Occupational therapist uses the biomechanical frame of reference in orthopedic cases, burn cases and patients with limited range of motion and strength. The Biomechanical frame of reference is based on Joint range of motion, Muscle strength, and Endurance with the intact central nervous system.
In the last article, we have explained you about Frame of reference, it’s better to understand the basic terminology before reading the specific type of Frame of reference. If you are not familiar with the term, we suggest to read it first.
Occupational therapy frame of reference
Occupational therapist uses frames of references for guiding their practice. Occupational therapist (OT) uses purposeful activities to treat their clients, purposeful activities have some purpose and meaning to the life. OT develops the method to integrate purposeful activities and their treatment goals.
Analysis of joints and muscles during an activity is the base of the Biomechanical frame of reference. This analysis helps OT to plan and check the progress, whether goals are achieved or not.
The biomechanical frame of reference has four assumptions (by Dutton)
The first assumption is the belief that the purposeful activities can be used to treat loss of range of motion (ROM), strength, and endurance.
The second assumption is the belief that after ROM, strength, and endurance regained, the patient automatically regains function.
The third assumption is the principle of Rest and stress. First, the body must rest to heal itself. Then, the peripheral structure must be stressed to regain range, strength, and endurance.
The fourth assumption is the belief that the biomechanical frame of reference is best suited for patients with an intact central nervous system. Patients may have limited range, strength, and endurance, but have the ability to perform smooth, isolated movements.
This part of biomechanical frame of reference focuses on concern areas or problem areas. Concern areas of this frame of reference are –
1. Structural stability, 2. Passive Range of motion, 3. Low level endurance
4. Edema control, 5. Strength, and 6. High level endurance.
These areas should be focused by an occupational therapist while assuming biomechanical frames of reference in the treatment plan.
Structural stability assumed as a primary concerned area after that only, therapist can stress peripheral structures (muscle stretching). In a fracture case, bone and soft tissue healing, consider as structural stability.
And, high level Endurance should take care of at the end of treatment planning. Low level endurance training can be initiated along with low resistance activities to boost repetition.
Above mentioned “concerned areas” can be assessed by the occupational therapist. In Biomechanical evaluation OT uses different tools for assessment like Goniometer for Joint range of motion, Volumetry for edema, and manual muscle testing for strength. Along with these formal tests, OT also does clinical observation, including Skin’s appearance, End feel during range of motion and grip strength.
Low level and high level endurance can be assessed by using cardiac step chart and metabolic equivalents chart (MET). After the formal and informal assessment, OT set the objectives and goals for the patient.
Postulates regarding change identify links among the presenting problems, biomechanical goals, and functional outcomes.
For Example, a patient who is a writer fell down on his hand and the radius bone got fractured (right side).
| General Deficit / Present problem | Loss of joint range of motion |
| Biomechanical Goals | Supination of forearm 70 degrees Pronation of forearm 70 degrees Wrist extension 70 degrees |
| Functional Outcome | Ability to hold a pen and write with wrist extended and forearm pronated. |
In the above example, the patient doesn’t care about 10-15 degree improvement in wrist extension; he must be more concerned about his writing abilities for the long duration.
Postulates regarding intervention create links between biomechanical goals and therapeutic activities.
| Measurable Biomechanical Goals | Supination of forearm 70 degrees Pronation of forearm 70 degrees Wrist extension 70 degrees |
| General Treatment Method | It consists of heat, manual stretch and splinting. Which increases elasticity of the skin, elongates collagen fibers and position of the joints in functional position |
| Functional Activities | Involve him/her in writing task. |
In the above example, both of these, general & functional activities, helps OT to achieve better client oriented result.
In the biomechanical frames of reference, it’s easy to develop measurable biomechanical goals because this frame of reference uses quantitative evaluation data such as degree of range of motion.
Other frames of reference may be used along with the biomechanical frame of reference for the better result, it depends upon the condition and need of a client.
References-
1. Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction
2. Willard and Spackman’s Occupational Therapy
3. Frames of Reference for Pediatric Occupational Therapy by Paula Kramer
