Task specific training in motor learning can not only make your treatment sessions more functional and engaging but taking this approach can actually facilitate better learning of the task at hand!
A basketball player will not achieve the skill level that gets them to the pros by playing H-O-R-S-E… they have to play the game! A musician will not make the band by improving their grip strength and learning music theory… they have to play the instrument! And this same concept rolls over into the rehab world. We can do all the exercises that we want, but exercise alone will not improve function. The patients have to practice the actual tasks!
You may be thinking… “But what about all the impairments? They can’t possibly improve on a task if they don’t have the strength, balance, endurance, etc! We have to build them up first.” But I say that you can eat your cake and have it too! Get creative and simulate functional tasks in a way that will still address the patient’s individual impairments and provide opportunity for the practice that will improve the skill. This way, task specific training to enhance motor learning will become second nature to you! Here are some practical examples to improve your motor learning game!
Task: Self-feeding with coordination impairment
If you note that a patient is having trouble feeding themselves because of impaired coordination, you may have them start to work on all the fine motor/coordination tasks under the sun, hoping it will carry over into building independence with self-feeding. Things like peg boards, graded clothes pins and putty will certainly get their hands and fingers moving and will improve their overall coordination with those tasks, but during each meal… you may not find as much improvement as you were hoping for.
Better approach to improve self-feeding –
Practicing the actual task of eating is the most obvious way to complete task specific training of self-feeding and improve motor learning, however this only allows your patient finite opportunities to practice this skill throughout the day.
Other ways to simulate eating may be of benefit as well! You could have the patient practice lifting an empty cup to their mouth, then gradually fill it with more liquid as they gain more control. Or you could have them transfer a small amount of liquid from one cup to the other before lifting it up to take a drink.
With the use of utensils, a patient could practice each part of the task, then put it all together. They could start by picking up small pieces of play dough with a fork and transferring it to another dish, then they could cut the play dough with a fork (or a fork and knife) before picking it up.
For using a spoon, you could first see how well they are able to balance the liquid in the spoon without spilling by having them scoop water from one container to another. All the while, making adaptations and trialing various equipment and techniques for when they get to practice the real task of self-feeding.
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Task: Walking with hemiplegia
With a patient that has difficulty walking due to weakness on one side of their body, you will need to move forward with treatments that strengthen the affected limbs. Seated exercises with free weights or theraband, will certainly improve the strength of the muscle groups targeted… however a better way to move forward with strengthening to improve walking with hemiplegia would be pre-gait activities.
Weight shifting, box taps, and minisquats are straightforward ways to improve strength in preparation to maintain control in stance on the affected limb. Kicking a ball, hip flexion and extension using a skate to eliminate friction and gravity, and marching will strengthen their affected limb and also better prepare them to manage swing phase during gait training.
Better approach to improve walking –
But to really facilitate better walking and better motor learning, you must have them practice walking! Now, you are going to see patients of all ability levels, so simply having them get up and start is not always realistic. But often times, your patients will surprise you and may be able do things you don’t expect them to do if given the opportunity.
For a person who requires more assistance, you may need to utilize a body weight support system. This can usually be completed on a treadmill or over the ground. The treadmill is definitely going to allow your patient to get more steps in (more practice) as the speed of the treadmill will set the pace. However, over ground body weight support walking is very beneficial as well!
With either option you will have both hands free to better facilitate activation of the muscles needed at each phase of the gait cycle. A second helper can facilitate the timing and degree of weight shifting during each step. Body weight support gait training is an excellent option to get patients up and walking before you may have thought they were ready to – and therefore they get more training specific to walking!
If you don’t have a body weight support system available, you may find success using other very effective and supportive techniques such as using a platform rolling walker or an EVA walker. These will offer the patient more stability than a regular rolling walker or hemi-walker and again will allow you more freedom to facilitate where you need to.
Task: Toileting – Clothing management with balance impairment
If you’re working with a patient who is having trouble managing their clothing because they just keep losing their balance, your first inclination is going to be to work on their balance! Now, you may have them stand at the therapy table and complete a task that requires them to only use one hand on their assistive device, so they are not as reliant on upper extremity support. You may have them reach outside of their base of support in order to complete the task.
These sorts of activities will certainly help a patient to improve their balance and it will even improve their standing tolerance however there are a few more things that are involved with managing your clothing during a toileting task. So, these activities may help to an extent but in order to really get to the heart of the problem you need to be stimulating the activity itself or completing the actual activity.
Better approach to improve toileting –
A better way to train your patient how to manage their clothes clothing and maintain their balance all at the same time is to either break it down into its parts and simulate the activities or complete the actual activity itself.
There are a few different ways that you can simulate taking down and pulling up pants. Part of the task requires the patient to have one hand on their assistive device and use the other hand to manage the clothing. This usually requires the patient to alternate between hands so they can get one side of the pants and then the other.
To simulate this task (since there are only a finite number of times that you will be able to bring your patient in the bathroom) … You can complete activities like placing clothes pins at the bottom edge of the back of their shirt and ask the patient to remove them – alternating right and left. This allows the patient to remove one of their hands and reach behind them as if they were straightening out the top of their waist band… Grasp onto the clothes pin and remove it. Another aspect of managing clothing is being able to bend forward and squat down far enough to either pull your pants down past your knees or reach down and pull them up.
A way that you can simulate this part of the task is by having the patient lift and lower items to and from the floor or from a low stool so that it forces the patient to do the same type of transitional movement as when they’re pulling their pants up and down. If they are getting to the point where they can balance adequately enough, you can have them step into a hula hoop and raise the hula hoop up to their waist and then place it back down on the ground. Sometimes, the resistance of the actual clothing can pose a balance challenge to the patient.
If they have stretchy pants or an elastic waist band that they have to pull and stretch to get over their hips, a way that you can simulate this is to put a piece of theraband around the person’s knees and have them pull it up over their hips as if it were a pair of pants. That would give them that resistance that the pair of pants would give and would allow them that opportunity to practice the more task specific activity. Now, the best way to practice managing your clothing with toileting is to actually practice pulling down your pants and pulling them back up.
Most therapy gyms have available and oversize pair of shorts or an oversized pair of pants that are used for ADL practice in the gym setting. So again if you’re not having the opportunity to actually take the person into the bathroom during an episode of toileting… You can break out these practice pants and have the person stand up, pull pants up, pull them back down, and sit down – and they can utilize all of the strategies that you have been stimulating with them.
Task: Carrying packages walking with a cane
Something that is very practical to day-to-day life but we don’t always incorporate into our treatment plan is carrying items when you’re walking with an assistive device such as a cave. There are several ways that you could start to work on this such as having your patient carry various dumbbells while walking, making sure to vary the weight and size of the dumbbells to simulate various objects that someone may need to carry.
Better approach to carrying items while walking –
But as with all the other tasks discussed here, the best way to facilitate motor learning and improve the skill of carrying packages and items while walking with a cane is to have them complete the task specific training. Now that may sound overly simplistic… But there’s a very great opportunity here to determine the best way that a person can accomplish this safely.
You may want to explore different shopping bag options – a plastic bag could be used, a reusable shopping bag can be used, a small box or a brown paper bag. If someone has trouble grasping the handles of the plastic shopping bag it may be more beneficial for them to put items in a brown paper bag and carry it close to their bodies, as this will eliminate the need for them to grip the item so heavily and it will also keep the weight of the item closer to their center of gravity and balance will not be as big of a challenge for them.
After determining what type of package or a bag is best suited for them to carry… You can then work on how they will safely pick it up in order to carry it and then how they can safely place it back down when they get to their destination. It will also give you the chance to see what their endurance level is like with this task. Will they only be able to carry items for short distances? Or will they have the stamina to carry them for longer periods of time?
This is important depending on where the person lives and what their environment is like. A person who has a home with a short driveway where they only need to carry items in from the car to the house wouldn’t necessarily need to build up stamina in this way… However, if someone lives in a home where they are mostly walking everywhere, they may need to walk several blocks from their home to the grocery store.
This would also present you with another opportunity to introduce various ways of carrying multiple packages such as a rolling grocery cart so the person can put several bags in and pull the cart behind them. It also requires a certain amount of coordination and balance if they are normally utilizing an assistive device such as a cane.
No matter what you were doing with your patients to have them improve on their impairment and their skills… You are certainly going to benefit them and help them reach their goals! But knowing that there are certain principles of motor learning that can help us tailor treatments more specifically to what our goals are is a very powerful thing. Whenever possible you always want to do the activity that you’re trying to improve or simulate the parts of the activity that you’re trying to improve. The more task specific, and the more specific the training the better the results for motor learning of the skill and retaining what they’ve learned!
If you liked what you learned here about task specific training for motor learning, make sure to check out our 3-CEU Update your Care Plan: Balance webinar! We discuss some other principles of motor learning and how to best choose interventions based on your comprehensive assessment!
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