Optimizing Motor Behaviour Using the
Occupational Therapy Task-Oriented Approach
(Trombly Ch#22)
•Treatment Principles and Practices:
Client-Centered Focus
 The art of the OT Task-Oriented Approach is the identification of
interventions for the unique needs of each client.
 Treatment planning cannot be prescriptive.
 Assessment and planning of treatment should look different for each client.
 During assessment and treatment activities often the priorities and
meaningful occupations identified by clients differ from therapists to
another and from clients to another.
•Treatment Principles and Practices: Elicit Active
Participation of the Client During Treatment
 Clients should have an active role in treatment.
 Clients who are actively engaged in their treatment show:

achievement in self-identified goals

greater participation in the rehabilitation process

increased functional independence at discharge

discharges to less restrictive environments.
 Teach clients the principles of task analysis and how to evaluate
their own performance in terms of the outcomes of their efforts and
the efficiency and effectiveness of their movement patterns.
•Treatment Principles and Practices:
Occupation-Based Focus
 Intervention plan for OT Task-Oriented Approach is
occupation based.
 Use functional tasks as the focus in treatment.
•Treatment Principles and Practices:
Occupation-Based Focus (Continued)
 Select tasks that are meaningful and important to the client’s roles:

Consider a client’s occupational roles and the meaning of these roles to
the person.

Satisfaction or reward comes from the feeling that roles are fulfilled.

Consideration of roles also helps the occupational therapist tap into the
personal motivations of clients for performing particular tasks.

Select tasks that are within the realm of capabilities, are goal oriented,
have meaning for the clients, and motivate them.
•Treatment Principles and Practices:
Occupation-Based Focus (Continued)
 Analyze the characteristics of the tasks selected for
treatment:

Task analysis is necessary because clients’ capabilities
vary and different tasks require different skills.

Examine task requirements and the personal capabilities
to determine whether there is a match that permits task
performance.
•Treatment Principles and Practices:
Occupation-Based Focus (Continued)
 Describe the movements used for task performance:

Description of the preferred movement patterns that emerge for a given
task in a given context helps guide treatment.

Clients in the acute stage of recovery often use movement patterns that
show little stability.

Other clients seem obligated to perform a task in only one way.

This movement pattern may be effective for task performance in
one context, but the person may be unable to achieve functional goals
in varied contexts because there is no flexibility in movement
patterns.
 Determine whether the movement patterns are stable or
in transition:

This information is important because it helps the therapist
identify the optimal times to provide treatment and the
strategies necessary to produce a change in the preferred
movement patterns.

Transition period may coincide with aging, CNS damage, a
new environment, or many other factors.

If there is no preferred movement pattern or if the pattern is
fixed, the therapist may consider treatment to facilitate
change by the influence of some personal or environmental
systems.

When the movement patterns are unstable or in transition,
therapists are generally more likely to facilitate a change to
different patterns that are more efficient and effective.
 Analyze the movement patterns and functional outcomes
of task performance:

Analysis of movement patterns will help estimate stability and
flexibility, understand changes, and prevent fixation of movement
patterns. (reaching high rack) ‫رف عالى‬

Look at fluctuations in one or more quantitative measures of
movement patterns during task performance.

Determine what happens when the therapist tries to disturb or
perturb the movement patterns by changing some critical personal
or environmental factors. (change height of the rack)

The quantitative measures of movement patterns are collective
variables, and the critical factors influencing behaviour are control
parameters. (psychological status)
•Treatment Principles and Practices:
Person and Environment
 Identify the Personal and Environmental Factors :That Serve as
Major Influences on Occupational Performance

Identify the systems that support optimal functional
performance and those that contribute to ineffective
performance.

Identify Part of the OT process is making systematic
changes in personal characteristics and environmental context
and observing the effect on occupational performance.

Do not ignore the potential influence of culture and other
personal and environmental factors that influence occupational
performance.
•Treatment Principles and Practices: Person
and Environment (Continued)
 Anticipate That the Personal and Environmental Variables
Influencing Occupational Performance Will Change

Critical variables influencing motor behavior change over
time. (Typing machine ------------- computer)

Some systems are highly affected immediately after CNS
damage, while other systems become a more important
variable when the person returns home.

Critical variables and systems at a given time may vary
greatly, depending on the characteristics of the person and
environment. ( playing in low O2 stadium)

Therapists must identify the major influences on motor
behavior at a specific time for a specific person and
anticipate changes in the critical variables.
•Treatment Principles and Practices: Person
and Environment (Continued)
 Address Critical Personal and Environmental Systems to
Change Occupational Performance

After a critical personal or environmental factor is identified,
the therapist alters this characteristic until a shift in motor
behavior is observable.

The goals of occupational therapy are to help individuals
identify and use critical factors that support optimal
performance and to determine the optimal value for
producing the best performance outcome.
•Treatment Principles and Practices: Person
and Environment (Continued)
 Adapt the Task or Broader Environment to Promote
Optimal Occupational Performance

Performance context is as important as the personal
characteristics in treatment.

Examples of ways to alter the physical context:


Adjust the slope and height of support surface.

Vary the size, shape, and texture of the object used in a
task.

Modify size, length, and width of tools used.

Ask for changes in accuracy, speed, and complexity of task.
Social context can also influence motor behavior.
•Treatment Principles and Practices: Person
and Environment (Continued)
 Use Natural Objects and Natural Environments




Simulations and rote exercise do not produce the
same movement patterns as tasks using real
objects.
Research supports that the greater the number of
real objects and symbolic information, the more
performance is improved.
The rehabilitation unit should simulate the real-life
setting as much as possible if interventions cannot
be provided in the actual situation.
Many rehabilitation units have apartments with
ordinary home furniture and other resources to
simulate community settings.
•Practice and Feedback: Structure Practice
of the Task to Promote Motor Learning
 Goal for the outcome of practice is that clients can perform better
once they leave treatment.
 Studies support that practice of tasks should vary randomly; the
goal is to enhance motor learning or the capability for later
performance rather than change observable behaviors during a
practice session.
 Variation of the context within a task is also an important
component of practice.

Support Surfaces

Objects

Equipment

Task Demands

Required Information
 Varied contexts promote development of preferred movement
patterns for specific contexts and flexibility in movement patterns for
different contexts.
•Practice and Feedback: Design the
Practice Session to Fit the Type of Task
and Learning Strategies
 Practice may require the client to practice the task
differently:



In its entirety

Recommended for continuous and discrete tasks

Recommended for more simple tasks
In separate steps

Recommended for serial tasks

Recommended for more complex tasks
In some combination of whole and part learning
•Practice and Feedback: Design the Practice
Session to Fit the Type of Task and Learning
Strategies (Continued)
 Stages of Learning

Discovery


Mastery


Slow performance, clumsiness, self-imposed rigidity
More consistent, more accurate, faster, better
coordinated
Generalization
•Optimize Occupational Performance Given
the Constraints on the Person and
Environment
 After CNS damage, clients may have to learn
strategies for task performance given
personal limitations.
 When clients understand the idea of the task,
their personal limitations and capabilities,
environmental resources, and a basic
solution to the problem, they may begin to
practice the task.
 Therapists must identify ineffective
movement patterns that are hindering optimal
task performance or contributing to future
problems in personal and environmental
systems.