a) In task-oriented approach the environment plays an important role – why?
To own a skilled performance, the patient must be able to perform complex movements, with the flexibility to vary the movement to meet ongoing environmental demands with economy of effort. Environment variable relates the real-world application to learnt movement patterns surrounding the patient.
If brain reorganization and functional recovery from brain lesions is dependent on use and activity, then the environment in which rehabilitation is carried out is performed can play an important role on patient outcomes. This environment might be influenced by several variables, including:
-Physical-setting: physical or build environment
-Intervention (including intensity and dosage): methods used to deliver intervention
-Staff: knowledge, skills, attitude, ability to reach
-Social stimulation: interaction (with people and objects stimulating activity)
One particular concern from a physiotherapeutic perspective, is patients’ tendency to adopt passive pursuits over physical activity. Considering time performing activity contributes significantly to rehabilitation, these environment orientated factors have great potential to influence rehabilitation.
b) What kind of environment could support the improvement of functional capacity after stroke. Justify your thoughts.
- It should be created an environment which is conductive for an active learner.
Organization structure:
Create a rehabilitation environment that encompasses the common challenges of everyday life because, according to studies, it produces a better outcome than medical wards. Moreover, clarify the goals of rehabilitation and promoting active participation may be to use strategies such as drawing up contracts with the patients. This promotes a positive morale for both residents and staff of institutions. The patient needs to understand the importance of practicing tasks outside therapy as well as being able to explain the procedure to staff members. Collecting information about patients’ lifestyles, preferences and interests and then acting on this information promotes indirect control of the environment by patients. Soliciting people’s opinions provide to create a sense of autonomy. Placing responsibility for routine housekeeping in the hands of patients has been suggests as another way of promoting autonomy because it becomes important not only for themselves but also to others.
Physical structure:
Physical structure of the rehabilitation environment can be arranged to produce more active participation (ex: to adapt the glass in order to practicing thumb abduction in order to grasp and release objects).
c) Feedback is an important aspect in task-oriented practice. What kind of things you have to consider when structuring the environment to provide feedback
- It should be promoted practice without the therapist present because skills performance increases as a direct function of the amount of practice. Therefore, practice of tasks by patients outside therapy will increase the total of amount of practice undertaken which should improve outcome.
Instructions:
The verbalization of parts of the task helps the learner recall what has to be done. Thus, a videotape contented a reminder of position, movement or compensatory strategies to avoid should be attended.
Structuring the environment to provide feedback:
The benefits of practice outside therapy may be put at risk if patients practice compensatory strategies or practice without a clear idea of which errors they are making and how to avoid them. The therapist should, therefore, structure the practice environment to provide information about goal attainment and reduce movement errors so that patients can practice effectively. The use of commercially available devices provides unbiased, reasonably accurate and immediate feedback about performance. For instance, EMG could provide feedback regarding muscle activity and Bathroom Scales provides feedback regarding patient’s weight distribution. Value of participation by relatives and friends in the rehabilitation process should not be underestimated because it may mean the difference between whether practice outside therapy occurs or not. Time and effort, therefore, should be invested in the education of patients’ relatives and friends.
Organizing and monitoring practice:
Daily schedules need to be planned which allow for the practice of several tasks because neurologically-impaired individuals usually have to learn more than on task in order to become functionally independent.
- It should be illustrating progress to the patient by measuring motor performance repeatedly over time trough short-term goal which will motivate individuals to keep practicing because it indicates that the achievement of long-term goals is foreseeable through simple graphs.
Jehanne Crouzier 