This study guide provides a comprehensive overview of essential OT frames of reference,
including Biomechanical/Rehabilitative, Allen's Cognitive Levels, Intentional Relationship
Model (IRM), and Model of Human Occupation (MOHO). It emphasizes key concepts,
assumptions, and therapeutic applications to facilitate your understanding and clinical practice.
I. Biomechanical & Rehabilitative Frames of Reference
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Focus: Disability-oriented, addressing physical and mental aspects of occupational
performance.1
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Assumptions:
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Clients can regain independence and contribute to society through intervention.23
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Restoring ROM, strength, and endurance leads to automatic functional regain.3
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Function: Maintaining normal ROM, strength, endurance, and proper body mechanics.1
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Dysfunction: Restrictions in ROM, strength, or endurance impacting daily occupations.4
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Evaluation: Goniometer (ROM), Dynamometer/MMT/BTE (Strength), Duration/Reps
(Endurance), Pain scales.4
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Intervention:
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Activity adaptation, energy conservation, work hardening, ergonomics, and rehabilitation.5
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Mosey's Role Acquisition Approach (addresses life roles and uses functional activities for
remediation).56
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Occupational Functioning Model (starts with client-chosen roles and tasks).7
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Compensatory devices based on biomechanical principles.7
II. Allen's Cognitive Levels (ACL)
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Focus: Cognitive processes, habits, routines, contextual effects, and activity analysis.8
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Populations: Dementia, brain injuries, mental illness, developmental disabilities.8
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Key Assumptions:
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Functional Cognition: Observable brain function patterns across activities.9
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Brain Conservation: Brain uses minimal energy for tasks.9
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Task Equivalence & Analysis: Analyzing tasks and finding those requiring similar skill
levels.10
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Task Demand: Task analysis plus contextual factors.10
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Task Environment: Setting influences performance; awareness grows with cognitive levels.11
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Just Right Challenge: Matching task demand with functional cognition.11
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Information Processing Model: Extrinsic and intrinsic factors influence processing.12
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Levy's Updates (2011): Clarified memory types, grounded ACLs in occupational
performance.13
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Levels: 6 levels, from automatic actions to planned actions, each with specific characteristics
and examples.131415
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Change: Adapting the environment and creating safe spaces.16
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Evaluation & Intervention:
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Leather Lacing Assessment (standardized, demonstrates cognitive level through craft
activities).16
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No clear distinction between assessment and intervention.16
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Tailoring the task environment to each level.16
III. Intentional Relationship Model (IRM)
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Key Contributor: Rene Taylor (2008)17
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Focus: Impact of therapist-client interactions on client motivation.17
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Goal: Leverage the therapeutic relationship to enhance occupational engagement.17
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Key Concepts:
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Therapeutic communication, establishing rapport, interviewing skills, managing difficult
behaviors, ethical conduct, and self-care are crucial interpersonal skills.18
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Understanding client characteristics: both enduring and situational.19
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Recognizing and effectively addressing inevitable interpersonal events.20
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Utilizing six therapeutic modes to tailor interactions (refer to OCCT505 notes for details).21
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Interpersonal reasoning: anticipating, identifying, coping, choosing response modes, and
gathering feedback.21
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Assumptions: Self-awareness, self-discipline, prioritizing rational thinking, mindful empathy,
continuous learning, flexibility in using modes, client-defined success, balancing activity and
interpersonal focus, adherence to OT values, and cultural competence.2122
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Assessments: Various versions of the Clinical Assessment of Modes and Suboptimal
Interactions.23
IV. Model of Human Occupation (MOHO)
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Founder: Gary Kielhofner (1975)24
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Focus: Occupation-centered, holistic, and culturally sensitive.24
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Goal: Facilitate client engagement and participation in occupations.24
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Key Components:
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Person: Volition (motivation), Habituation (routines), Performance Capacity (abilities).24
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Environment: Physical and social aspects.24
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Occupation: Meaningful activities.24
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Assumptions:
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Heterarchical Organization: Interplay of variables for adaptation.25
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Inherent Motivation: Individuals are driven to engage in occupations.25
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Environmental Influence: Environments shape perception and performance.25
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Feedback Mechanisms: Continuous interaction between person and environment.25
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Function: Order, balance, occupational adaptation, identity, and competence.26
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Dysfunction: Barriers to participation due to environmental or personal limitations.26
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Change: Driven by dissonance and the desire for occupational adaptation.27
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Therapeutic Reasoning: Questioning, collaborative information gathering, hypothesis
generation, goal setting, intervention, observation, and outcome assessment.27
This response clarifies key concepts and assumptions of the Intentional Relationship Model
(IRM) and the Model of Human Occupation (MOHO) based on the provided source material.
Intentional Relationship Model (IRM)
IRM centers on the therapeutic relationship between the therapist and the client. It emphasizes
that this relationship itself serves as a tool that can either facilitate or hinder a client's progress
and engagement in therapy.1 The model highlights the importance of therapists being mindful
and deliberate in their interactions with clients, using their understanding of both the client's
personality and the situation to tailor their communication and approach.12
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Key elements within the IRM:
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Interpersonal events: Occur within the therapeutic relationship and carry significant weight.
They can either present opportunities for growth or pose challenges that may strain the
relationship if not addressed appropriately.3
○
Therapeutic modes: These are different approaches a therapist can take in their interactions
with a client, such as advocating, collaborating, empathizing, problem-solving, instructing, or
encouraging.24
○
Interpersonal reasoning: A process where the therapist reflects on the client's reactions, the
situation, and their own behavior to determine the most effective way to respond.2
Key assumptions of the IRM:
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Self-awareness is crucial: Therapists must be aware of their own thoughts, feelings, and
behaviors to use themselves effectively as a therapeutic tool.5
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Self-discipline is essential: Therapists need to manage their own emotions and reactions,
ensuring they remain professional and focused on the client's needs.5
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Rational thinking comes first: While empathy is important, therapists must prioritize clear,
objective thinking when making decisions about client care.5
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Mindful empathy is key: Understanding the client's perspective and experiences is essential, but
this must be balanced with the therapist's own professional judgment.5
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Continuous learning is necessary: Therapists must actively seek to expand their knowledge and
skills to provide the best possible care.5
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Flexibility in using modes: Therapists must be adaptable in their approach, using different
therapeutic modes as needed to meet the client's changing needs.5
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Client defines success: Ultimately, it is the client's perspective on the relationship that
determines its effectiveness.5
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Balancing focus: While the therapeutic relationship is important, it must not overshadow the
focus on the client's occupational goals and engagement in activities.5
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Alignment with OT values: Application of the IRM must be consistent with the fundamental
values and principles of occupational therapy practice.5
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Cultural competence is central: Understanding and respecting the client's cultural background
is essential for building a strong and effective therapeutic relationship.5
Model of Human Occupation (MOHO)
MOHO, developed by Gary Kielhofner, centers on how people engage in occupations and how
these occupations shape their lives.6 It emphasizes the dynamic interplay between an
individual's internal characteristics, the environment, and the occupation itself.67
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Core components of MOHO:
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Volition: The individual's motivation, interests, and values that drive their engagement in
occupations.6
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Habituation: The individual's habits, routines, and roles that shape their occupational patterns.6
○
Performance capacity: The individual's physical and mental abilities that enable them to
participate in occupations.6
○
Environment: The physical, social, and cultural contexts that influence the individual's
occupational choices and experiences.67
Key assumptions of MOHO:
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Heterarchical organization: A person's characteristics (volition, habituation, performance
capacity) interact and influence each other, as well as being influenced by the environment.7
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Inherent motivation: Individuals are inherently driven to explore and engage in occupations
that are meaningful to them.7
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Environmental influence: The environment can either facilitate or hinder a person's
occupational engagement, impacting their sense of self and their ability to participate.7
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Feedback mechanisms: There's a continuous loop of feedback between individuals and their
environments, shaping their occupational choices and experiences.7
MOHO's approach to change:
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Dissonance/disequilibrium: Change is triggered when a person experiences a mismatch
between their desires and their current occupational situation.8
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Exploration and engagement: The first step in change involves exploring new possibilities,
discovering interests, and experimenting with different occupations.8
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Competency challenges: As individuals engage in occupations, they encounter challenges that
test their skills and push them to develop new abilities.8
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Full participation: The ultimate goal is to achieve a state of occupational balance and
satisfaction, where individuals feel competent and fulfilled in their chosen occupations.8
In summary: Both IRM and MOHO are essential frameworks in OT, guiding therapists to
consider not only the physical and cognitive aspects of a client but also the powerful influence of
the therapeutic relationship, the individual's motivation, and the environment.
