STRATEGIES FOR EXERCISE

AND TASK SPECIFIC

INSTRUCTIONS
DR. AROOSHA ABRAR
INTDRODUCTION
As a patient educator, a therapist spends a substantial amount of time teaching patients or their
families how to perform exercises correctly and safely.

Effective strategies founded on principles of motor learning are designed to help patients
initially learn an exercise program under therapist supervision and then carry it out on an
independent basis over a necessary period of time.
PREPARATION
When preparing to teach a patient a series of exercises, a therapist should have a plan that will
facilitate learning prior to and during exercise interventions.
A positive relationship between therapist and patient is a fundamental aspect for creating a
motivating environment that fosters learning.
A collaborative relationship should be established when the goals for the plan of care are
negotiated.
Effective exercise instruction is also based on knowing a patient’s learning style; that is, if he or
she prefers to learn by watching, reading about, or doing an activity.
PRACTICAL SUGGESTIONS
Select a non distracting environment for exercise instruction.
Demonstrate proper performance of an exercise (safe vs. unsafe movements; correct vs.
incorrect movements).Then have the patient model your movements.
If appropriate or feasible, initially guide the patient through the desired movement.
Use clear and concise verbal and written directions.
Complement written instructions for a home exercise program with illustrations (sketches) of
the exercise.
Have the patient demonstrate an exercise to you as you supervise and provide feedback.
Provide specific, action-related feedback rather than general feedback. For example, explain why
the exercise was performed correctly or incorrectly.
Teach an entire exercise program in small increments to allow time for a patient to practice and
learn components of the program over several visits.
CONCEPTS OF
MOTOR LEARNING
MOTOR LEARNING
Motor learning is a complex set of processes that involves the relatively permanent acquisition
and retention of a skilled movement.
TYPES OF MOTOR TASK
There are three basic types of motor tasks.
◦ Discrete
◦ Serial
◦ Continuous
DISCRETE TASK
A discrete task involves a movement with a recognizable beginning and end.
EXAMPLES
◦ Grasping an object
◦ Doing a push-up
◦ Locking a wheelchair
SERIAL TASK
A serial task is composed of a series of discrete movements that are combined in a particular
sequence.
EXAMPLE
To eat with a spoon, a person must be able to grasp the spoon, hold it in the correct position,
scoop up the food, and lift the spoon to the mouth.
CONTINUOUS TASK
A continuous task involves repetitive, uninterrupted movements that have no distinct beginning
and ending.
Examples include walking, ascending and descending stairs, and cycling.
 GENTILE TAXONOMY FOR
PROGRESSION OF MOTOR TASK
If an exercise program is to improve a patient’s function, it must include performing and learning a variety of tasks.
A taxonomy of motor tasks, proposed by Gentile,
is a system for analyzing functional activities and a framework for understanding the conditions under which
simple to complex motor tasks can be performed.
There are four main task dimensions addressed in the taxonomy

1. The environment in which the task is performed

2. The intertrial variability of the environment that is imposed on a task
3. The need for person’s body to remain stationary or to move during the task
4. The presence or absence of manipulation of objects during the task
STAGES OF MOTOR LEARNING
There are three stages of motor learning
1. COGNITIVE STAGE
2. ASSOCIATIVE STAGE
3. AUTONOMOUS STAGE
 COGNITIVE STAGE
1. When learning a skilled movement, a patient first must figure out what to do.
2. Then the patient must learn how to do the motor task safely and correctly.
3. At this stage, the patient needs to think about each component or sequence of the skilled movement.
4. The patient often focuses on how his or her body is aligned and how far and with what intensity or speed to
move.
5. During this stage of learning errors in performance are common, but with practice that includes error
correction, the patient gradually learns to differentiate correct from incorrect performance.
 ASSOCIATIVE STAGE
1. The patient makes infrequent errors and concentrates on fine-tuning the motor task during the associative
stage of learning.
2. Learning focuses on producing the most consistent and efficient movements.
3. The timing of the movements and the distances moved also may be refined.
4. The patient explores slight variations and modifications of movement strategies while doing the task under
different environmental conditions (intertrial variability).
5. At this stage, the patient requires infrequent feedback from the therapist and, instead, begins to anticipate
necessary adjustments and make corrections even before errors occur.
 AUTONOMOUS STAGE
1. Movements are automatic in this final stage of learning.
2. The patient does not have to pay attention to the movements in the task, thus making it possible to do other
tasks simultaneously.
3. In fact, most patients are discharged before reaching this stage of learning.
THE END