CH22
Optimizing motor behavior using the occupational therapy task-oriented
approach
When to discontinue treatment
2008/09/29 971生疾職療 授課：劉倩秀
Client-centered focus
1. Adopt a client-centered focus in treatment 2. Elicit active participation of the client
during treatment
2008/09/29 971生疾職療 授課：劉倩秀
1. Adopt a client-centered focus in treatment
the identification of interventions for the unique needs of each client
taking into account unique personal and environmental systems and roles that
have importance and meaning for the individual
2008/09/29 971生疾職療 授課：劉倩秀
2. Elicit active participation of the client during treatment
Client should have an active role in treatment
How to facilitate active participation in treatment?
1. Provide user-friendly instructions on how to practice tasks outside of the therapy session and structure client’s environment to facilitate this practice
2. Active learning environment
2008/09/29 971生疾職療 授課：劉倩秀
Characteristics of an active learning environment
2008/09/29 971生疾職療 授課：劉倩秀
Occupation-based focus
The intervention plan for the OT Task- oriented approach is occupation based
1. Use functional tasks as the focus in treatment
2. Select tasks that are meaningful and important to the client’s role
3. Analyze the characteristics of the tasks selected for treatment
4. Describe the movements used for task performance
2008/09/29 971生疾職療 授課：劉倩秀
1. Use functional tasks as the focus in treatment
Treatment goal:
enable clients to do the things they want to do now and in the future
The interventions emphasize the practice of real functional tasks
Therapist’s interventions for motor behavior problems should revolve around meaningful occupations and functional goals.
2008/09/29 971生疾職療 授課：劉倩秀
2. Select tasks that are meaningful and important to the client’s role
The importance of many functional tasks is unique to the individual
Life satisfaction is not determined by successful completion of a random set of functional tasks
Satisfaction comes from the feeling that roles are fulfilled.
e.g. , parent, homemaker
Select tasks that are
within the realm of capacities, goal oriented,
have meaning for the clients, motivate them
2008/09/29 971生疾職療 授課：劉倩秀
3. Analyze the characteristics of the tasks selected for treatment
Task analysis entails an examination of the task requirements and the personal
capabilities to determine whether there is a match that permits task performance
If there is no match, therapist plan interventions that address the
problems of clients
Characteristics of the environment
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both
971生疾職療 授課：劉倩秀Types of Task (1) Continuous task
Repetitive task without a clear beginning or end
Serial task
Tasks with connected discrete movements
Discrete task
Task involving movements with a recognizable beginning and end
Types of Task (2)
Closed task
A task with stable environmental condition and consistency from one trial to the next
Open task
Task in which some features of the environment are in motion or unstable and there is variation from one trial
2008/09/29 971生疾職療 授課：劉倩秀
4. Describe the movements used for task performance
Attractor
Preferred but not obligatory pattern of motor behavior that emerges from the interaction of a unique person with a particular task and
environment
Attractors are ordinarily stable and the optimal way to achieve a functional goal because they are efficient and effective
2008/09/29 971生疾職療 授課：劉倩秀
Various attractor states
2008/09/29 971生疾職療 授課：劉倩秀
A :
many clients with CNS damage show good motor recovery and resumption of movement patterns similar to this example
They resume stable but flexible performance of tasks in their daily lives
B:
Task performance is not efficient or effective
This is similar to the movement patterns seen the first few times a new sport is tried
Clients in the acute stage of recovery often use movement patterns that show little stability
C:
The client may be unable to adapt movements and thus be unable to achieve the functional goals
This movement pattern may be effective in one context, but the person maybe unable to achieve functional goals in varied contexts (no flexibility) These obligatory patterns are often observed in people years after CNS damage
2008/09/29 971生疾職療 授課：劉倩秀
5. Determine whether the movement patterns are stable or in transition
Therapists observe performance of the same task several times in the same context and then in
different contexts Stable :
Preferred movement pattern is relatively efficient and effective for a given task and the different contexts
Intervention is not needed
Transition:
No preferred movement pattern or if the pattern is fixed Therapist consider treatment to facilitate change in
movement pattern and occupational performance
2008/09/29 971生疾職療 授課：劉倩秀
Remediation of motor behavior problems should begin before the movement
patterns fall into stereotyped patterns In the movement patterns have been obligatory (C) or irregular (A) for a long time, interventions may not effect a
change to other movement patterns.
2008/09/29 971生疾職療 授課：劉倩秀
6. Analyze the movement patterns and functional outcomes of task performance
An analysis of movement patterns will help estimate stability and flexibility, understand changes, and
prevent fixation of movement patterns Collective variables
Fewest number of variables or dimensions that describe a unit of behavior quantitatively
Control parameters
Variable that shifts behavior from one preferred pattern to another and does not control the change but act as agent for reorganization of behavior
2008/09/29 971生疾職療 授課：劉倩秀
Collective variables
Strategy 1:
Look at fluctuations in one or more quantitative measures of movement patterns during task performance
Strategy 2:
Determine what happens when the therapist tries to
disturb the movement patterns by changing some critical personal or environment factors
How much change is necessary to disturb the pattern How long it takes for the movement pattern to return to the previous state
Strategy 3:
Determine the critical factors influencing behavior – control parameter
2008/09/29 971生疾職療 授課：劉倩秀
Person and Environment
The intervention used in the OT task-oriented approach address personal and environmental systems to enable optimal
occupational functioning.
1. Identify the personal and environmental factors that serve as major influences on occupational performance
2. Anticipate that the personal and environmental variables influencing occupational performance will changes
3. Address critical personal and environmental systems to change occupational performance
4. Treat neural and non-neural factors of the sensorimotor system that interfere with optimal occupational performance
5. Adapt the task or broader environment to promote optimal occupational performance
6. Use natural objects and natural environment
2008/09/29 971生疾職療 授課：劉倩秀
1. Identify the personal and environmental factors that serve as major influences on occupational
performance
Personal factors (observe the effect on occupational performance)
Attention, positioning…
Lifting an empty can vs. full can ~ critical factor:
arm strength
Lifting a tennis ball vs. beach ball : hand size
Environmental factors
Size of object, stability of base of support…
Lifting an empty can vs. full can ~ critical factor:
weight
Lifting a tennis ball vs. beach ball : object size
Identified control parameter to cause a shift in motor behavior
2008/09/29 971生疾職療 授課：劉倩秀
2. Anticipate that the personal and environmental variables influencing occupational performance will
changes
2008/09/29 971生疾職療 授課：劉倩秀
Therapist must identify the major influences on motor behavior at a specific time for a
specific person and anticipate changes in the control parameter
2008/09/29 971生疾職療 授課：劉倩秀
Soft tissue contracture
spasticity
3. Address critical personal and environmental systems to change occupational performance
After a critical personal or environmental factor is identified, the therapist alters this personal or environmental characteristic until a shift in motor behavior is
observable.
Ex:
Application of a splint to provide wrist support
Change upper extremity movement pattern and then change occupational performance
2008/09/29 971生疾職療 授課：劉倩秀
4. Treat neural and non-neural factors of the sensorimotor system that interfere with optimal occupational performance
Many subsystems of the sensorimotor
system, not just neural subsystems, may have a role in motor behavior after CNS damage
Muscle weakness Loss of dexterity
Inability to dissociate the scapula from the thorax
Inability to counteract gravitational forces Abnormalities in muscle tone
2008/09/29 971生疾職療 授課：劉倩秀
5. Adapt the task or broader environment to promote optimal occupational performance
Performance context ~ an important personal characteristic in treatment
T’s explores modifications of the physical performance context to promote optimal functional performance, not simply to
compensate.
Slop and height of the support surface Size, shape, and texture of the object Size, length, and weight of tools
Social reinforcements for behavior
Provide feedback to help clients achieve reliable, stable, and efficient performance
2008/09/29 971生疾職療 授課：劉倩秀
6. Use natural objects and natural environment
Use natural environment to help clients to develop stable but flexible movement
patterns
Rehabilitation units
Simulated real-life setting, apartments with ordinary home furniture
Simulated community setting, gift shop, cafeteria
2008/09/29 971生疾職療 授課：劉倩秀
Practice and Feedback
The design of practice sessions and characteristics of feedback are important in interventions based on the OT task-oriented approach
1. Structure practice of the task to promote motor learning 2. Design the practice session to fit the type of task and
learning strategies
3. Provide feedback that facilitates motor learning and encourages experimentation with solutions to
occupational performance problems
4. Optimize occupational performance given the constraints on the person and environment
2008/09/29 971生疾職療 授課：劉倩秀
1. Structure practice of the task to promote motor learning
Structure practice
Blocked practice
Practice that consists of drills and requires many repetitions of the same task in the same way
Random practice
Practice of tasks that vary randomly within the session When adopting a random practice approach is that
performance during the practice session may actually look worse than performance after blocked practice
Varied contexts
Varied contexts promote development of preferred
movement patterns for specific contexts and flexibility in movement patterns for different contexts
2008/09/29 971生疾職療 授課：劉倩秀
2. Design the practice session to fit the type of task and learning strategies
The different types of tasks require different types of practice sessions to facilitate learning
Types of Practice
Part learning
Practice of separate steps of a task Whole learning
Practice of a task in its entirety
Types of Task
Continuous task
Repetitive task without a clear beginning or end Discrete task
Task involving movements with a recognizable beginning and end
2008/09/29 971生疾職療 授課：劉倩秀
3. Provide feedback that facilitates motor learning and encourages experimentation with solutions to occupational
performance problems
Better feedback strategies to retention of motor skills
Less frequent, scheduled randomly or intermittently, faded over time, given as summary information
Therapist should carefully analyze the effect of their feedback on an individual client’s performance
2008/09/29 971生疾職療 授課：劉倩秀
4. Optimize occupational performance given the constraints on the person and environment
Optimization in the process of therapeutic intervention should be directed at a functional outcome rather than a peripheral motor pattern to promote learning in a
functionally significant context
Therapists must identify ineffective movement patterns that are hindering optimal task performance or
contributing to future problems in personal and environmental systems
Caution regarding the analysis of preferred patterns:
Achievement of functional outcomes is more import to the goal of normal movement patterns
Client-centered approach focused on meaningful occupations and roles
2008/09/29 971生疾職療 授課：劉倩秀
Case example
Mr.B. : Application of the OT task-oriented approach
Patient information
55 yrs, man
L’t CVA, right hemeparesis, 6ms ago Job: administrator, junior college OPD
Goal: to determine whether he has potential to return to work (administrative job)
Recommendations
1. OT recommeneded 3 1-hr T’x sessions at the college
2. OT will work on tasks related to Mr. B.’s role as mediator in student issues.
3. Identified task
Contact student to gather information and set up meeting Review documentation
Meet the student in a conference room Discuss issue with student
Document discussion
return to office, and write, copy, send report to students and others as needed
2008/09/29 971生疾職療 授課：劉倩秀
(3) Simulated a meeting
Problems related to perform this work
Slow movement in bringing his chair close to the table
Slow movement in bringing his arm to rest on top of the table Slow movement and limited endurance in grasping a regular pen
Decreased speed and accuracy in cursive writing
(4) Critical factors
Weight of the conference room furniture Decrease strength in shoulder flexion
Decrease strength and endurance in palmar pinch
2008/09/29 971生疾職療 授課：劉倩秀
Summary of short-term foals (STG) and progress
STG:
At the end, Mr. B. will independently
1. Adjust furniture in the conference room to prepare for task performance
2. Use a tape recorder record the discussion 3. Record note
First session
Conference room chare : adjustable height, wide armrests, swivel seat
Tape recorder : voice activation, adjustable speed, internal microphone
Felt-tip pen : adapted pen, pen holder
Mr. B. helped design a home program of additional tasks (strengthen targeted muscle groups in the right hand)
Reaching for spices Organizing cupboards Buttering bread
Writing down recipes
2008/09/29 971生疾職療 授課：劉倩秀
Second session
M.B. practice a variety of ways to
Position himself for efficient writing
Position the chair close to the table before sitting Operate the tape recorder…….
OT’s observation and recommendation
Summary feedback was provided after each performance Use of the left hand to manipulate the small buttons on the recorder
Modified home program to
Promote practice of positioning self Promote operating the recorder
Increase the task demands related to targeted muscle groups
Develop a template for recording discussions and reducing the writing requirements (OT & Mr. B.)
2008/09/29 971生疾職療 授課：劉倩秀
Third session
Mr. B. demonstrated all task components Analyze the performance (OT & Mr. B.)
Increase speed in bringing the right arm from the lap to table
Movement time for picking up the pen was still slow
Right palmar pinch had increased in strength sufficiently to enable completion of a 10-min writing with felt-tip pen…
Modified home program
To promote practice of use in simulated discussions To continue work on tasks related to targeted muscle groups
2008/09/29 971生疾職療 授課：劉倩秀
Homework
討論Mr. B. case example之治療過程，使 用了哪些Task-related approach之原則？
（依Treatment principles of a Task-related approach ）
2008/09/29 971生疾職療 授課：劉倩秀
