Occupation-Based Hand Therapy!

Hand Therapy and Client-Centered Approaches to Care

Using Frames of Reference
When asked what model dictates a therapist’s methods of practice, many hand therapists generally respond with the answer: “biomechanical”.  However, when asked about specific frames of reference that structure their client care, some therapists find themselves at a loss for words. 


Treatment is all about doing what’s in the best interest of the client and their injury in order to restore or compensate for the functional deficits currently being experienced.  In a perfect world, things like insurance and reimbursement would not affect a therapist’s approach to treatment methodology but they do.  This creates the pressure of the time crunch that is frequently felt in today’s modern society—not only in treatment but in everyday life.  However, exploring hand issues through the lens of frequently-used, accepted, and renowned OT frames of reference might add a new dimension to a therapist’s practice.

Below are listed a select few frames of reference (FoR) that are commonly discussed in occupational therapy schools today.  Each FoR will follow the tale of Jim - a medical student who developed a nasty case of carpal tunnel syndrome over the past few months.  The individual links provide a broad "therapist's-eye-view" of treating Jim in accordance to the principles of that particular FoR.  If any of the models catch your eye, I strongly encourage you to investigate more on your own as the information provided here is introductory.

The Case
Jim is a 25-year old medical student at a local university.  He’s in his second year of school there and has hopes of one day becoming a pediatric cardiac surgeon.  Jim enjoys working with his hands and is currently fixing up an old motorcycle that he bought at an auction.  He lives with 3 of his best guys friends in a 2-story house that’s located about 15 miles from Jim’s university.  As a part-time job, Jim performs prosections on cadavers for the MD, PT, OT, and PhD programs at his university.  Jim is a fit and active student who lifts 3 days a week at the gym and plays golf with his friends in his spare time.  He plays on a basketball team that averages about 2 games per week.  Despite his good habits, Jim admits to being a social smoker when he’s hanging out with his friends.

Jim started feeling shooting, tingling pains extending from his wrist into his right thumb, index, middle, and part of his ring finger.

Due to his busy schedule, he ignored the pains until he was no longer able to work on his bike, type papers for class, grip his car’s steering wheel, or read magazines without experiencing a significant amount of discomfort.  Frustrated with his inability to perform simple tasks, Jim finally went in and saw one of the doctors at his student health clinic.  Jim's doctor wisely sent him on to a hand therapist :)

FRAMES OF REFERENCE FOR TREATMENT:
The PEOP Model
Lawton's Model of Environmental Press
The KAWA Model
The ENABLER Model