Chap 10 & 12 Flashcards
1
Q
3 stages of Motor Learning
A
Cognitive
Associative
Autonomous
2
Q
Motor learning:
Cognitive
A
learner relies on cognition to guide movement; talks and thinks through steps; requires increased time and effort to complete tasks
3
Q
Motor Learning:
Associative
A
learner makes connections to previous experiences without having to talk through steps
4
Q
Motor learning:
Autonomous
A
learner no longer thinks consciously about movements, performing them quickly and efficiently while adjusting to changes
5
Q
Procedural learning
A
involves mastering movements or techniques
- OT practitioners divide motor performance into simple actions for instruction, include a demonstration in instruction, and follow demonstration with practice and feedback sessions
- Doing it all at once - mastering it
6
Q
Declarative learning
A
depends more on memory and other analytic skills and refers to descriptive sequencing of events; can be related as a story (“first, I do this…next, I do that…”)
- Tasks are often first learned in a declarative way and later become procedural
- Talking it through - learning step by step
7
Q
Motor Learning Principles
A
guidelines for how to structure intervention (pg.160 Box 10.2)
- clients learn movements more easily if they are meaningful, practiced as a whole (vs. part), and practiced in the natural context (which promoted variability and problem solving)
8
Q
Motor Learning Strategies
A
Evidence-based techniques based on principles that promote motor control (pg. 162 Table 10.2)
- use of motor learning strategies to improve motor performance (as measured by accuracy, improved muscle co-contractions, increased repetitions or movement, and improved participation in daily activities)
9
Q
Motor Learning Strategies:
Meaningfulness
A
- Skill has meaning or purpose to the client
- Client expresses interest in skills/chooses activities and skills.
- Client acknowledges abilities and self-efficacy (belief in skills).
- Client shows pleasure in the activity.
- Client wants to demonstrate skill.
10
Q
Motor Learning Strategies:
Transfer of Learning
A
- To obtain a true measure of learning and skill retention, performance must be assessed outside of intervention sessions and in as realistic a setting as possible
- Generalization occurs more reliably with practice in different contexts
- Practice under variable conditions can increase the generalization of learning to new situations
- Training should occur in the environment most appropriate and most realistic for the task being performed
11
Q
Motor Learning Strategies:
Feedback - Modeling or Demonstration
A
- Demonstration is most effective when given before the client practices the skill and in the early stages of skill acquisition
- Demonstration should be given throughout the practice as needed but should not be accompanied by verbal commentary
- Practitioner should direct client’s attention to critical cues before the skill is demonstrated
12
Q
Motor Learning Strategies:
Feedback - Verbal Instructions
A
- Brief, highlight main cues, and be carefully timed
- Should be used for major aspects of the movement and repeated so that the client can use the cues
- Practitioners may benefit from practicing limiting verbal cues, especially when the client is performing movement
13
Q
Motor Learning Strategies:
Feedback - Intrinsic feedback
A
The natural consequence of performing the task; occurs during task performance and after the task is completed
14
Q
Motor Learning Strategies:
Feedback - Extrinsic feedback
A
Information about performance from an outside source; used to augment intrinsic feedback:
- Knowledge of Performance
- Knowledge of Results
15
Q
Distribution and Variability of Skill Practice:
Blocked practice:
A
- involves the repeated performance of the same motor skill
- The client solves the motor problem once or twice, then repeats the same motor skill
- Provides limited learning
- In early learning or with confused individuals, it can promote learning
16
Q
Distribution and Variability of Skill Practice:
Distributed practice
A
- may involve taking short breaks while practicing multiple skills over longer periods
- May assist with client’s learning better than massed practice
17
Q
Distribution and Variability of Skill Practice:
Random practice
A
- involves repetition of motor patterns + formulation of plans to solve motor problems
- Motor skill acquisition is not as rapid compared with blocked practice but is more beneficial to retention
18
Q
Distribution and Variability of Skill Practice:
Skill acquisition stage
A
- client understands the idea of movement but has not learned it
- Errors are common; performance is inefficient and inconsistent
- Frequent repetition and feedback are necessary
- Blocked practice is used
19
Q
Distribution and Variability of Skill Practice:
Skill refinement stage
A
- client demonstrates improved performance, fewer and less significant errors, and increased consistency and efficiency of movement
20
Q
Distribution and Variability of Skill Practice:
Skill retention stage
A
- the client can perform movement and achieve functional goals; the hallmark of true motor learning
- Objective is to retain the skill and transfer it to different settings
21
Q
Distribution and Variability of Skill Practice:
Whole learning
A
- client practices the entire task at one time; simple and discrete tasks are learned best via this method
22
Q
Distribution and Variability of Skill Practice:
Progressive-part learning
A
- teaching in steps; intermediate skills and serial tasks are learned more easily via this method
23
Q
Distribution and Variability of Skill Practice:
Pure part learning
A
- part of a task is learned alone
24
Q
Distribution and Variability of Skill Practice:
Whole-to-part-to-whole learning
A
- learning a part in the context of the whole; leads to best retention when the client must learn a complex skill
25
Occupation as whole learning:
Occupation-based activities
Activities are those deemed meaningful to the client in terms of desired occupations, occur in actual context, require the client to adapt to real situations
26
Occupation as whole learning:
Contrived activities
Activities may be used in clinical settings when replicating the exact occupation is impossible; when activity is closer to the actual occupation, the learning is more useful
27
Occupation as whole learning:
Preparatory activities
Activities include activities that help the client perform the specific components of motor tasks; should be used sparingly because they are far from occupation, and clients may struggle to connect activities to their goals
28
Mental practice
(also known as visualization)
- Involves imagery or rehearsing motor performance mentally
- Can facilitate the acquisition of new skills and relearning of old ones
- Most beneficial when combined with physical practice
29
Teaching/Learning Process
– a systematic problem-solving process designed to facilitate learning
30
Teaching/Learning Process:
Assessment
- OT practitioner assesses characteristics of self; characteristics of patient; client factors, including cognitive, perceptual, physical, and psychosocial factors.
- Pt. attitudes, feelings, and emotional state in relation to the task, the practitioner, and the teaching process are also considered
31
Teaching/Learning Process:
Design of teaching plan
- In selecting intervention activities, OT practitioner considers the client’s goals, interests, and sources of motivation (intrinsic/extrinsic) and selects the most appropriate environment to foster learning
* Selecting activities relevant to the client’s roles and meaningful in family or social group ensures a higher level of motivation and participation
32
Teaching/Learning Process:
Instruction
- OT practitioner teaches task/activity in an understandable, meaningful way; repetition may be important to the learning process; clients are given opportunities to ask questions/seek clarification
- Clients are challenged in task performance but still experience some success (just right challenge)
- Tasks are taught in a relevant environment and context
33
The Teaching Process:
Preparation
- Pre-Instruction phase
- Preparation of environment for therapy session before the client arrives; intervention time should not be spent setting up treatment session
34
The Teaching Process:
Demonstration
- Motivation and instruction phase
- Key points are stressed, and instructions are given clearly, competently, and patiently, using few and easily-understood words; repetition and review are often necessary
- Some clients require tactile and kinesthetic cues or gentle manual guidance with verbal and demonstrated instruction
35
The Teaching Process:
Return Demonstration
- Performance phase
- If possible, the client should attempt to list aloud key points while performing the activity to reinforce understanding
36
The Teaching Process:
Follow-Up
- Guided Independence Phase
- Practitioner corrects faulty performance, gives client opportunities to ask questions, and provides realistic, positive, and appropriate feedback
37
How is feedback beneficial to the client?
Feedback can encourage a person to continue learning, allows recognition of mistakes, and performance modification
- Correcting the learner as soon as an error is noted is best so that erroneous patterns do not develop
38
Reinforcement for Cognitive tasks
– verbal reinforcement should be direct and meaningful; behavior that is reinforced tends to be repeated
39
Reinforcement for Motor tasks
– external reinforcement may override intrinsic mechanisms and not allow for innate self-correction
40
How is Constructive feedback given
Constructive feedback is given thoughtfully, tactfully, and is delivered in a non-threatening and honest manner
41
Methods of Teaching:
Teaching through the Auditory System
- Verbal Instruction
- The client must understand words spoken, retain the memory of the command, retrieve it from memory, and plan and execute the motor task
42
Methods of Teaching:
Teaching through Visual and Auditory Systems
- Verbal Instruction and Demonstration
- Clients with dyspraxia will have difficulty imitating demonstrations; poor visual or auditory memory may also limit learning via this method of instruction
43
Methods of Teaching:
Teaching through Somatosensory and Vestibular Systems
- Touch, Proprioception, and Motion
- Useful for clients who have difficulty following verbal and demonstrative instruction; the feeling of the correct movements and tactile cues may augment visual/auditory input to enhance learning
- Practitioner may choose to provide no verbal guidance or short, simple commands
- Guiding is a special form of tactile, proprioceptive, and vestibular input
- little to no verbal instruction is given
- The client maintains contact with a reference point of the solid support (e.g., table, counter surface) rather than moving through space unsupported - the purpose of guiding is to give the client familiar sensory input
- Clients with severe tactile and proprioceptive sensory losses or who dislike/resist being touched will not benefit from this approach
44
Forward chaining
- Pt completes the first step independently
- Only slightly help with other steps
- Slowly stop helping them with each step
45
Backward chaining
- Helping all the way up to the last step - next time
Pt would complete all steps with aid and only complete the last step alone
46
How does OT utilize occupation?
OTPs utilize occupation, the activities or tasks that people need or want to do, to facilitate meaningful engagement in daily life
47
What are Principles of Occupation
○ Occupation stimulates growth and changes through the complex interaction between the individual, the task, and the environment (Box 12.1, pg 183)
○ Process of “doing, being, becoming, and belonging” is directed by the inherent need for mastery, self-actualization, self-identity, competence, and social acceptance
48
What are the three components of interplay?
Person
Enviroment
Occupation
49
Interplay of the Person
– Each person has specific capacities, characteristics, and beliefs that influence occupational choices and performance
50
Interplay of the person: Client factors
value systems, body functions, and body structures can be affected by the presence or absence of illness or injury and can affect performance skills
51
Interplay of the person: Performance Skills
(motor, processing, social) demonstrate a client’s abilities to perform daily occupations
* An injury that limits motor functions can affect functional mobility and the ability to transfer from one position to the next
* Change in one performance skill can affect other performance skills and improve overall performance in the desired occupations
52
Interplay of the person: Performance Patterns
(habits, routines, roles, rituals) can support or hinder occupational performance
* OT practitioners that consider a client’s performance patterns will have a better understanding of how performance skills and occupations interrelate and are integrated into one’s life
53
Interplay of the environment: Physical Environment
A person’s abilities, limitations, and overall occupations cannot be understood without the consideration of the environment
* Physical environment is non-human (i.e. buildings, furniture, tools, devices, animals, terrain) and refers to the natural and built surroundings in which daily occupations take place
* The physical environment may present barriers to participation in occupation, including the size of doorways or access to entry ramps, for individuals who use a wheelchair
* It is important to note the sensory elements (visual, auditory, olfactory) and their impact on performance
□ A cold therapy gym, can increase the muscle tone in the hand of a client following a CVA, inhibiting participation
54
Interplay of the environment: Social Environment
consists of the networks and relationships of family, friends, colleagues, and caregivers
□ Individual or group behavioral expectations as well as psychological aspects may have an effect on mood and stress levels
* The tangible environment and the social environment guide and dictate occupational performance to the same extent that physical and mental capacities do and must be considered in developing an intervention plan
55
Interplay of the environment: Cultural Context
includes an awareness of and respect for the customs, beliefs, behavioral standards, and expectations of the client’s society
56
Interplay of the environment: Temporal Context
time of day, chronological age, and expected length of stay, as well as the anticipated duration of disability, stage of illness, and individual history
57
Interplay of the Occupation
Occupation occurs within a certain environment and context and is influenced by client factors, performance skills, and performance patterns.
* Occupation can be organized into many categories, such as ADL, IADL, leisure, play, social participation, education, work, rest, and sleep
* Each client engages differently due to the multidimensional nature and complexity of the occupation
* Unique features of each occupation need to be analyzed by OTPs to be effective in facilitating engagement.
58
Methods Used in Occupational Therapy Intervention
○ OTPs and OTAs utilize therapeutic reasoning to consider how each therapeutic method may affect the targeted outcome of the intervention (See Table 12.1)
* Therapeutic use of meaningful occupations and purposeful activities
* Environmental modification
* Activity adaptations
* Preparatory tasks and methods
* Education and training
* Advocacy
* Group intervention
59
Why use meaningful occupations and purposeful activities?
○ Meaningful occupations and purposeful activities promote health and wellness, prevent disability, restore function, maintain performance capacity, and are used to modify factors related to participation
○ Purposeful activities may include practicing medical management with beads and mock medication bottles, or practicing shower transfers in the hospital bathroom
60
What are preparatory tasks?
○ Preparatory tasks and methods prepare for the engagement in therapeutic activities
* Preparatory tasks typically include active client participation and occur in a clinical or simulated setting
* Preparatory methods are passive intervention applications used to improve a specific client factor in order to increase participation in occupation
□ These include sensorimotor techniques such as the application of neutral warmth to decrease hypertonicity in the UE to increase engagement and PAMs
61
What is Occupational Analysis
systematically analyzing the aspects of an activity and how a person or group of people completes an activity
* Through this process, OTPs synthesize information obtained from the activity analysis with assessment results to understand the specific situation in order to facilitate client change
62
Occupational Adaptation and Grading
○ Comprehensive analysis of occupation allows practitioners to understand how to adapt the task to the client’s functional capacities, strengths, and challenges and maximize participation, engagement, and performance
○ Helps to determine the just right challenge, which is a careful balance between the challenge of the task and the skills of the person
* If the challenge is too high and the skills of the person are low, frustration may result
* If the challenge of the task is too low and the skills of the person are too high, decreased motivation and engagement may result
63
Adapting Activity (Compensation)
* Components of an occupation that need to be adapted to increase participation may be discovered through activity analysis
* If a client has decreased strength and endurance required to complete an ADL task, the method may be altered
□ Sitting instead of standing
□ Change of environment
□ Adaptive equipment
64
Grading Occupations (Remediation)
* Grading activities by increasing or decreasing the demands facilitates skill development, increases the likelihood of success, and improves participation
* As with compensation, many factors need to be considered when grading a task, especially what the activity demands are, and what performance skills are required for successful completion
* Grading can be done through changing the activity itself, or changing the environment in which the activity is performed
* There are almost endless varieties of ways to grade activities, which makes occupational therapy both an art and a science (Table 12.2)
65
Selection of Activity: physical dysfunction
Treatment activities for physical dysfunction are usually designed for their potential to improve function in sensory, movement-related, and mental factors to help sustain motivation to engage in activity
66
Selection of Activity: improvement of physical performance
Activities selected to improve physical performance should provide desired exercise or purposeful use of affected areas.
67
Activities should...
* Activities should enable the patient to transfer the motion, strength, and coordination gained in adjunctive and enabling modalities to useful, normal daily activities
* Activities should allow for active participation and opportunities for practice, such as those involving repetition of motion to benefit the patient
* Other examples are using puzzles and cognitive training media to develop visual perception functions, motor planning skills, memory, sequencing, and problem solving
* Practice should be daily or frequent, and feedback should be given often to reduce errors and refine skills for performance in real life purposeful activity
68
What is a preparatory task
Therapeutic exercise is a preparatory task
□ TheraPutty exercises to improve hand strength and dexterity
69
What is a preparatory method
* Preparatory methods may include PAMs
□ Heat can prepare soft tissue for movement or stretch
□ Electrical stimulation can influence soft tissue extensibility and prepare muscles for stretch or movement
□ Other forms include manual edema mobilization, wound care, dressing changes, and assistive technology
70
Preparatory Tasks: Therapeutic Activity
Therapeutic activities are dynamic activities that develop or restore normal movement patterns, muscle strength, endurance, coordination, ROM deficits, and joint contractures
□ Facilitates improved performance in functional activities
□ Using a dressing frame fitted with laces, buckles, buttons, and zippers to aid manual dexterity and finger coordination
