Application of Affolter approach to occupational therapy intervention. The presentation ended with a case study of a patient management using affolter techniques.

1. AFFOLTERAPPROACH TO
TREATMENT
Presented By: Odeyoyin Yusuph Abiodun

2. CONTENTS
• Introduction
• Definition
• Basic principles of Affolter approach
• Applied conditions
• Implementations
• Current research in child development
• Case study
• Journal

4. INTRODUCTION
• Developed by Felicie Affolter.
• Used Jean Piagets interaction model of
development as a foundation for this theory.
• This practical technique emphasizes evaluation
and treatment in realistic situation using
functional & age appropriate activities.

5. BASIC PRINCIPLES OFAFFOLTER’SAPPROACH
• Relationship between tactile-kinesthetic input and problem
solving skills
• Non-verbal guiding to facilitate perceptual-cognitive
interaction
• Therapy emphasizes on appropriate input rather than
successful output
• Development of sensory motor skills provides a foundation
for the development of complex cognitive & perceptual
skills.

6. • Treatment aims to improve the individuals
underlying sensory motor abilities & enhance the
ability of the person to take in & process
information.
• Motor learning is enhanced when individual is
given the opportunities to make errors & learn
from mistakes.
• Motor learning is enhanced when given
opportunities to initiate a task.

7. • Affolter does not embrace symptom by symptom
treatment
• Therapy does not involve on specific skills
• Learning occurs more by tactile- kinesthetic input
rather than auditory and visual
• Information processing differs from moment to
moment with information requirement for
interacting.
• Eg- where do you brush, where do u eat,
Tactile information are the primary input for
interaction in treatment
- Eg- cutting orange with knife.

8. The goal is for the patient to reach his optimum level
of performance, which is termed “ performance
ceiling”.
Davis describes indications that the patient is
functioning at his performance ceiling as follows:
1- Silence while the patient is working
2- Intent facial expression
3- Appropriate eye contact
4- Normal muscle tone

9. CONDITIONS FOR WHICH IT HAS BEENAPPLIED
• Coma recovery
• CVA
• Traumatic brain injury
• Alzheimer's disease
• Aging issues
• Pervasive developmental disorder
• Learning disability.

10. GUIDINGASATREATMENT
The Affolter Approach focuses on “facilitating
perceptual-cognitive representation through problem-
solving experience”. Affolter believes the tactile-
kinesthetic system is crucial to this problem-solving
experience.
- In order to learn the patient must experience learning
situations and interact with the environment.
- The therapist must present to the patient problem-
solving tasks such as those he experiences in
everyday life.

11. CONT..
• Types of guiding:
• Maximal assistance (heavy)
• Moderate assistance
• Minimal assistance (light)

12. • Affolter approach is based on the premise that the
patient must be challenged enough so that
learning takes place, but assisted so the patient
does not get frustrated. Mistakes are allowed
during treatment so that the patient is able to help
solve the problem.
• The goal is for the patient to reach “performance
ceiling”:

13. INTERVENTION
• The patient must receive tactile-kinesthetic
information. The therapist assists the patient in
gaining this information through nonverbal guiding.
The amount of tactile-kinesthetic information
provided depends on muscle tone, which will change
depending on the input or activity. The therapist
places his hands over the patient’s down to the
fingertips and guides the correct manipulation of an
object. Only the patient’s hand should come into
contact with the object and when the therapist feels
the patient is taking over the movement, the
assistance is reduced.

14. • When guiding, the therapist must be sensitive to
the patient’s movements, and be familiar with the
activity in order to anticipate what the patient
will experience.

15. GUIDING FACILITATES SKILLDEVELOPMENT
• The client is able to access the primitive and
powerful tactile/kinesthetic/proprioceptive systems
for learning.
• Guiding works at a subcortical level, and is not
reliant upon cognition. Children are able to
automatically access the movement component of
a skill rather than having to follow instructions and
think through each step of a task. Adults who have
perceptual dysfunction as a result of neurological
insult are able to access a kinesthetic memory of a
previously familiar skill.

16. • Guided movement using activities of daily living
provides multiple opportunities for problem
solving, the mastery and generalization of skills.
• Guiding works with sensory defensiveness. This
provides potent deep pressure, which results in
increased organization and sensory modulation.

17. THE THERAPIST FACILITATES MAXIMUM BODY
CONTACT:
– Trunk against trunk
– Behind the client
– Hands contacting dorsal surfaces of both of
clients hands, active and stabilizing hands
– Joints are aligned with joints of the client’s hands
– Movement uses mature patterns
– Mouth is incorporated into activity when it
facilitates problem solving and learning (removing
lid from sauce bottle while stabilizing with both
hands)

18. THE SELECTEDACTIVITYMUST
BE MEANINGFULTO THE CLIENT:
• It has to be within client’s natural environment
with familiar objects.
• The activity has a natural opportunities for
problem solving.
• The activity is graded for an appropriate level of
challenge.
• Process, experience of and engagement in the task
are more important than the product
• Ideal activities have a clear start and finish with
identifiable changes in resistance

19. The guiding process starts with the therapist
being directive and decreasing input, as the client
becomes more active in the task.
• The therapist receives kinesthetic feedback from
the client’s increased muscle activity as well as
when the client’s facial expressions indicate
attentiveness and pleasure
• Talking is kept to a minimum to prevent
processing of information at a cortical level
• Natural pauses in the activity should be used for
resting break.

20. Case study
• 40 years of research and clinical observations of
populations ranging from various groups of children to
adults with brain damage.
• They argue that early tactual feedback, is more critical for
the perceptual/cognitive organization of experiences that
constitutes a foundation for language development than
either visual or auditory input.

21. JOURNAL
Spatially distributed tactile feedback for kinesthetic motion guidance
Author: Kapur P, Jensen M, Buxbaum L J, Jax SA,
Kuchenbecker K.J
GRASP Lab Univ. of Pennsylvania, Philadelphia, PA, USA
Pages: 519 - 526

22. Abstract
• Apraxic stroke patients need to perform repetitive arm
movements to regain motor functionality
• Low cost sleeve that can measure the movement of the upper
limb and provide tactile feedback at key locations.
• The feedback provided by the tactors should guide the patient
through a series of desired movements by allowing him or her
to feel limb configuration errors at each instant in time

23. Cont..
• Wearable tactile interface that uses magnetic
motion tracking and shaft less eccentric mass
motors.
• The sensors and actuators are attached to the sleeve
of an athletic shirt with novel plastic caps, which
also help focus the vibration on the user's skin.

24. REFERENCES
• Occupational therapy practice skills for physical dysfunction.
- Lorraine William Pedretti
• Guided interaction therapy: movement and action in learning
&development.
(https://milogomemima.wordpress.com/2014/08/05/guiding-
as-a-treatment-affolter-approach/)
- Ida J stockman
• Barbara Zoltan, MA, OTR; Vision, Perception and
Cognition: A manual for the Evaluation and Treatment of the
Neurologically Impaired Adult, 3rd edi, Chp1 pg, (3-11)