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Neurofunctional Approach Ch. 24 (Skills retraining principles (Antecedent…
Neurofunctional Approach Ch. 24
occupation-based model of intervention/ "learning by doing" - the doing is highly structured and planned /determined by the needs of the client and not the underlying pathology
theoretical foundations: motor learning theory, social psychology and other skill acquisition theories
shown to be effective when applied in early rehab and in clients with less severe impairments
Behavioral automacity (so you don't have to think about e.g we don't think about brushing teeth) and the ways in which the environment can support performance
-person, occupation, environment model
Evaluation process
Occupational profile
occupational performance: observation of actual performance (unstructured) in the client's natural context to identify what supports performance and what hinders performance
structured observation: 1. cueing & observation, 2. specific behavior evaluation
individualized activity analysis
standardized testing
determining occupational dysfunction: standardized testing to determine the functional cognition problems associated with the occupational performance problem so that an adequate intervention plan can be developed.
"not what the client can do, but he or she actually does on a daily basis"
standardized assessment: performance based tests of functional cognition- ability to use and integrate thinking and performance skills to accomplish everyday activities such as household and finical management, medication management, community mobility and work
OT's use PBT to assess a person's ability to manage community living tasks in circumstances in which actual observational of skills execution is not possible.
Intervention
treatment focuses on learning by doing - 8 basic elements
motivational factors= by using goal setting/positive feedback
cues are faded as long as the performance remains errorless
for NFA to be effective, the task practiced must be performable given the fixed aspects of the person's deficits
The role of therapist is to negotiate with the client the occupational performance deficit to be addressed, conduct the observation, task analysis, develop methods that allow the client to perform the task with minimum amount of new learning, create a process that directs the client's attention to the central components of the task, and then engage the client in sufficient practice of the task for the behavior to develop automaticity
cognitive over learning: focuses the client's attention on the behavior or areas of skills deficit that is identified for change and develops a verbal label for the behavior that is acceptable and seems to "fit" the client
Sessional practice of required behavior: client practices the behavior for a short behavior of time in an environment controlled by the therapist
24 hour approach: involves an attempt to target each instance of the behavior throughout the day.
blocked and random practice, chaining, motivational interviewing, awareness
Intervention Components
Intervention Components
therapeutic alliance: 1. emotional bond between client & therapist , 2. Mutual agreement on goals, 3. Mutual agreement on tasks that form the substance of the intervention
MI and goal setting: MI can help facilitate engagement in the rehabilitive endeavor by building rapport via empathy and collaborative goal setting.
engaging: compassion, understanding and respect for client's autonomy . - focusing: involves assisting clients to attend to their goals for being in therapy . - evoking: assisting clients t o recognize how their current behavior conflicts with the goals that they have for themselves . -planning: clients plan how to implement the things
-therapist first attempts to understand the client's perspectives without judging, criticizing or blaming / "respectful listening"
Goal Setting: determining a target or preferred end state to be achieved at some point in the future / setting specific and difficult but achievable goals has been shown to improve outcome in the general population across contexts : 1. direct attention and effort toward goal-relevant activities and away from goal irrelevant activities, 2. have and energizing function, 3. affect persistence and lead to the discovery of task-relevant knowledge and adaptive strategies
Goal statements: Implementation intentions or predecisions about how and when to enact goal actions, have been found to be more effective in facilitating goal attainment than goal setting alone
Skills retraining principles
Antecedent Control: alter the chances that a behavior will occur in changing the cueing events in the environment or by changing the reinforcement effectiveness of an object or an event.
offer an indirect way to elicit desired behavior
reinforcement and skills building: is an event that increases the likelihood that a behavior that preceded will be repeated
task analysis
chaining: 1. backward chaining: last step of the task is trained first , 2. forward chaining: in which the first step of the chain is trained first , 3. whole task method: each step of the chain is trained on each presentation
cues : 1. system of least prompts , 2. time-delay procedures.. : 1. progressive time delay , 2. constant time delay
practice effects: - consistent mapping, variable mapping (non consistent + little improvement)// practice schedules: 1. blocked practice= learning during the acquisition phase and random practice= may facilitate generalization and transfer after initial mastery
overlearning: skill is consolidated in the person's repertoire of skills ad reduces the effort required for performance of the skill
spaced and expanding retrieval techniques : maximizing the recall of limited amounts of information.
between recall interval is gradually increased
Errorless learning: 1. the person learns by propagating errors, registering the error and correcting the error on later attempts
EL: therapist provides sufficient support to prevent the propagation of errors and support is gradually withdrawn as learning takes place