IPHREHAB :OCCUPATIONAL THERAPIST ASSESSMENT AND INTERVENTION FOR MOTOR LEARNING

IPHREHAB

Assessment

• OCCUPATIONAL THERAPIST Assessment includes:

1. Dynamic evaluation, watching client during occupational performance, including responses to cues.
2. Collaboration with client to determine occupational problems and priorities.
3. Evaluation of person, task, & context, to determine appropriate OT interventions.

Assessment

• OT evaluations may incorporate manual muscle tests, range of motion, strength & endurance tests, which directly relate to problems with specific task performance.
• Sensory & perceptual evaluations stem from client-identified problems with those aspects of task performance.
• Cognitive evaluations may further clarify difficulties with awareness, goal identification, motor planning, and generalization of learning.

INTERVENTION

• Client-centered role/task selection
• Discussion of OT assessment results
• Collaboration which includes therapeutic use of self in determining and/or raising level of client self-awareness
• Imparting information on current evidence with regard to a choice of approaches
• Practice of needed skills in natural settings

Motor Learning Interventions

• Prevention of injury/dysfunction through splinting, positioning, educating, & sensitization to relevant environmental cues.
• Promoting function through individualized task problem-solving & collaborative experimentation about the best way to accomplish the task.

• Practicing whole tasks, not isolated parts.
• Providing skill practice in varied contexts during daily routines.
• Providing randomized practice (changing parameters or circumstances).
• Providing intermittent feedback during task performance or summarized at end.
• Encouraging self-evaluation & error detection (both KP & KR).

Interventions

• Modify task demand in order to achieve task goal (use e-mail instead of telephone to communicate with others; use alarm to remember next step).
• Modify contextual factors in order to achieve task goal (use bolsters to position for active movement in playing a game).

Intervention: Constraint-Induced Movement Therapy

• Contemporary variation of task-focused approach for stroke survivors (1 year post-stroke).
• Consists of “constraining” nonaffected arm, forcing use of affected limb for performing daily tasks. 
• In 2-week experiment, “constrained” group showed significantly greater motor skills, carry over to life tasks, and maintenance of gains in 2-year follow-up.
• Original study replicated (Blanton & Wolf, 1999) shows that 20% to 25% of clients with chronic stroke symptoms may benefit from this approach.

Please make your own copy of article. Focus on distinctions made between traditional & contemporary OT approaches.