Task based training is based on a simple concept: you learn what you practice. In other words motor learning is specific to the task.
If you want to learn to ride a bicycle you need to practice riding a bicycle. Balance training on a wobble board or core stability exercises on a therapy ball won't do the trick. Mastering peddling and steering on a tricycle can be helpful because the actions needed to push the pedals and steer are similar in the two activities.
This example highlights three important general principles in motor learning:
- motor learning and tasks demands are specific to the task
- a task can be adapted to make it easier
- if two tasks are similar there is some carry over from on task to the other.
Why is motor learning task specific?
Because every task requires a different combination of muscle actions to maintain balance and stability while moving the limbs and adapting the movement to changing circumstance.
Even a seemingly simple task such as lifting a ball above the head as part of a throwing action requires complex planning:
- To hold the ball the hands need to maintain contact with the ball so that it does not slip out of the hands
- The arms must be lifted above the head and the movement stopped above the head where tha ball cannot be seen
- Lifting the ball, especially if the movement is fast, destabilizes the head and trunk. To stop this happening the trunk and neck muscles contract even before the arm movement starts.
- Lifting the ball also requires small adjustments in alignment of the trunk over the feet to maintain balance.
Sensory information and task performance
The movement brain uses sensory information from the body (muscles, joints, skin, vestibular system) and from the environment (visual and sound information) to plan movements, to adapt the movements during execution of the task, and evaluate the outcome of the action.
Before we execute a movement we gather information from the environment to plan the movement: how far do I need to move my hand to reach the cup, how high is the step I want to step up onto, is the standing in front of me going to move as I approach?
During the movement we use sensory information to check the progress of our actions: is my hand moving in the right direction, have I lifted my foot high enough to get it onto the step, has the dog moved?
In neurotypical children the visual information reaches the areas of the brain involved with motor planning and evaluation, rapidly and concurrently, and information is selected and integrated in a timely manner that allows for ongoing adjustments in the movement.
In children with autism the differences in connectivity in the brain means that information from the visual areas of the brain take longer than proprioceptive information to reach the movement brain. As a result children with autism rely more on information from the the muscle and joint sensors (proprioceptors) when planning and executing movements.
Task specific training allows children with autism to compensate for these differences in sensory feedback: this compensation is task specific.
Increasing proprioceptive feedback is not the answer
Sensory based treatment strategies often recommend a range of strategies to increase proprioceptive feedback to improve motor control. This is not useful: in fact children with autism mostly have heightened sensitivity to information coming from the joints and muscles.
It is more important to train the movement brain to use the available proprioceptive information more effectively for motor planning, on a task by task basis.
Task based training allows children to compensate for differences in brain connectivity
Lola learning to cut out a circle
Lola, 8 years, is having difficulty cutting out a circle with a pair of scissors. It takes forever to complete the task and the end result is jagged and not pleasing.
Step 1: Understanding the task
I do the task slowly, with careful attention to every aspect of the task, and notice how:
I hold the paper with a circle drawing in my left hand and the scissors in my right hand.
My fingers hold the scissors so that it is easy to make the opening and closing action.
I hold the scissors at right angles to the paper.
As I cut out the circle I move the paper around so as to align the outline of the circle with my scissors.
After each cutting action I move the paper in readiness for the next cut.
Step 2: Watch Lola performing the task
Watching Lola I notice that she does not hold the scissors at right angles to the paper and instead of moving the paper she moves the scissors to line it up with the circle outline. The size of the paper is a problem.
This movement is awkward.
Step 3: Simplify the task
Children learn when they perform a task successfully. Success improves motivation and willingness to persist. Interestingly, success at a task improves motor control.
I need to simplify the task to allow Lola to succeed.
We start our cutting practice by cutting straight across a strip of card.
This activity trains Lola to hold the scissors at right angles to the paper, and to align the strip of card at right angles to the scissors.
I also show Lola how to move her hand on the paper so that she cuts off pieces moving from right to left.
Step 4: Provide verbal cues
At the begriming of the training session Lola needed repeated reminding to align the card with the blade of the scissors. She was also not very accurate with cutting along the marked lines.
To jog her memory, I instructed Lola to use verbal reminders. Hold the card near the next cutting line. Open the scissors. Position the blades over the line. Cut.
With these verbal reminders Lola managed to cut up several strips of card quickly and neatly along the lines. We used the squares that we cut to make a mosaic.
|Step 5: Provide encouragement and feedback
Step 6: Make the task a little more difficult - cutting diagonally
In this session Lola practiced cutting along diagonal lines drawn on a strip of paper. This is quite tricky because the strip of card needs to be aligned at an angle to the blade of the scissors.
It took some time and quite a lot of frustration before Lola got this right. Using the verbal instructions helped her focus her attention and with encouragement from me she stayed on task and persisted.
When she finally mastered this tricky work she was elated. Success!
Now it was time to practice cutting out a circle
We started with cutting out a circle drawn on a small piece of card. The size and stiffness of the card made it easier for Lola to hold and postilion the card for cutting.
Steps in implementing task based training
Start with a task your child and you would like to improve
If a task has a series of different actions, such as getting dressed, start by working on each one separately.
Identify the steps that make up the task
- I find that performing the task slowly, in a very deliberate way, with careful attention to each movement is a very helpful way to identify the different components of a task.
Think about the visual information that is needed at each step along the way.
Gathering visual information in a very systematic manner before the task is initiated helps to compensate for the poor online visual feedback.
Think about ways the task can be adapted to make it easier to perform
Start easy - progress to more difficult
Catching a soccer ball is easier than catching a tennis ball, putting on trousers with an elastic band is easier than a pair with a zip, pouring milk from a half empty bottle is easier that pouring from a full bottle, walking down a flight of three steps is easier than starting at the top of a long flight of stairs.
Practice the task - provide support and encouragement as needed.
Let your child try performing the task without help to start with. He/she needs experience with working things out for themselves.
Notice what aspects of the task are particularly difficult and lead to failure. Provide help if needed.
Provide task specific praise
Praise that identifies the specific actions that were well done is more effective than a general statement such "Well done" or "Good job".
Instead talk about the action that was well performed: "You poured without any spilling" is more effective than "You are good at pouring."
Feedback such as "You caught the ball 6 times out of ten. Well done." provides the child with a sense of achievement and a measure of success.
Sleep consolidates learning
Children with DCD and autism use different neural pathways for learning and control of motor tasks. These pathways sometimes need time for consolidation to form, and very often a child's performance on a task only improves after a good night's sleep. This is because memory pathways are consolidated during sleep.
So if your child seems to make no progress during a training session, do not be disheartened. Try again tomorrow and often you will be pleasantly surprised at how much improvement there has been.
How to help your child: Information and tips for training coordination and fitness
Why take a task based approach to physical therapy?
A video tutorial