Task-oriented

therapy
„ If you don’t use it, you will loose it!!!!“
by Lisa Haedicke, Occupational therapist since 2006, Germany
4 steps to practice functional tasks
1. Analyse the functional task – what are the
essential components of the task and what is
the patient missing? Why? - what is the
IMPAIRMENT?
Impairments may be:
Motor – paresis, spasticity, co-ordination, non-
neural weakness.
Sensory – tactile loss, proprioceptive loss,
vision or vestibular.
Cognitive and perceptual – pain, habits, fear of
falling, dementia, unilateral spatial neglect
Musculoskeletal – joint ROM, muscle length
changes, contructure/stiffness (resistance to
passive movement as a consequence of
spasticity), alignment problems
4 steps to practice functional tasks
1. Analyse the functional task – what are the
essential components of the task, and what
is the patient missing? Why? - what is the
impairment?

2. Practice the missing components

3. Practice the task

4. Practice the task in different contexts /

environments
Questions for the therapist during the task:
How does the patient perform this task?
Which movement is difficult to perform for
the patient?
What can I change to make it better for this
patient?
What can I change to make it easier or more
difficult?
What is the main problem and how can I train
this problem?
Which objects can I use to train the missing
function?
Important:
Goal setting is very important!!!
You have to know the patient’s main goal/s !!!
In each exercise you must explain how it will help to
achieve the end result
Set short-term goals to reach the final goal and give
feedback to the patient, if he reaches the goal! Don´t say
so often, if he doesn´t reach the goal (maybe it´s
demotivating for the patient), prefer to ask questions to
the patient (What do you think, how was your
performance? What was good? What was not so good?
Can you change something?)
What is the patient’s age, family situation,
working/retired, hobbies etc.
Summary
Do you know something about the patient?
Do you know his problems? (Assessment)
Do you know the patient´s goal?
Do you know your goal?
Check, is it the same goal? If not, you have to
find a goal which can be accepted from the
therapist and patient!
WHAT WILL YOU DO NOW???
WHICH OBJECT CAN YOU USE???
It is important to use objects because:
Feedforward-Orientation (produce from
postural-tone and movement-tone, because
the patient know what will happen)
Attention from the patient is higher,
especially visually (he can see, if he can do it
or not!)
More attention to the hand (also important
for patient with mental and cognitive deficits)
Orientation to ADL-tasks, to make more
movements with the effected hand,
participation
 !
Possibly very early assistive tasks/ grasping!
If the patient has some functions try to make
something with objects! Don´t make so much
passive mobilisation, because the patient has
nothing to do during this mobilisation (and
this is boring) and nothing will be happen in
his brain! Only if the patient imagine the
movement or try to do it, then you will get the
possibility to make new ways in the patients
brain (neuroplasticity!!!!)!!!
 !
Make it interesting for the patient, not
boring, make some surprise for the patient,
not always the same! Be creative! patients
attention will be higher and better!!! He will
be also more motivated.
Advantage task- orientation/
meaningful tasks:
Patient knows before, what he has to do
initiation from tone (postural-tone and
movement-tone)
You don’t need so much verbal help, because
the patient know his task/ the object says you
the task movement is half-automatic
postural-tone better
Patient can see after the task, what he did
(goal-setting, feedback is good)
Disadvantage task- orientation:
If the patient know, what he has to do, maybe
he will do it in an abnormal movement
To reach the goal is the most important thing,
that’s the reason that the movement maybe is
too fast or in an abnormal structure or the
patient makes a compensatory movement
The quality is not important for the patient (
this is sometimes not good!)
Standards for a therapist
Specialized knowledge
Learn new things
Have a good and honest communication with
the patient and his family
Client-centre-practice
To be sensitive/ sensible/ understanding
self-criticism
Motivate the patient
Be creative
Practical time: Factors considering during
adapting therapy session
Search an object, what you use in your
therapy
What can you do with this object?
Which movements can you train with this
material?
How can you make it easier or more difficult?
What other materials can you use to make
new things with this object?
Handgroup
For patients with some or more functions
Task-oriented therapy! With objects!
Not more than 8 patients and 3 therpists
One therapysession 45/50 min
Every task for 8 min (use a alarm)
4 different tasks for each patient
The patient do spezific exercise for his
problems
Turn the sticks from one site Take 1, 2, 3… or as much as
to the other side finger- you can sticks in your hand
manipulation, precession Finger-strength, Finger-
Flexion, Manipulation
put the sticks in one line on
the table coordination, (if put the sticks in a square, triangle,
you take it far away shoulder- etc coordination, holding the arm
flexion, elbow-extention…)
Pronation (goal: touch the Supination (goal: touch the
table) you can hear the click table) you can hear the click
from the material from the material
Supination ca. 10° with a goal Supination ca. 40° with a goal
 Pronation; goal: don´t touch
Supination 60° with goal
the box coordination
Turn the stick in your hand Manipulation, Finger-flexion-
extention
 Clip the clips on the box
Opposition with coordination,
put the clips in a box
manipulation, some
Opposition
pronation, Finger-strenght,
Precession, tri-point-pinch
Clip the clips on the box in a
 shoulder-flexion, shoulder-
higher position shoulder-
abduction, external rotation,
Flexion, internal roation,
elbow-extention
elbow-extention
Put the cube in a square,
triangle, line etc on the table pile 2 cubes on top each
grasping, finger-coordination, other coordination,
tripoint pinch
pile 3 cubes on top each
pile all cubes on top each
other; take 1,2,3… cubes in
other, build a tower
your hand and build then a
shoulder-flexion (if the tower
tower coordination, in-hand-
is high), holding arm/
manipulation, fine-motor
endurance, handfunction
activities
Put the chips behind the line
Pile the chips on top each other, turn
(=goel) shoulder-flexion,
them around coordination, finger-
elbow-extention, pronation, manipulation
finger-flexion, precession
Build a tower behind the line Turn the money on the other side
shoulder-flexion, elbow- finger-coordination, manipulation,
extention, precession opposition/ precession
Bring the rubbers on the Take the rubbers from the
paper-roll finger-extention, paper-roll finger-flexion,
pronation manipulation, span grip
Put the pearls in the pot
 Precession dig 1 and 3
precession dig 1 and 2
 Precession dig 1 and 4  Precession dig 1 and 5
Take 1,2,3… or as much as you
can murmels in your hand and
put they seperatly on the
table/ into a box
Look for objects of your daily life!
„ The answer of the question, if it is good
what are you doing, is the reaction from
the patient of this, what you are doing!“
Karel Bobath