Frames of Reference
Frames of Reference are structures of existing knowledge that guides and informs therapists, by helping to illustrate the reasoning and rationale behind their decisions for practice (Foster 1997 cited Parker 2009).
Being Client Centred is a key belief of Occupational Therapists, and client centred thinking should appear in every intervention. However it can also be seen as a frame of reference (Parker 2009), which aims to guide therapist’s to ensure that they are linking this theory to practice (Duncan 2009). It is considered as a basis of the therapy, where the client is active throughout the process (Law et al cited Parker 2009). It is a holistic approach, considering all aspects of the person, their environments and their meaningful occupations. Within this framework, the therapist is seen as the facilitator, allowing the client to be integral in decision making and goal setting (Parker 2009). The symptoms of Multiple Sclerosis are unpredictable and range from mild to severe. No two people will have exactly the same, or develop them all (Ennis 2008). By using the client centred frame of reference, the intervention can be tailored to the individual, taking to account their wants and needs and enable them to reach their goals (Bloom et al 2006 cited Engin and Pretorius 2008).
The Learning frame of reference used with an educative approach may be used to provide the teaching of new behaviours, information about and strategies of managing the symptoms of a disease or impairment (Tipping 2005). In regards to Multiple Sclerosis, new techniques can be learned to simplify daily tasks, such as cooking and conserve energy when coping with fatigue. This education can be provided in several formats, such as verbal instructions, practical demonstrations, and visual guidance, such a booklets and leaflets (Foster 2005). These materials and discussions with a therapist can provide a wealth of knowledge to the individual and empower the decisions they make in their intervention to enable change.
The Compensatory frame of reference allows for adjustments to be made to the way in which an activity is done, either through the method, materials or environment, to make certain that the occupation is completed by any possible means (Foster 2005). When used with a rehabilitative approach, functioning is assessed and intervention modified as the condition progresses, and allows for the use of adaptive equipment to overcome the deficits the individual may have to increase wellbeing and independence (Cooper 2005). This method is often used where medical intervention can no longer improve the condition, and remediation is not possible (Dutton 1995). Providing that an individual with Multiple Sclerosis is motivated and has the ability to learn, this frame of reference can enable the completion of meaningful occupations, such as cooking to fulfil the role, and identity of being a mother (Roessler et al 2003), by working towards collaboratively set goals using key strategies such as environmental adaptation, assistive technology and new techniques (Dutton 1995).
The Biomechanical frame of reference sees the body as a functioning ‘machine’ and if any part is affected by injury or disease, its purpose is to return that part back to function (Foster 2005). The use of this frame of reference within Multiple Sclerosis can be successful as it focuses on physical mobility, strength, stamina and range of movement, and matching these levels to the occupation. Activities can be graded to suit function (Tipping 2005). Research suggests that maintaining a level of movement or exercise can be beneficial to improve the symptoms of MS (Ennis 2008). Activities in the kitchen can have a vast range of tasks that can be graded to suit an individual’s needs, such as pre-prepared foods and other areas that may need modification, such as positioning, co-ordination, complexity and endurance (Foster and Pratt 2005).
Frames of reference are often used alongside conceptual models of Occupational Therapy. These further provide explanations and support a therapists’ clinical reasoning for intervention (Duncan 2009).