Learning and Teaching Cues in Occupational Therapy

.
Learning and Teaching in Occupational Therapy

Giving cues
A cue is a stimulus for an action to occur. It is a signal to a person
that a response is necessary.
In planning the individualized educational program, naturally
occurring cues for the activity are identified so that the person can
be taught when to initiate the activity.
If at first the person finds difficulty in discriminating and
responding to the natural cue, it may be necessary to begin by
using an additional or artificial cue in order to elicit the correct
response. This is sometimes called stimulus prompting

Whether natural or artificial, a cue occurs before the person
performs the desired action, and is specific enough to initiate or
occasion the activity. The program always specify what the cues
are. Teaching in natural settings and at natural times will make
maximum benefit of environmental cues.
Artificial cues are:
1. Understandable to the learner
2. Given only once on each occasion the activity is carried out (on
each trial) at the beginning of the task
3. Provided only when the learner is paying attention
4. Given in such a way that the natural cue is present and highlighted
5. Faded in favor of the natural cue as quickly as possible, because
of the danger that the artificial cue will teach the learner to rely on
direction to initiate activity
6. Included in the presentation of materials or may require the
learner to locate them

In practice, a combination of natural and artificial cues is generally
used for teaching purposes. Cues can be classified thus:
Verbal cue:
• An instruction which highlights to the learner important features of
the environment that are critical for successful task performance e.g.
‘Julian, here is the salad bowl’ (avoiding questions such as ‘would
you like some salad?’). OR ‘Look for the green light, then we can
cross the road’ or ‘Choose the pink colored note to pay for the milk’.
Gestural/visual cue:
• Non-verbal action which cues the person to perform, e.g. holding
out the salad bowl. Pointing to the green light or the pink
highlight a particular feature, e.g. using iridescent tape on the
appropriate button on a cassette player; color coding various parts of
an assembly task to make it easier; introducing tags or labels to
promote orientation of clothing.

Modelled cue:
• A demonstration to the individual of attending to and responding to
the appropriate cue with the required action, e.g. helping oneself to
salad and passing the bowl to the learner, pressing a switch to
operate a video game, laying a place setting, with cutlery correctly
oriented.
The type of cue(s) you select in order to teach a person a functional
skill will depend on the needs of the learner, how they understand
information best as well as the nature of the skill under instruction.

How to fade artificial cues
It if has been necessary to use an artificial cue to bring about the
learner’s action, the reliance on the artificial cue is gradually
decreased or faded as the learner becomes more proficient so that the
desired behavior will be initiated by the presence of the natural cue.
Cues can be faded by decreasing them in number and strength. In
the example of the presentation of a bowl of salad, the volume of
instruction is gradually decreased until it is totally inaudible, or the
length or artificiality of the cue reduced by saying ‘Salad’ instead of
‘Take some salad’, to the point when nothing is said. If the cue was
pointing to the salad bowl, the cue could be faded by pointing to the
bowl from a gradually increasing distance, and eventually not
pointing at all.
The fading process is specified in the program. Fading is carried out
systematically and once an artificial cue is no longer required it is no
longer used..

Latency
An individual is able to respond to a cue within a certain period of
time in order for the response to be functional. For example if the
telephone rings or someone knocks at the door it is necessary to
respond within certain functionally based time limits.
Latency refers to the time between the presentation of the cue and
the commencement of the response.
What is an appropriate latency period varies greatly between
different functional tasks and different functional task
environments. This is an important issue to address in the
provision of instructional support.
Provide support in order to ensure that performance meets the
person’s functional needs. This may include specifying a functional
latency period; providing feedback to the learner; promoting speed
of discrimination of cues and promoting rate of responding

Teaching complex discriminations
Match to sample is of particular value in teaching tasks whose key
feature is that the learner learns to discriminate relevant from
irrelevant aspects. It can be used within a whole activity where the
task involves a discrimination that is repeated a number of times
within the natural sequence of the activity, e.g. putting
socks into pairs, sorting cutlery after washing up.
As learning to discriminate the relevant from irrelevant aspects of
a situation may be difficult while participating in the activity, some
initial learning may need to take place in isolation. Performance of
the particular step however is placed back into the context of the
activity as soon as possible.

In its simplest form the learner is presented with two different
stimuli from which a choice needs to be made.
For example, in the activity of setting a table, a knife and a fork in
outline on a placement can be used. The learner has to indicate
which of the two outlines is identical in shape to a sample presented
by the instructor. The instructor says ‘put the fork with the fork’
and hands the fork to the learner.
A correct response is recorded if the learner takes the fork from the
instructor and places it on the outline of the fork.
The model is gradually removed leaving only the natural cue. This
is called stimulus fading.

This instructional format can be used to develop the learner’s
ability to make progressively finer and more complex
discriminations in a procedure sometimes referred to as stimulus
shaping
This provides opportunities to develop discrimination skills by:
• Increasing the number of items from which the learner chooses
• Making the differences between the targeted item and the
alternatives or distracters increasingly fine.

In a discrimination learning task such as this, a ‘most to least’
prompt strategy may be the most effective. A correct response may
be prompted by the following prompt hierarchy (‘most to least’).
• Therapist physically guides learner’s hand to correct card
• Instructor pushes correct card towards learner
• Instructor points to correct choice.
The instructor may prevent errors by covering or removing
incorrect choices. The person is able to match items consistently
correct and independently before moving on to the next step in the
sequence
select 480 given a choice of 480 and 414
select 480 given a choice of 480, 414 and 415
select 480 given a choice of 480, 415, 414 and 483
selects yellow given a choice of yellow and white
selects yellow given a choice of yellow and blue and green and white
selects yellow given a choice of red and yellow

Strategies for using prompts
Systematically implemented prompts are the means of teaching the
learner how he or she behaves in response to the cue, that is, what
are the correct motor actions required.
In teaching learners with severe disabilities it is necessary to plan,
specify and systematically use prompts so that just enough
assistance is given for the learner to complete the task.
Prompts are specified in the program.

Verbal signed) prompts
Words or signs that tell the patient how to respond (“Spray the
mirror”); not the same as instructional cues (e.g. “Clean the
bathroom”) or directions.
Match to fit patients comprehension of words/signs and the amount
of prompt needed (e.g. nonspecific prompts like “What’s next?”
may be good later in learning, but provide little information).
Pros: Can be given to a group and used from a distance; do not require visual attention;
involve no physical contact.
Cons: Must be heard and understood by patient and followed. Level of complexity varies
highly. May be hard to fade.

Pictorial or written prompts
Pictures or line drawings that tell the patient how to perform a
behavior. Pictures may show the completed task or one or more
steps in the task. Words may accompany pictures if patient can
read.
May be used as permanent prompts that are not faded. Level of
abstraction needs to fit patient (e.g. photos, drawings, line
drawings, letters, numbers, words)
Pros: Can be used unobtrusively; does not require reading. Can promote independence even
when used as permanent prompts. Standard symbols may help maintain consistency.
Cons: Pictures may be poorly drawn or taken; if lost, pictures may not be replaceable. Some
actions are difficult to illustrate. Must be seen and understood by patient and followed. Level
of abstraction varies.

Gestural prompts
Movements made to direct a person’s attention to something
relevant to a response.
Pointing toward the desired direction tapping next to the material
needed.
Pros: Unobtrusive, more natural cues. Can be given to a group and used from a distance;
requires no physical contact.
Cons: Must be seen and understood by student and followed.

Model prompts
Demonstrations of the target behavior that patients are expected to
imitate. Models often involve movement (showing a step in shoe
tying) but may involve no movement, as in showing a finished task
(show one place set at a table and match to sample) or be verbal
(“sign ‘want ball’”).
Models may be complete (show entire step) or partial (show part of
the step). If the model is done on a second set of materials, it need
not be undone. Model prompts usually match task steps
Pros: No physical contact with person is needed, can be used with a group and given from a
distance. Versatile: models suit many target behaviors.
Complexity of model can be adjusted to suit patients level of performance. Others can
be effective models on a planned or incidental basis. Modeling can be unobtrusive.
Cons: Requires patient to attend (see, feel, or hear the model) and to imitate. If model is too
long or complex, imitation will be difficult

Partial physical prompts
Brief touching, tapping, nudging, or lightly pulling or pushing a
student’s hand, arm, leg, trunk, jaw, etc.
Used to help a patient initiate a response or a sequence of
responses. Follow the rule: “as little as necessary”.
Pro: Gives some control over patient responding with little physical contact. Useful when
vision is limited.
Con: Can be intrusive. Some patients do not like to be touched; can’t be used at a distance.
Care must be taken not to injure or throw student off balance

Full physical prompts
Full guidance through a behavior, often involving hand-over-hand
assistance (as in using a spoon or smoothing a bed spread) or
movement of the trunk and legs (as in assisting crawling or walking
forward).
Physical prompts should match task steps. Follow the rule: “as little
as necessary,” while being sensitive to any patient movement and
easing physical control. Does not involve force.
Pros: Allows total control over response, thereby reducing errors. Useful when vision is
limited.
Cons: Highly intrusive, unnatural, and stigmatizing in public. Some patients do not like to
be touched; can’t be used at a distance. Care must be taken not to injure through tight
holding, to force compliance with a movement, or to throw the patient off balance

Constant time delay
- Select prompt that controls the response and determine how
many trials will be given at 0–sec delay.
- During initial requests to respond, the prompt is given at the same
time as the request (0–sec delay), making early trials look like
simultaneous prompting. After a trial, several trials, or session(s),
the delay between the task request and the prompt is lengthened to
4 sec. If the patient does not respond correctly in 4 sec the prompt
is given, Initially reinforce prompted correct responses, later
differentially reinforce. Always reinforce unprompted correct
responses.
- Continue giving delayed prompts until learning occurs. If errors
occur, interrupt with the prompt; after several consecutive errors,
reintroduce 0–sec delay for 1 trial or more.

Constant time delay
- Response fading is part of the procedure as patients learn that
anticipating the delayed prompt enables faster reinforcement
and/or completion of the task
- Recommended use: During early to late acquisition, as well as
other phases, but with less intrusive prompt. Good with chained or
discrete tasks; equally effective but easier to use than progressive
delay and more efficient than increasing assistance system.

Simultaneous Prompting
- Request patient to perform the target behavior while prompting
at same time. Model prompts are often used.
- Reinforce both prompted correct and independent correct
responses.
- Before every training session, give an opportunity to perform
without prompting (probes) (or following a set number of trials)
to determine when to fade prompts.
- Fading of prompts occurs when probes alert teacher to stop
prompting, prompting is stopped, and patient continues to
respond correctly.

Simultaneous Prompting
- Recommended use: During early to late acquisition phase.
Seems to work well when patient cannot use less intrusive
prompts. Perhaps less useful in later stages of learning.

System of Least Prompts (Increasing Assistance)
- Select a response latency and two to four different prompts that
suit patient and task; arrange prompts in an order from least
assistance to most (e.g. verbal, verbal + model, verbal + physical).
- Patient is asked to perform the task and allowed the latency to
respond.
- Whenever a correct response (or a prompted correct) is made,
reinforcement is given and the next training step/trial is provided.
- Patient makes an error or no response, the first prompt in the
hierarchy is given and the latency is waited, If the patient again
makes an error or no response, the next prompt is given
and the latency provided, and so on through the last level
prompt.

System of Least Prompts (Increasing Assistance)
- Errors are interrupted with the next prompt.
- The last prompt should be adequate to produce the response.
Prompt fading generally occurs as patients learn to respond to less
intrusive prompts and then become independent.
- Recommended use: If learning is in fluency stage, this is more
efficient than decreasing assistance. Reduce intrusiveness of
prompts for use in later learning phases

Progressive Time Delay
- Similar to constant delay, except delay interval is gradually
increased from 0 sec to 8 or more seconds.
- Determine delay levels and how many trials will be given at each
level; plan error approach. During initial requests to respond, the
prompt is given at the same time as the request (0–sec delay),
making early trials look like simultaneous prompting. After a trial,
several trials, or session(s), the delay between the task request and
the prompt is lengthened by 1 to 2 sec increments up to 8 (or more)
sec. where delay remains until patient learns.

Progressive Time Delay
- Errors and corrects are handled as in constant delay, except delay
may be reduced partially or completely when errors occur and then
increased gradually or quickly when prompted correct responding
returns.
- Response fading is part of the procedure as patients learn that
anticipating the delayed prompt enables faster reinforcement
and/or completion of the task.
- Recommended use: During early to late acquisition; good with
chained or discrete tasks; equally effective with constant delay but
less easy to use; and more efficient than increasing assistance
system.

Most-to-Least Prompt Hierarchy (Decreasing Assistance)
- Select a response latency and two to four different prompts that
suit patient and task; arrange prompts in an order from most
assistance to least (e.g. verbal + physical, verbal + model, verbal).
- The first prompt should be adequate to produce the response.
Determine the criterion for progressing to a less intrusive prompt
(e.g. so many minutes of training at each level; a certain number of
corrects patient is asked to perform the task and allowed the latency
to respond.
- Whenever a correct response (or a prompted correct) is made,
reinforcement is given and the next training step/trial is provided.
Prompt fading generally occurs when teachers substitute less
intrusive prompts for more intrusive ones and patients learn to
respond to less intrusive prompts and then become independent.

Most-to-Least Prompt Hierarchy (Decreasing Assistance)
- Recommended use: Better for teaching skills in acquisition than a
least-to-most system. Works well when patient cannot use less
intrusive prompts (e.g. cannot follow verbal direction, imitate,
or does not wait for prompts) and makes many errors. Good
when target task is chained and requires fluent movement. Less
useful in later stages of learning

Description of prompt system
Select a general procedure to use:
a) Gradually lighten physical assistance from full to partial to light
touch to shadowing.
b) Hand to shoulder fading, which uses a full Physical prompt
applied at the hand and then faded to the Wrist, the fore-arm, the
elbow, the upper arm, the shoulder, and then to shadowing;
hand to shoulder fading has been accompanied by ongoing verbal
praise and tactile reinforcement, with concrete rein-forcers given at
the end of a task chain.
c) Reducing the amount of pressure from initial full hand-over-hand,
assistance to two-finger assistance, to one-finger guiding, and then
hands are close to the student’s involved body part
(hand, mouth, arm) but not in contact, ready to assist if needed

Prompts are delivered simultaneously with task request and the
patient movements through the task are continuous.
Develop a plan to fade prompts. Begin fading when there is evidence
that patient can perform with less assistance:
a) Sensing the patients assistance with the response through tactile
cues
(b) Improved performance (less help or no help) during probe or test
trials
(c) Patient initiates the task, or
(d) What seems like an adequate amount of training.

Recommended use: Use during early to later acquisition only and
after other, less intrusive systems have not worked

Examples of prompt hierarchies
A ‘most to least’ assistance hierarchy:
• full physical prompt
• to partial physical prompt
• to modelling
• to gestural prompt
• to verbal prompt
A ‘least to most’ assistance hierarchy:
• verbal prompt
• to gestural prompt
• to modelling
• to partial physical prompt
• to full physical prompt.

How to use a most to least (decreasing assistance) prompt hierarchy
- Cue: The cup containing the drink.
- Prompts: The instructor gives cue and assists the learner to pick up cup.
- When learner has learned to perform effectively at this level, the instructor gives
cue and assists the learner to pick up the cup.
- When learner has learned to perform effectively at this level, the instructor gives
cue and assists the learner to grasp the cup.
- When the learner performs effectively at this level, therapist gives cue and points to
the cup.
- When the learner performs effectively at this level the instructor gives cue and says,
‘here’s your drink’.
- When the learner performs effectively at this level, the instructor gives cue and
gradually fades verbal prompt.

How to use a most to least (decreasing assistance) prompt hierarchy
- Prompts: If the learner does not respond within 3 seconds, the
teacher says: ‘Here’s your drink’.
- If the learner does not respond within 3 seconds, instructor points to
cup.
- If the learner does not respond within 3 seconds, instructor assists
learner to grasp cup.
- If the learner does not respond within 3 seconds, instructor assists
learner to pick

In the same way that artificial cues may be used in order to learn
to respond to natural cues, artificial reinforcement can be used to
motivate learners to perform behavior that will eventually be
maintained by the natural environment.
Positive reinforcement occurs with the presentation of preferred
consequences for an identified behavior leads to an increase in the
performance of that behavior.
The rein-forcers to be used are specified in the learner’s
program, so that every person involved in implementing the
program is consistent in his or her delivery of reinforcement.
Everyone knows what rein-forcer is being used, how much of it to
give, etc

Positive reinforcement is:
1. Pleasurable and actually increases performance.
2. Given according to a predetermined schedule. For example in
acquisition continuous provision of small amounts of
reinforcements for every correct response. Moving to less
frequent reinforcement increases the rate of performance.
3. Given in such a way that the most likely natural consequence
of the learner’s response is highlighted and occurs
simultaneously with the artificial rein-forcer.
4. Gradually faded in favor of the natural rein-forcer so that
behavior comes to be maintained by the natural rein-forcer.

As individual preferences differ it is essential to determine what
reinforcement is necessary for each learner. This can be
determined by observation and recording of the person’s likes and
dislikes. Identified likes are tested to ensure that they cause an
increase in behavior. A rein-forcer is age appropriate.
This information can be obtained by using the following general
techniques:
1. Ask the learner directly about his/her likes and dislikes. Direct
questioning, although effective may be less informative for
people who have high support needs because it relies on verbal
communication

2. Ask others who are familiar with the person’s likes and dislikes
for a list of potential rein-forcers and be sure to verify their
responses with one of the other three methods. What is
reinforcing in one setting may be impractical, ineffective, or
unavailable for use in another.
3. Observe the learner over a period of days in their regular
routine and environments and list observed reinforcing events.
If carried out systematically for long enough, direct
observation of his/ her preferences (for food, toys, activities,
people, clothes) probably yields the most accurate list of rein-
forcers.

Structure the environment to observe a reinforcement period. As
with natural observations, structured observations do not depend
on language skills – an advantage for many learners with severe
handicaps.
Structured observations will determine the learner’s reaction to
potential rein-forcers that are normally unavailable. In a
structured observation, a learner is first allowed to sample briefly a
small group of similar items or events suitable to his/her
chronological age. The learner is then given the entire group of
potential rein-forcers and the frequency or duration of choices is
recorded, other groups of rein-forcers may be observed in a similar
fashion.

Besides arranging rein-forcers from most to least preferred, they
also can be arranged along a continuum from those perceived by
our culture as less natural or more immature to those perceived by
our culture as more natural and mature.
At more mature levels of reinforcement, the learner has learned to
expect less immediate and less frequent reinforcement.

Rein-forcers can be grouped in the following hierarchy from
primary to secondary and generalized rein-forcers.
1 Food
2 Toys and leisure activities
3 Tokens or payments with backup rein-forcers from 1 and 2
4 Parental, peer and teacher approval
5 Self-praise for accomplishment of a goal

Within the level of reinforcement preferred, the instructor selects actual rein-
forcers that are appropriate to the learner’s chronological age and the
functional task setting. For example if observation indicates that an adolescent
boy likes food and pre-school toys best, you would:
1. Reinforce with food less often and eventually not at all when other rein-
forcers are established
2. Select suitable toys or leisure activities that are liked and easily used and
avoid the use of pre-school toys if you can substitute others that are not age
bound or food
3. Reinforce with praise before every tangible reinforcement while gradually
reducing tangible reinforcement
4. Teach the use of new, potentially reinforcing, age-appropriate activities (video
games, listening to CDs), which would be the group of activity rein-forcers
and replace food
5. Reduce the frequency of activity rein-forcers through intermittent
reinforcement.

Shaping is a very useful reinforcement technique although the term is
frequently misused to mean physical promoting. Shaping refers to the rewarding
of successively closer approximations to the desired response. For example:
When a learner is reaching to press a touch sensitive switch to operate a toy:
• at first any movement of the arm would be rewarded
• then only a movement in the right direction would be rewarded
• then only a movement that produces contact would be rewarded
• finally only operating the switch would produce the reward
When a learner is learning to say ‘drink’
• the first vowel sound is rewarded
• then the learner saying ‘di’ is rewarded
• then ‘drink’ would be rewarded
• finally the learner says ‘drink’ and is rewarded.

How to fade artificial reinforcement
In the same way that artificial cues and prompts need to be faded in favor of
naturally occurring cues, artificial reinforcement also needs to be faded in favor
of naturally occurring rein-forcers. In this way, appropriate behavior can be
maintained without the intrusion of another person.
Artificial reinforcement can be faded in terms of intensity, duration and
frequency. For instance a learner could be rewarded with applause. The applause
could be faded by making it less loud, brief or even less often, i.e. after the person
has completed a greater number of correct responses.
In the initial stages of learning, it is common to reward every correct response.
This is referred to as continuous reinforcement. Once learning gets underway it is
recommended that reinforcement for responses be given only intermittently

Fixed ratio schedule
In the initial stages of learning a task the reinforcement is delivered in a fixed
ration, frequently 1:1, that is for every correct response a rein-forcer is delivered.
As the person becomes more competent, the rein-forcer is given less frequently,
for example, a fixed ration of 1:2 (one rein-forcer for every two correct
responses), and then 1:5 (one rein-forcer for every five correct responses.
Variable ratio schedule
Once the learner has acquired the skill, but still needs practice in order to perform
the skill at a reasonable rate and to maintain the skill, the reinforcement changes
to a variable ratio schedule, i.e. the reinforcement is delivered on an apparently
random basis. The learner cannot predict which performance of the behavior will
be reinforced and is therefore motivated to repeat the behavior to get the
‘occasional’ reward.

A variable schedule is carefully planned so that the instructor knows on which
occasions the behavior will be positively reinforced. For example with a 1:5
variable ratio schedule, a rein-forcer would be given at an average of once for
every five correct answer, i.e. if 20 correct answers were given, reinforcement
would be given at nos. 4, 10, 13, and 20. The ratio is gradually increased so that
the rein-forcer is given less often.
The process of decreasing the instances of reinforcement of correct responses is
described as thinning. If the program has been planned with learner
independence in mind, the natural reinforcement is identified from the outset and
schedules used systematically, so that thinning of artificial reinforcement occurs
without significant problems.
Learners learn best when artificial reinforcement is given continuously as a new
skill is acquired and then intermittently to maintain the skill.

Immediacy of reinforcement
An additional consideration of effective positive reinforcement, which affects the
degree of behavior change, is ‘timing’. The relationship is direct: the more
immediately the rein-forcers are presented after the behavior, the greater is their
effect.
Immediacy promotes the association of the rein-forcer with the performance of
the target behavior.
Immediacy is especially important in children and adults with limited language
skills. They are less able to learn contingencies from verbal contracts such as
‘After you perform a certain behavior, you may have a particular rein-forcer’.
Immediacy also decreases the change of accidentally reinforcing behaviors not
targeted for positive reinforcement.
Immediacy is more essential during acquisition than during the later stages of
learning, when the behavior is performed more reliably. Further, after a behavior
is in the fluency or maintenance stage, the learner may be taught to tolerate delays
as well as less reinforcement.

Satiation
Satiation results from the overuse of a rein-forcer. It is quite possible to tire of an
event so that it is no longer reinforcing, especially if it is given too frequently or in
large amounts. If too much of an edible rein-forcer is offered too frequently, the
reinforcing effect may be lost.
After extensive involvement with certain toys or activities, the novelty lessens and
the desired behavior is no longer effectively reinforced. This same outcome occurs
when rein-forcers are given freely or non-contingently (unlimited access to certain
events devalues their contingent effect on the target behavior).

Responding to errors in Performance
It is unlikely that learners with severe disabilities will learn efficiently through
making errors. It is therefore important that errors be corrected quickly so that
intensive remediation is not required.
Whenever a learner begins to respond incorrectly to a cue, or fails to respond at
all within the specified time specific support is needed.
Punishment or negative reinforcement are not relevant support procedures when
mistakes are made in learning. On NO account are coercive procedures to be
used.
Occupational performance can only be promoted with the active participation of
the learner.
Occupational roles are pursued by individuals according to their personal
priorities and interests.
Coercion is incompatible with this process.

Responding to errors in Performance
The exact support technique used will depend on circumstances but the general
practice is to interrupt an incorrect response, then re-present the cue and
immediately provide as much additional assistance as is required to ensure the
learner performs correctly. The correct performance is then reinforced. The
additional assistance might take the form of full physical assistance, a verbal
prompt, etc. The learner is subsequently given another opportunity to perform the
step.
Interrupting performance can take the form of preventing the incorrect response
occurring e.g. when the person is buying a loaf of bread and is about to pick up a
packet of bread rolls, the instructor could put their arm in front of the rolls; or
through covering up an incorrect choice, covering over all but the correct choice.

Repeating the stimulus for the performance of behavior while increasing the
amount of assistance provided, as in the system of least intrusive prompts, is
another way to deal with errors in performance.
For example,
- While teaching a person to eat with a spoon the therapist may say, “Pick up the
spoon”. After they do not respond, the therapist repeats the verbal cue and
points to the spoon
- The learner touches the spoon but does not grasp it.
- This time, the therapist says “Pick up the spoon like this”, while physically
guiding the learner to grasp the spoon correctly.
- The therapist releases the learner’s hand and the learner continues the
response. The therapist responds: “Right, you picked up the spoon

Another method is to interrupt the error and follow it immediately with the
least assistance needed to obtain a correct response and not repeating the cue.
For example
- A learner is learning to set the table while the therapist is using a system of
least prompts.
- On the first step (go to the kitchen), the learner requires a verbal prompt.
- The learner errors on the second step by going to the wrong cupboard. The
therapist sees the error develop and stops the learner’s hand as they try to open
the wrong cupboard.
- Next the therapist gives a verbal prompt, “Open the dish cupboard”, the
therapist waits 5 seconds, the learner does not respond and looks confused.
The therapist repeats the verbal cue while modelling which cupboard to open.
The learner responds correctly and is praised.
- Another approach to correcting errors is to interrupt the error and follow it immediately
with a verbal prompt and repeated practice, with physical assistance on the incorrect
step. In vocational assembly tasks this has been found to be more effective than a single
verbal-gestural prompt a verbal-gestural correction.

Once the learner has learned most or all of the skill and moved to the fluency or
maintenance stage, slightly different responses to mistakes or errors in
performance may be used.
Because the learner will be more proficient at the skill, errors are infrequent and
may be caused by distraction or carelessness rather than not knowing what to do.
In these cases one of the following procedures may be chosen:
1. The learner who makes an error or hesitates may be given a brief time (10–
15 seconds) to self-correct. Some errors, if uninterrupted, will provide
natural correction cues. If a person learning to set the table was allowed to
open the wrong cupboard, the absence of the dishes would provide a natural
cue that they had made an error. They may then correct their own error and
complete the correct response without prompts from the therapist. If a
correction is not forthcoming then one of the other procedures can be tried.

2. The error may be followed by a statement indicating that an error had
occurred (“No, that’s not right”) possibly also mentioning that reinforcement
would be withheld (“You can’t be paid this time”) plus a request to try the step
again with the possibility of earning reinforcement. If the same error is
repeated for two-four consecutive times the therapist reinstitutes a prompt
system.
3. A minimal prompt (“What’s next?”) or verbal rehearsal of the last two
steps correctly performed (“You just finished getting the plates, now what’s
next?”) may be applied as soon as the error is stopped. If the learner stops
before the step is completed, the therapist may confirm and urge the learner
to continue (“That’s right, keep going”).

There are other possible methods of correcting errors; however, to be effective,
error correction procedures are:
1. Matched to the learner’s present level of function
2. Applied immediately and consistently
3. Enough help to correct the error quickly if in acquisition or to help the
learner to discriminate that correct responses are followed by reinforcement
while errors are not (if in fluency or maintenance)
4. Suited in their amount of assistance to the learner’s stage of learning for that
task
5. Followed by additional opportunities to respond to the same task or step

Measuring performance
In addition to planning and using systematic teaching strategies it is necessary to
closely monitor the achievement of the learner in their performance of the set
objectives to make sure the program is proving effective.
Data collected on client performance can be used to make informed decisions
about necessary changes to program content and instructional strategies in order
to increase the effectiveness of instruction.
Strategies for collecting data
The best technique for evaluating progress is to observe and record performance
on each occasion the person is taught. This recording technique is usually
referred to as the collection of data.
Teaching which makes use of data as the basis for evaluating progress and
making instructional decisions can be referred to as data-based instruction or
systematic instruction.
There is no point in taking data if it is not going to be used in order to make
instructional decisions.

Data collection is planned in such a way that the data can be the basis for
decision making about the person’s performance in relation to achievement of the
short-term objective.
The amount and type of data to be taken in an instructional session is planned .
and specified as part of the program. The data collected may also change during
the instructional program as the phase of learning changes
The following principles apply when collecting data:
- The data-taking and recording system are to be carefully planned.
- The data-taking and recording are as simple as possible, yet enable
sufficient information to be collected.
- The type of information collected will depend on what is important to
know, for example, whether the learner responds correctly or
incorrectly, the time taken or the amount of assistance or prompting
that is necessary.

A number of formats for the collection of specific information may
be found in the professional literature. The format chosen
complements the instructional strategies and the specific
information required.
If pencil and paper are too slow or difficult to use in recording data,
use alternative techniques: timers, counters, e.g. golf counters and
CD/video recordings.
Some form of permanent and easily accessible record is kept for
comparison with data taken in the previous and the following
teaching sessions.

Data may need to be collected to determine how the learner can
perform before final decisions are made about what to teach.
Data collected over a few sessions in which an objective is targeted
but before instruction begins can provide detailed assessment of
learner response and can be used to pinpoint the appropriate short-
term objective in an activity or task analysis.
This initial data will provide information against which to measure
responses after instruction has begun. Progress can be easily seen
by comparison with background information. The process of
collecting information for initial assessment is referred to as
collecting baseline data or screening.

Data is collected frequently.
The frequency of data collection is specified in the individualized
educational program.
Data is recorded after the learner is presented with each opportunity
to respond within a planned instructional setting relating to a
particular short-term objective.
Each presentation can be referred to as a trial.
Some objectives are such that a number of trials would be given
each time the objective is targeted, e.g. the activity of setting the
table:
■ each opportunity to place a knife correctly would be a trial
■ each attempt to lay a place setting could be a trial.

Data is collected frequently.
Data is collected during each learning sessions but not necessarily
recorded for every trial.
Depending on the objective, learner responses may be recorded for
each trial or on a sample basis and that number of trials specified
in the program, e.g. in the activity of eating lunch, 20 trials of
filling the spoon may be necessary to finish the meal but data on
performance in 10 trials only is to be recorded at each lunch time.
The sampling frame used remains the same, that is, if recording
data on the first 5 trials, then every time the program is implemented
data from the first five trials is recorded.

Data is collected consistently.
The data collection system is such that all instructors (teachers, aids,
therapists and volunteers) involved in carrying out a particular
program can readily record learner responses. This assumes that all
those involved have been given prior instruction and practice on the
use of formats for the collection of information.
The collection of data for each objective can then be standardized
and provide a reliable base for decision making.
Ongoing recording during instruction is vital as few people can
remember details reliably even a few minutes after an event. Even if
at first it is difficult to instruct and record, practice makes it easier

Daily data collection formats provide an easy way to demonstrate
trends in the learner’s performance.
The most common technique is to take data in such a way that,
using the appropriate format, points indicating daily or scheduled
performance can be joined to make a graph.
Trends across time can be seen and interpreted. Decisions can then
be made regarding the efficiency of the program and any changes
that may be necessary one at a time.
The data is particularly valuable for demonstrating which
changes have worked.

Changes based on data could include:
a. Change to rein-forcer
This is often indicated when the learner shows only intermittent
success. The data will indicate that the step is within the capability
of the learner, but the learner does not appear sufficiently motivated
to perform correctly all the time.
Try to find out what is really reinforcing to the learner,
remembering that a rein-forcer increases the behavior which
immediately preceded

b. Further analyze the activity or task to simplify the objective
The activity or task can be analyzed further to identify simpler
behaviors so that smaller (simpler) steps can be inserted at the point
at which the learner is failing.
The smaller steps may require the learner to perform the step for a
shorter time (e.g. looks at book for 30 seconds as opposed to 40); or
for a shorter distance (e.g. swims unassisted for 3 metres as opposed
to 5).
Any change can be expressed as an alteration to the criterion or as a
new short-term objective.

c. Change cues or prompts
The program may also be changed by making the cue more obvious
or using an additional or different artificial cue.
Consideration is given to whether the natural cue or cues have been
correctly identified.
A different prompt hierarchy can be designed, or you could consider
trying a ‘most to least’ prompt hierarchy if you have been using
‘least to most’ prompts.

e. Use of an adaptation
Consider adapting the environment, e.g. find a more comfortable
position for the learner or change the location of teaching.
Consider the use of adapted equipment, e.g. specialized cutlery,
either in the targeted objective or in the other steps of the activity,
where a change might influence progress in the particular objective.

f. Temporarily cancel the program
This is the last resort and unlikely if the activity is of the highest
priority, in which case systematic program changes are more
appropriate. If, however, a learner is not succeeding, and stepping
up the reinforcement and all other possible changes have been tried
and proved ineffective, the program is temporarily cancelled rather
than maintaining the learner in a failure situation.
The learners are reassessed at regular intervals using task analyses

Fluency building
High levels of accuracy do not necessarily mean that a skill is
being performed at a functional level. Problems with the rate and
efficiency of performance will have an enormous impact on the
utility of the skill for the learner. If a skill is not proficiently
performed it probably will not be used by the learner nor
encouraged by those around them. In fact for certain tasks the
meaning and purpose of the task will be lost unless a certain rhythm
is matched in performance, e.g. in communicating, reading.
Proficient performance is often necessary before more complex
skills can be attempted. Fluency is therefore closely identified as
the foundation stone of successful maintenance of skills. It is also
the basis upon which many judgements about an individual are
made.

Fluency building
Competent performers receive positive social reinforcement in
terms of being given opportunities to respond. This is sometimes
referred to the competency corollary.
Fluent responders look more like their peers and will be less likely
to experience negative social interactions. Fluency is also important
for safety reasons, for example in street crossing.

Fluency is usually measured by monitoring the rate of
performance, its duration or the latency period between the stimulus
to act and the performance of a behavior.
The choice of dimensions depends on the skill to be evaluated. It is
important to consider whether problems of fluency are related to the
total task performance or some aspect of the decision making or
‘tool movement’.

To set the time-based criterion for fluency it is important to ensure
that time rates have good social validity.
For certain tasks the naturally occurring consequences will dictate
the time dimension for normalized use of the skill. For other skills it
will be important to determine the functional time range appropriate
in environments where the learner will need to perform the skill.
This can be done by observing others perform the task in the
appropriate setting or timing your own performance.
Instruction to promote fluency occurs after accurate performance
has been achieved. Fluency building techniques. It is rely primarily
on manipulating consequences and opportunities for practice it’s
important to continue to monitor the accuracy of performance as
efforts to increase speed can sometimes reduce accuracy

Massed practice
There are times when frequent, intensive instruction on the targeted
step is required in order for a learner to master the step. This is
often referred to as massed practice. A targeted step that would
normally only be done once (or at very low incidence) in the usual
performance of the activity or may under certain circumstances be
subject to instruction separate from the sequence of the activity or
task steps.
For example, at the start of the sequence of the activity of having
lunch, the targeted step for an individual may be to remove lunch
from their bag. A task analysis of this task is carried out and the
short-term objective may relate to unzipping the bag. If the learner
does not make rapid progress in learning this step, they may be
required to practice unzipping their bag five times each day before
lunch. Then the learner proceeds through all the rest of the steps as
usual to complete the sequence.

Massed practice
The way a learner performs the task, including any change to the
number of times it is to be carried out, would be specified in the
instructional program with the cue, the prompts and the
reinforcement to be given.
Then the short-term objective is achieved and the learner can unzip
their bag independently, another step in the process is targeted for
systematic instruction, which could involve massed practice, and the
learner would unzip the bag just the once necessary to remove their
lunch. In this way the skill would be maintained within the
meaningful sequence of activity steps

Massed practice
It may be necessary to remove a step from the sequence of an
activity. It would be inappropriate for most learners to shower more
than once or twice a day, but the learner may need more frequent
practice in turning on a shower tap than once or twice a day.
Where the other activities chosen as having a high priority for that
learner do not include opportunities for more frequent instruction in
turning on a shower tap, intensive instruction may be required.
Other examples where massed practice outside the sequence of the
activity and in a simulated setting may be required would be in
community activities where only one trial is appropriate, such as
paying for a meal in a fast food restaurant or for items at a
supermarket checkout.

Massed practice
Learning is placed back in the true context of the activity as
rapidly as possible. Massed practice in a simulated environment
does not substitute for learning in the real environment – but may
occur as an adjunct to experience in the real environment. The
learner needs to be able to identify readily the true context for the
particular step – including natural cues and reinforcement. In this
way the highly structured learning of parts of an activity contributes
to independent functioning in everyday life.
Massed practice is desirable only in the acquisition stages of
learning and while the learner is learning to perform an activity at
an acceptable rate. In the long run we want the learner to perform
the activity when and only when it is appropriate, however
infrequently that may be.

Maintenance
It is important that the learner can continue to perform activities
correctly and at a functional rate after instruction has been
withdrawn. This continued performance is referred to as
maintenance.
Maintenance is the continued correct performance over time of a
learned behavior in the repeated presence of the appropriate cue.

How to promote maintenance
1. The selection of activities and objectives is crucial. If chosen
activities are relevant to the learner’s present and future needs
then they will be maintained by naturally occurring
consequences in the learner’s life. Making a sandwich, for
example, gives rise to the natural reinforcement of eating, so the
behavior of making a sandwich does not need elaborate effort to
maintain if the learner enjoys sandwiches. Some activities may
naturally occur at low frequency: the priority accorded such
activities is carefully evaluated.
Continued consultation with parents/care givers may be vital to the
selection of appropriate activities. For example activities taught in
the home are those which parents will allow their children to
actually perform at home.

2. Fluency (i.e. the speed of performance) is at a functional level in
order for skill to be maintained. A learner who can dress for
work, but too slowly and needs to be assisted to get to work on
time has not reached a point where the behavior will maintain
itself.
3. Where the behavior is still subject to artificial reinforcement,
maintenance will be enhanced if reinforcement occurs only
intermittently and is not predictable to the learner.
For example, during acquisition, verbal praise may be given
for every correct response. Once the response is acquired and
performed at a functional rate, the instructor praises correct
responses on an apparently more random basis.

4. It is very important that natural reinforcement continues to be
available for a correct response and that artificial reinforcement
is thinned. Therefore maintenance is more likely to occur if
instruction has occurred in environments and at times when
natural cues and rein-forcers are present.
5. Many activities give the learner the opportunity to use and
therefore to maintain already learned skills. For example a
learner who has learned to brush or comb their hair has a
natural opportunity to practice that skill as part of hair washing.
A learner who can walk to the railway station can utilize that
skill when learning to travel to new places by rail. Consideration
of the overall daily routine and the balance of occupational
performance areas can be used to promote maintenance.

6. Some component steps of an activity will be performed
independently before others. Going through all steps each time
the activity is scheduled provides regular maintenance, even
though instruction may be focusing specifically on a small
number of steps.
7. Using appropriate error correction procedures

Promoting generalization
In everyday life people perform activities under varying situations
and conditions, for example, crossing the road at various pedestrian
crossings, in different traffic and weather conditions. In order to do
this most people adapt behavior learned at another time to suit
current circumstances. This is known as generalization.
It cannot be assumed that behavior learned under one set of
conditions will automatically occur when conditions are varied. Nor
can it be assumed that the variation requires identical behavior.
The learner needs to be ably to adapt to various environments in
which they are likely to participate. Instructional programs need to
ensure that the learner is able to participate in the activity under the
varying conditions they are likely to encounter

Promoting generalization
Generalization is the ability to perform a learned activity under
conditions which vary from conditions under which the activity
was actually learned. (Considerations for promoting
generalizations are not an afterthought but require careful
development and planning before instruction commences and will
affect all parts of instruction from the establishment of objectives to
data collected.)

How to promote generalization
1. Ideally learners are taught to participate in the actual
environments where the activity is usually performed. A variety
of sites where the behavior is likely to occur are targeted for
instruction, e.g. once a learner has learned to push a trolley
around a local supermarket, instruction would be given at a
different supermarket.
2. Once a learner has learned to perform a task with one instructor,
they learn to perform with another instructor. Thus a task
performed by a child for the therapist is also practiced with
the parents.
3. Advantage can taken of natural cues and rein-forcers to
facilitate generalization learning, e.g. where the learner usually
buys a favorite snack at one cafe, he or she might buy it from a
different cafe.

5. When selecting short-term objectives, the instructor examines
the priority activities chosen for the learner to determine whether
the same or similar tasks occur in more than one of the chosen
activity areas. Where possible these tasks are targeted at the
same time so that the learning takes place simultaneously
across a number of activities. For example, if the learner is
learning to cross roads to get to several leisure activities, the
steps involved in crossing roads would be targeted
simultaneously for each of these activities.
6. Particularly where this strategy involves learning to cross
different roads under different conditions it is possible to avoid
learning road crossing skills on one road and having to learn
when different conditions apply.

6. Activities are examined to determine the extent of variation that
the learner may encounter in the way the activity is usually
performed. For example, the learner may be required to operate
a television set at school, in the family home and in the group
home, or at some stage a new television may be purchased in one
of these locations. However, the On/Off switch of each television
may be in a different position and require pushing/pulling or
tuning. The indicators for the channels may be oriented
differently, e.g. horizontally, vertically or even in a circle, and
the learner may be required to operate several televisions so that
they can generalize the skill of turning on a television and
changing channels.

6. Generalization is greatly assisted if the instructor is aware of this
variation and teaches the learner several examples of the
variation likely to be encountered in the real world. The learner
is instructed in approximately 3–6 maximally different examples
and learns to respond to those aspects of the tasks that are
relevant and ignore those that are not.
7. Ensure ecological validity of skills and setting (that is, that the
learning context is relevant to the learner).
8. Use small group instruction where peers facilitate the learning
of each other.
9. Ensure the learner can see the value of the use of the approach
in a particular context.

10. Enhance motivation by using any one, or a combination, of the
following strategies: select behavioral repertoires of interest to
the learner; minimize the number and type of external
rewards and feedback (e.g. use self-reinforcement and
feedback and self-regulation); ensure the active participation
of the learner.
11. Transfer learning control and responsibility to the learner
(intervene only when necessary by facilitating the development
of self-management skills).
12. Teach rules of general principles and when and how to use
them.

13. Provide learners with opportunities to use skills or strategies and
help them make links between skills requiring the same strategy
for solution.
14. Encourage a problem-solving approach to skill solution.
15. Encourage the learner to make a prediction that a particular
strategy, accessible to the learner, will work. This principle will
require self-monitoring which will serve to promote self-
motivation.

A central theme underlying these principles is that people are taught
how to learn so that they can take responsibility for their own
learning and become aware of their own cognitive strategies.
In other words, use of these principles in instruction provides
learners with executive processes or meta-cognitive skills to
enhance their generalization. The procedures are, therefore,
designed to keep the program flexible and variable to ensure that
learning does not become “welded” to a specific instructional
situation or process.

Miriam Cho is 35 years of age and lives with her husband
Matthew and 2 children in a terrace in the inner city.
- Miriam enjoys gardening, home decorating, woodworking
classes and restoring furniture.
- She works as a systems analyst in the CBD.
- She has experienced severe pain, swelling and decreased range
of motion in forearm, wrist and fingers.
- In order to prevent symptoms recurring she is being taught to
have a break every hour for 10 minutes, to do no more than 4
hours of keyboard work in a day, use wrist splints, a wrist rest
attached to her keyboard and to keep her body, forearm, wrist and
hand well aligned and supported with the use of well designed
and fitted furniture, particularly when doing repetitive tasks.

Responsible use of systematic instruction in occupational therapy
Concern is raised occasionally about the use of applied behavior
analysis and systematic instruction. Accusations are made about its
manipulative, coercive nature, or that it is just plain bribery. On
the other hand it is countered that using identified systematic
relationships between events and learning increases the options
available to people and it is more ethical to provide learning
opportunities based on effective, proven and efficient means rather
than guessing.
All of these statements can be true. The motives, rationale and
procedures used in the adoption of any tool, such as applied
behavior analysis, will determine whether or not it is being used
ethically or unethically

Fundamental Principles Guiding the Ethical Use of Systematic Instruction
1. The goals and procedures of the program reflect the expressed
wishes and aspirations of the learner and their personal
priorities, what is most important to them. Where the learner is
unable to indicate their personal aspirations or there is serious
conflict between their personal aspirations and their best
interests then the person’s family members, guardian,
advocates and significant others are consulted with particular
reference to the social validation of goals.
2. The goals and procedures of the program develop appropriate
behaviors and consequently enhanced opportunities. That is for
example they are likely to lead to the person’s participation
and inclusion in the community, they are age appropriate and
likely to contribute to the learner’s role as a valued community
member.

Fundamental Principles Guiding the Ethical Use of Systematic Instruction
3. The goals and procedures of the program are stated objectively
and openly in an understandable form and are therefore open to
critical scrutiny, evaluation and review.
4. The goals established are achievable.
5. The learner and others involved are voluntary participants in the
program.
6. Procedures have been demonstrated to be effective.
7. The therapist and other people involved are competent in
applying the procedures and assisting a person to achieve the
stated goals.

Glossary of Terms
- Acquisition The initial stage of learning when a learner has no information
or very little information about signals, behavior or reinforcement associated
with particular learning objectives and requires this basic information.
- Applied behavior analysis The use of our knowledge about the relationship
between antecedents, behavior and consequences to identify and promote
human learning in natural settings.
- Behavior Motor action or motor activity, which is performed by an individual
and can be observed by others.
- Behavioral objective Specific statement of motor behavior, criterion for
performance and conditions under which performance is to occur. This
statement is used as the specific targeted outcome of a teaching program and is
stipulated before instruction begins.

Glossary of Terms
- Chaining This is related to task analysis. Skills are said to consist of a
chain of smaller component responses. Some skills are best taught starting
with the first step in the chain called “forward chaining” and then moving
onto the next step when that is mastered. Other skills are best taught starting
with the last step in the chain and working backwards in each session to
include the previous step. This is called “backward chaining”.
- Conditions Part of a behavioral objective which stipulates the physical
settings and/or the amount of assistance and/or equipment etc. which will be
present/provided to the learner whenever they are required to perform the
behavioral objective.
- Correction Consequence or action delivered by the instructor or required of
the learner following an error performed by the learner. Its aim is to reduce the
occurrence of errors.
- Criterion The standard of performance which is to be reached before the
behavioral objective can be considered to be achieved. Stipulates level of
accuracy/safety and/or independence to be achieved.

Glossary of Terms
- Cue The stimulus for an action to occur. This can occur naturally as part of
the everyday performance of an activity or action or it can be artificially
introduced by a teacher who wishes to highlight a naturally occurring cue.
Artificial cues can be verbal, gestural/visual or modelled.
- Fading The planned and gradual reduction and removal of any element of
instruction, which was artificially introduced by a teacher to promote learning.
Can be applied to reduction and removal of artificial cues or artificial
reinforcement.
- Fixed ratio Schedule reinforcement is delivered for every correct response,
e.g. one rein-forcer for every correct response of reinforcement where the or a
group of responses in a standard and repeating fashion. 1:1 e.g. one rein-
forcer for every two correct responses 1:2 or one rein-forcer for every five
correct responses 1:5.
- Fluency Learner has some information about signals; behavior or
reinforcement bus is not yet efficient or accurate enough in performance for
the task to be functional.

Glossary of Terms
- Generalization Ability to perform the targeted objective in a range of
environments, with a range of equipment and therefore stimulus conditions
and in the presence of different individuals depending on the functional
requirements of the task.
- Maintenance Sustaining efficient and reliable performance over time after
training has ceased.
- Phases of learning Four main aspects of learning or stages a person passes
through when learning something new: acquisition, fluency, maintenance and
generalization, which are all essential for competence but which require
different teaching strategies and considerations to be applied to promote
learning. These stages are not sequential.
- Prompt Assistance or intervention provided by a teacher to ensure that a
learner’s motor action or behavior is appropriate. Prompts can be verbal,
gestural/visual, modelled or physical.

Glossary of Terms
- Reinforcement The consequence delivered to an individual when they
perform an appropriate motor action in the presence of a specific cue(s). Can
be naturally occurring result of good performance or can be artificially
introduced by a teacher to highlight the naturally occurring positive
consequences.
- Shaping The rewarding of successively closer approximations to a desired
response.
- Stimulus A signal in the environment which indicates that a certain specific
action is required.
- Systematic instruction The application of a defined, replicable process which
reflects currently accepted “best practices” and in particular using
performance data to make modifications to ensure that the learner acquires, a
fluency level of performance, which is maintained and generalized.

Glossary of Terms
- Task analysis A series of motor steps listed in sequence, which are observed
when an individual performs an activity. Usually used to break down a
complex multi-step task into a series of single steps. (The instructor will then
decide what assistance will be provided to teach the learner each step.)
- Task analytic assessment The use of task analysis in order to assess an
individual’s performance of a task – usually a functional task. As this is used to
test performance no assistance is provided to help the learner perform each
step and the assessor may or may not complete steps to allow the person who
has become stuck on one step to try performing later steps.
- Variable ratio The learner cannot predict which performance of the behavior
is likely to be reinforced. For example they may be reinforced for the second,
seventh, eighth, eleventh and seventeenth correct responses.

The difference between a verbal prompt compared to a verbal cue is entirely
related to the specific part of the instructional sequence that is being highlighted.
If the signal or stimulus or cue is being highlighted verbally then it is a verbal cue,
e.g. in street crossing the instructor might give the verbal cue “Are there any cars
coming?”.
If, on the other hand, a verbal prompt is being given it is the motor action or
behavior which is being highlighted, e.g. in street crossing the instructor might
give the verbal prompt “Quickly walk across the street”. The same applies to the
difference between a visual cue and a visual prompt and a modelled cue and a
modelled prompt.

Occupational therapists are concerned with enabling clients to engage in
meaningful occupations. To this end, it is often appropriate to assist clients in
acquiring key skills relevant to their occupational goals. Although environmental
modification and adaptation of tasks can support skill learning, the process of
facilitating skill acquisition primarily involves engaging clients in teaching–
learning encounters
Clinical reasoning is the process by which therapists integrate theory and practice
It depends on familiarity with various levels of theory and the manner in which
each relates to the therapeutic encounter. These various levels of theory enable the
principles of occupational therapy to be implemented by guiding the selection of
appropriate evaluation and intervention methods.
In working with clients, particular tools or techniques are used to enable
performance. Tools are the specific therapeutic strategies that are employed
during therapy encounters to bring about change

Conceptual (theoretical) models of practice all help to understand the complexity
of human occupation by focusing on constructs that are central to the profession
such as occupational form, occupational role and occupational performance
Theoretical models guide practice to ensure it remains occupation-centered.
One strategy to maximize occupational performance is to establish, enhance
and/or restore the skills that will enable the client to participate in the identified
occupation

Learning and Teaching Cues in Occupational Therapy

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Learning and Teaching Cues in Occupational Therapy

Similar to Learning and Teaching Cues in Occupational Therapy (20)

More from Stephan Van Breenen

More from Stephan Van Breenen (20)

Recently uploaded

Recently uploaded (20)

Learning and Teaching Cues in Occupational Therapy