Examining the Relevance of Neurological Frames of Reference in Regional Practice
of Stroke Rehabilitation
Mylene Schriner, PhD, OTR/L; Madie Bahlinger, OTS; Katie Neil, OTS;
Lindsey Pollock, OTS; Nikki Rosenhauer, OTS; Colleen Schneider, OTS
Department of Occupational Therapy Education, Rockhurst University, Kansas City, MO
Background
Methods
•  Currently 7 million people live with detrimental effects from surviving a stroke
(National Stroke Foundation, 2013).
•  Those working within rehabilitation services need to develop appropriate
intervention techniques which lead to individual success (Delaney, 1983).
•  In order to ensure success of occupational therapy students on fieldwork and in
practice, occupational therapy (OT) faculty should consider whether current
curriculum is relevant to stroke rehabilitation.
•  Neurological frames of reference (FoRs) supply occupational therapists (OTs) with
intervention techniques for treatment, leading to successful outcomes.
•  The following FoRs taught in the current OT curriculum include:
•  Brunnstrom, which uses reflexes and primitive movement patterns to facilitate
recovery of voluntary movement.
•  Constraint-Induced Movement Therapy (CIMT), which requires use of the
affected extremity in daily activities by restraining the non-affected extremity.
•  Neurodevelopmental Treatment (NDT), which concentrates on eliminating
abnormal patterns of muscle tone and motor control to restore normal
movement patterns.
•  Proprioceptive Neuromuscular Facilitation (PNF), which stresses passive and
active-assisted movement in diagonal patterns of flexion and extension.
•  Rood, which uses reflex arcs to elicit motor responses by supplying sensory
stimulation in a controlled way.
•  Task-Oriented approach, which focuses primarily on meaningful tasks and
functional goals through the use of real objects and natural environments.
•  A 2012 study showed universities on coastal regions (CR) had superior master’s
programs compared to Midwest (MW) universities (Washington Monthly, 2012).
•  It is important to analyze the differences of neurological FoRs OTs teach and
implement into practice in different regions of the United States.
•  This is a continuation of a 2012 study which surveyed OTs and neurological
intervention use in the MW (Brightman et al., 2012).
•  Sample size of CR =96 and MW =167. Participants completed a 33 question
online survey (SurveyMonkey). Questions included demographics and OT
intervention questions . Participants rated frequency of intervention techniques
based upon the six neurological FoRs, which remained hidden throughout the
survey.
•  Responses concerning techniques used a 4-point Likert scale defined as “usually
(4)”, “sometimes (3)”, “rarely (2)”, and “almost never (1)”.
•  Participants received invitations through email or web postings via OT state
associations, alumni and fieldwork sites associated with OT and OTA programs
located on the coasts, and OT organizations through social media.
•  Data was analyzed using IBM® SPSS® Statistics version 19.0.
The purpose of this study is to establish frequency of neurological interventions in
OT practice on the CR, if differences exist between the MW and CR regarding
frequency, and curriculum accuracy.
2"
8.354%
8.156%
9.094%
9.096%
5.302%
5.012%
4"
10.198%
9.6%
6"
9.557%
8"
8.389%
10"
10.094%
12"
8.875%
Total%Mean%of%FoR%Use%
Figure%1:%Neurological%Frames%of%Reference%Use%Coast%vs.%Midwest%%
Coast"
Midwest"
0"
Brunnstrom"
NDT"
Task"
Oriented"
PNF"
Rood""
Figure&2:&Sources&of&Knowledge&for&Neurological&Treatments&for&Coast&
4"
3"
2"
1"
0"
3.146&
OT"educa.on"
3.313&
OT"fieldwork"
Source&of&Knowledge&
3.917&
Source"of"
Knowledge"
OT"work"experience"
Discussion
•  Survey results exposed NDT and Task Oriented as the most frequently used
FoRs in MW and CR alike.
•  Frequency data indicated Rood as the least used frame of reference (FoR)
among both MW and CR.
•  Results showed that CR use NDT, Brunnstrom, and Task Oriented significantly
more than the MW with no significant differences between the remaining FoRs.
•  Figure 2 displays evidence that OTs gain knowledge for intervention planning in
upper extremity rehabilitation from a variety of sources.
•  No correlations exist between FoR use and years since graduation and years of
experience in stroke rehabilitation.
•  Limitations of the study include:
•  Errors with data collection and formatting of SurveyMonkey.
•  Difficulties soliciting survey participants in the CR.
•  Honesty and accuracy in self-evaluations of respondents regarding FoRs
use.
Conclusions
CIMT"
Neurological%Frames%of%References%
Mean&Likert&
Purpose
Results
•  Figure 1 displays results of an independent t-test that reveals the CR used
Brunnstrom, NDT, and Task Oriented significantly more than the MW.
•  Figure 2 demonstrates, based on frequency statistics, OTs on the CR gained
knowledge from work experience foremost, followed by fieldwork experience
and lastly OT education (according to Likert scores of 3.917, 3.313, and 3.146
respectively).
•  OTs in the CR use NDT, Brunnstrom, and Task Oriented significantly more than
MW in stroke rehabilitation.
•  OTs use an eclectic approach when gathering knowledge for treatment
interventions.
•  The MW and CR equally use a variety of FoRs when determining treatment for
upper extremity stroke rehabilitation.
Acknowledgements
The authors thank the following faculty members for their contributions:
Michael Clump, PhD
Liz Zayat, MS, OTR/L
Catherine Thompson, PhD, PT, MS
Katie Ryan, PhD, OTR