TASK-ORIENTED APPROACH

             

                TASK-ORIENTED APPROACH

1.      DEFINITION:

·         Movement is organized around a behavioural goal and is constrained by the environment

·         Patients learn by actively attempting to solve the movement problem rather than by repetitively practicing normal patterns of movement

2.      ASSUMTION:

·         Personal and environmental systems, including the central nervous system, are hierarchically organized.

·         Functional tasks help organize behavior.

·         Occupational performance emerges from the interaction of persons and his or her environment.

·         Experimentation with various strategies leads to optimal solutions to motor problems. 

·         Recovery is variable because patient factors and environmental contexts are unique.

·         Behavioral changes reflect attempts to compensate and to achieve task performance.

3.      THEROY:

·         The assumptions and propositions of theories of motor development and motor behavior changes therapist were using interventions based on assumption such as

ü  The CNS is hierarchically organized

ü  Normal movement can be facilitated by providing specific patterns of sensory input

ü  Recovery from brain damage follows a predictable sequence

·         Occupational therapy task oriented approach includes assumption and propositions from broad occupational theories a systems model of motor control, an ecological approach to perception And action and dynamic systems theory

·         Motor control and learning from the neuropsychological ,biomechanical and behavioural sciences

3.1.Systems Model of Motor

·         The systems model of motor control is more interactive or heterarchical and emphasizes the role of the environment more than the earlier reflex-hierarchical model.

·         The nervous system itself is organized heterarchically such that higher centers interact with the lower centers but do not control them. Closed-loop and open-loop systems work cooperatively and both feedback and feedforward control are used to achieve task goals

·         The central nervous system (CNS) interacts with multiple personal and environmental system As a person attempt to pursue the goal

3.2.Ecological approach to perception And action

·         Emphasizes the study of interaction between the person and the environment during everyday, functional tasks and the close linkage between perception and action (i.e., purposeful movement).

·         The role of functional goals and the environment in the relationship between perception and action.

·         Higher centers send down a command for a muscle to contract, middle and lower centers have the opportunity to modify the command. Lower and middle centers receive peripheral sensory feedback. Thus, the impact of the command on the muscle will vary depending on the context and degree of influence of the middle and lower centers. As a result, the relationship between higher center or executive commands and muscle action is not a one-to-one.

3.3.Dynamical systems theory

·         Dynamical systems theory proposes that behaviors emerge from the interaction of many systems and subsystems. Because the behavior is not specified but is emergent, it is considered to be self-organizing

·         Despite the many degrees of freedom or ways of performing a task available to persons, they tend to use relatively stable patterns of motor behavior

·         These relatively stable patterns of motor behavior, which are unique to each person, provide evidence of self-organization

·         It is during unstable periods, characterized by a high variability of performance, that new types of behaviors may emerge either gradually or abruptly. These transitions in behavior, called phase shifts, are changes in preferred patterns of coordinated behavior to another.

4.      SYSTEMS VIEW OF MOTOR DEVELOPMENT:

·         A systems view of motor development suggests that changes over time are caused by multiple factors or systems such as maturation of the nervous system, biomechanical constraints and resources, and the impact of the physical and social environment

5.      CONTEMPORARY VIEW OF MOTOR LEARNING:

·         Defined motor learning as a set of processes associated with practice or experience leading to relatively permanent changes in the capabilities of responding

6.      SYSTEMS MODEL OF MOTOR BEHAVIOR:

·         Role performance (social participation)

ü  Roles: worker, student, volunteer, home maintainer, hobbyist or amateur, participant in organizations, friend, family member, caregiver, religious participant, other? Identify past roles and whether they can be maintained or need to be changed.

ü  Determine how future roles will be balanced.

·         Occupational performance tasks (areas of occupation)

ü  ADLs: bathing, feeding, bowel and bladder management, dressing, functional mobility, and personal hygiene and grooming

ü  IADLs: home management, meal preparation and cleanup, care of others and pets, community mobility, shopping, financial management, and safety procedures Work and education: employment seeking, job performance, volunteer exploration and participation, retirement activities, and formal and informal educational participation

ü  Play and leisure: exploration and participation

ü  Rest and sleep: preparation and participation

·         Task selection and analysis

ü  What client factors, performance skills and patterns, or contexts and activity demands limit or enhance occupational performance?

·         Person (client factors; performance skills and patterns)

ü  Cognitive: orientation, attention span, memory, problem solving, sequencing, calculations, learning, and generalization

ü  Psychosocial: interests, coping skills, self-concept, interpersonal skills, self-expression, time management, and emotional regulation and self-control

ü  Sensorimotor: strength, endurance, ROM, sensory functions and pain, perceptual function, and postural control

·         Environment (context and activity demands)

ü  Physical: objects, tools, devices, furniture, plants, animals, and built and natural environment

ü  Socioeconomic: social supports: family, friends, caregivers, social groups, and community and financial resources

ü  Cultural: customs, beliefs, activity patterns, behavior standards, and societal expectations.

7.       EVALUATION FRAMEWORK USING THE OCCUPATIONAL THERAPY TASK-ORIENTED APPROACH:

·         Evaluation efforts focus initially on role performance and occupational performance tasks because they are the goals of motor behavior.

·         Top down approach  

·         Therefore, therapists use interviews, skilled observations, and standardized assessments to evaluate their clients.

·         The therapist may assess role performance using a nonstandardized, semistructured interview. However, a standardized assessment tool such as :

ü  Role Checklist

ü  Occupational Performance History Interview-II (OPHI-II

·         The evaluation process is the assessment of occupational performance tasks: Because roles, tasks, activities, and their contexts are unique to each person, a client-centered assessment tool such as:

ü  Canadian Occupational Performance Measure (COPM)

ü  Assessment of Motor and Process Skills (AMPS)

·         Occupational therapists use a variety of assessments to evaluate patient factors, performance skills, and performance patterns that support or constrain occupational performance.

ü  Arnadottir OT-ADL Neurobehavioral Evaluation (A-ONE)

8.      TREATMENT PRINCIPLES USING  THE OCCUPATIONAL THERAPY  TASK-ORIENTED APPROACH:

·         Help patients adjust to role and task performance limitations

·         Create an environment that uses the common challenges of everyday life

·         Practice functional tasks or close simulations to find effective and efficient strategies for performance

·         Provide opportunities for practice  outside of therapy time

·         Use contemporary motor learning principles in training or retraining skills

·         Minimize ineffective and inefficient movement patterns

     

8.1.Help patients adjust to role and task performance limitations

ü  Therapists can help by exploring alternative ways of fulfilling roles and of performing the associated tasks.

ü  Therapists also can explore potential new roles and new tasks

ü  The uses of compensatory strategies (i.e., adapted equipment or techniques) can be an efficient way to address role and task performance limitations

8.2. Create an environment that uses the common challenges of everyday life

ü  Therapists need to be creative in creating environments within their clinical settings that provide typical challenges. Some facilities have purchased more real-life environments facilities have remodeled their clinics to simulate environments in which patients typically have to interact

ü  Home care settings are ideal situations for following this treatment principle because the patient’s own environment and objects can be used for therapy.

8.3.Practice functional tasks or close simulations to find effective and efficient strategies for performance

ü  Persons need to practice functional, everyday activities to find the most effective and efficient way of doing the activity.

ü  Use of functional, natural tasks rather than rote exercise in treatment is important

ü  The therapist must use the functional tasks and activities that have been identified as important and meaningful to their patients. This demonstrates to patients that the therapist has listened to them and respects their choices and priorities. As a result, patients more easily understand the relevance of therapy to their lives.

ü  There is strong evidence that patients benefit from exercise programmes in which functional tasks are directly and intensively trained

8.4.Provide opportunities for practice  outside of therapy time

ü  Therapists need to recognize that the amount of time they have to work with a patient is short relative to the total time in a day

ü  Therapists can provide homework assignments for patients to work on their own

8.5.Use contemporary motor learning principles in training or retraining skills

ü  Use random and variable practice within natural contexts in treatment.

ü  Provide decreasing amounts of physical guidance and verbal feedback.

ü   Develop task analysis and problem-solving skills of patients so they can find their own solutions to occupational performance problems in home and community environments.

8.6.Minimize ineffective and inefficient movement patterns

ü   A patient performing an occupational performance task, therapists attempt to identify what may be critical personal or environmental factors that are interfering with effective and efficient movement patterns

ü  The following strategies are ways that therapists can intervene to reduce ineffective and inefficient movement.

Ø  Remediate a client factor (impairment) if it is the critical control parameter. When therapists identify person factors in the cognitive, psychosocial, or sensorimotor systems as possible critical control parameters, then they should attempt to remediate those factors, assuming it is possible.

Ø  Adapt the environment, modify the task, use assistive technology, or reduce the effects of gravity. For many patients, the quickest and most effective approach to improving occupational performance is to adapt the task or the environment.

Ø  For persons with poor control of movement, constrain the degrees of freedom. Persons learning a new task initially restrict the degrees of freedom at their joints by selfimposing some form of freezing of body segments. as a result, their performance appears stiff and uncoordinated. With practice, the performance becomes smoother and more coordinated as the restrictions on the degrees of freedom decrease

Ø  For persons who do not use returned function in their involved extremities, use constraint-induced therapy

9.      COMPARISON OF THE NEUROPHYSIOLOGICAL AND TASK ORIENTED APPROACH

	Neurophysiological approach	Task oriented approach
Models of motor control	Reflex – hierarchial  ·         Movement are elicited by sensory or controlled by central programs ·         Open loop and closed loop control is used ·         Feedback and feed forward influence movement ·         Central nervous system {CNS} is hierarchically organized with centers controlling lower center ·         Reciprocal innervation is essential for coordinated movement	Systems ·         Personal and environmental systems interact to achieve functional goals ·         Movement emerges from the interaction of many systems ·         Systems are dynamical ,self organizing and heterrarchial ·         Movement used for a task is the preferred means for achieving a functional goal ·         Changes in one or more systems can alter  behavior
Theories of motor development	Neuromaturational ·         Changes are due to CNS maturation ·         Development follows a predictable sequence ·         CNS damage lead to regression to lower levels and more stereotypical behavior’s	System ·         Changes are due to interaction  of multiple systems ·         Progression varies because person and environment context are unique ·         CNS damage leads to attempts to use remaining resources to achieve  functional goal
Assumptions of therapeutic approach	·         CNS is hierarhially organized ·         Sensory stimuli inhibit spasticity and abnormal movement and facilitate normal movement and postural response ·         Repetition of movement result in positive permanent changes in CNS ·         Recovery from CNS damage follows a predictable sequence ·         Behavioural changes after CNS damage have a neurophysiological basis	·         Personal and environmental systems, including the central nervous system, are hierarchically organized. ·         Functional tasks help organize behavior. ·         Occupational performance emerges from the interaction of persons and his or her environment. ·         Experimentation with various strategies leads to optimal solutions to motor problems.  ·         Recovery is variable because patient factors and environmental contexts are unique. ·         Behavioral changes reflect attempts to compensate and to achieve task performance.
Evaluation	Primary focus on performance components ·         Abnormal muscle tone ·         Abnormal reflexes and stereotypical movement patterns lead to incoordination ·         Postural control ·         Sensation and perception ·         Memory and judgment  ·         Stage of recovery or developmental level	Primary focus on role and occupational performance using a client centered view ·          Task analysis to determine performance component and context that limit function and to identify preferred movements patterns for specific tasks in varied contexts ·         Variables that cause transitions to new patterns
	Secondary focus on occupational performance	Secondary focus on selected occupational performance components and contexts that limit function