Model of Human Occupation (MOHO)

The Model Of Human Occupation (MOHO) frame of reference in occupational therapy is based on theories and assumptions given by the Mary Reilly. The model of human occupation was initially based on Occupational Behavior model (developed by Mary Reilly) and later on, it was introduced to the occupational therapy profession by the Gary Kielhofner and Janice Burke in 1980.

This model had undergone continuous development since it’s starting. Initially, it was originated as a model, but later on, it evolved into a frame of reference.

Reilly’s MOHO and Kielhofner’s MOHO has the same base, but a different perspective.

Mary Reilly’s Model Of Human Occupation–
The model of human occupation frame of reference is heavily based on the principles of occupational behavior model. In the occupational behavior model, “occupational behavior” means “occupational roles”. Reilly’s model reinforced the principles of habit training along with the work-play-rest continuum to occupational roles (such as worker, student, preschooler, housewife)

Gary Kielhofner’s Model of Human occupation (MOHO)-

Kielhofner was a student of Mary Reilly, he has modified the concept of model of human occupation and proposed General open system theory as a baseline for the MOHO. He introduced MOHO frame of reference in Occupational Therapy.

Read More… Occupational Therapy Frames of Reference

The Human Open System- In this structural framework, kielhofner, considered an individual as an open system. The open system that develops and goes through different forms of growth, development, and changes through ongoing interaction with the external environment.

The cycle of interaction with the environment includes four phases;
Input, Throughput, Output, and Feedback.

Input – entry of information into the system.

Throughput – refers to the process of conversion of information or input and absorption by the system and make it meaningful by adaptation of incoming energy.

Output– It refers to the external action or the behavior of the system due to the input and throughput process.

Feedback– It’s the process of modification or control of a process by its results or effects.

This ongoing cycle is responsible for the process of self maintenance and self change.
This Open System also has three subsystems.
1. Volition
2. Habituation
3. Performance
These subsystems are the part of the throughput process in the open system.
For more detailing and understanding, these three subsystems are further divided into its different structure and function.

#1 Volition –

It’s the first and highest subsystem of an open system. It is directly related to the motivation and voluntarily involvement of a person in occupation.
Volition also refers to the human’s inborn urge to explore and master the environment. The volition is depends upon the internal thought and beliefs, which is further broken down into- personal causation, values, and interest.

Personal causation – when someone involves himself/ herself in any occupation, he considers his skill requirement for the effective result related to occupation for further growth.

Valued Goals – are a person’s internal belief concerning what is good, right, and valuable.

Interest – it depends on the person’s involvement and getting pleasure and satisfaction due to prior experiences.

#2 Habituation –

The middle subsystem is habituation; it is responsible for organizing behavior into routines or patterns. Its function is to maintain the behavior. This subsystem is based on the occupational roles and habits. The Roles are a set of connected behaviors, obligations, and norms as conceptualized by people in a social situation. The habits are a routine of behavior that is repeated regularly and tends to occur subconsciously following social norms.

The middle subsystem is habituation; it is responsible for organizing behavior into routines or patterns. Its function is to maintain the behavior. This subsystem is based on the occupational roles and habits. The Roles are a set of connected behaviors, obligations, and norms as conceptualized by people in a social situation. The habits are a routine of behavior that is repeated regularly and tends to occur subconsciously following social norms.

#3 Performance –

The last and lowest subsystem is performance, which consists of the basic capacities for action (skills). Its function is to produce the action of the system. Mainly there are three types of skills: perceptual motor skills, process skills (planning and problem solving), and communication skills. These types of skills are required for better performance in human occupation. A person must be emotionally fit, and his/her neurological and musculoskeletal system must be normal for better performance in occupation.

Function – Dysfunction Continua (Areas of concern)–

As we have mentioned, Moho is based on occupational functioning and satisfaction. When someone is not able to perform his/her occupational roles, identification of causes is important to overcome the difficulty while performing occupational roles.

In the function- dysfunction continua, areas of concern related to occupational roles are discussed for assessment, and interventional planning. An occupational function is based on exploration, competency, and achievement. While, occupation dysfunction is based on inefficiency, incompetency, and helplessness.

Occupational dysfunction is where the occupational therapist has to work and root out the causes of uninvolvement in occupation.

Inefficiency – refers to the initial level of occupational dysfunction. This may cause due to dissatisfaction with performance after applying meaningful activity.

Incompetence – it may occur due to major loss or limitation of skills. An Individual may experience feelings of failure or dissatisfaction. Due to which limitation can see in an occupation as well as in daily routine.

Helplessness – it is characterized by a total or near-total disturbance in occupational roles and performance. This is because of extreme feelings of ineffectiveness, anxiety, depression, or all three.

Behavior indicative of function- dysfunction (Evaluation and Assessment)-

Occupational functioning assessment is important to set meaningful goals. After goals setting, OTs can set an intervention plan according to the need of an individual.

Generally, OCAIRS (Occupational Case Analysis Interview and Rating Scale) can be used as an initial screening of occupational function. This scale focuses on the valued goals, interest, performance, skills of an individual, and most importantly, is he/she satisfied or dissatisfied while performing activities. But there is no limitation for the assessment.

Occupational therapist’s can also perform various other scales after doing the initial screening. Some scales are – occupational performance history, interview, interest checklist, ADL checklist, decision making inventory, and so on.

Postulates regarding change and intervention –

After the initial screening and assessment, the therapist will get the information about the cause of occupational dysfunction, due to which individual is not taking part in his occupational roles.
Its duty of a therapist to find out the problem in subsystems of an open system. i.e volition, habituation, and performance. If there is a problem in one of the subsystem, for example in performance subsystem. We know that performance depends on the skills available or defect in skill. Skill impairment may occur to any injury or problem in the musculoskeletal or neurologic system. The therapist will focus on the skill training and primary goal will be to resume his/her occupation.

Occupational therapists remediate occupational dysfunction by directly providing an occupation in which the person engages as therapy, counseling, and problem solving with the person to identify and alter a maladaptive occupational lifestyle, and facilitating engagement in occupation by improving the fit between the person and his or her environment.

Read more.. Biomechanical Frame of Reference

Developmental Frame of Reference

Rehabilitation Frame of Reference

Psychodynamic Frame of Reference

References –
1. Kielhofner’s A model of human occupation: theory and application. Baltimore: Williams & Wilkins.
2. Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction
3. Willard and Spackman’s Occupational Therapy