Table 5: Characteristics of Successful Motor Learning Interventions Characteristics and Strategies
References
de Werd et al., 2013; Kessels & de Haan, 2003; Li & Liu, 2012; Ries, 2018.
Integrate errorless learning strategies (eliminate or minimize possible mistakes made by the learner), or structure the environment so errors are less consequential: • Use feed-forward instruction, mnemonics, task modeling, tactile guidance, and cues. • Using excellent observation and movement analysis skills, anticipate errors and intervene before they are made. • Taper guidance and cues as learning occurs. Consider part-to-whole practice by deconstructing mobility or ADL skills as appropriate: • Utilize forward chaining (adding the next component part when learner masters the previous part). • Always put component parts back into the whole task prior to finishing practice session.
Werner et al., 2017; Ries, 2018.
Access to visual feedback may support learning: • Assure appropriate and clean prescription eyewear. • Provide external motivation with visual cues.
Dick et al., 2001; van Halteren-van Tilborg et al., 2007; Ries, 2018.
Practice with appropriate level of challenge and intensity: • Patients should be challenged at the highest level possible. • Rest breaks should be offered only when necessary (i.e., the patient truly needs to rest).
Dawson et al., 2017; Littbrand et al., 2006; Ries et al., 2015; Ries, 2018; Telenius et al., 2015; Toots et al., 2016.
Note . From Western Schools, 2020.
FACILITATING OPTIMAL INTERACTIONS
Establishing and maintaining a therapeutic relationship with individuals who have AD can be challenging, especially as dementia progresses, but there are many strategies to facilitate success in this endeavor and there is evidence that even late in the disease, a therapeutic connection is possible (Williams
& Tappen, 1999). Prioritizing a “relationship focus” over a “task focus” will better engage clients, facilitating improved participation and outcomes. This requires attention to the immediate practice environment, the manner of communication, and the skill of optimally cueing clients. Communication with individuals who have AD should be simple and direct without being condescending; therapists are sometimes guilty of infantilizing individuals with AD and should be mindful to avoid this. The complexity of conversations and commands can easily be modified to meet the needs of each client, but it is good practice to initially simplify verbal instructions. Facial expressions and body language that are consistent with oral expressions can facilitate optimal communication. Table 6 offers tips for creating a successful therapeutic environment and relationship (Dawson, Gerhart, & Judge, 2017; Fazio, Pace, Flinner, & Kallmyer, 2018; Haak, 2002; Hauer et al., 2012; Heliker, 2009; Hernandez, Coelho, Gobbi, & Stella, 2010; Kovach & Henschel, 1996; Ries, 2018; Sadowsky & Galvin, 2012; Small, Gutman, Makela, & Hillhouse, 2003; E. R. Smith et al., 2011; Stinson, 2000) Music may be a useful adjuvant component to the therapeutic environment, although this may need to be evaluated on a case-by-case basis. Moving or exercising to music may facilitate more participant engagement and movement if the music is well chosen. Frank Sinatra and big band music may not be the optimal choice for the aging baby boomer generation; the increasing numbers of individuals with AD may better relate to the Beatles and the Rolling Stones! There is limited study of the use of music in conjunction with exercise or dance for this population (Low et al., 2016; Satoh et al., 2014; Spildooren, Speetjens, Abrahams, Feys, & Timmermans, 2018), but anecdotally and intuitively, the integration of music into therapeutic interventions may be a useful strategy.
Optimizing environment, communication, and the therapeutic relationship Therapeutic or exercise interventions may take place in a variety of environments, and the comfort of the participant in the given environment is pivotal to the success of the program. Interventions may be in the form of individual physical therapy treatments (e.g., inpatient, outpatient, or home care), caregiver- guided home exercise programs, community-based small group exercise programs, or group exercise programs in long-term care settings. Each setting has benefits and limitations; for instance, the home environment is familiar and comfortable, but it may
have limits related to space or equipment, and it sacrifices the social benefit of community-based group activities. Adult daycare centers are excellent locations for group exercise classes because the community-dwelling participants are a captive audience and are already familiar with the environment. Establishing excellent therapeutic relationships with individuals who have AD requires assuring that individuals’ immediate needs are met (e.g., toileting, thirst, hunger) prior to a therapy session and an investment in learning about a client’s personal and family history. By encouraging a client to talk through a reminiscence (e.g., “Tell me about when you flew planes in the Navy,” “What did you love about teaching?”), therapists can establish a connection that grounds the therapeutic relationship. By knowing family members’ names and bits of information, therapists can help clients to see that there is one team of people working together (e.g., “Your daughter Susan will be thrilled to hear how well you’re doing in exercise class!”).
Table 6: Creating a Successful Therapeutic Environment and Relationship Optimal Characteristics and Tips for Success
References
The environment should be low stress. Avoid agitation, frustration, and fear, which are often caused by confusion/not knowing what to expect.
• Familiar and consistent setting. • Familiar and consistent people.
Kovach & Henschel, 1996; Ries, 2018; Sadowsky & Galvin, 2012; Small, Gutman, Makela, & Hillhouse, 2003; Smith et al., 2011; Stinson, 2000.
• Safe, calm, and predictable. • Little or no distracting stimuli. • Use redirection and refocusing as necessary. • Consistent timing so the program is part of the routine. • Capitalize on social interaction.
EliteLearning.com/Physical-Therapy
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