Week 2 - 4QM Flashcards
How do you decide which children the 4QM frame of reference is most suitable for?
4QM is suitable for:
● The child requires necessary performance components (not about developing those skills / building up
strength etc)
● A child who has the capacity to be autonomous (skills mastery, decision making & contextual competence) in
the activities; includes cognitive and physical learning
● not a child who requires us to address environmental strategies
● A child requiring a person-centred implementation of strategies to achieve an activity (needs
facilitation/scaffolding to attain performance components)
What would being ALERT mean when designing intervention for a child using 4QM?
Looking at 5 aspects of the intervention:
- Activity
- Learner
- Environment
- Relationship
- Therapist
Describe ALERT
● Activity: understand impact of nature of task (for selection of strategies)
○ pre-planned or during execution / how long? / physical, cognitive or social task? what facilitation
required?
● Learner: know specifics about the child’s learning ability
○ preference; verbal or visual
○ ability & limitations; cognitive, physical and psychological, sensory
○ motivation for engagement (reinforcers or known helplessness)
○ task difficulty; appropriate level to facilitate performance
○ past learning; previous experience of child
○ attribute success and failure; internal & external factors of child
● Environment: develop strategies to enable performance, what is the best strategy to use for them
○ use of visual prompts; where?
○ use of verbal self-regulation, is it possible?
○ use of kinesthetics; is it possible?
○ is it safe, sensory and socially valid?
● Relationship: develop strategies that will empower the child
○ demonstrate empathy
○ provide unconditional positive regard
● Therapist: develop strategies to reflect on your competency
○ what’s your experience with facilitated learning / using these strategies
○ how will you communicate with the child for most effective practice
○ do you have the same expectations of the child in terms of success and failure
What are the four quadrants of 4QM?
- Task specification
- Decision making
- Recall
- Autonomy
When could each quadrant be used?
- Used if child has base/no knowledge or in beginning of intervention
- Used when child is learning a previously unknown skill
- Used when child is able to perform skill with assistance
- Used when child is able to independently complete skill
What are the strategies related to Task specification
- Explicit instruction/explanation
- Demonstration
- Physical patterning (guide child through the task)
- Lower order questions (what comes next?)
What are the strategies related to Decision making
- Think aloud modelling (talk through what you’re doing)
- Feedback (have you got your arm in the right sleeve?)
- Physical prompts
- Non-verbal prompts (looking at something)
- Higher order questions (What’s gone wrong?
What are the strategies related to Recall
- Priming
- Pneumonic
- Verbal self-instruction
- Visual cues
- Kinaesthetic self-prompting
What are the strategies related to Autonomy
- Mental imagery
- Self-instruction
- Self-monitoring
- Problem solving
- Automaticity
(Often hard to see as a therapist)
Top down vs bottom up approaches
- Top down approach - Focus first on the specific difficulties they’re having with these activities (e.g. keeping up) and specify the child’s concerns, ability, goals using an assessment/observation tool. Identify goals based on the specific findings of this tool to enable the child. The wider focus (gross motor skills maybe) may be addressed through this intervention.
- Bottom up approach - Focus on tools that will supply the broader concern (e.g. gross motor skills) and determine a goal and intervention to increase these. Note that this will not focus on the child’s ability to keep up with other children exactly. Moreso, the act of increasing motor skills should assist in fixing the individual issue too.
Why is teaching and learning an OT strategy?
We are involved in trying to help people become autonomous in the ADLs
Direct teaching methods
- Command
- Inform learner of key elements of task
Indirect teaching methods
- Self-teaching
- Consider barriers to performance
- More likely to arrive at solutions
- Engage learner in decision making and task
Evaluation of occupational analysis
- What tasks need to be mastered
- How is the child currently performing the task
- Does the child have the necessary performance components
- Nature of the task & environment
Task specification
Does the child know what to do and how to do it?
- Requires facilitator to indicate the nature of the task and characteristics of performance (show them, describe what they goals is)
