Task Oriented Movement Therapy and Training provides a principled and systematic approach to the assessment and training of developmental movement based tasks.
TOMT is implemented within the broader context of family centered OT and PT:
- Identify family concerns and goals;
- Understanding the factors that contribute to the infant's difficulties and delays: temperament, conditions, family circumstances.
- Task oriented, context sensitive assessment of motor abilities
- Identifying goals for intervention Read more: TOMT 0-3 Training Principles.
A systematic approach to task oriented movement training
Steps
1 Select the tasks that need to be assessed - based on identified goals
2 Task assessment - within a task-child-environement framework
- Identify factors that limit/constrain task performance
- Adapt the task or environment to allow the infant to succeed at the task
3 Provide training opportunities for practicing adapted tasks
- Work with parents/caregivers to provide an enriched everyday environment that invites/encourages/motivates the infant to engage in activities that make use of new abilities.
4 Increase task demands in a systematic manner (activity progression) to allow infant to improve her ability to perform the task in more difficult contexts.
Task-child-context framework for assessment
Developmental theorists and modern guidelines for intervention all promote a task-child-environment (T-C-E) framework for understanding motor development and task performance:
1 The individual child has a set of abilities that allow them to interact with the social and physical environment in a particular way under particular circumstances.
- Independent sitting allows the child to use the hands to expand her use gestures for communication.
- An infants ability to clamber up onto the sofa in the living room may be constrained by the height of the sofa, but a small step in front of the sofa makes the task instantly do-able.
Successful performance of a particular task requires the child to have a set of physical, social and attention abilities.
- Building a tower of tubs requires careful and precise placement of the tubs one on top of the other. This depends on the the ability to stabilize the head and trunk in space as the arms are lifted forwards.
- Catching a ball involves careful attention to the actions of the social partner to allow the child to anticipate the trajectory of the ball in order to get the hands to the right place at the right time to catch the ball.
- Reaching down to pick up a toy from the floor involves controlling flexion of the hips and knees along with forward tilting of the trunk while at the same time maintaining the COM over the BOS.
The social and physical environment creates a particular set of demands that may enhance or constrain task performance.
- A new crawler may find it difficult to reach mom on the other side of the room if the floor is very slippery.
- Walking across a flat surface is less demanding than walking on an uneven incline.
Constraints as limiting factors in task performance
Within the T-C-E framework, factors that limit successful task performance are seen as constraints.
Constraints may by inherent in the child, the task or the context.
Child centered constraints may be factors such as flexibility, muscle strength, attention, coordination.
Task constraints are inherent to the task: they include the aspects of the physical environment, attention demands, postural stability and balance demands.
Environmental constraints can be social or physical and tend to increase the complexity of the task - ie the number of factors that need attention when performing a task.
Adapting the task and/or context to allow for success
Task assessment will usually start observing the child performing the task, and identifying the task and context constraints that are limiting task performance.
The next step is to adapt the task and the context in a way that changes the task demands and allow the for successful task completion.
As the child's abilities improve with practice, the task demands can be increased to allow for ever increasing levels of skill.
This approach will usually address many of the child centered constraints by providing the experience the child needs change these constraints.
- If LE muscle weakness is identified as a constraint in a child who is learning to walk up stairs, then practicing stepping up onto a lower step (adapting the task) and then systematically increasing the height of the step will also improve muscle strength.
Essentials knowledge for task oriented movement analysis
Biomechanical principles of movement: balance, stability, momentum, internal and external perturbing force
A dynamic systems analysis of the development of the basic movement abilities (actions in supine and prone, sitting, standing, cruising).
How infants learn to use surfaces for supporting their actions
The imp[ortance of anticipation and prediction in task performance.
How infants learn to harness and control momentum for successful task performance.
How infants learn through exploring new ways of experiencing and doing things.
The task specific nature of stability and balance control
The importance of information pickup for motor planning and execution.
How intentional and goal directed actions provide the infant with the experience needed to filter and select sensory information in a task specific manner.