Developmental Frame of Reference

The developmental frame of reference is based on the normal human development. Generally, an occupational therapist uses this frame of reference in the kids with gross motor skills or fine motor skills delays. Developmental theories have typically described patterns or sequences of development that are accepted as being characteristic for children.

The theories and concepts behind the developmental frame of reference are presented by many experts. Lela Llorens was one of them, who described the theory of Developmental frame of reference.

According to her, occupational therapy is a facilitation process that assists the individual in achieving mastery of life tasks and the ability to cope as efficiently as possible with the life expectations made of him/ her through the mechanism of selected input stimuli and availability of practice in a suitable environment.

In the clinical setting, this theory is applied when the occupational therapist facilitates or assist, the adaptation process of the client within his/her environment.

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

Function – Dysfunction continua –

Llorens constructed 10 premises that fit together in a sequential and fundamental statement to support her vision of growth and development:
#1. The human organism develops horizontally in the areas of neurophysiological, physical, psychological, and psychodynamic growth and in the development of social language, daily living sand sociocultural skills at specific periods of time;

#2. The human organism develops longitudinally in each of these areas in a continuous process as he ages;

#3. The mastery of particular skills, abilities and relationship in each of the areas of neurophysiological, physical, pychosocial and psychodynamic development, social language, daily living and sociocultural skills, both horizontally and longitudinally is necessary to the successful achievement of satisfactory coping behavior and adaptive relationships;

#4. The mastery of these skills is usually achieved naturally in the course of development;

#5. The fundamental endowment of the individual and the stimulation of experiences received within the environment of the family come together to interact in such a way as to promote positive early growth and development in both the horizontal and longitudinal planes;

#6. Later the influences of extended family, community, social group assist in the growth process;

#7. The physical or psychological trauma related to disease, injury, environmental insufficiencies or intrapersonal vulnerability can interrupt the growth and development process;

#8. These such “growth interruption” will cause a gap in the developmental cycle resulting in disparity between expected coping behavior and adaptive facility and the necessary skills and abilities to achieve same;

#9. The occupational therapy through the skilled application of activities and relationship can provide growth and development links to assist in closing the gap between expectation and ability by increasing skills, abilities and relationships in the areas of development as indicated both horizontally and longitudinally;

#10. The occupational therapy through the skilled application of activities and relationships can provide growth experiences to prevent the development of potential maladaptation related to insufficient nurturance in the areas of development both horizontally and longitudinally. (Llorens, 1970)

Behavior indicative of function –dysfunction (guide for evaluation)

While applying the principle of developmental frame of reference in clinical practice, OT must assess the client about his/her current level of skills present in the client at stage specific developmental periods across all domains.

Growth occurs simultaneously in many areas. OT looks child as a whole, so it’s important to assess all the skills development at specific periods. OT identifies the deficiencies in the development pattern and milestones.

For example, assessment of child’s fine motor skills, gross motor skills, social skills, language development and other areas at the same period.

The interweaving of each area of development supports future growth of the child. As Llorens used the terminology horizontal & longitudinal development, these terms may confuse others. So, later on, she clarified them as,
Horizontal – concept of simultaneous
Longitudinal – concept of chronology.

Horizontal growth specifically refers to gains made in all the development that appear simultaneously in a given age. For example, what are the skills can be performed by a 3 year old child?

Longitudinal growth is related to growth over time, observing the chronological age increments of the child. For example, observing the growth over the span of zero to 20 years.

Postulates regarding change & intervention –

In this phase of a developmental frame of reference, OT plans out the objective & goals for the child. After the assessment of a child, if OT finds disruption in the normal progression of growth and development (due to any disease, injury or chromosomal problems)

Postulates of change, particularly focus on the “gaps” in the developmental cycle. The growth interruption may cause a wide variety of problems for the child and his/her ability to interact with the environment.

We believe that what is commonly referred to as the ‘‘developmental frame of reference’’ is truly a frame of reference wherein the therapist uses various contemporary legitimate tools of the profession to facilitate the traditionally accepted sequence of normal development.

This involves the clinical reasoning of the therapist, a manipulation of the environment, the use of teaching and learning theories, the provision of additional growth-enhancing experiences, and conscious use of self.

In these situations, the therapist identifies the critical skills needed by the child within the generally accepted normal developmental sequence, and uses these tools and external factors to facilitate the development of those skills.

Model of Human Occupation (MOHO)

Rehabilitative Frame of Reference

Psychodynamic Frame of Reference

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

Deepam Pawar