Occupational Therapy Models of Practice
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Direct answer
A model of practice tells the therapist what to look at; a frame of reference tells them what to do about what they find. The Model of Human Occupation (MOHO) explains behaviour through volition, habituation and performance capacity; the Canadian Model of Occupational Performance and Engagement (CMOP-E) places spirituality at the person's core; and the Person–Environment–Occupation (PEO) model reads function as the fit among all three. Beneath the models sit frames of reference — biomechanical, neurodevelopmental, sensory integration, cognitive-behavioural — each with its own assumptions and techniques, and exams routinely ask you to name the constructs of a model and match a frame to a clinical population.
What you must remember
- Hierarchy of theory: paradigm (the profession's worldview) → model of practice (general explanation of function) → frame of reference (specific, population-ready approach).
- MOHO (Kielhofner): volition (personal causation, values, interests), habituation (habits and roles), performance capacity (the lived body), all in interaction with the environment; assessments include MOHOST, OCAIRS and the Volitional Questionnaire.
- CMOP-E: spirituality at the centre of the person, whose physical, cognitive and affective components engage occupation (self-care, productivity, leisure) within the environment; the COPM grew out of this model.
- PEO (Law and colleagues) and PEOP (Baum and Christiansen): occupational performance is the transactional overlap of person, environment and occupation — a poor fit produces dysfunction.
- Biomechanical frame: range, strength, endurance and joint protection; the natural home of orthopaedic and hand conditions.
- Neurodevelopmental frame (Bobath/NDT): normalise tone and movement patterns through handling and key points of control; applied in stroke and cerebral palsy rehabilitation.
- Sensory integration frame (Ayres): organised sensory processing enables adaptive responses; applied to sensory processing disorder, autism and ADHD.
- Cognitive frames: restorative versus compensatory approaches; the Allen Cognitive Levels, tested with the leather-lacing task, dominate dementia practice.
One patient, three lenses
Take a 35-year-old accountant, eight weeks after a moderate traumatic brain injury, desperate to return to his office desk. Through the MOHO lens the therapist first reads volition: he believes he is "completely normal" (personal causation) and still identifies as the family provider (roles), so intervention must work with that drive, not against it — graded office tasks that his own values pull him toward. Habituation is shattered; the therapist rebuilds a daily routine around a written schedule, because habits cannot be re-formed while the day is shapeless. Through the PEO lens the problem shifts to fit: fluorescent lighting and an open-plan desk (environment) collide with his slowed processing and noise intolerance (person) during spreadsheet work (occupation) — so the trial placement begins in a quiet corner with a checklist, changing the environment before blaming the man. Through the cognitive frame the therapist chooses compensatory strategies over restoration at this stage: diary systems, alarms, errorless learning of his commute. Nothing in the three lenses contradicts; each sees a different layer of the same return-to-work problem, and mature practice braids them — which is exactly the answer a viva examiner wants when asked "which model would you use?"
How the exam frames it
Matching questions decide most marks: spirituality at the centre points to CMOP-E; volition–habituation–performance capacity to MOHO; overlap-of-three-circles diagrams to PEO. The Allen Cognitive Levels test with its leather-lacing stitches belongs to the cognitive disability frame, and its appearance in a stem is practically a named answer. Students lose marks by calling NDT or sensory integration a "model" — they are frames of reference — and by describing MOHO's volition as mere "motivation" instead of the structured trio of personal causation, values and interests.
Frequently asked questions
What is the difference between a model and a frame of reference?
A model explains function and guides what to assess across the profession; a frame of reference is a specific, population-based prescription for intervention.
What are the components of MOHO?
Volition (personal causation, values, interests), habituation (habits, roles) and performance capacity, interacting with the environment — assessed with tools such as MOHOST.
What is unique to the CMOP-E?
It places spirituality at the core of the person, surrounded by physical, cognitive and affective components engaging occupation within the environment.
Which model is drawn as three overlapping circles?
Person–Environment–Occupation: the overlap of the three is occupational performance, and a poor fit is read as dysfunction.
Which frame of reference suits a stroke patient with spasticity?
The neurodevelopmental (Bobath/NDT) frame, using handling and key points of control to influence tone and movement quality.
What is the Allen Cognitive Level screen?
A leather-lacing task assessing cognitive disability, used mainly in dementia and psychiatric occupational therapy to grade function and predict safe discharge.