Model of Task-oriented practice

Question 1

What is the fundamental unit of therapist

Answer 1

• the task
• learning is goal oriented
• PTs are teachers of movement skills
• primary model of intervention should be manipulation of tasks
• produces activity-dependent neuroplasticity (changes the brain and SC)

Question 2

What does teaching movement skills involve

Answer 2

• task selection
• structuring the task context and environment
• task variation/changing difficulty and complexity
• switching to new tasks

Question 3

What does true attainment of a motor skill imply the movement has?

Answer 3

• consistency
• flexibility
• efficiency

Question 4

How to organize a task

Answer 4

• choose one task/functional movement
• list constraints and resources
• describe the components of the task
• how will you organize the environment and structure/change the task to work on consistency, efficiency and flexibility

Question 5

Assessing consistency uses a skill based framework

Answer 5

• rate of goal achievement
• accuracy

Question 6

assessing efficiency using a skill based frame work

Answer 6

• time (faster is generally more efficient)
• speed
• duration (longer periods of time increases efficiency)
• distance
• dual-task performance

Question 7

flexibility using a skill based frame work

Answer 7

• different conditions or environments
• predictable vs unpredictable conditions

Question 8

Measuring outcomes for task oriented practice

Answer 8

• patient-specific functional scale
• developed for pts with primary MSK dysfunction
• validity tested for pt with chronic pain, UE/LE dysfunction, amputation, MS
• can be used at initial exam, re-eval, dishcarge

Question 9

what are other ways to measure skill acquisition

Answer 9

• level of assistance (min/mod/max)
• components of a skill
• benchmark task: walking and holding something = more functional
• retention: do they retain a skill from 1 session to another; related to practice at home
• transfer: can they take the skills learned and apply it to another (STS to getting out of a car)

Question 10

Practice considerations

Answer 10

• dosing
• timing
• accessibility

Question 11

Dosing

Answer 11

• considerations: reps, intensity, duration
• effective dosing = neuromuscular changes, changes in brain/sc, changes in muscle function
• doing a functional task with proper function will cause long term neuromuscular changes

Question 12

Reaching example with dosing

Answer 12

• in infants 3-5 months is a critical period for developing reaching skills
• an infant with a stroke do not experience same early skills esp. bilaterally
• this can affect gross motor development
• more reaching practice is important
• dosage: 90 hours
• timing: as early as 8 weeks are associated with better outcomes

Question 13

Importance of participation and practice

Answer 13

• contextual interventions: change the task or child but not impairments
• examples: adapting a bike, climbing a wall with assistance, supported crawling device

Question 14

Participation and accessibility: when does participation start and why is it important

Answer 14

• participation starts the day you are born
• should continue throughout lifespan
• need to improve participation for those with greatest impairments in body structure and function (children who are unable to walk, adults with chronic conditions that limit participation)
• long term cost for them and society (they need to work/have more medical conditions that society will end up paying for)