3 yrs. Old)
• Key is immediate reinforcement of a
o Anus: Erogenous
response
o Fixation: Orderliness=Messiness
• Reinforcement, increases the
• Phallic (3-6 y/o)
probability that the same behavior will
o Erogenous: Genital
occur again
o Fixation: competes for attention of
• Shaping, procedure in which the
opposite sex parent
experimenter or the environment first
• Latency (6-11/13 y/o)
rewards gross approximations of the
o Erogenous: None
behaviors, then closer approximations,
o Fixation: none
and finally the desired behavior itself
• Genital (11-13 until adulthood)
• E.g. giving token or punishment
o Erogenous: Genital
o Fixation: Failure to establish mature
relationships
▪ Defense Mechanism
• To avoid dealing directly with sexual
and aggressive implosives and to
 o Token Economy
▪ Systems of operant conditioning designed
to alter behavior which several or more
reinforcements have not proven effective
o Modeling
▪ role of imitation in learning, rapid method
of learning
▪ demonstrating the learning
 Developmental
o Erik Erikson and Kohlberg*
o Psychosocial Theory
o There are stages that each one has to resolve
otherwise they are stuck in that age and will not
be able to function
▪ Trust vs Mistrust - Birth – 1/1.5
▪ Autonomy vs Shame & Doubt - 1-3
▪ Initiative vs Guilt - 3-5
▪ Industry vs Inferiority - 5-12
▪ Identity vs Role Confusion - 12-20
▪ Intimacy vs Isolation - 20-40
▪ Generativity vs Stagnation - 40-65
▪ Integrity vs Despair - 65++
o Intervention: Facilitate resolution of conflicts
 Cognitive Disability
 Cognitive Behavioral
o Seek to change the thoughts believed to result
in or cause specific behaviors
o To develop a knowledge base for problem-
solving
o A person’s cognitive function is believed to
mediate or influence one’s affect and behavior
o Provides an assessment guide for determining
cognitive function, affective states and
generalized behaviors
o Rational Psychotherapy
▪ Ellis’ Rational Emotive Therapy (RET)
▪ Meichenbaum’s Self-Instructional Training
(SIT)
▪ Beck’s Cognitive Therapy
o Bandura’s Social Learning Theory
▪ Assumptions
• The outstanding characteristic of
human is plasticity, having the
flexibility to learn a variety of behaviors
in diverse situations
• Triadic Reciprocal Causation Model
includes behavioral, environment, and
personal factors, people have the
capacity to regulate their lives
• Social Cognitive Theory takes agentic
perspectives: humans have the
capacity to exercise control over the
nature and quality of their lives
o In OT Practice
Treatment
Change Change
Thoughts Behavior
▪ Techniques
• Homeworks
• Reading
• Film showings and other media
• Modeling
• Role play
• Educational groups
o Claudia Kay Allen*, Catherine Earhardt, Tina
Blue
o Developed in the 1980s
o Applicable for adults (geriatrics)
o Impaired cognition (e.g. Dementia)
o Basic Assumptions
▪ Allen (1987) defines cognitive disability as
“a limitation in sensorimotor actions
originating in the physical or chemical
structures of the brain and producing
observable and assessable limitations in
routine task behavior.”
▪ Best Ability to Function:
• highest practicable physical, mental, &
psychological performance for client
despite cognitive limitation
▪ Allen’s theory uses the World Health
Organization system for classifying
functioning, disability, & health
• Body functions, structure &
impairments
• Activities & participation
 • Activity limitations and participation
restrictions
▪ Allen gives guidelines on how OT helps
persons adapt to chronic health conditions
▪ Allen’s theory focuses on SAFETY in all
occupational performance areas
▪ Allen focuses on three OT Practice
Framework areas
• Process Skills (cognitive level)
• Context (environmental adaptation &
care giver assistance)
• Analysis of Activity Demand
▪ Task Environment: setting in which task is
performed, including room, lighting,
temperature, placement of supplies,
equipment available, positioning of person,
assistance available, etc.
▪ Just right challenge: activity demand is
matched to individual’s current capacity to
function, providing a sense of well-being
and motivation
o Function–Dysfunction Continuum
▪ Allen defines 6 cognitive levels & 52 modes
of performance
▪ Range: 0.8 to 6.8
▪ Below level 1 is basically comatose
▪ Above level 6 is normal functioning
▪ Level 4.6 is minimal for living
independently (predictive validity)

Cognitive Activity
Levels Analysis Cognitive Disability
Model (Allen)

Performance
Modes