Biomechanical Frame of Reference for Positioning Children for Function - An OT Review

The Biomechanical frame of reference for positioning children for function is applied to individuals who are unable to maintain posture from appropriate automatic muscle activity caused by neuromuscular or musculoskeletal dysfunction. The goals of this frame of reference are (1) to enhance development of postural reactions, which can be done by reducing the demands of gravity and aligning the body, and (2) to improve functional performance by providing external support for proximal stability to improve distal function. This frame of reference focuses on static position instead of transitional movements. The developmental sequence of motor behaviors is required to understand dysfunction and immature motor patterns. It assumes that motor patterns are developed from sensory stimulations from the environment, and autonomic motor responses (includes righting and equilibrium reactions) are required for maintaining postures. Motor behaviors are reflexive in infancy, and are developed and modified by sensory input from the environment. This frame of reference identifies function and dysfunction in the areas of range of motion, head control, trunk control, control of arm movement, mobility, and positions that are related to participation in daily activities like self-feeding and toileting. In evaluation, postural components of dysfunction are assessed and identified for intervention planning. Some critical areas of assessments are range of movement against gravity, right reactions of head and trunk, positioning of hands, mobilization of limbs to get to desired goal by walking or creeping, etc. Interventions mainly include translating therapeutic interventions by prescribing assistive devices in order to enhance proximal stability and posture in functional activities. Eventually this will enhance participation in the client’s home, school, and community.