contemporary task oriented approach.pptx

CIMT

1. Contemporary task oriented approach Dr. Madhu

2. BACKGROUND Contemporary task oriented approach is a restorative, therapeutic training based on a systems model of motor control and theories of motor learning. This was given by bernstein in 1967 to retrain the patients with movement disorders. This approach attempts to understand the problems faced by the nervous system to control movements. It utilizes a training program that focuses on specific functional tasks to promote and restore optimal functional capacity.

3. INTRODUCTION Movement emerges from interactions of many systems. Personal characteristics and environmental context interact to achieve functional goal. Systems are dynamical, self organised and heterarchial . Movement patterns for a given task are stable and the preferred means for achieving a functional goal. Control parameters or changes in one or more systems can shift behaviour from one movement pattern to another.

4. THEORIES Contemporary developmental theories- (a)Changes in motor development are due to multiple factors or systems such as maturation of the nervous system, biomechanical constraints and resources and the impact of the physical and social environment. (b) Normal development is the search for optimal solutions to functional problems and does not follow a rigid sequence( intertask ) as the motor milestones. Childrens follow variable developmental sequences owing to their unique personal characteristics and environmental contexts. Intratask sequences provide guides for age appropriate movement patterns.

5. THEORIES 2. Contemporary motor learning theories- Learning is defined as relatively permanent changes in performance due to practice or experience. Learning is enhanced through practice of whole tasks in varied contexts and summary, less frequent feedback.

6. Main goal Find optimal movement patterns for task performance. To use the actual activities and tools for therapy that you would use in daily life.

7. Major concepts Functional tasks help organise motor behaviour. Occupational performance emerges from the interaction of multiple systems that constitute the unique characteristics of the person and environment. Practice and experimentation with multiple strategies and in various contexts are needed to find the optimal solution for motor problems and enhancing skills and performance. After CNS damage or other changes in personal or environmental systems, clients behaviour role changes reflect attempts to achieve functional goals. The art of the task oriented approach is the identification of interventions for the unique needs of each client, taking into account unique personal and environmental systems and roles that have importance and meaning for the individual . Thus treatment planning cannot be prescriptive.

8. ASSUMPTIONS Personal and environmental systems, including the CNS are heterarchically organised. Behaviours seen after CNS damage or changes in other systems reflect attempts to compensate and achieve task performance. Functional tasks help organise behaviour. Occupational and role performance emerge from the interaction of multiple personal and environmental systems. Practice and experimentation with varied strategies are needed to find the optimal motor solutions and to develop skill. Recovery from CNS damage will be variable because of each patients unique personal and environmental systems.

9. EVALUATION 1. Occupational and role performance. Tasks are selected by considering a clients occupational roles and their meanings. 2. Patient centered identification of problematic and important tasks. 3. Preferred movement pattern for given tasks in varied contexts. 4. Systems which can cause transition from one pattern to another. 5. Secondary evaluation of subsystems which are interfering with performance.

10. PRINCIPLES OF TREATMENT Client centered Occupation based Person and environment Practice and feedback General treatment goals

11. Client centered – Adopt a client centered focus in treatment. Elicit active participation of the client during treatment.

12. Occupation based- Use functional tasks as the focus in treatment. Select tasks that are meaningful and important to the client’s roles. Describe the movements used for task performance. Analyse the movement patterns and functional outcomes of task performance.

13. Person and environment- Identify the personal and environmental factors that serve as major influences on occupational performance. Adapt the task or broaden the environment to promote optimal occupational performance.

14. Practice and feedback- Structure practice of the task to promote motor learning. Design the practice session to fit the type of task and learning strategies. Provide feedback that facilitates motor learning and encourages experimentation with solutions to occupational performance problems.

15. General treatment goals- Discover the optimal movement patterns for task performance. Achieve flexibility, efficiency and effectiveness in task performance . Develop problem solving skills with clients so they can identify their own solutions to occupational performance problems in home and community environments.

16. Strength of the approach Use of real objects and natural environment. Focus on meaningful tasks and functional goals. Client centered Intervention not limited to one strategy. Efficient and focused. Enables problem solving skills in the client.

17. Limitations Conflicting evidence Not yet fully developed or refined Efficacy studies are needed. Limited application in acute settings. Limited application for clients with significant cognitive impairment. Difficult to stimulate natural environments or some tasks in clinical settings (interventions should ideally occur in the acute settings …. ie home, school, at work etc…. Difficult to measure improvements.