4. Task Oriented Approach

Question 1

Task Oriented Approach

In repetitive, task-oriented training, the therapist provides 4 forms of interaction with the patient

Answer 1

• Feedback: KR about performance.
• Coaching
• Modeling
• Encouragement

Question 2

Task Oriented Approach

what are the 3 main elements of the CIMT protocol?

Answer 2

1. Repetitive tasks-oriented training (mass practice, shaping)
2. Adherence
3. Constraining

Question 3

Task Oriented Approach

The authors suggest that walking in daily living is predominantly

Answer 3

short duration with lots of initiation, termination, speed modulation, corner negotiation, and maneuvering.

Question 4

Task Oriented Approach

What are the initial parameters in Body Weight Support Training?

Answer 4

• Intensity: 40% of body weight, no incline, low speed (0.5 mph)
• Duration: a total of 30-60 min per session (may be 5 min bouts); 6-12 weeks.
• Frequency: 5 days/wk

(progress to ↑ speed, incline duration, ↓ amount of BWS)

Question 5

Task Oriented Approach

tasks are analyzed at three levels:

Answer 5

The functional, strategy, and impairment level

Question 6

Task Oriented Approach

how does a brain injury patient learn not to use a limb?

Answer 6

brain injury → unsuccessful motor attempts → stops using the limb → brain “learns” not to use the limb

Question 7

Task Oriented Approach

The task oriented approach looks at and treats motor behavior by focusing on:

Answer 7

• Functional abilities
• Strategies used to accomplish functional skills
• Recognition of the underlying impairments

Question 8

Task Oriented Approach

when is functional independence achieved?

Answer 8

when the patient is able to perform a functional task in many environmental contexts

ex: when the patient is able to get out of many types of beds and in many environmental contexts

Question 9

Task Oriented Approach

what is Accelerated Skill Acquisition Program?

Answer 9

• Uses skill, capacity, and motivation
• Combination of task-specific and skill-based/impairment-mitigating training with embedded patient-centered motivational enhancements

Question 10

Task Oriented Approach

what is task practice?

Answer 10

• Patient performs functionally based activities for 15-20 min
• PT provides global KR feedback at the end of the practice period.
• Functional activities are made more challenging by changing various parameters

Question 11

Task Oriented Approach

True or false: Body Weight Support Training can be used to improve cardiovascular function in patients who wouldn’t have otherwise been able to have this much movement

Answer 11

true

Question 12

Task Oriented Approach

what is the Modified Constraint Induced Movement Therapy?

Answer 12

• is a less intense protocol than original CIMT;
• 30 min sessions instead of 3-6 hours.
• And restraining 5 hours per day instead of 90% of wake hours.

Question 13

Task Oriented Approach

what does the physical therapist integrate/use to apply the task oriented approach?

Answer 13

• Functional Training
• Sensorimotor techniques (PNF, NDT etc)
• Motor learning theories.

Question 14

Task Oriented Approach

Describe 3 of the task-oriented approach basic principles

Answer 14

• Work on functional tasks that are meaningful to the patient, rather than on movements patterns (for cortical changes to occur).
• Vary practice conditions with emphasis on flexible task performance.
• Active participation/problem-solving by the patient.
• Clear identification of the goals to the patient.
• Feedback as needed (manual guidance only as needed)
• Early intervention.
• Specificity of training.

Question 15

Task Oriented Approach

As is true throughout this book (MAIII textbook), our task-oriented approach is based on both the…

Answer 15

the International Classification of Functioning, Disability and Health (ICF) and systems framework.

Question 16

Task Oriented Approach

What is the task-oriented approach based on?

Answer 16

• Theories of motor control (systems, reflex-hierarchical)
• Understanding kinetics and kinematics
• Neuroplasticity
• Theories of motor learning (Fitts and Posner)
• Role of the environment
• There is a shift from facilitation and inhibition towards the relearning of motor control necessary for specific functional tasks

Question 17

Task Oriented Approach

what is shaping?

Answer 17

• Shaping is a method of operant conditioning (Skinner behavioral technique) by which successive approximations of a target behavior are reinforced. Only small improvements are required for success but the challenge is increased steadily.

Question 18

Task Oriented Approach

a training program to be considered tactile task-oriented, it must be:

Answer 18

challenging, progressive and optimally adapted, and active participation

1. Challenging enough to require new learning and to engage attention to solve the motor problem;
2. Progressive and optimally adapted such that over practice, the task demand is optimally adapted to the patient’s capability and the environmental context; not too simple or repetitive to not challenge, and not too difficult to cause a failure of motor learning or a low sense of competence,
3. Interesting enough to invoke active participation to engage a “particular type of repetition” referred to as “problem-solving.”

Question 19

Task Oriented Approach

walking is most often performed in conjunction with other tasks, such as

Answer 19

carrying loads, scanning the environment, and engaging in social interactions.

Question 20

Task Oriented Approach

describe the steps of the Motor Relearning Program:

Answer 20

1. analysis of tasks (observation, comparison, identify missing components)
2. practice of missing components (using verbal, manual, and visual FB)
3. practice entire task (avoid learned errors and learned non-use)
4. transfer of training

Question 21

Task Oriented Approach

Within the ICF, mobility is considered both an….

Answer 21

1. activity (e.g., a task performed by an individual)
2. and a domain of participation (e.g., the societal level of functioning).

This can make it difficult to classify tests of mobility function. In this chapter, a mobility test performed in a standardized clinical environment is classified as an activity measure considered to capture the ICF’s concept of capacity.

Question 22

Task Oriented Approach

In a task-oriented approach, examination of mobility function analyzes performance at three levels

Answer 22

1. the functional-task level (10 m walk test, etc)
2. the essential strategies used to accomplish the requirements of mobility (observational)
3. the underlying sensory, motor, and cognitive impairments that constrain mobility.

Question 23

Task Oriented Approach

the relationship between impairment and gait parameters is very complex, and depends on many factors, including the

Answer 23

type and extent of impairment, the functional level of the patient, and the capacity for compensation by other systems.

Question 24

Task Oriented Approach

Describe three of the task oriented approach assumptions:

Answer 24

• Normal movement emerges from the interactions between many systems.
• Movement is dependent upon interactions among the individual, the task, and the environment.
• Mvmt organized around a behavioral goal.
• Sensation is not only for stimulus/response, but essential for predictive and adaptive control.
• What is observed in a pt with a motor cortex lesion is the effort of the remaining system to participate.
• The brain is plastic and can recover.

Question 25

Task Oriented Approach

name 4 clinical applications of the task-oriented approach:

Answer 25

• Motor Relearning Program
• Body Weight Support Training
• Accelerated Skill Acquisition Program (ASAP)
• Constraint-Induced Movement Therapy (CIMT)

Question 26

Task Oriented Approach

Body Weight Support Training progression strategies:

Answer 26

Standing training → step training → step adaptability training (change speed, incline, and duration) → overground walking training → community integration

Question 27

Task Oriented Approach

what are the two rationale mechanism underlying Constraint Induced Movement Therapy?

Answer 27

1. Overcome learned non-use
2. Use-depended brain/cortical plasticity