Task oriented approaches to intervention

Over the last two decades there has been a shift in the approach to early intervention away from paying attention to what was thought to be the underlying cause of a child's movement difficulties (referred to as process approaches) to models that emphasize the importance of motor learning within the context of performing tasks referred to as task oriented approaches (Law and Darrah 2014).

The task oriented models are based on the understanding that motor learning occurs when an infant engages with a task that has a goal and an endpoint.

The task oriented  models have defined tasks and goals in different ways 
Some have emphasized tasks drawn from everyday life, others have defined tasks in terms of basic skills (eg rise-to-standing activities). Others have emphasized family centered goals and or have a program of functional activities. (See below)

More recently the CanChild team have described an approach to intervention, called Focus on Function, that emphasizes family centered goals and the adaptation of selected tasks to allow the child to succeed. The emphasis is on adapting the task and the environment rather than changing the child (ie working on impairments) (Law et al 2011).

The most recent work on task oriented intervention comes from the team at the Cerebral Palsy Alliance Research Institute, University of Notre Dame in Australia  who have developed the GAME (Goals,activitiy motor experience) intervention for infants at high risk for developing cerebral palsy. A RCT published in 2016 has shown  the GAME approach to be effective. Read more

Why are all task oriented approaches effective?

Research into the effectiveness of task oriented shows that all the different models have a significant impact on a child's function as defined by each research team.

A look at the similarities between all the models provides a clue to what makes them effective.

Independent action:  the infants are encouraged to engage independently with the task in an effortful way to reach new goals. Infants are encouraged to find their own solutions to the movement problem.

Independent action means that the infant acquires a ever expanding set of solutions to different movement problems and builds up a store of action plans. Success breeds success.

Independent achievement of goals increases the infant's sense of I-can-do and self efficacy. The infant starts to expect more of him/herself - as do parents and caregivers. 

Frequency of practice: all approaches provide increased opportunities for an infant to practice new skills.

Family centered intervention: parents are motivated to put effort into training and practice. This means more time and effort goes into task practice.

Training attention skills: independent action teaches the infant to pay attention to the task. 

Finding solutions to movement problems requires the ability to adapt and adjust to task requirements and the environment. The infant learns to explore and use trial-and-error to find a solution. This requires the ability to adjust movement patterns to suite the task requirements. 

Bibliography

Darrah, J., Law, M. C., Pollock, N., Wilson, B., Russell, D. J., Walter, S. D., et al. (2011). Context therapy: a new intervention approach for children with cerebral palsy. Developmental medicine and child neurology, 53(7), 615-620. PDF

Law M, Darrah J, Pollock N, Rosenbaum P, Russell D, Walter SD, Petrenchik T, Wilson B, Wright V. Focus on Function - a randomized controlled trial comparing two rehabilitation interventions for young children with cerebral palsy. BMC Pediatr. 2007 Sep 27;7:31.  PDF

Law, M. C., Darrah, J., Pollock, N., Wilson, B., Russell, D. J., Walter, S. D., et al. (2011). Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Developmental medicine and child neurology, 53(7), 621-629.

Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals - Activity - Motor Enrichment) in infants at high risk of cerebral palsy. Res Dev Disabil. 2016 Aug;55:256-67. Abstract

Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. GAME (Goals - Activity - Motor Enrichment): protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy. BMC Neurol. 2014 Oct 7;14:203.  PDF

Morgan C, Novak I, Dale RC, Badawi N. Optimising motor learning in infants at high risk of cerebral palsy: a pilot study. BMC Pediatr. 2015 Apr 1;15:30. doi: 10.1186/s12887-015-0347-2.  Article 

Morgan C, Novak I, Badawi N. Enriched environments and motor outcomes in cerebral palsy: systematic review and meta-analysis. Pediatrics. 2013 Sep;132(3):e735-46. doi: 10.1542/peds.2012-3985. Article 

Ahl LE, Johansson E, Granat T, Carlberg EB. Functional therapy for children with cerebral palsy: an ecological approach. Dev Med Child Neurol 2005; 47: 613–9. PDF

Ketelaar M, Vermeer A, Hart Ht, Petegem-van Beek Ev, Helders PJM. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys Ther 2001; 81: 1534–45  PDF

Salem Y, Godwin EM. Effects of task-oriented training on mobility function in children with cerebral palsy. NeuroReha- bilitation 2009; 24: 307–13. Full Abstract    

Ryalls, B. O., Harbourne, R., Kelly-Vance, L., Wickstrom, J., Stergiou, N., & Kyvelidou, A. (2016). A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy. Frontiers in Psychology, 7, 643. http://doi.org/10.3389/fpsyg.2016.00643