gms | German Medical Science

Clinical issue/s: Orthotic intervention, as commonly described in hand therapy literature, tends to be predominated by discussions of orthoses being used, largely in acute stages of treatment, to address biological (anatomical/physiological) disorders of the upper extremity. With the publication of the revised International Classification of Functioning, Disability and Health (ICF) by the World Health Organization, hand therapists are increasing their focus on enabling activity and participation from a more holistic (occupational) perspective. However, the ICF does not explicitly consider the concepts of persons' values, what is meaningful to them and the social roles that affect participation in occupations important to individuals.

Clinical reasoning: What orthotic interventions are required to optimally continue, or return, to play, work, school, one's household or daily living activities? How can hand therapists achieve the best outcomes from orthotic interventions?

Innovative, analytical or new approach: The Bio-Occupational Framework, with its six principles, guides therapists to address the (1) biological and (2) occupational (functional) goals of the client while considering current or future activity and participation. Client stories will illustrate how optimal outcomes occur when orthotic interventions are designed with client input and holistic consideration of the individual's unique circumstances.

Contribution to advancing HT practice: The Bio-Occupational principles and explicit dual focus guide the therapist through a holistic, client-centered, professional practice process that considers personal attributes and unique environmental contexts to provide an optimally usable, well-engineered orthosis. This Framework goes beyond addressing biological needs by facilitating participation in occupations that are important and meaningful to the person.