Task Oriented Approach (TOA):

• Activity-based intervention is the structured

use of goal directed tasks for the purpose of
providing repetitive practice and graded
challenge.

• When clients engage in activity-based therapy,

their attention is focused on completing the
task instead of performing a particular
movement or mastering a particular skill.
 THEORETICAL ASSUMPTIONS AND MODEL UNDERLYING
THE OCCUPATIONAL THERAPY TASK-ORIENTED APPROACH

• Systems Model of Motor Control

Emphasize the interaction between persons and their environments and suggest
that motor behavior emerges from persons’ multiple systems interacting with unique
tasks and environmental contexts.
Thus, the systems model of motor control is more interactive or heterarchical and
emphasizes the role of the environment more than the earlier reflex-hierarchical
model.

The nervous system itself is organized heterarchically such that higher centers
interact with the lower centers but do not control them.
• Ecological Approach to Perception and Action
Emphasizes the interaction between the person and the
environment during everyday, functional tasks and the close
linkage between perception and action (i.e., purposeful
movement).”

• Dynamical Systems Theory

Dynamical systems theory proposes that behaviors emerge from the interaction of
many systems and subsystems. Because the behavior is not specified but is
emergent, it is considered to be self-organizing.
For example, when one walks or brushes the teeth, one has many choices in how to
perform the task, yet one tends to use preferred patterns. These relatively stable
patterns of motor behavior, which are unique to each person, provide evidence of self-
organization
 SYSTEMS VIEW OF MOTOR DEVELOPMENT
A systems view of motor development suggests that changes over time are
caused by multiple factors or systems such as maturation of the nervous
system, biomechanical constraints and resources, and the impact of the physical
and social environment.

A systems view also suggests that normal development does not follow a
rigid sequence, as the motor milestones would suggest.
When inefficient or ineffective movement patterns are seen after stroke,
therapists need to consider multiple factors as potential contributing
variables
• CONTEMPORARY VIEW OF MOTOR LEARNING

Motor learning research supports the idea that random practice (i.e., repetitive
practice of several tasks in a varied sequence within a practice session) is better
than blocked practice (i.e., repetitive practice of the same task within a practice
session). Similarly, practicing variations of the same tasks in varied contexts is
better than practicing the same task in the same context.

When persons are learning a new task such as golfing, they should focus on
the movement effects (external focus on the golf club head) rather than
on their own arm movements (internal focus). Self-controlled practice
(i.e., a person being trained decides when and how feedback is given and
whether assistive devices are used) is better than instructor-controlled
practice. Finally, dyad training, in which a person is able to alternate
observing and practicing a task, is beneficial to learning a new task.
 Treatment Principles Using
The Occupational Therapy
Task-oriented Approach

• Help Patients Adjust to Role and Task Performance Limitations

Therapists can help by exploring alternative ways of fulfilling roles and of performing the
associated tasks. Therapists also can explore potential new roles and new tasks.

• Create an Environment That Uses the Common Challenges of Everyday Life

need to be creative in creating environments within their clinical settings that provide typical
challenges.

• Practice Functional Tasks or Close Simulations to Find Effective and Efficient

Strategies for Performance
the therapist must use the functional tasks and activities that have been identified as important and
meaningful to their patients.
Because persons are unique, their performance patterns and levels of skill vary. Therefore, therapists should
not expect that one way of performing a task would be the most effective and efficient way of performing a
task for all patients.
• Provide Opportunities for Practice Outside of Therapy Time
• Use Contemporary Motor Learning Principles in Training or Retraining
Skills
The following three motor learning principles:
• Use random and variable practice within natural contexts in treatment.
• Provide decreasing amounts of physical guidance and verbal feedback.
• Develop task analysis and problem-solving skills of patients so they can find their
own solutions to occupational performance problems
• Minimize Ineffective and Inefficient Movement Patterns
 Treatment Practice
• Fokus 1: Client-centered
– Pendekatan (assessment dan treatment planning) didasarkan pada
kebutuhan yang unik dari individu baik unik personality, lingkungan, dan
rolesnya. No cookbook strategies.
– Pasien harus aktif terlibat dalam treatment
• Client yang aktif dalam treatment menunjukkan
achievement in self-identified goals
• Bagaimana caranya agar klien partisipasi dalam treatment?
– user-friendly instruction on how to practice tasks
outside of therapy session and structure client’s
environments to facilitate this practice
Bagaimana karakteristik lingkungan
terapeutik yang konduktif?
 Characteristics of an active Learning Environment (Ada, Canning,
Westwood, 1990 in Trombly & Radomski, 2008)
• Encompass (include) the common challenges of everydaylife
• Describe shared rehabilitation goals
• Cohesive team that is committed to active learning
• Require clients to communicate their need for help in specific tasks to staff
• Give client control over when and where they are to be transported
• Give able clients responsibility for routine housekeeping
• Arrange chairs in small circles in reception and common areas
• Provide opportunities for practice outside of therapy
• Provide written instructions, audiotapes, videotapes, and diagrams for practice
• Organize the environment to match the level of performance
• Illustrate progress to clients
• Fokus 2 : Occupation Based
– Gunakan functional tasks sebagai fokus treatment
• Tujuan utama untuk pasien motor-behavior problem adalah agar
mereka mampu mengerjakan aktifitasnya sekarang dan yang akan
datang
• Intervention emphasize the practice of real functional tasks
– Neurological recovery from CNS dysfunction requires task-
related training (Dobkin, 1998)
– Functional disability is one of the most important predictorsof
discharge outcomes (Brodi, Holm & Tomlin, 1994)
– OT emphasizes measuring of functional task performance
– Functional tasks are prefered by many clients over other types
of treatment activities (Zimmerer-Branum & Nelson, 1995)
– Gunakan aktifitas yang meaningful & important to the client’s roles

• One activity may important to one person may be not important

to another

Life satisfaction is not determined by successful completion

of a random set of functional tasks but it coming from the
feeling that roles are fulfilled.

• Using Roles Based helps OT tap into the personal motivations of

clients for performing particular tasks.

Select tasks that are within the realm of capacities, are goal
oriented, have meaning for the clients, and motivatethem
– Analisis karakteristik aktifitas yang digunakan untuk terapi.
Schmidt’s classification(1988):
• Continuous task
Latihan naik sepeda saat anak-anak tetapi bertahan ‘bisa terus’
sampai dewasa walaupun sudah lama tidak bersepeda.
• Discrete
Keterampilan gerak mengolah bola dalam sepak bola diperlukan
latihan yang terus menerus agar menjadi lebih terampil

Gentile (1987)
• Closed task
Lingkungan tidak berubah. Misal: latihan menulis
• open task
Lingkungan berubah. Misal: latihan menstir mobil
– Menjelaskan gerakan2 yang diperlukan untuk melakukanaktifitas.
Misal: Menjelaskan bagaimana gerak tangan untuk menulis akan membantu
pasien belajar menulis

– Tentukan apakah pola gerakan stabil atau in transition (un stable)

• In transition →banyak variasi gerak untuk menyelesaikan aktifitas, aktifitas
mudah diubah tergantung pada pengaruh personal dan lingkungan. Pada in
transition ini terapis akan memfasilitasi untuk merubah pola gerak agar
menjadi lebih efisien dan efektif untuk mencapaigoals.

• Bila pola geraknya stable pada saat aktifitas tertentu maka akan lebih sulit
diubah. Bila diubah (dan bisa berubah) maka akan cepat kembali ke pola
sebelumnya lagi. Intervention may not effect a change to order movement
pattern if the movement patterns have been obligatory or irreguler for along
time

Therapist observes performance of the same task several times in the

same context and then in different contexts. Intervention is not
needed if the preferred movement pattern is relatively efficient and
effective for give task and is stable but flexible
– Analsis pola gerak dan functional outcomes dari aktifitas yang
dikerjakan
• Look at fluctuations in one or more quantitative measure of
movement patterns during performance task
• Determine what happens when therapist tries to disturb the
movement patterns by changing personal or environmental
factors
• Potential to measures: slow reaction time, slow movement time,
increase variability performance, time to finish task
• TOA uses of real objects and natural
environment, focus on meaningful tasks and
functional goals
• Focus 3 : Person and environment
– Identifikasi faktor-faktor personal dan lingkungan yang sangat
berpengaruh pada occupational performance
• Qualitative analysis may be used to describe interaction of the
person and environment on task performance
– Antisipasi kemungkinan adanya variabel dari personal dan
lingkungan yang akan berpengaruh (negatif) occupational
performance

• sensorimotor system, psychosocial system, cognitive system,

physical system, socioeconomic system, cultural system
– Perhatikan kemampuan personal dan lingkungan yang merubah
occupational performance
– Treatment untuk faktor neural dan non neural dari sistem
sensorimotor yang menghambat optimalnya occupational
performance

– Adaptasi aktifitas dan lingkungan untuk mendapatkan

occupational performance yang optimal

– Gunakan natural object and natural environments

• Prinsip 4 : Practice and feedback
– Struktur latihan dalam mengerjakan aktivitas mengarah
pada motor learning
• Blocked practice → mengulangi mengerjakan aktifitas berkali-kali
agar hasil baik
• Random practice → mencoba memakai baju dengan berbagaicara
dalam satu sesi terapi
– Desain aktifitas untuk terapi harus sesuai dengan strategi
pembelajaran. Perlu dipertimbangkan:
• Whole learning or Steps/partlearning?
• Complexity task?
• Stages of learning (discovery (cognitive), mastery (associative) &
generalization (autonomous)
• Types of learning – apakah learning yang dilakukan perlu
memperhatikan betul aturan-aturan dalam mengerjakan atau tidak
– Berikan umpan balik
– Optimize occupational performance
• The achievement of functional outcomes is probably more
important to the client and family than the therapist’s goal of
‘normal’ movement pattern (Mulder, 1991)
 EBP
• Use Of The Occupational Therapy Task-oriented Approach To Optimize
The Motor Performance Of A Client With Cognitive Limitations
(Preissner, Occupational Therapy September/October 2010 Vol. 64 No. 5
727-734 );

• Effect Of Occupational Therapy Task Oriented Approach On Recovery Of

Upper-extremity Motor Function And Activities Of Daily Living In Stroke
Patients (Mandal, The Indian Journal Of Occupational Therapy : Vol. XLI :
No. 2 (May 2009 - August 2009)

• Efficacy Of Occupational Therapy Task-oriented Approach In Upper

Extremity Post-stroke Rehabilitation (Occup. Ther. Int. 23 (2016) 444–456
© 2016 John Wiley & Sons, Ltd)