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THEORIES OT Exam Insights

Biomechanical
- Principles of ROM, strength, and endurance with a focus on
regaining function.
- Primarily used in orthopedics.

Brunnstrom
- Facilitates neuro recovery through a specific 7 stage sequence. 1:
Flaccidity, 2: Spasticity Appearance, 3: Increased Spasticity, 4:
Decreased Spasticity, 5: Complex Movement Combinations, 6:
Spasticity Disappears, 7: Normal Function Returns.
- Significant approach used with CVA.

Neurodevelopmental
-- Very HANDS ON - - specific handling techniques are used to
facilitate normal posture and movement patterns.

Rood
- Appropriate stimuli yield sensorimotor responses. 4 sequential
phases of motor control: reciprocal inhibition/innervation, co-
contraction, heavy work, and skill.

PNF
- Focuses on diagonal movement patterns that are used during
functional activities.
- Uses a person’s stronger movement patterns to strengthen weaker
motions. Uses manual stimulation and verbal feedback to induce
movement

Compensatory
- Uses compensatory techniques to increase occupational
performance.
- This approach is based on the assumption that dysfunction cannot be
changed (e.g., SCI, amputation).
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Rehabilitative
- The goal is to become as independent as possible. The focus is on
the client using his/her remaining abilities and to attain their highest
level of functioning despite continued disabilities.

Life-Style Performance Model

- Provides a holistic approach to treatment. A person’s quality of life
is a result of interactions between individual and environmental
factors.

Occupational Adaptation
- The goal is for the client to achieve mastery over their environment.
- The client should actively participate and engage in evaluation,
goal setting and treatment planning as this will promote the
development of an adaptive response.

Neurofunctional
- A client-centered, goal driven approach designed primarily for
persons with TBI.
- Emphasizes the use of repetition and feedback for functional tasks
completed in natural settings.

CMOP-E
- Includes the three main components: person, environment, and
occupation. The person is composed of their affective, cognitive, and
physical abilities and at the center is the person’s spirituality.
- Emphasizes both occupational performance and occupational
engagement.

PEO
- Person: includes roles, self-concept, personality, cultural
background, health, cognition, physical and sensory abilities.
- Environment: includes physical, cultural, institutional, social, socio-
economic factors.
- Occupation: includes the tasks that a person engages in.
- These 3 areas are dependent on and affected by each other.
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Cognitive Disabilities Model
- Includes the Allen Cognitive Levels
- Function is based on cognition and behavior. Cognitive performance
varies between 6 different levels.
- Evaluation focuses on determining which level a person is at –
namely what are their current cognitive and functional abilities?
Based on this information, what interventions will maximize the
person’s function at their current level?

Behavioral
- Based on the idea that all behaviors are acquired through
conditioning. Frequency of occurrence of a behavior depends on its
reinforcement contingencies.
- Environmental cues, habits, and the person’s reinforcement history
influence behavior.
- The OT’s role is to organize factors that influence the person’s
behavior to assist in the learning and maintenance of adaptive
behavior.

Cognitive Behavioral
- A person’s thoughts, behaviors, and actions are all connected. By
changing someone’s thinking, you can change someone’s behaviors
and actions.
- Cognitive restructuring involves altering a person’s cognitive
processes to improve behavior and encourage more positive
thinking.
Developmental
- The general theory that development occurs through various
stages that build on one another.
- The expectation that people develop certain skills at different ages.

Kawa Model
- Based on the metaphor of a river representing one’s life journey.
- Considers the environment (river bank), personal components /
resources (driftwood), and personal dysfunction (rocks), and how
these impact a person’s life.

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Dynamic Interactional Approach
- Primarily designed for persons with brain injury.
- A model of cognitive rehabilitation that focuses on a person’s
metacognitive skills (one's self awareness and ability to use prior
knowledge to plan a strategy for approaching a learning task, take
necessary steps to problem solve, reflect on and evaluate results, and
modify one's approach as needed).
- Considers the importance of transfer of learning, and that tasks
need to be graded so that a person can gradually transfer skills from
one context to another.

Sensory Integration
- Focuses on the organization of the senses throughout the body
and from the environment.
- Sensory input is critical for brain function. The brain needs to
actively organize and use sensory input to interact with the
environment.
- An adaptive response involves successfully responding to a
challenging, but not overwhelming, level of sensory stimulation to
CNS, and this contributes to the development of sensory integration.
- Plasticity: Through adaptive responses to environmental demands,
changes occur at the neuronal synaptic level.

Top-Down Approach
– Focuses on participation in activity rather than specific performance
components.
- The priority is functional activity, and compensating for the client’s
deficits so that they can participate in desired occupations.

Bottom-Up Approach
- Focuses on the specific deficits / components of function first, for
example ROM, strength, and balance.
- The assumption is that addressing / improving these specific
components will in turn improve / maximize performance
in daily activities.

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References
Ayres, A. J. (2005). Sensory integration and the child: Understanding hidden

sensory challenges, 25th anniversary edition. Western Psychological Services.

Brown, C., Stoffel, V. C., & Muñoz, J. P. (Eds.). (2019). Occupational therapy in

mental health: A vision for participation (2nd ed., pp. 155–164). F.A. Davis Company.

Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A

practical approach. SLACK Incorporated.

Dawson, D. R., McEwen, S. E., & Polatajko, H. J. (2017). Cognitive orientation to

daily performance in occupational therapy. AOTA Press.

Fleming-Castaldy, R. P. (2017). National occupational therapy certification

exam review & study guide. TherapyEd.

Hoffman, H. (2018). Stages of stroke recovery: The Brunnstrom stages of stroke

recovery. Saebo. Retrieved October 1, 2020, from [Link]

of-stroke-recovery/

McHugh Pendleton, H., & Schultz-Krohn, W. (Eds.). (2018). Pedretti’s

occupational therapy: Practical skills for physical dysfunction (8th ed.). Mosby Elsevier.

O’Brien, J. & Kuhaneck, H. M. (Eds.). (2020). Case-Smith’s occupational therapy

for children and adolescents (8th ed.). Mosby Elsevier.

Townsend, E. A., & Polatajko, H. J. (2007). Enabling occupation II: Advancing

an occupational therapy vision for health, well-being, & justice through occupation.

Ottawa: CAOT Publications ACE.

Weinstock-Zlotnick, G., & Hinojosa, J. (2004). Bottom-up or top-down

evaluation: Is one better than the other? American Journal of Occupational Therapy, 58(5),

594–599. [Link]

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