Therapeutic Intervention Strategies for Adults and Children Essay Example
Therapeutic Intervention Strategies for Adults and Children Essay Example

Therapeutic Intervention Strategies for Adults and Children Essay Example

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  • Pages: 7 (1908 words)
  • Published: January 11, 2019
  • Type: Essay
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The purpose of this literature review is to examine the various therapeutic intervention strategies being administered to adults and children with perceptual, spatial, gross, and fine motor proficient disabilities. Additionally, the review aims to identify the approaches that have been effective in the rehabilitation process for adults with perceptual dysfunction secondary to brain injury. Occupational therapy has been widely used as a main therapeutic strategy for perceptual retraining (Holzer, Strassny, Senner-Hurley & Lefkowitz, 1982; Hopkins & Smith, 1983; Prigitano, 1986; Siev Freishtat, & Zoltan, 1986; Trombly, 1983, Van Deusen, 1988; Wahlstrom).

Various occupational therapists have offered a variety of approaches for retraining perceptual deficits (Trombly, 1983; Neistadt, 1988). These approaches have been categorized differently by different authors (Abreu & Toglis, 1987; Siev et al., 1986). However, Trombly and Neistadt are the only authors who discuss the common assumptions underlying different treatment approaches. Neither of t


hese authors fully explains the assumptions underlying the classifications.

Treatment techniques for perceptual deficits in occupational therapy can be classified into two categories: adaptive and remedial. Adaptive approaches focus on promoting adaptation to the environment and capitalizing on the client's strengths and situational advantages. Examples of adaptive approaches include developmental skills, occupational behavior, and rehabilitation treatment paradigms (Hopkins ; Smith, 1983). These approaches provide training in daily living behaviors rather than the perceptual skills of functional behavior.

On the other hand, there are remedial approaches that aim to promote the recovery or reorganization of impaired central nervous system functions. These approaches include perceptual motor training (Abreu, 1985), sensory integration (Ayres, 1972), and neurodevelopmental treatment (Bobath, 1978). Specifically, sensory integration techniques address sensory processing and the perceptual discriminations it is based on. However, it should

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be noted that sensory integration was not originally developed for clients with brain lesions, so it may not be entirely applicable to this population. Nonetheless, some sensory integration techniques can be cautiously used with adults who have brain injuries (Fisher, 1989).

Neurodevelopmental treatment focuses on proprioceptive and kinesthetic perception in relation to functional movement patterns. These approaches involve training in the perceptual processing components of functional behavior through perceptual drills or specific sequences of sensorimotor exercises. These are the common assumptions underlying the current use of adaptive and remedial treatments. Occupational therapy's literature on perceptual retraining describes both adaptive and remedial approaches (Siev et al., 1986). For adults, four perceptual treatment approaches are discussed:

  • Sensory integration.
  • Transfer of training.
  • Functional training.
  • Neurodevelopmental.

Three of these approaches - sensory integration, transfer of training, and neurodevelopmental - can be classified as remedial because their underlying assumptions align with the previously outlined remedial assumption, such as retraining sequences.

In the sensory integration and neurodevelopmental approaches, therapists use controlled vestibular, tactile, proprioceptive, and kinesthetic stimulation to facilitate normal central nervous system processing of sensory information. The goal is to promote more normal perceptual-motor responses in clients by improving their sensory processing abilities.

In the transfer of training approach, therapists utilize activities such as puzzles and pegboards to target specific perceptual skills that are necessary for these activities. By practicing these skills that have been affected by a brain injury, it is believed that improvement in these deficit skills will transfer to other activities that require the same skill.

However, authors have noted that because functional activities often involve the use of multiple perceptual skills, it is challenging

to determine which specific skills a client is utilizing to successfully perform these tasks.

The notion of improvement and transfer of skills in this approach suggests that the tasks used require the brain to repair itself or recognize itself in order to produce a successful behavioral response to the perceptual tasks. The functional approach can be categorized as adaptive because it aligns with the adaptive assumption. In this approach, perceptual retraining is incorporated into everyday activities training. During such training, clients are educated on how to compensate for any perceptual deficits they may have by adjusting their approaches to functional tasks to make the most of their intact perceptual skills. In a cognitive rehabilitation model described by Klonoff, H. Clark, and Kloproff (PS 1993), perception is viewed from an information processing perspective.

This model can be classified as remedial because it matches the assumption of remedial. In this model, the perceptual process includes sensory detection, analysis, and hypothesis formation. This involves comparing the analysis with prior experiences and relating it to the overall purpose and goal of the activity. The response can be data driven, which are direct responses to external stimuli or conceptually driven, which come from external expectations of incoming data. Treatment in the cognitive rehabilitation model aims to improve weaknesses across the entire perceptual system.

(Abreu & Toglia, 1987, p. 493) emphasizes the cognitive strategies used in performing different tasks in various environments, while also considering different body positions and active movement patterns. Strategies are defined as organized sets of rules that help in selecting and guiding the processing of information. Treatment strategies involve encouraging clients to plan ahead, control their response speed, review their

work, and scan from left to right.

The text suggests that there are various strategies to improve clients' ability to handle more information. These strategies can be implemented through computer games, gross motor tasks, group activities, games and crafts. The main aim of this treatment is to develop efficient mental strategies and behaviors in clients. The model also aims to enhance the perceptual processing capabilities of the central nervous system. In addition to the mentioned strategies, (Abreu and Toglia 1987) have discussed other treatment approaches for adults with perceptual deficits. These approaches are categorized as functional, sensory integration, and perceptual motor training approaches, which are similar to Siev et al's (1986) functional training, sensory integration, and transfer of training categories. Trombly (1983) has also discussed neurophysiological and compensatory approaches to perceptual retraining, corresponding to remedial and adaptive approaches respectively.

Within the neurophysiological category, Trombly listed sensory retraining and visual scanning training as techniques. Additionally, Trombly included backward training for specific functional activities and structuring of the environment under compensatory education techniques. Wahlstrom (1983) suggested a perceptual retraining program involving sensory integration and positioning based on neurodeveloponental treatment principles. Wahlstrom also recommended perceptual retraining using puzzles, pegboards, and games for all clients with head injury except those experiencing confusion. For confused clients, Wahlstrom advised a functional approach of self-care training to address perceptual deficits. Wahlstrom's earlier recommendation can be classified as remedial, while the latter one is adaptive.

The Constructional Deficit Approach, also known as the Constructional Deficit Strategy, is a strategy that focuses on the ability to combine parts into a unified entity or object. This skill is important in various activities such as drawing, building, dressing, and

setting a table. These activities require the integration of visual perception, motor planning, and motor execution. Previous literature on constructional deficits in occupational therapy has primarily focused on remedial treatment rather than utilizing the client's other strengths to compensate for the deficit. One approach suggested by Sieve et al. (1986) is to have clients practice simple copying or construction tasks, with the belief that improvement in one task will transfer to similar tasks. Additionally, the authors recommend using a clay board instead of paper and pencil for drawing designs, as it provides additional proprioceptive and kinesthetic input. Recommended construction tasks include block designs in Frostig's teacher book (Frostig & Horne, 1973) and Kohs puzzles.The text discusses various block designs and activities used in the Wechsler Adult Intelligence Scale (WAIS), including parquetry block designs, match stick designs, pegboards, connecting dots with a design in Frostig's workbook, pegboard blocks, and puzzles. These recommendations derive from Siev et al.'s transfer of training approach. The text raises the assumption that materials designed for perceptual training in children, such as Frostig's workbook, are also suitable for adults. This assumption is based on the belief that adult recovery from central nervous system trauma follows a similar developmental path as early childhood.Another assumption derived from the recapitulation of ontogeny idea is that the stimuli provided to an adult recovering from central nervous system trauma should follow a developmental sequence. For example, because children can accurately draw circles, squares, triangles, and diamonds at ages (3) three, (4) four, (5) five and (7) seven to (8) eight years respectively (Henderson, 1986; Rand, 1973), adults with constructional deficits should be asked to copy simple shapes

in that order.

In this activity, researchers Bowska, Kauffman, and Marcus (1985) proposed a remedial approach to Constructive deficits. They suggested that visual analysis, synthesis, and visuoconstructive skills should be treated simultaneously because they are often utilized together during task performance. They classified circles as the lowest difficulty level and diamonds as the highest difficulty level when copying simple two-dimensional shapes. Visual analysis skills consist of four components: analyzing similarities and differences, understanding the relationship of parts to one another, reasoning, and deducing the nature of visual stimuli.

According to Bouska et al. (1985), it is suggested that visuoconstructive treatment should follow developmental considerations. This means progressing from horizontal to vertical to oblique lines, and from two-dimensional to three-dimensional designs. Additionally, tasks should start with common objects and gradually move to abstract designs (pp. 581-582). The specific tasks that can be adjusted based on these parameters include simple puzzles, dot-to-dot tasks, drawing from memory or copying, copying block designs, assembling woodwork projects, sewing from a pattern, organizing shelves, and setting a table. However, the key to effective visuoconstructive learning lies not in the task itself, but in how carefully the therapist organizes it and monitors performance (Bouska et al., 1985 p.).

582). Bouska et al. (1985) proposed two therapeutic techniques to help clients organize and track their tasks: saturational cuing and backward chaining. The initial step involves presenting controlled verbal instructions on task analysis and cueing on spatial boundaries. The subsequent step entails progressing clients from nearly complete perceptual tasks (with just a few blocks missing from a block design) to incomplete perceptual tasks (with no blocks placed in the client's design).

The therapist gradually makes the task completion

more challenging for the client by reducing the number of steps required. It is important to note that this remedial approach is based on developmental sequence assumptions. Unlike Siev et al. (1986), Bouska et al. (1985) included functional activities in their repertoire of therapeutic tasks.

The goal of the treatment is not to train in the tasks themselves, but to train the perceptual processes needed for those tasks. This approach to task selection is more flexible than relying on evaluation tasks, but assumes that occupational therapy activity analysis is accurate, reliable, and objective. However, there is no standardized approach to occupational therapy activity analysis for adults with neurological dysfunction. Therefore, therapists often disagree on the necessary perceptual and cognitive skills for activities. Many occupational therapists agree that both adaptive and remedial approaches to perceptual retraining have been successful for clients with neurological brain dysfunction. However, most literature suggests that therapists primarily use remedial techniques rather than adaptive approaches. There needs to be more research done in both areas of remedial and adaptive retraining, although more has been published on the remedial approach. Some believe that remedial techniques have been more prominent in treating subjects with minimal brain dysfunctions.

In a review by Kunstaetter (1988) and Neistadt (1986), various treatment modalities in occupational therapy have been examined and categorized. It was observed that a majority of these modalities primarily involve remedial techniques. Many researchers agree that it is difficult to determine whether theory influences practice or vice versa. Nonetheless, most researchers recognize the need for further investigation into the theoretical assumptions underlying specific practices. This is crucial to develop critical assumptions that align theory and practice, ultimately delivering

the best services possible to clients.

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