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Table 1 Comparison of Process and Components of Child-Focused and Context-Focused Approaches

From: Focus on Function – a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy

Factor

Context-Focused Approach

Child-Focused Approach

Location

Home or community setting

Outpatient or community setting

Therapist

Physical or occupational therapist (prime therapist model)

Only one therapist providing intervention (other therapists available for consultation and development of treatment plan)

Regular physical therapist and/or occupational therapist

May have more than one therapist

Goal Identification

Parent defines goals based on identification of transitions using the COPM

Therapist sets goals after discussion with parent, teachers, etc.

Assessment Process

Observe and videotape child performing identified tasks and use the task/context-focused framework for performance analysis to identify barriers and supports to performance.

"Top-down" approach starting with identification of functional goals and then identifying specific constraints that are barriers to achievement of functional goal

Assess child's current level of functioning in motor, behavioral, functional areas of performance.

"Bottom-up" approach starting with identification of impairments and then identifying functional limitations

Primary Treatment Strategy

First target of intervention is to change constraints identified within the task and/or environment

Work always at activity and/or participation level in the ICF model. Use success at task as guide to intervention

Different movement strategies are expected in different environments

First target of intervention is a focus on remediation using neurodevelopmental and other regular therapy techniques at the level of body function and structure

Work from body function and structure in ICF model thus leading to changes in functional activity

Use typical patterns of movement and hierarchical skills as guide to intervention.

The movement strategy chosen is expected to generalize across different environments

Frequency

Intermittent and intense, focused on goals identified (typically 3–4 sessions followed by a break before therapy focuses on another task). 18–24 sessions over 6 months.

Regularly scheduled appointments (typically 3–4 times/month). 18 – 24 sessions over 6 months.