New and Expanded Neuropsychosocial Concepts Complementary to Llorens' Developmental Theory

Achieving Growth and Development through Occupation for Neonatal Infants and their Families

Lynne F. LaCorte OTD MHS

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780789034687
• eBook ISBN: 9781317994138
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

This book analyzes and suggests an expansion of Llorens' developmental theory of occupational therapy, applying these concepts in a final schematic model for use by occupational therapists, occupational scientists, and others involved in occupational tasks, relationships, and activities. The book then uses the International Classification of Functioning in a context of health promotion and disease prevention to relate the expanded theory to psychosocial, cognitive, and sensorimotor correlates in preterm infants and their families in the neonatal intensive care unit and after discharge to the home environment. Last, it provides an NICU infant case illustration on the Developmental Analysis, Evaluation, and Intervention Schedule.

The major theme of this book focuses upon expanding the psychological, neurophysiological, and sociological aspects of Llorens' developmental theory for a person-occupation-environment based practice and research. The book will then correlate these concepts with current terminology from the World Health Organization, and specialized knowledge and skills in the neonatal intensive care unit.

This book was published as a special issue of Occupational Therapy in Mental Health.

PART 1: THEORY ANALYSIS AND NEW CONCEPTS

The goal of Part 1 of this book is to analyze Llorens’ theoretical model and to make recommendations for its expansion. First, Llorens’ original 1970 thesis, premises, and schematic illustrate the Llorens theory, along with the author’s interpretation of same. Tracing the model’s history to more recent additions and changes made in 1976 and 1991 from the original version in 1970 analyzes theory development over a 20-year period.

Second, an evaluation of the model’s most recent changes (Llorens, 1991) reflect either continued relevance or needed revisions. Additionally, the author recommends developmental stages from Bandura’s Social Learning Theory in self-efficacy; Brofenbrenner’s Bioecological Theory of roles, activities, and relationships; and Bruner’s Discovery Learning in the role of developmental constructivism, to enhance the Llorens theory and schematic. This section concludes with a summary of these important considerations for the model’s expansion.

Tracing the Model’s History

To formulate a developmental theory for health and rehabilitation, Llorens (1970) drew her assumptions from the growth models presented by Ayres, Gesell, Erikson, Freud, Havighurst, Mosey, Pierce and Newton, and Piaget, and from her own professional experience and philosophy about the role of occupation in health and rehabilitation. Llorens presented her theoretical premises and constructs and then illustrated them in a three-part schematic model for practice as concurrent areas of growth and as temporal, chronological age levels. In Section 1, Llorens blends various theories in hierarchal and heuristic continuums of developmental expectations, behaviors, and needs that enable occupational performance. In Section 3, she presented the behavioral expectations and adaptive skills that one uses in the performance of occupational behavior roles related to environmental tasks, activities, and relationships. In Section 2, Llorens explained the role of purposeful activities (occupation) and relationships as occupational therapy’s medium for practice in the adaptation process (Llorens, 1970).

Developmental Model’s Thesis and Premises

Facilitating Growth and Development (Llorens, 1970; Walker & Shortridge, 1993) provides a theoretical model for occupational therapy to seek out, identify, and respond to a person’s occupational performance needs. According to Mosey (1974), a theoretical model for practice “… provides certain assumptions, a theoretical base, and a set of operating principles” (p. 138). Llorens developed Facilitating Growth and Development from the following thesis:

That occupational therapy is a facilitation process which assists the individual in achieving mastery of life tasks and the ability to cope as efficiently as possible with the life expectations made of him [or her] through the mechanisms of selected input stimuli and availability of practice in a suitable environment (Llorens, 1970, p. 93).

Llorens (1970) supported her thesis with the following premises:

1. That the human organism develops horizontally in the areas of neurophysiological, physical, psychosocial, and psychodynamic growth and in the development of social language, daily living, and sociocultural skills at specific periods of time;

2. That the human organism develops longitudinally in each of these areas in a continuous process as he ages;

3. That mastery of particular skills, abilities, and relationships in each of the areas of neurophysiological, physical, psychosocial, and psychodynamic development, social language, and daily living, and sociocultural skills, both horizontally and longitudinally, is necessary to the successful achievement of satisfactory coping behavior and adaptive relationships;

4. That such mastery is usually achieved naturally in the course of development;

5. That the fundamental endowment of the individual and the stimulation of experiences received within the environment of the family come together to interact in such a way as to promote positive early growth and development in both the horizontal and longitudinal planes;

6. That later the influences of extended family, community, social and civic groups assist in the growth process;

7. That physical or psychological trauma related to disease, injury, environmental insufficiencies, or intrapersonal vulnerability can interrupt the growth and development process;

8. That such growth interruption will cause a gap in the developmental cycle resulting in a disparity between expected coping behavior and adaptive facility and the necessary skills and abilities to achieve same;

9. That occupational therapy through the skilled application of activities [occupation] and relationships can provide growth and development links to assist in closing the gap between expectation and ability by increasing skills, abilities, and relationships in the neurophysiological, physical, psychosocial, psychodynamic, social language, daily living, and sociocultural spheres of development as indicated both horizontally and longitudinally.

10. That occupational therapy through the skilled application of activities [occupation] and relationships can provide growth experiences to prevent the development of potential maladaptation related to insufficient nurturance in neurophysiological, physical, psychosocial, psychodynamic, social language, daily living, and sociocultural spheres of development both horizontally and longitudinally (pp. 93–94).

Basic Concepts of Llorens’ Schematic Model

Llorens’ theoretical model (schematic) resulted from these constructs (thesis and supporting premises). According to Llorens, the human organism uses purposeful activities and relationships to adapt to developmental change in distinct phases and levels of growth throughout the life cycle. These changes occur through adaptive neurophysiological processing of internal and external stimuli in response to occupational demands that are activated by specific types of activities and affective object relationships and in accordance with the individual’s dynamic genetic endowment and environmental context (Lorens, 1981a). The following definition of terms and discussion of Sections 1, 2, and 3 of Llorens’ schematic refer to (a) the explanatory role of activities for occupational enablement and role acquisition (Section 1 and 3) and (b) the predictive role of occupational therapy in facilitating activities and relationships to accomplish same (Section 2) (see schematic in Figure 1).

Developmental Model Explained: Sections 1, 2, and 3 of Facilitating Growth and Development

Terminology

Definitions of terms in Table 1 that are used throughout Parts 1, 2, 3, and 4 of this book are provided after Figure 1.

FIGURE 1. Schmatic Representation of facilitating Growth and Developement

From Llorens, L. A. (1970). Facilitating growth and development: The promisw of occupational therapy. 1969 Eleanor Clarke Slagle Lecture. American Journal of Occupational Therapy, 24, 93-101. Section 1, p.96 (Reproduced with Permission).

TABLE 1. Definition of Terms

Occupation (the state of being occupied)	An activity in which one engages (Merriam-Webster, 2005), as “a person’s goal directed use of time, energy, interest, and attention” (Llorens, 1981b, p. 2).
Occupational association	The association of simultaneous and sequential stimuli (information) to select and/or retrieve and plan for object finding and using. Association used here connotes “the process of forming mental connections or bonds between sensations, ideas, or memories” (Merriam-Webster, 2005).
Occupational process	The use of occupational association for doing- with meaning (Fidler & Fidler, 1978) in purposeful object (animate and inanimate) action sequences (activity as means).
Occupational activity	The use of the occupational process to connect multiple body/mind components into a unified purposeful performance (ends) (Llorens, 1981a; Yerxa, 1994/1996).
Occupation form	The ecological objects/relationship used in the occupational activity (Nelson, 1986).
Vocation	“the work in which a person is regularly employed” (Merriam-Webster, 2005).
Occupational task	Represents a grouping of activities which have a similar productive role value (Llorens, 1991).
Occupational adaptation	A person’s ecological adjustment to their occupational activity, task and role demands/expectations (Schultz & Schkade, 1992a, 1992b). Ecological means “the totality or pattern of relations between organisms and their environment” (Merriam-Webster, 2005).
Science of occupation (activity theory)	Purposeful engagement in activity (occupation) within relevant contexts. Incorporates multiple spheres of science; such as sociological theory, neurological theory, psychophysiological theory, developmental theory and occupational theory (Llorens, 1973, 1981a, 1981b, 1984a, 1984b, 1986, 1993; Llorens & Rubin, 1962; Humphry, 2005; West, 1984).
Activity components (enablers of occupation)	Neurophysiological, sensorimotor, physical, psychosocial, and psychodynamic growth; and social language, daily living, and sociocultural skills (Llorens, 1970, 1976).
Spatiotemporal adaptation	The neurophysiological process by which the distribution, timing, frequency, and amplitude of occupation enablers (as growth parameters) mature (Gilfoyle, Grady, & Moore, 1990). Distribution used in this sense means “the pattern of branching and termination of a ramifying structure (as a nerve)” (Merriam-Webster, 2005). Timing is used here to mean “to set the tempo, speed, or duration” (Merriam-Webster, 2005). Frequency is used to mean “the number of times that a periodic function repeats the same sequence of values during a unit variation of the independent variable” (Merriam-Webster, 2005). By amplitude, it is meant the “extent or range of a quality, property, process, or phenomenon” (Merriam-Webster, 2005).
Central pattern generation	Rhythmical neurophysiological feed forward patterns, endogenously activated and sensorially mediated, for both occupational and spatiotemporal adaptation (Kuo, 2002; Marder & Bucher, 2001).
Occupational balance	The well-being that results from the synchronization of occupational associations with reality (Wilcock, 1999; Wright, 2004).
Occupational performance	The productive outcome of activities or tasks required by social and occupational role in the areas of work/education, leisure/play, self-maintenance and rest (Baum & Law, 1997; Llorens, 1976).
Occupational performance enablers	The specific components of purposeful activity (see activity components) (Llorens, 1991).
Occupational performance roles	The occupational and social role behaviors connected with performance of occupational activities and tasks (Llorens, 1991).

Note: The definitions are presented as the terms relate to one another, rather than alphabetically.

Section 1. Developmental Expectations, Behaviors, and Needs

Llorens (1970) drew from activity theory and growth models (Llorens, 2004; Papalia et al., 2001) to construct a “loosely knit” developmental framework that describes phases and levels of developmental growth. People perform activities and engage in relationships that incorporate object-environmental reciprocity and that typify a specific developmental phase and role. In Section I, the activities and relationships typical of growth correlate to a person’s intrapersonal and interpersonal environment of neurophysiological, physical, psychosocial, and psychodynamic growth, and development of social language, daily living, and sociocultural skills, all of which illustrate “Developmental Expectations, Behaviors, and Needs” (Llorens, 1970, p. 96 [Section 1 of the conceptual model]). Llorens illustrated these growth areas and relationships as activity component subskill areas that may categorically coexist within any given activity. An example of complimentary activity components needed, expected, and behaviorally observed is illustrated in playing baseball on a team during a baseball game. In this one integrated activity, a child needs good eye and hand coordination, physical strength, social-emotional stability, and regulation in intrapersonal and interpersonal relationships, motor skills, and planning language ideation to accompany the actions involved, the ability to tie her shoes (coordination) so that she doesn’t trip and fall when she runs, and an environment suited to the activity. To provide an example of abilities needed in each of the activity component areas, Llorens identified behavioral and biologically based theorists who have contributed important explanations or observations of functioning within a specific component area. As noted in Figure 1, these areas include neurophysio...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• LIST OF TABLES
• LIST OF FIGURES
• FOREWORD
• PREFACE
• INTRODUCTION
• PART 1: THEORY ANALYSIS AND NEW CONCEPTS
• PART 2: OCCUPATIONAL PHYSIOLOGY
• PART 3: APPLICATION OF NEW CONCEPTS AND NEURO-PSYCHOLOGICAL ELEMENTS
• PART 4: THE DAEIS FOR RESEARCH AND CLINICAL PRACTICE
• REFERENCES
• APPENDIXES
• Index