Moral Treatment Era (1801-1860)

-​ Use of occupation (work, exercise, music, literature) to treat mental illness

●​ Philippe Pinel – Introduced occupation-based interventions for mental illness. Used
physical exercise, work, music, and literature as therapy.
●​ William Tuke – Advocated for non-restraint treatment; believed in self-control,
employment, and amusement for mental health recovery.
●​ Samuel Tuke – Popularized the moral treatment approach; wrote Description of the
Retreat.
●​ Benjamin Rush – The first American physician to implement moral treatment,
considered the Father of American Psychiatry.

Arts and Crafts Movement (Early 1900s)

●​ “occupation or doing with the hands can be seen as an integral part of experiencing a
meaningful life”
●​ A response to industrial Revolution which promoted a return to handcrafting
●​ To increase leisure and productivity through “hand and mind”

Mental Hygiene Movement (1909)

●​ Clifford Beers, Adolph Meyer, William James
●​ Broadened to focus on helping people find ways of living healthy lives, preventing mental
illness, and better handling of mental illness
●​ Emphasized early intervention, prevention, and promotion of mental health
●​ Adolph Meyer coined the term “mental hygiene”
●​ Philosophy of OT (1921).

The Birth of Occupational Therapy

1914
●​ Dr. William Rush DuntonJr. (Father of OT) along with George Edward Barton,
formed an organization of persons interested in “occupation work”
●​ George Barton: changed the term “occupational work” to “occupational therapy”

1916:
●​ The first school of OT - Henry B. Favil School of Occupations was established by
Eleanor Clarke Slagle.

Eleanor Clark Slagle: Habit Training

●​ oldest model of occupational therapy
●​ Based on the concepts of balance, order, and sequenceof occupational cycles and habit
forming as a learning process
●​ 24 hour regimen of self-care, occupational classes, meals in groups, and recreation
●​ Belief that life should become as routineas possible
●​ Goal-directed activities were used to help individuals learn new skills to be productive,
and derive benefits of a balanced daily schedule
Susan Tracy
●​ First organized OT classes for nurses in 1906 in Boston
●​ Created an OT program which catered to patients with neurasthenia
●​ Studies of Invalid Occupation (1910)-first known OT book

1917:
●​ National Society for the Promotion of Occupational Therapy (now AOTA) was founded.
●​ Eleanor Clarke Slagle (Habit Training) – The oldest OT model based on balance,
order, and routine.

1940-1970: Shift to Medical Model

●​ Occupational therapists explore medical model (Psychoanalytic and Behavioral
approach)
●​ Began to use activities to evaluate their patient’s psychodynamics
●​ Analyze activities for their capacity to meet patient’s need.
●​ Activities were matched symbolically.
●​ Psychoanalytic & Behavioral approaches became dominant.
●​ OTs began analyzing activities to meet patient needs.
●​ 1947: First Edition of Willard and Spackman’s Principles of Occupational Therapy
●​ 1955: First antipsychotic drugs were introduced.

1963
●​ Community Mental Health Center Act (PL 88-164) began deinstitutionalization.
●​ Begins de-institutionalization trend
●​ From institutional settings to community living
●​ Act to provide federal funding for community mental health centers in US

1965: Medicaid and Medicare enacted

●​ Increases de-institutionalization trend

1965-1990:OT begins to develop a theoretical basis for the profession that is separate from
medical model
●​ -Occupational performance and MOHO

1972-1990s: Development of OT Theory

●​ Lorna Jean King (1972) applied Sensory Integration to psychiatric OT.
○​ Chronic schizophrenia could be caused by errors in sensory processing

1979-1999:Intensive Psychiatric Rehabilitation Treatment (IPRT) becomes widespread

●​ Designed to help consumers gain independence living, learning, working, and socializing
in the community

Claudia Allen (1985) introduced the Cognitive Disabilities Model.

●​ She identified 6-level of cognitive functioning

1990: Occupational Science was established as a distinct discipline by Florence Clark.

●​ Exploration of narrative reasoning
●​ American with Disabilities Act (ADA) (Public Law 101-336)
1990-1999
●​ Increase emphasis on research, outcome studies, establishing proof of OT’s
effectiveness
●​ Other professions, nursing, social work, and neuropsychology begin claiming
occupational functioning as part of their practice

Occupational Science
●​ Field of study not a practice
●​ Humans are occupational beings
●​ Humans have the need to engage in occupations

Occupational Science and Occupational Therapy

●​ ‘Occupational scientists research, while occupational therapists practice’. (Jonsson,
2008)
●​ Applied science versus basic science
●​ Occupational science sits firmly within the OT profession’s paradigm
●​ Both are concerned with occupation and health.

Implications of Occupational Science to OT

●​ OT needs more knowledge to inform practice. (Yerxaet al, p.3)
●​ Occupational Science has the potential to enhance existing practice and expand OT
practice into health promotion and population health.

●​ Occupational Science – Research-based discipline studying human occupation.

○​ The basic science that studies human occupation; it examines how humans
engage in meaningful
●​ Occupational Therapy – Applied science focused on rehabilitation and interventions.
○​ The applied practice that uses occupation to promote health and well-being; it is
grounded in the principles of occupational science.
●​ OT and Occupational Science are interrelated, with OT applying research findings for
practice.
●​ Humans are inherently occupational beings with an essential need for engaging in
meaningful work and leisure.
Key Differences:

Pioneers of OT in the Philippines

1945
●​ André Roche introduced OT at PCAU I General Hospital (Mandaluyong Emergency
Hospital).
1946
●​ Conchita Abad & Gliceria Andaya established the first OT department in the
Philippines was founded at PCAU I General Hospital
●​ Charlotte Aspuriawas granted a scholarship by the Hawaii Association of OT at
Milwaukee Downer College

1949
●​ Charlotte Aspuria became the first certified Filipina OT at Milwaukee Downer College

1959-1961
●​ the first B.S. OT curriculum was drafted by Mrs. Charlotte A. Floroand Mrs. Conchita
Abad

1962
●​ the School of Allied Medical Professions (SAMP) was established as the first school in
Asia to offer a baccalaureate degree in OT

1965
●​ Occupational Therapy Association of the Philippines (OTAP) was founded.

1966
●​ the first batch of OTs graduated

1969
●​ RA 5680 (Board of Physical and Occupational Therapy) – Created the Board of
Examiners for PT & OT.

1973
●​ First board of Examiners was inducted in June: Dr. J. Mendoza, H. Pitog, F. I. Sano, J.
Rabino, C. Abad
●​ TahanangWalangHagdananwas established by Sister ValerianaBaerts

1974
●​ First OT Board Exam was conducted.
●​ Corazon Tablan, Cynthia Isaac, MarylynnQuerouz, Delia Ramos

1977
●​ SAMP renamed to the College of Allied Medical Professions (CAMP) with Dr. Guillermo
Damian as the first dean
1981: “International Year for Disabled Persons”

1981-1991:“Decade for Disabled Persons”

1983: BP 344 was approved on February 25

●​ “An Act to Enhance the Mobility of Disabled Persons by Requiring Certain Building,
Institution, Establishments, and Other Public Utilities to Install Facilities and Other
Devices.”

1985: OT was established in the College of Perpetual Help, Binanby Ms. Querouz
1991: Emilio Aguinaldo College, Cebu Velez, Cebu Doctors opened

1992: RA 7277: Magna Carta for Disabled Persons

●​ An act providing for the rehabilitation, self-development and self-reliance of disabled
persons and their integration into the mainstream of society and for other purposes
1996
●​ UST OT Program was launched.

Clinical Reasoning in OT
Process used by OT practitioners to understand the client’s occupational needs, make decisions
about intervention services, and as a means to think about what we do.
●​ Narrative Reasoning
○​ Focuses on the client’s life story and how illness affects it.
○​ OT helps create a therapeutic story that becomes a meaningful short story in the
larger life story of the patient
○​ Propositional reasoning relies on logic and scientific evidence to guide
clinical decisions, while narrative reasoning focuses on the client’s personal
story and lived experiences to shape therapy.
●​ Pragmatic Reasoning
○​ Considers practical aspects such as the intervention setting, therapist
competence, and available resources.
○​ Extends beyond the interaction of the client and therapist
■​ Practice Context – Refers to external factors that influence therapy,
such as workplace policies, resources, and institutional constraints.
■​ Personal Context – Involves the therapist's individual experiences,
values, beliefs, and competencies, which affect decision-making in
clinical practice.
●​ Conditional Reasoning
○​ Concerned with the contexts in which interventions occur, the context in which
the client performs occupations, and the ways in which various factors might
affect the outcomes and direction of therapy
○​ Involves making moment-to-moment decisions based on changes in the client's
context and performance.
●​ Procedural Reasoning
○​ Concerned with getting things done, with “what has to happen next”
○​ Closely related to the medical form of problem solving
○​ Emphasis is often placed on client factors and body functions and structures
○​ Influence by using current evidence about the client’s condition and selected
intervention
●​ Interactive Reasoning
○​ Concerned with the interchanges between the client and therapist
○​ Therapist uses this type of reasoning to engage with, to understand, and to
motivate the client
■​ OT wants to understand the client as a person
■​ Takes place during the face-to-face interaction between client and
therapist
■​ OT involves “doing with” the client
 ●​ Ethical Reasoning
○​ What should be done for this client?”
○​ Client’s perspective and goals for treatment
○​ OT is responsible for:
■​ supplying information to the client (process, pros/cons of treatment,
alternative)
■​ assisting client’s in making decisions regarding goals and methods
○​ OT should:
■​ develop therapy plan addressing occupational limitations based on
patient’s goals/wishes

Development of Clinical Reasoning

1.​ Clinical experience
2.​ Personal experience
3.​ Reflection on experiences
4.​ Education

Theory
●​ Helps us describe, explain, and predict behavior and/ or the relationship between
concepts and events
●​ Theories are built through the systematic gathering of data and thorough observation
●​ As theories develop, they may be tested through experimentation

Models of Practice in OT
●​ Refers the application of theoryto occupational therapy practice
●​ Serve as a means to view occupation through the lens of theory with the focus on the
client’s occupational performance
●​ Purpose:facilitate the analysis of occupational profile and consider potential outcomes
with selected interventions

Australian Model of Occupational Performance

●​ Focus: Lifelong person-environment relationship and it’s activation through occupation
Considers the interactions between two environments relative to occupations
●​ Internal Environment
○​ found within humans and include roles, areas, components, core elements of
occupational performance, and aspects of time and space
●​ External environment
○​ outside the internal environment and within which occupations are performed
(sensory, physical, social, and cultural dimensions)

Construct 1: Occupational Performance

●​ Occupational Performance is the ability to perceive, desire, recall, plan, and carry out
roles, routines, tasks and subtasks for the purpose of self-maintenance, productivity,
leisure and rest in response to demands of the internal and/or external environment
●​ Major construct around which this model is conceptualize.
Construct 2: Occupational Performance Role
●​ Occupational performance roles are those roles that constitute the bulk of daily
function and routines (Keilhofner, 1995; Keilhofner & Burke,1985; Llorens, 1991).
●​ Patterns of occupational behaviour composed of configurations of self-maintenance,
productivity, leisure and rest occupations.
●​ Goals of the profession include the preservation, maintenance and development of
valued occupational roles
●​ Central organizing construct of occupational performance in the Occupational
Performance Model (Australia)

Construct 3: Occupational Performance Areas

1.​ Rest occupations
2.​ Self-maintenance occupations
3.​ Productivity/School occupations
4.​ Leisure/Play occupations

Occupational Role
●​ Self-Maintenance
●​ Rest
●​ Leisure
●​ Productivity

●​ Routine: sequences of tasks that begin in response to an internal or an external cue and
end with the achievement of the identified critical function (Brown, 1987).
○​ Structure
■​ Flexed
■​ Flexible
○​ Timing
■​ Regular
■​ Intermittent
●​ Tasks: are viewed as sequences of subtasks that are ordered from the first performed to
the last performed to accomplish a specific purpose.
●​ Subtasks: consist of steps or single units of the total task and are stated in terms of
observable behaviour(Romiszowski, 1984).

Construct 4: Occupational Performance Components

●​ Occupational performance components are broadly classified into five component areas:
biomechanical, sensory motor, cognitive, intrapersonal and interpersonal
●​ The impact of components on occupational performance is the result of a complex
network of interactions involving interdependent relationships between the components
themselves as well as between each component and other constructs within the model.
●​ Biomechanical Component
○​ From the perspective of the performer : include range of motion, muscle strength,
grasp, muscular and cardiovascular endurance, circulation, elimination of body
waste.
○​ From the perspective of the task: size, weight, dimension and location of objects
●​ Sensorimotor Component
○​ From the perspective of the performer : regulation of muscle activity, generation
of appropriate motor responses, registration of sensory stimuli and coordination.
○​ From the perspective of the task : gravity, colour, texture, temperature, weight,
movement, sound, smell and taste.
Construct 5: Core Elements of Occupational Performance
●​ acknowledges the body-mind-spirit interactionist paradigm
○​ Body Element is defined as all of the tangible physical elements of human
structure. (anatomic)
○​ Mind Element is defined as the core of our conscious and unconscious intellect
that forms the basis of our ability to understand and reason.
○​ Spirit Element is defined loosely as that aspect of humans which seeks a sense
of harmony within self and between self, nature, others and in some cases an
ultimate other; seeks an existing mystery to life; inner conviction; hope and
meaning.

Construct 6: External Environment

●​ all the conditions surrounding a person, and has been classified in various ways:
○​ Physical Environment (Tall building made of glass and steel)
○​ Sensory Environment (Style, noise)
○​ Cultural Environment (Values and beliefs)
○​ Social Environment (codes of conduct and behavior)

Construct 7: Space
●​ Space refers to compositions of physical matter (Physical Space) as well as a person's
view of experience of space (Felt Space).
●​ Ex: People describe their work role(s) relative to what they do (the final form), the people
or tools they work with (objects) and where they work (position in space).

Construct 8: Time
●​ Time refers to a temporal ordering of physical and other events (Physical Time) as well
as a person's understanding of time based on the meaning attributed to it (Felt Time).

Canadian Model of Occupational Performance (CMOP)

●​ Forms the basis of client-centered practice in occupational therapy in Canada and
increasingly in other countries
●​ Interaction between people, their roles, and the environment is quite dynamic and must
constantly accommodate a variety of changes
○​ Occupation
■​ Self-maintenance: activities done to maintain the person’s health and
well-being in the environment
■​ Productivity: activities or tasks done to enable the person to provide
support to self or other
■​ Leisure: activities or tasks done for enjoyment or renewal
○​ Performance Components
■​ Affective – Emotions, mood, and social interactions that influence
engagement in occupations.
■​ Physical – Body structures and functions, including strength, endurance,
coordination, and mobility.
■​ Cognitive – Mental processes such as attention, memory,
problem-solving, and decision-making.
■​ Spiritual – Personal values, beliefs, and sense of purpose that provide
meaning to activities.
 ○​ Environment
■​ Physical environment: provides resources for life as well as
opportunities for creativity
■​ Social environment: composed of social groups such as family,
co-worker and friends, and their roles
■​ Institutional environment: includes legal elements that often overlap
with the economic one, as control of funds and who makes financial
decisions
■​ Cultural environment: beliefs, values, and customs

KAWA Model
●​ The aim of occupational therapy in this metaphorical representation of human being is to
enable and enhance life flow
●​ Life is a complex, profound journey that flows through time and space, like a river
●​ Japanese-based model using the river metaphor:
○​ Mizu(water): represents the subject’s life energy or life flow
○​ Kawano soku-heki(river-side wall) and kawano zoko(river bottom):stand for
the client’s environment; represent the subject’s social context, predominantly
those who share direct relationship with the client.
○​ Iwa(rocks): life circumstances perceived by the client to be problematic and
difficult to remove
○​ Ryuboku(Driftwood): represents the subject’s personal attributes and resources
such as values (honesty, thrift), character (optimism), personality (outgoing),
special skills (public speaking), and immaterial (friends) and material (wealth)
assets
○​ Sukima(space between obstructions):
■​ points through which the client’s life energy (water) evidently flows, and
these spaces represent ‘occupation’ in an East Asian perspective
■​ Spacesare potential channels for the client’s flow, allowing the client and
therapist to determine multiple points and levels of intervention

Ecology of Human Performance (EHP)

●​ Area of concern is the role of context in task performance
●​ Emphasizes a preventive, health-promotional, and rehabilitative attitude
●​ Designed to be used by various disciplines including educators and rehabilitation
specialists
●​ Consider activities that fall within the area of ADL, work and productive activities,
leisure/play, and social participation
●​ Four Constructs
○​ Person: sensorimotor, cognitive, and psychosocial domains
○​ Tasks: Objective sets of behaviors necessary to accomplish a goal
○​ Context: Temporal and environmental
○​ P-C-T Transaction: Reflects a process whereby a person engages in a task
within his or her contexts that result in human performance
 Function Disability

●​ High performance range of tasks-capacity ●​ Evident when incongruent emerges within

to participate in numerous occupations and the transaction among the person, context,
roles that match their person variables and and the tasks
●​ May be due to person variables or due to
natural contexts
contextual features that are not conducive
●​ Shows various abilities and interests to human performance
●​ Can integrate the expectations and
supports and manage barriers of the
context
●​ Can fulfill the task requirements that are
part of their life roles

Guidelines for Evaluation Process:

●​ Identify and prioritize the person's wants and needs
●​ Do a task analysis of the designated tasks to understand the skill requirements and
demands
●​ Observe and evaluate the client’s present functional degree of performance while
engage in these tasks
●​ Identify the desired contexts naturally sought by the client
●​ Assess the person variables (Strengths and weaknesses)
●​ Assess the person/task/context match to select reasonable goals and intervention
strategies

Interventions
●​ Establish/Restore – teaching skills not previously learned or restoring lost skills due to
illness or disability
●​ Alter – Uses his or her assessment of person’s variables to seek the best match for
one’s context
●​ Adapt/Modify – task and context are modified
●​ Prevent – Focus is to minimize risks and avoid the development of performance
problems
●​ Create – Meant to promote enriching and complex performances in one’s context

Person-Environment-Occupation-Performance (PEOP) Model

●​ Suited for a variety of individual, group, and institutional needs across the life span
●​ Client-centered relationship is fostered
●​ Focus is on occupation(consisting of valued roles, tasks, and activities) and performance
●​ Domain of practice is predominantly selected by the client
○​ Person – composed of physiological, psychological, cognitive, and spiritual
factors that are intrinsic in nature
○​ Environment – composed or built of physical, natural, societal, and social
interactive factors and social and economic systems that are extrinsic in nature
○​ Occupation – what person want or need to do in their daily lives
○​ Performance – actual act of doing the occupation
Four Major Construct:
1.​ The person is made up of series of intrinsic factors that make up one’ set of skills and
abilities
a.​ Neurobehavioral: sensory and motor systems that facilitate adaptive responses
b.​ Physiological: Physical health and fitness such as endurance, flexibility,
movement, and strength
c.​ Cognitive: mechanism of language comprehension and production, pattern
recognition, task organization, reasoning, attention, memory that allow the ability
to learn, communicate, move, and observe
d.​ Psychological: personality traits, motivational influences, and internal processes
used by an individual to impact what they do, how these events are interpreted,
and how they contribute to sense of self
e.​ Spiritual: signs and symbols that influence everyday life and provide meanings
that contribute to greater sense of personal understanding about self and one’s
place in the world
2.​ Participation is always impacted by the extrinsic characteristic of environment in which it
occurs
a.​ Built Environment: physical properties such as design, use of tools and
appliances, and assistive technology devices
b.​ Natural Environment: geographical features such as hours of sunlight, air
quality, climate
c.​ Societal Factors: social acceptance as a universal need, and interpersonal
relationship
d.​ Social Interaction: Experience of social support that enables a person to do
what he wants
e.​ Social and Economic System: access to health care, policies and procedures
3.​ Occupations are the activities and tasks done in managing a person’s daily life
a.​ Abilities: general traits and characteristic that can lead to occupational
performance (above-average intelligence will allow for scholarly occupations)
b.​ Actions: Observable behaviors (typing, answering an e-mail, completing an
on-line application)
c.​ Tasks: combination of actions for a common purpose that is defined and
recognized by the doer (driving to the store to buy personal items)
d.​ Occupations: tasks become occupations when they have distinct purpose, and
performed with different outcomes in mind (studying to be an OT)
e.​ Social and Occupational Roles: recognizable positions that define one’s status
in the society (competent student, classical pianist)
4.​ Occupational Performance and Participation
a.​ is the culmination of doing occupations. It is the interaction of a person’s intrinsic
factors, the environment, and one’s chosen occupation that all lead to
occupational performance

Dimension of Time and Space

●​ PEOP reflects how individuals grow and change over the course of their lives
●​ People can engage in occupation in multiple locations
 Function Disability

●​ when an individual expresses a level of ●​ Observed when a personal occupational

competency in his or her ability to perform performance is limited and restricted
and master occupations ●​ Occupational performance is not achieved
●​ Persons may demonstrate a lack of goal
●​ Shows adaptation in occupational
attainment and participation in activities
performance as he or she naturally meets ●​ “occupational performance dysfunction”
the challenges in life which is most evident in role
●​ Established healthy role patterns that fulfill responsibilities
personal and societal expectations

Assessment
●​ Top-Down approach begins with the practitioner assessing the client’s perception of
problems within occupational performance
●​ Priority goal is to analyze the client’s strengths and issues/problems in occupational
performance

Intervention
●​ Should aim to increase occupational performance competency, develop life-long skills,
and increase one’s sense of health and well-being
●​ Appreciate the restorative benefits of occupational performance as a means to enhance
the person's ability
●​ Recognize the role of environment as it affects a person’s health condition and
participation in meaningful activities, task, and life roles
●​ Enhance occupational performance by structuring occupationsfor meaningful
participation and competent mastery

Occupational Therapy Practice Framework – 3rd Edition (OTPF-III)

●​ A guiding document by the American Occupational Therapy Association (AOTA)
that standardizes terminology and concepts in OT practice.
●​ Key Areas:
○​ Domains – Occupations, Client Factors, Performance Skills, Performance
Patterns, and Contexts & Environments.
○​ Process – Evaluation, Intervention, and Outcomes.
○​ Client-Centered and Evidence-Based approach to OT.
Model of Human Occupation (MOHO)
●​ A theory-driven model developed by Gary Kielhofner that explains how motivation,
routines, and skills influence occupational participation.
●​ Key Components:
○​ Volition – Motivation for occupation (interests, values, personal causation).
○​ Habituation – Formation of roles and routines.
○​ Performance Capacity – Physical and mental skills needed for engagement.
○​ Environment – Social and physical surroundings that affect performance.

Occupational Adaptation (OA)

●​ A theory-based framework that focuses on a person’s ability to adapt when faced
with occupational challenges.
●​ Key Components:
○​ Person – Internal drive for mastery.
○​ Occupational Environment – Demands and expectations of tasks.
○​ Interaction Between the Two – Success depends on the person's ability to
adapt and respond to challenges.
●​ Main Goal: Improve a person’s adaptive capacity rather than just their skills.

Frames of Reference in OT
●​ Purpose: to help the clinician link theory to intervention strategies and to apply clinical
reasoning to the chosen intervention methods
●​ Tends to have a more narrow view of how to approach occupational performance when
compared to model of practice
●​ Components:
○​ Theoretical Postulates
○​ Function-Dysfunction Continua
○​ Evaluation
○​ Postulates Regarding Change

Behavioral FOR
●​ Uses Operant & Classical Conditioning for behavior modification.
●​ Uses reinforcement techniques to shape behavior.
●​ Ivan Pavlov: Classical Conditioning
○​ Also Called “Respondent Conditioning”
○​ A neutral(conditioned) stimulus is paired with an unconditioned stimulus a
number of times until it is capable of bringing about a previously unconditioned
response
Extinction When conditioned stimulus is repeated without the
unconditioned stimulus until the response gradually weakens
and eventually disappears

Stimulus Generalization Describes a process whereby a conditioned response is

transferred from one stimulus to another

Response Generalization Two or more responses are evoked by the same stimulus
because these responses occur in close temporal contiguity

Discrimination Process of recognizing and responding to differences between

similar stimuli

●​ B.F. Skinner: Operant Conditioning

○​ Also called Instrumental conditioning

Adding a pleasant stimulus to increase a behavior (e.g.,

Positive Reinforcement giving praise for completing a task).
Removing an unpleasant stimulus to increase a behavior (e.g.,
Negative Reinforcement turning off a loud alarm when a task is completed).
Adding an unpleasant stimulus to decrease a behavior (e.g.,
Positive Punishment getting extra work for being late).
Removing a pleasant stimulus to decrease a behavior (e.g., taking
Negative Punishment away privileges for misbehavior).
Using a preferred activity to reinforce a less preferred behavior
Premack Principle (e.g., "Finish homework before playing video games").
Learning a behavior to remove an ongoing unpleasant stimulus
Escape Conditioning (e.g., putting on sunglasses to reduce glare).
Learning a behavior to prevent an unpleasant stimulus before it
Avoidance Conditioning occurs (e.g., studying early to avoid failing an exam).
Removing an unpleasant stimulus to increase a behavior (e.g.,
Positive Reinforcement turning off a loud alarm when a task is completed).

Consumable A tangible reward that can be eaten or consumed.

Social Positive interaction or acknowledgment from others.

Activity Access to a preferred activity as a reward.

Function-Dysfunction Continuum
Goals of Evaluation:
●​ Identify problems and target behaviors to be extinguished and skills to be learned
●​ Help identify viable intervention strategies
●​ Act as a baseline of performance against which progress can be measured

Assessment Instruments
●​ Kohlman Evaluation of Living Skills (KELS) – Assesses a client's ability to perform
basic living skills (e.g., self-care, safety awareness, money management) to determine
independent or supported living needs.​

●​ Comprehensive Occupational Therapy Evaluation (COTE) – Measures general

behaviors, interpersonal skills, and task performance in psychiatric OT settings.
Used to track progress and response to intervention.​

●​ Bay Area Functional Performance Evaluation (BaFPE) – Evaluates cognitive,

social, and task performance skills in daily activities, often used for mental health
and cognitive impairments.​

●​ Milwaukee Evaluation of Daily Living Skills (MEDLS) – Assesses real-world ADL

and IADL skills (e.g., hygiene, medication management) in adults with mental illness
to determine intervention needs.​

●​ Scorable Self-Care Evaluation – Measures self-care performance in areas like

personal hygiene, dressing, eating, and mobility to identify deficits and track
rehabilitation progress.

Intervention
●​ Setting of goals and making a Behaviour Modification program
●​ Environment Modification Technique
●​ Activities are graded and specific tasks are presented to provide progressively more
difficult learning challenges

Function of Activity
●​ The patient can learn new skills for occupational function
●​ The patient can learn to manipulate the environment thru problem solve and improve
occupational function
●​ Generalizationis enhance when skills are practiced in different settings

Lifespan Developmental FOR

●​ Assisting clients with transitional tasks
●​ Establishing Or restoring client-chosen, age-appropriate occupations within continued
life roles
●​ Helping clients to adapt to the changes brought on by health conditions within and
across lifespan developmental continuum
●​ Life Stages – Distinct periods of human development (e.g., infancy, childhood,
adolescence, adulthood, old age) characterized by unique challenges and growth
milestones.
●​ Developmental Tasks – Age-related skills and responsibilities individuals must achieve
for successful adaptation (e.g., learning to walk in infancy, developing career skills in
adulthood).
 ●​ Marker Events – Significant life experiences that signal a transition to a new stage
(e.g., starting school, getting a job, retirement).
●​ Enabling Skills – The abilities needed to accomplish developmental tasks (e.g., fine
motor skills for writing, problem-solving for work tasks).

Theories of Lifespan Development

Kohlberg’s Theory of Moral Development

Stage 1 ●​ Orientation to punishment and obedience

●​ Avoidance of punishment/ irrational conscience

Stage 2 ●​ Instrumental Purpose and Exchange

●​ Exchange or marketplace orientation
●​ Desire for rewards

Stage 3 ●​ “Am I a good boy or good girl?”

●​ To please and avoid disapproval

Stage 4 ●​ Law and Order Orientation”

●​ “What if everybody did it?”
●​ Motivated by anticipation of dishonour and by guilt over harm done to others.

Stage 5 ●​ “Morality of contract, individual rights, and democratically accepted law”

●​ maintaining respect of equals and of the community

Stage 6 ●​ “Universal Ethical Principle Orientation”

●​ Concern about self-condemnation for violating one’s own principles
Erik Erikson’s Psychosocial Theory

●​ Epigenetic Principle- we develop through an unfolding of our personality in

predetermined stages, and that our environment and surrounding culture influence how
we progress through these stages.
●​ Maladaptation- overly adapting positive extreme
●​ Malignancy- overly adapting negative extreme
Life Transition Theory
●​ Daniel Levinson
●​ Most detailed lifespan theory addressing young and middle adulthood
●​ Each transition lasts approximately 5 years
 Function Disability

●​ Adaptation-able to respond to external ●​ Results when stage-specific enabling skills

expectations as well as one’s own feelings have either not been learned or can no
●​ Able to accomplish developmental tasks longer be used effectively
●​ A time of temporary difficulty in transitions
for each life stages
●​ Inflexibility
●​ Has stage-specific enabling skills

Evaluation
●​ Take note of stage within life span
●​ Identify the person’s “characteristic lifestyle” (values and culture)
●​ Determine which enabling skills are deficient or weak and which are strong
●​ Determinebarriersthat are keeping the individual from developing or utilizing skills
●​ Determine what situations and under what conditions is the individual most likely to
function best

Assessment Tools
●​ Lifestyle Performance Profile – Evaluates a person’s quality of life, occupational
performance, and balance in areas like self-care, work, leisure, and social
interactions to guide intervention planning.
●​ Adolescent Role Assessment (ARA) – Assesses role development in adolescents
(ages 13-17) by evaluating their participation in family, peer, school, and occupational
roles to identify areas needing support.
●​ Role Checklist – A self-report tool that identifies a client’s past, present, and future
roles (e.g., student, worker, caregiver) and their perceived value, helping therapists
understand role loss or changes due to disability.
●​ Occupational Performance History Interview – Second Edition (OPHI-II) – A
semi-structured interview assessing a person’s life history, occupational identity, and
competence to understand how past experiences shape current occupational
performance.

Intervention
●​ Remediation or prevention
●​ Provides an environment that enhances opportunity for the individual to follow a normal
developmental pattern
●​ Selects activities that bridge the gap between the individual’s present skill level and the
skills needed to learn and master

Cognitive Disability FOR (Claudia Allen)

●​ Describes the nature of cognitive processing impairments that compromise the ability for
normal function and identifies adaptations that will optimize the ability of cognitively
disabled persons to function in their everyday world
●​ Cognitive disability leads to a reduction in normal task performance

Focus
●​ Role of cognition
●​ Role of habits and routines
●​ Effect of physical and social context
●​ Analysis of activity demand
Theoretical Base
Piaget’s Cognitive Development Theory
Piaget proposed that cognitive development occurs in four stages, where children actively
construct knowledge through experience and interaction with their environment.
1️⃣ Sensorimotor Stage (0-2 years)
●​ Learning through senses and movement (touching, grasping, sucking).
●​ Develops object permanence (understanding that objects exist even when out of sight).
2️⃣ Preoperational Stage (2-7 years)
●​ Uses symbols and language, but thinking is egocentric (difficulty seeing others’
perspectives).
●​ Engages in pretend play but struggles with logic and conservation (e.g., understanding
that liquid remains the same amount despite changing containers).
3️⃣ Concrete Operational Stage (7-11 years)
●​ Develops logical thinking and understands conservation, classification, and
cause-effect relationships.
●​ Can perform mental operations, but thinking is still concrete and tied to real-world
experiences.
4️⃣ Formal Operational Stage (12+ years)
●​ Develops abstract and hypothetical thinking (e.g., problem-solving without needing
concrete objects).
●​ Can engage in deductive reasoning and moral reasoning.

Allen’s Cognitive Levels

some Many unable to

self-care self-care anticipate
task can tasks can or plan
be done be done ahead
independe independe
ntly ntly
 Function Disability

●​ Level 6 ●​ Levels 1-5

●​ Physiologic abnormality results in
impairment, disability or handicap in turn
reflecting compromise in the ability for
functional performance

Assessment:
●​ Allen Cognitive Level Screen (ACL)
●​ Large Allen Cognitive Level Screen (LACL)
●​ Lower Cognitive Level Test
●​ Routine Task Inventory-II
●​ Cognitive Performance Test
●​ Work Performance Inventory
●​ Allen Diagnostic Modules

Intervention
●​ To identify activities at which patient can succeed
●​ To advise other professionals and caregivers about the limitations on functional
performance that are imposed by cognitive disability
●​ To make environmental recommendations compatible with functional level

Physical Dysfunction Frame of References

Biomechanical FOR
●​ It can inform the OT and assist the overall therapeutic process if an individual has lost an
occupational role because of occupational performance problems primarily concerning
movement
●​ It can be located within a ‘top-down’ and a ‘bottom-up’ approach to occupational therapy
●​ Primarily concerned with an individual’s motion during occupations
●​ Assumptions:
○​ Purposeful activities can be used to treat loss of range of motion (ROM), strength
and endurance
○​ After ROM and endurance are regained, the patient automatically regains
function
○​ Principle of rest and stress
○​ Best suited for patients with intact CNS
■​ Still has the capacity in the CNS to initiate the production of smooth,
controlled, isolated movements

Function-Dysfunction
1.​ Limitations in movement during occupations (Range of Motion)
a.​ Shortening (contracture) of soft tissues, i.e. tendon
b.​ Presence of inflammation, edema, or hematoma
c.​ Localized destruction of bone, i.e. rheumatoid arthritis
 d.​ Acute and chronic pain
e.​ Congenital abnormalities
f.​ Amputation
2.​ Inadequate muscle strength for use in occupations
a.​ Limitations in movement
b.​ Disuse or atrophy of muscle (e.g. post fracture immobilization)
c.​ Primary muscle pathology (e.g. muscular dystrophy)
d.​ Peripheral nerve injury
e.​ Acute and chronic pain
f.​ Peripheral neuropathy (e.g. diabetes)
g.​ Anterior horn cell pathology (e.g. LMN diseases)
h.​ Maladaptive environmental condition
3.​ Loss of Endurance in occupation
a.​ Limitations in movement
b.​ Inadequate muscle strength
c.​ Compromised cardiopulmonary system
d.​ Acute and chronic pain
e.​ Maladaptive environmental factors
4.​ Biomedical conditions
a.​ Rheumatoid arthritis/ Osteoarthritis
b.​ Amputations, burns
c.​ Fractures and other orthopedic conditions
d.​ Motor neuron diseases
e.​ Cardiac problems
f.​ Respiratory problems
g.​ Chronic pain
h.​ Peripheral neuropathy

Assessment: Test of Function

MOVEMENT (ROM) STRENGTH

●​ Observation ●​ Grip strength in the hand

●​ Goniometry ○​ Dynamometer
●​ Pinch strength in the fingers
○​ Pinch Gauge
●​ Muscle bulk
○​ Observation, tape measure
●​ Edema/ swelling
○​ Observation, tape measure, volumeter
Measurement - circumferential
Test of Function
Endurance Sensation

●​ Observation ●​ Light touch and pressure

●​ Functional ●​ Thermal sensation
●​ Cardiorespiratory machine ●​ Paineter

Intervention
●​ Reduce deficits thru direct cause and effect treatment process –exercise and activity
●​ Improve functional performance thru use of external supports
●​ Enhance development of postural reactions thru the reduction of gravity’s demands and
aligning the body properly

Rehabilitation FOR
●​ Theoretical Base:
○​ A person can regain independence through compensation
○​ Motivation for independence cannot be separated from the volition and
habituation subsystems
○​ Motivation for independence cannot be separated from the environment
○​ A minimum of cognitive and emotional prerequisite skills are needed to make
independence possible
○​ Clinical reasoning should take top-down approach

Factors to Consider
●​ Client’s culture and its values: mores in relationship to self-care, the sick role, family
assistance, and independence
●​ Environment: Will patient live alone? With family? How much assistance can be given
by the family? Caregiver training?
●​ Finances available: special equipment and home modification
●​ Different levels of independence
●​ Modesty: need for respect and privacy
●​ Fatigue factor

Behaviors indicative of Function-Dysfunction

●​ PADL evaluation
Ex: FIM, BarthelIndex
●​ IADL evaluation
Ex: Extended RTI, AMPS
●​ Work evaluation
Ex: VALPAR, TOWER
●​ Leisure
Ex: Leisure Checklist

Parameters of Task Performance for Description and Measurement

●​ Value: importance or significance to patient
●​ Independence: measure of disability/ activity restriction, type of assistance required to
finish an activity
●​ Safety: refers to the extent the patient is at risk when engaged in task
●​ Adequacy
Postulate Regarding change and intervention
●​ Compensate for disability by learning to live with one’s capabilities in all aspects of life
●​ Adapt the environment to obtain independence

Independence in ADLs, work, leisure will be maximized by using…

●​ Adaptive devices and orthotics
Ex: Swivel spoon, built-up handle, raised toilet seat
●​ Environmental Modification
Ex: Grab bars, ramps, braille signages
●​ Wheelchair Modification
Ex: transfer boards, seat cushion, detachable leg rest
●​ Ambulatory aids
Ex: crutches, walker, AFOs
●​ Adapted procedures
Ex: Work simplification, energy conservation
●​ Safety Education
Ex: proper body mechanics, joint portection

Sensorimotor FOR
●​ Enhances movement patterns and postural control through sensory integration and
motor training.
●​ Focuses on using sensory input and motor activities to improve movement, coordination,
and neurological function in individuals with neuromotor disorders (e.g., cerebral palsy,
stroke, brain injury).
●​ Key Principles:
○​ Uses sensory stimulation (e.g., touch, proprioception, vestibular input) to facilitate
movement.
○​ Encourages repetitive practice of motor tasks to promote learning.
○​ Based on neurodevelopmental theories like Bobath/NDT, Rood, and Brunnstrom
approaches.
●​ Application:
○​ Used in pediatric OT for children with developmental delays.
○​ Applied in stroke rehabilitation to restore motor control.

PEDIATRIC FRAMES OF REFERENCE

Acquisitional FOR
●​ Focuses on the acquisition of specific skills required for the optimal performance within
an environment
●​ Also known as teaching-learning process
●​ Primary Goal: Learning
●​ Conglomeration of three areas:
1.​ Behaviorism- Pavlov, Thorndike, Bandura
2.​ Cognitive Science- attention, perception, information processing
3.​ Neuroscience- memory, synaptic connections
●​ Learning is not stage-specific, sequential, or cumulative
●​ Quality of performance is not initially important
●​ Theoretical Base
1.​ Behavior is viewed as a response to the environment
2.​ The environment either reinforces and strengthens a behavior or fails to provide
a positive reinforcement or ignoring behaviors
 3.​ Working in authentic and naturalistic environments is central to this FOR
●​ Assumptions: AcquisitionalFOR
1.​ Intrapsychic Dimensions are irrelevant to the behavior shaped by the
environment
2.​ The therapist accepts the child unconditionally and without judgment
3.​ Competence, or the belief that a person can act and have influence over the
environment, results from learning skills
4.​ A skill is a skill is a skill
5.​ Practice makes perfect
●​ Theoretical Postulates
1.​ State the relationship between concepts in the theoretical base
■​ Acquisition of skills is a result of reinforcement
■​ Function is not stage specific
■​ Behaviors result from environmental interaction
●​ Function-Dysfunction Continuum
1.​ Defined by the specific behavior to be acquired
■​ Function:a child can perform a skill needed
■​ Dysfunction:a child cannot perform a skill needed
2.​ A criterion-referenced dichotomous measure is used
3.​ Can be identified for any task necessary for the child to perform within a
particular environment
●​ Indicators of Function and Dysfunction for Self-Feeding (With a Fork)

●​ Evaluation: Focused Observation

●​ Provides additional information about the component steps of the skills in addition to
what aspects of the environment are encouraging or interfering with the child’s
performance
●​ Determines the ff:
1.​ What are the specific component steps of the tasks?
2.​ Which of these component steps can the child do well, and which require
intervention?
3.​ Which skills need to be shaped?
4.​ What are identifiable positive and negative reinforcements?
5.​ What constitutes a positive reinforcer and what constitutes a negative reinforcer
for the child?
6.​ Within this environment, which would be the most powerful positive reinforcer
●​ Postulates Regarding Change
●​ GENERAL POSTULATES:
●​ If the therapist provides positive reinforcement specific to the child and the
environment, then the child will be more likely to acquire component steps of
skills or specified skills
 ●​ If the therapist provides negative reinforcement specific to the child and the
environment, then non-adaptive behaviors will be more likely to extinguish

1️⃣ Sensory Integration (SI) FOR

●​ Developed by Dr. Jean Ayres, this FOR focuses on the organization of sensory input
(touch, movement, body awareness) to improve functional performance in children.
●​ Key Concepts:
○​ Helps children with Sensory Processing Disorder (SPD) who struggle with
over-responsiveness, under-responsiveness, or sensory-seeking
behaviors.
○​ Enhances self-regulation, attention, and motor planning for daily activities.
●​ Function: Child can process and respond appropriately to sensory stimuli.
●​ Dysfunction: Child shows sensory modulation issues, poor coordination, or difficulty
with gross and fine motor tasks.
●​ Intervention Examples:
○​ Swinging, brushing, deep pressure for regulation.
○​ Obstacle courses for motor planning.
○​ Sensory bins for tactile processing.

2️⃣ Visual-Perceptual FOR

●​ Focuses on developing visual processing and perceptual skills needed for reading,
writing, and other academic tasks.
●​ Key Concepts:
○​ Visual discrimination, spatial relations, figure-ground perception are crucial
for task performance.
○​ Supports children with dyslexia, visual-motor integration issues, and
developmental coordination disorder.
●​ Function: Child can accurately interpret and respond to visual information.
●​ Dysfunction: Child has difficulty recognizing letters, copying shapes, tracking
objects, or maintaining visual attention.
●​ Intervention Examples:
○​ Mazes, puzzles, and matching games to improve visual discrimination.
○​ Eye-hand coordination tasks like tracing and dot-to-dot activities.
○​ Letter and number recognition exercises for academic skills.

3️⃣ Neurodevelopmental Treatment (NDT) FOR

●​ Created by Bobath, NDT aims to improve motor control and movement patterns in
children with neurological disorders (e.g., cerebral palsy, brain injury).
●​ Key Concepts:
○​ Focuses on postural control, weight shifting, and alignment.
○​ Uses facilitation and inhibition techniques to correct abnormal movement
patterns.
●​ Function: Child can control movement efficiently for daily tasks.
●​ Dysfunction: Child shows abnormal muscle tone (too high or low), difficulty with
postural control, and poor coordination.
●​ Intervention Examples:
○​ Weight-bearing activities to improve muscle activation.
○​ Facilitation techniques like gentle tapping or stretching to encourage normal
movement.
○​ Ball exercises and core strengthening for postural stability.
 1.​ Who is considered the Father of Occupational Therapy?
2.​ What year was the National Society for the Promotion of Occupational Therapy (now
AOTA) founded?
3.​ Philippe Pinel and William Tuke are associated with what era in OT history?
4.​ Which movement, influenced by the Industrial Revolution, promoted handcrafting as a
meaningful occupation?
5.​ Who wrote Description of the Retreat and helped popularize Moral Treatment?
6.​ What law in the United States (1963) led to the deinstitutionalization movement?
7.​ In what year was Occupational Science established as a separate discipline?
8.​ Eleanor Clarke Slagle developed which early OT treatment model?
9.​ Who was the first certified Filipina OT?
10.​Which Philippine university was the first in Asia to offer a bachelor's degree in OT?
11.​What model of practice describes a person's volition, habituation, performance capacity,
and environment?
12.​Which client-centered model focuses on the interaction between person, occupation,
and environment?
13.​The KAWA Model compares life to what natural element?
14.​What model emphasizes how context and environment impact task performance?
15.​The PEOP Model stands for what?
16.​The Occupational Adaptation Model focuses on what key concept?
17.​In the Ecology of Human Performance (EHP) Model, what is the primary focus?
18.​What is the oldest model in occupational therapy, emphasizing routine and habit
formation?
19.​The Canadian Model of Occupational Performance (CMOP) places what at its core?
20.​The Occupational Therapy Practice Framework (OTPF-Ill) focuses on three main areas:
occupation, client factors, and _
21.​Who developed the Cognitive Disability Model, which identifies six levels of cognitive
functioning?
22.​The Behavioral Frame of Reference is based on the work of which two psychologists?
23.​Which Frame of Reference (FOR) is used to improve range of motion (ROM), strength,
and endurance?
24.​What FOR helps clients regain independence through compensation and adaptation?
25.​The Sensorimotor FOR is used to improve what type of skills?
26.​What type of clinical reasoning focuses on understanding the client's personal
experiences?
27.​Pragmatic reasoning considers which external factors in therapy?
28.​What type of reasoning is concerned with ethics and moral decision-making in OT?
29.​The Lifespan Developmental FOR incorporates which two major psychological theories?
30.​What is the primary focus of the Acquisitional Frame of Reference in pediatric OT?

T if the statement is true and F if it is false.

1.​ Philippe Pinel and William Tuke were the pioneers of the Arts and Crafts Movement.
2.​ The Moral Treatment Era emphasized the importance of occupation in treating mental
illness.
3.​ The National Society for the Promotion of Occupational Therapy (AOTA) was founded in
1920.
4.​ Eleanor Clarke Slagle is known as the "Mother of Occupational Therapy" The
Community Mental Health Act of 1963 led to an increase in long-term institutional care.
5.​ The Canadian Model of Occupational Performance (CMOP) places spirituality at its core.
6.​ The KAWA Model views life as a journey similar to a mountain.
 7.​ The Model of Human Occupation (MOHO) emphasizes the interaction between
8.​ volition, habituation, performance capacity, and environment.
9.​ The Occupational Adaptation (OA) Model focuses on client adaptation to increase
occupational function.
10.​The Ecology of Human Performance (EHP) Model is based on the interaction of task,
person, and environment.
11.​The Biomechanical Frame of Reference (FOR) is primarily used in mental health
treatment.
12.​The Cognitive Disability Model, developed by Claudia Allen, categorizes cognitive levels
from 1 to 6.
13.​The Sensory Integration Frame of Reference is widely used in pediatric occupational
therapy.
14.​Procedural reasoning focuses on understanding the client's personal story and life
experiences.
15.​The Lifespan Developmental Frame of Reference includes theories from Erik Erikson
and Lawrence Kohlberg.

Each question contains two statements. Choose the correct answer:

• A - If both statements are correct.
• B - If the first statement is correct, but the second is incorrect.
• C - If the first statement is incorrect, but the second is correct.
• D - If both statements are incorrect.

1.​ The Model of Human Occupation (MOHO) focuses on volition, habituation, performance
capacity, and environment. The Person-Environment-Occupation-Performance (PEOP)
Model ignores environmental factors.
2.​ The KAWA Model emphasizes spirituality as a central concept. The Canadian Model of
Occupational Performance (CMOP) views spirituality as the core of occupational
engagement.
3.​ The Biomechanical Frame of Reference is commonly used for physical rehabilitation.
The Cognitive-Behavioral Frame of Reference is primarily concerned with motor control
and muscle strengthening.
4.​ The Occupational Adaptation (OA) Model highlights a person's ability to adjust to
occupational challenges. The Ecology of Human Performance (EHP) Model disregards
context as a key factor.
5.​ The Sensory Integration Frame of Reference is primarily used for children with
processing difficulties. The Acquisitional Frame of Reference focuses on developing
social interactions rathe than learning specific skills.
6.​ The Cognitive Disability Model classifies cognitive function into six levels. The Allen
Cognitive Levels suggest that individuals at Level 1 require full assistance for all
activities.
7.​ The Rehabilitation Frame of Reference is based on adaptation and compensatory
strategies. The Neurodevelopmental Frame of Reference (NDT) primarily addresses
mental health disorders.
8.​ In procedural reasoning, therapists focus on what steps need to be taken next in
intervention. Interactive reasoning is focused on understanding the financial resources
available for therapy.
9.​ The Behavioral Frame of Reference is based on classical and operant conditioning. B.F.
Skinner developed classical conditioning, while Ivan Pavlov introduced operant
conditioning.
10.​The Ecology of Human Performance (EHP) Model focuses on the interaction between
person, task, and environment. The Model of Human Occupation (MOHO) does not
consider volition as an important aspect of occupational performance.
11.​In ethical reasoning, therapists consider moral and professional obligations when making
decisions. Pragmatic reasoning focuses only on a therapist's personal beliefs.
12.​The PEOP Model stands for Person-Environment-Occupation-Performance. The KAWA
Model compares life to an ocean.
13.​The Lifespan Developmental Frame of Reference integrates theories from Erik Erikson
and Lawrence Kohlberg. It disregards developmental tasks at different life stages.
14.​The Acquisitional Frame of Reference is concerned with skill acquisition in pediatric
therapy. The Visual-Perceptual Frame of Reference focuses on motor control.
15.​The Canadian Model of Occupational Performance (CMOP) is client-centered. It does
not emphasize the environment as a key factor in occupational performance.