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. 

IPHREHAB : MOTOR LEARNING , FUNCTION AND DYSFUNCTION AND CHANGE WITH MOTIVATION

IPHREHAB


FUNCTION & DYSFUNCTION

• Gentile (1992): early & late stages of learning
• Fitts & Posner (1967):

1. Cognitive stage of motor learning (understanding of task, experimentation)
2. Associative stage: refined practice
3. Autonomous stage: skill relatively automatic
4. Example: child learning to climb stairs

Function 

• Degrees of freedom: refers to gradual increase in smoothness of performance of skilled movement. Example: using a hammer.
• Specific definitions for function & dysfunction have not been defined in occupational therapy (Kaplan & Bedell, 1999). 
• Definition of dysfunction in OT must include all three components: person, environment, & occupation.

CHANGE & MOTIVATION

• Holistic approach: OT ALWAYS incorporates practice of perception and movement within the context of SPECIFIC TASKS. 
• Client centered: Motivation comes naturally when clients and/or families set priorities for tasks to be accomplished & goals to be achieved. 
• Systems approach begins with role performance, considering the best combination of remediation, adaptation, & compensation in order to promote client-identified level of functioning to fulfill desired roles.

Change

• Change occurs through learning process.
• Recovery may be:

1. Spontaneous, without benefit of intervention
2. Forced recovery, function gained through therapeutic intervention, such as – example?
3. Adapted or functional recovery, attained through altering methods or contexts within which client accomplishes a task

Postulates of Change, cont.

• Defined in Pediatrics by Kaplan & Bedell. Motor skills more likely to improve when:

1. Match between child’s ability, task, & context.
2. Child understands expectation & receives clear guidance
3. Independent problem-solving encouraged
4. Just right challenge (zone of proximal development).