Common Frames of Reference Used in the Evaluation and Treatment of Adult Clients
Assumptions
Examples of Evaluations and Assessments
Frame of reference objectives
All frames of reference aim to increase (restore), adapt, maintain, prevent or enhance (promote) occupational performance so that health, well-being, and
participation are the outcome. Although the process objectives in the final column of this table are mainly stated at a body function or structure level, it is
implicit that the practitioner’s therapy goals would be functional and focused on a client’s performance skills and engagement in his/her daily occupations.
Biomechanical Frame of Reference
Clients’ condition, diagnosis, or impairment is musculoskeletal disorders e.g., fracture, amputations, rheumatoid arthritis, hand injuries, or back pain.
Applies knowledge from anatomy, physiology,
kinesiology, and physics to restoring function.
Occupation-based Assessments
 Barthel Index
 Borg Rate of Perceived Exertion (RPE Scale
Engagement in occupation requires movement via
for endurance)
body structures and functions.
 Disability of Arm, Shoulder and Hand (DASH)
 Functional Independence Measure (FIM)
Client Factor Assessments
 Hand Strength using a dynamometer and pinch
meter
 Manual Muscle Test
 Pain Scale (visual analog and numerical rating
scale)
 ROM measured using a goniometer
 Volumeter for edema
To enhance occupational performance by:
 Increasing strength, endurance or range of
motion.
 Compensating for musculoskeletal pathology.
 Reducing pain, swelling, or scarring.
 Preventing deformity or contractures
 Maintaining joint ROM or muscle strength
Rehabilitative Frame of Reference
Clients’ condition or disabilities are usually associated with neuro-motor, sensorimotor, or neurodevelopmental disorders such as multiple sclerosis, spinal
cord injury, cerebral vascular accidents, or those that include cognitive, psychosocial or visual-perceptual disorders such as an acquired brain injury, that
creates performance difficulties associated with the chronicity of a disorder.
Engagement in occupation requires adaptive
techniques/ compensatory strategies to
environment, and/or occupation.
To maximize performance in occupations through
Occupation-based Assessments
 Canadian Occupational Performance Measure adaptation of the environment or activity
(Client factors, performance skills and patterns,
(COPM)
may not be able to be restored in a timely manner)
 Functional Independence Measure (FIM)
 Klein-Bell Activities of Daily Living Scale
 Kohlman Evaluation of Living Scale (KELS)
Client Factor Assessments
 Bells Test
 Mini Mental State Exam (MMSE)
 ROM using goniometer
 Semmes-Weinstein for sensation
Frames of Reference for cognition, perception, and motor planning problems focus on the ability to perceive and participate in one’s environment
to perform occupations.
Multicontext Treatment Approach:(Toglia)25,26 This approach is used with clients who have neurological disorders that involves cognition,
psychosocial and/or perceptual dysfunction.
Addresses the dynamic nature of cognitive (i.e.
memory, sequencing, motor planning, problemsolving, visual processing, attention, selfawareness, and how participation in occupation is
influenced by personal factors, the
activity/occupation being performed and the
environment in which it takes place.
Occupation-based/focused Assessments
 Assessment of Motor and Process Skills
(AMPS)
 Cognitive Performance Test (CPT)
 Executive Function Performance Test (EFPT)
 Arnadottir OT-ADL Neurobehavioral
Evaluation (A-ONE)
Client Factor Assessments
 Cognitive Assessment of Minnesota (CAM)
Aims for clients to generalize strategies learned in  Lowenstein Occupational Therapy Cognitive
therapy to transfer these techniques across new
Assessment (LOTCA)
situations.
 Motor Free Visual Perceptual Test (MVPT)
To restore cognitive and/or perceptual abilities to
engage in occupational activity.
To adapt the activity or environment to allow the
client to participate in meaningful occupations.
To facilitate transfer of learning across a variety of
contexts
To develop self-awareness to utilize strategies to
promote function and decrease barriers.

Test of Everyday Attention (TEA)
Emphasizes the practice of skills in context.
Quadraphonic Approach: (Abreu and Peloquin)27 Cognitive deficits following a brain injury
Continuous analysis of occupational performance
is required for effective rehabilitation.
See assessments above
Emphasizes a “micro” focus on body function(
e.g., attention, sequencing, problem-solving, motor
planning) and postural control, and a “macro”
focus on occupational performance areas, such as
ADL’s and Work, and understanding the client’s
priorities, motivation and well-being. 26,28
To remediate or compensate for abilities in body
function (cognitive, perceptual and motor abilities)
to be able to participate in occupations.
To promote client-centered strategies based on age,
health and personal characteristics to promote
engagement in functional activity
The narrative process of story- telling and story
making is integral to the rehab process.
Neurofunctional Approach:(Giles)29 Used with clients who have severe cognitive deficits following a brain injury28
“Intervention emphasizes the use of task-specific
training or rote repetition of a task/routine in
natural contexts to develop habits or functional
behavioral routines.” (p.746) 26,29
See assessments above
To retrain the lost skill/s through compensatory
techniques and repetitive practice using the same
task and within the same environment
Frames of References for sensorimotor disorders, motor learning or motor control disorders. These are clients with impairments due to injuries,
trauma or disorders of the central nervous system. These frames of references are designed to assist clients to learn and acquire appropriate developmental
movement patterns and utilization of sensory input to engage in functional actions in a controlled way that allows an individual to respond to their
environment and occupations.30
Motor learning/Motor Control Approach: (Carr and Shepherd) 20 Musculoskeletal, neuromotor, sensorimotor, neurodevelopmental conditions, and
cognitive/perceptual disorders
Usually associated with assisting clients to learn and acquire appropriate developmental movement patterns utilizing sensory input to engage in functional
actions in a controlled way that allows an individual to respond to their environment and occupations.30 Motor control is the result of motor learning. 30
Emphasizes the practice of learning motor
movement and control of movement to enhance
participation in occupational activity (e.g.,
intrinsic and extrinsic feedback).
Emphasizes a heterarchic dynamic process of
client factors, context, environment and
occupations. (Phipps)
Occupation-based Assessments
 AMPS (Assessment of Motor and Process
Skills)
 FIM (Functional Independence Measure)
 AMAT (Arm Motor Ability Test)
 COPM (Canadian Occupational Performance
Measure)
 Wolf Motor Function Test (WMFT)
Client Factor Assessments
 Fugl-Meyer Assessment (FMA)
 Modified Ashworth Scale
 Motor Assessment Scale (MAS)
 Reflex Testing
 Observe the quality of volitional movement
patterns
 Observe reflex patterns, such as equilibrium
and righting reactions.
To learn and practice strategies to enhance the
quality and effectiveness of movement in
functional activity (i.e., the goal is to increase
motor control).
Utilizes both facilitation and inhibitory techniques.
To gain voluntary, motor control to participate in
occupations in a variety of contexts.
Sensorimotor Approach: ( Rood ) Neuromotor, sensori-motor, and neurodevelopmental conditions that utilizes a neurophysiological approach to
treatment
Emphasizes the use of facilitation and inhibitory
sensory stimulation techniques to normalize
muscle tone in order to initiate a volitional motor
response for functional performance skills31
See assessments above
To normalize muscle tone through the use of
facilitory or inhibitory techniques to initiate
controlled developmental movement. Utilized
primarily as a preparatory precursor to engage in
occupations.31
Emphasizes both a reflexive and hierarchic
model of motor control.31
Movement Approach: (Brunnstrom) Approach is specific to people who have suffered from a cerebral vascular accident (CVA) and is a
neurophysiological approach to treatment.
This approach addresses the reflexive and
abnormal patterns in the UE and encourages
synergic (flexor or extensor) activation of
muscles to promote the development of
purposeful, voluntary movement. The approach
identifies six sequential stages of motor recovery
after a stroke-induced hemiplegia.
Emphasizes both a reflexive and hierarchic
model of motor control.31
See asessments above
The Brunnstrom Approach has influenced the
development of a standardized assessment to
evaluate a person recovering such as the FuglMeyer Assessment of Physical Performance
(FMA).
To improve movement from a reflexive pattern to
voluntary control31
Proprioceptive Neuromuscular Function- PNF: ( Kabot, Knott and Voss) Focus on Central Nervous System Disorders and is a neurophysiological
approach.32
Emphasizes the use of diagonal patterns (use of
agonist and antagonist muscles) combined with
sensory stimulation to promote voluntary,
functional movement31
See assessments above
Emphasizes developmental sequencing of motor
movement31
To produce a controlled diagonal movement
pattern of the limbs and trunk (during functional
activity) that incorporates sensory input and
strengthens both the agonist and antagonist
muscles.
_______
Emphasizes both a reflexive and hierarchic
model of motor control.31
Neurodevelopmental Treatment Approach- NDT:( Bobath and Bobath)33 Central Nervous System Disorders and is a neurophysiological approach.
Utilizes the facilitation of functional volitional
movement patterns through manual facilitation
techniques.
Guides “normal’ movement patterns through the
use of “handling” at key points of control (i.e., the
head, shoulders, and pelvis) to engage in function
activity31
See assessments above
Important to emphasize normal and quality
movement patterns in functional activity with
manual facilitation
To gain proximal stability to produce distal
mobility
To restore quality movement and postural control
to engage in occupations31
Reinforces developmental motor milestones and
integration of reflexes to promote volitional
movement patterns required for performance skills
Compiled with information from Cole (2012)35, Pendleton (2013)36, Radomski &Trombly (2008)37, Crepeau (2009)14