Teaching Activities in Occupational Therapy

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Teaching Activities in Occupational Therapy

• (?????????)
• ??? (Jyh-Jong Chang) ???
• ????????????
• Email jjchang_at_kmu.edu.tw
• TEL [phone], Office CS505

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Learning Objectives

• Clarifying Activity analysis, Adaptation, and
  Synthesis
• Learning the Teaching Processing in Occupational
  Therapy
• Types of Learning in Occupational therapy
• Stage of Skill Development
• Factor that influence the teaching-learning
  process
• Reference
• Lorraine Williams Pedretti, Mary Beth Early.
  Occupational Therapy Practice Skill for Physical
  Dysfunction. 5th edition. P83-90

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Activity A critical component of Occupational
Therapy

• Enhance activity performance for OT intervention
• Analyze activities
• Adapt activities
• Synthesize activities
• Teach activities

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Activity Analysis

• To determine an activitys long-range effect on
  the clients health
• Activitys ergonomic effects
• Activitys energy requirements
• To determine the extent to which specific
  performance components are needed
• Criteria for activity adaptation for clients
  maximal independence

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Activity Adaptation

• Modification of well-recognized tasks
• Context, material, and rule of activities
• Making performance easier or safer
• Activity engagement as a therapeutic challenge

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Activities Synthesis

• The development of new and often unfamiliar
  activities
• Create a unique option for accomplishing
• Providing opportunity to practice meeting
  performance component goals

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Teaching Activity Why OT Teach
Activities?

• The needs for new ways of performing familiar
  activities after illness
• To meet medical or therapeutic goals
• Living with disability
• Serving as therapeutic challenge to help
  individuals improve performance component
• To achieve the functional goal of the individual

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Types of Learning Processes

• Training versus Learning outcomes
• Goal of training ---- to memorize a prescribed
  solution to a selected task challenge
• Goal of learning ---- to develop his or her own
  solution, which can be applied in a variety of
  solutions

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Stage of Skill Development

• Learning
• Stage one Skill acquisition
• Stage two Skill retention
• Stage three Skill generalization

• Training
• Stage one Skill acquisition
• Stage two Skill retention

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• Both training and learning entail skill
  acquisition and skill retention
• Skill generalization is the major distinction
  between training and learning
• Skill generalization is an outcome of learning,
  but not outcome of training

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• Occupational therapist structure the environment,
  the task goal, and interactions with each client
  to maximize the teaching-learning process

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Client Therapist Interaction
Task
Environment
Teaching-Learning Process in Occupational Therapy
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Taxonomy of Task Categories

• Task classificationtwo dimension
• Supporting surface
• Stationary or moving
• Environment features
• Task objects (size, configuration)

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Task Open vs. Close

• Open tasks
• An unpredictable motion of supporting surfaces
  during task performance
• Timing of responses, spatial anticipation
• Sitting in a moving train, people cross the
  street
• Open task performance cannot be learned through
  repetitive in a stationary environment
• Most ADL tasks changing in environment and times
  (open tasks)

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• Close task
• The use of repetitive practice is effective only
  with closed tasks
• Task with supporting area or stationary objects

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• The skills required for successful open-task
  performance cannot be learned through repetitive
  practice in a stationary environment

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Learning Procedural vs. Declarative

• The learning necessary for motor execution is
  referred to as procedural learning
• Without a significant language involved
• The learning necessary for highly contextual,
  categorical, analytical, and cognitive activities
  is called declarative learning
• A significant language involved
• Mental rehearsal ? increased declarative learning
  

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Factor that influence the teaching-learning
process

• Active participation
• Strategy development
• Externally forced instruction
• Intrinsic feed back
• Practice conditions
• Contextual interference
• Random practice schedules
• Naturalistic contexts
• Whole-task practice

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Active participation

• Learning is an active process
• Massage is not useful for motor learning
• Understanding the outcome goals
• Ready for learning
• For declarative learning
• Rephrase the objectives and procedures for task
  performance is helpful

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Strategy Development

• Motor strategies
• Cognitive strategies
• Interpersonal strategies
• Coping strategies

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Developing of strategy

• Encounter problem ? implementing solutions?
  monitoring the effects of these solutions
• Occupational therapist use activities to help the
  clients develop useful strategies by structuring
  the environment, the task goal, and interactions
  with each client that provide individuals with
  opportunities to try out different solutions to
  the challenges that arise

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• Self-awareness and self-monitoring skills
• Skill to generate and apply appropriate strategy
• Metacognition
• The knowledge and regulation of personal
  cognitive processes and capacities
• An awareness of personal strengths, limitation,
  abilities to evaluate task difficulties, plan
  ahead, choose appropriate strategies etc

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Instruction

• Therapeutic instruction provides cues that orient
  the client to selected performance guidelines
• Verbal instruction
• Visual instruction
• Photo, picture and drawings
• Somatosensory instruction
• Through tactile, kinesthetic channels
• Manual guides speed, direction
• Procedure learning, effective

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• Instructions elicit internal or external focus of
  attention
• Internal focus of attention
• Reaching forward as far as possible
• External focus of attention
• Reaching to control a game panel ? more effective

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Feedback

• Information about a response
• Feedback can be
• Intrinsic feedback or extrinsic feedback
• Concurrent feedback or terminal feedback
• Providing knowledge of performance and result

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Intrinsic Feedback

• Intrinsic feedback is information received by the
  learner as a result of performing the task
• Proprioceptive, tactile, vestibular, visual, and
  auditory sensory system
• It arises from sensory stimulation while
  performing the task and after the task is
  completed (i.e., the results of the action)

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• Intrinsic feedback may not be brought to
  conscious awareness, but should be processed
  within the cortical as well as the cerebellar
  structures to determine whether the motor
  patterns selected for task accomplishment were
  correct or need refinement.

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• In reality the patient does not notice all these
  variables but does recognize whether the task is
  accomplished.
• If the CNS determines that corrections are
  appropriate, the plan will be modified the next
  time the task is practiced.

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• In patients with sensory, perceptual, or
  cognitive impairments, the capacity for intrinsic
  feedback may be mildly to severely limited.
• If intrinsic feedback is not possible or is
  distorted by sensory or motor dysfunction,
  extrinsic feedback is needed for motor learning.

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Extrinsic Feedback

• Feedback about performance from an outside source
  such as a therapist or a mechanical device is
  called extrinsic feedback.
• It is used to augment intrinsic feedback.
• Extrinsic feedback can provide information about
  (1) knowledge of performance (KP) and (2)
  knowledge of results (KR).

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Performance feedback (KP)

• Verbal feedback about the process or performance
  provides the patient with information about the
  movements in achieving a motor skill.
• Kinematic and kinetic components of movement
• This feedback informs the performer of the
  movement's effectiveness in achieving the goal
• Typing fingers alignment, force generation, KMG
  feedback

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Results feedback (KR)

• The therapist provides feedback about the
  outcome, product, or results of the motor actions
• Results feedback can also point out faulty
  performance and facilitate the revision of
  movement patterns
• Typing speed, number of words

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• Therapists should use performance feedback more
  than results feedback during treatment sessions
• Performance feedback is directed toward
  correcting faulty movement patterns

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• The frequency and level of extrinsic feedback are
  determined by the task being performed and the
  stage of learning.
• Feedback should be given more frequently in early
  stages of learning so that the patient can
  correct performance errors.

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• Studies have demonstrated that when enough
  feedback has been provided for the patient to
  correct important errors in movement, it should
  be gradually decreased.

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• This declining schedule of feedback actually
  enhances long-term retention of activities
  learned in the rehabilitation program because the
  patient uses inherent feedback to self-correct.

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Practice conditions
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Contextual interference

• Factors in the learning environment that increase
  the difficulty of initial learning
• e.g. limited KR
• A high level of contextual interference forces a
  person to use multiple and variable processes to
  overcome the difficult of practice

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Practice Contexts

• Practicing in different contexts facilitates
  generalization of learning.
• Practice conditions affect transfer and retention.

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Transfer

• Transfer enables an individual to perform similar
  tasks in a new context by drawing on past
  experience.
• Transfer indicates the motor retention stage of
  motor learning has been reached.

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• Practice under variable conditions can increase
  generalization of learning.
• Training should be done in the environment most
  appropriate to the task and should be as
  realistic as possible.

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Blocked and random practice schedules

• Low and high contextual interference

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Random Practice

• Clients attempt multiple tasks or variations of a
  task before they have mastered any one of the
  task
• If several tasks are planned for the treatment
  session, it is best to present them in random
  order.
• For example, the patient may be asked to pick up
  cones, cubes, buttons, and spheres in random
  order.

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• The prehension pattern for each is different,
  requiring the patient to reformulate the solution
  to the motor problem each time a different object
  is approached.

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• Practice involves not only repetition of the same
  motor patterns but also the formulation of plans
  to solve motor problems.

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• If motor skill acquisition is measured by
  performance during a random practice session,
  learning may not appear to be taking place as
  rapidly as during repetitive or blocked practice.

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• Repeated solving of motor problems has been shown
  to aid retention more than repetitive practice of
  the same motor skills.

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Blocked Practice

• Blocked practice refers to the repeated
  performance of the same motor skill (one task)
  until they master it
• For example suppose a patient is asked to pick up
  a cup from the left and place it on a saucer on
  the right side of a table.

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• The patient needs to solve the motor problem only
  once or twice and then repeat the motor skill
  over and over again.
• If measured during the practice session
  performance appears to improve faster with
  blocked practice.

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• In blocked practice, however, the patient need
  not attend to the task, once learned, because it
  no longer requires novel solutions.

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• In early learning or with confused patients,
  blocked practice may be necessary.
• The patient needs to practice the same movements
  over and over to establish the motor pattern.

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Whole versus part practice

• Breaking a task into its components is only
  useful if the task can naturally be divided into
  recognizable units
• Whole practice is prefer to part practice in OT

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Summary

• Active participation and strategy development are
  key features of effective learning
• OT may facilitate learning through
• Developing self-awareness and self-monitoring
• Providing effective instruction
• Implementing feedback strategy
• Intervention with appropriate practice conditions

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Discussion
Discussion