2. GOAL ATTAINMENT THERAPY
A systematic method for
evaluating and training tasks
that the child and family want
to improve on or master is
goal attainment therapy, which
is ingrained in child- and
family-centered therapies.
Other names for this
intervention include task-
oriented therapy, activity-
based functional therapy,
goal-directed training (GDT),
task-specific training, and
3. • The child's ability to perform a task successfully may be
constrained by one or more factors within the task .
• Using the OPTIMAL principles to enhance task learning
and behavioral and temperamental aspects that impact
motor learning and task engagement are key components
of task-oriented treatment.
• The task-oriented models are predicated on the knowledge
that motor learning happens when a baby works on a task
that has a beginning and an end.
• This approach incorporates developmental facilitation and
strengthening techniques. The aim is to engage the child
through play, functional and fun activities.
4. • It is important to ensure that the child can clearly see progress through
regular reviews of the goals.
• This approach is implemented with an intensive home programme.
• According to this model, the pediatric therapist:
(1) Develops activity-related goals in collaboration with the child and
the family
(2) Plans activity-focused interventions by adapting knowledge of
motor learning to the child's individual learning strengths and needs
(3) Integrates impairment-focused intervention with activity-focused
intervention.
5. Features :
1. Independent action
The infants are encouraged to engage independently with the task in
an effortful way to reach new goals. Independent action means that the
infant acquires a ever expanding set of solutions to different movement
problems and builds up a store of action plans. Independent achievement
of goals increases the infant's sense of I-can-do and self-efficacy.
2. Frequency of practice
All approaches provide increased opportunities for an infant to practice
new skills. Parents are motivated to put effort into training and practice.
This means more time and effort goes into task practice.
3. Training attention skills
Independent action teaches the infant to pay attention to the task.
Finding solutions to movement problems requires the ability to adapt and
adjust to task requirements and the environment.
6. Selection of goal :
• It is important that the goals are chosen by the
family and the child.
• It is best to choose goals that help to improve
function and/or gross motor skills.
• It is important that the physiotherapist, child and
family discuss the best measure to use to set the
goal. For an intervention to be truly goal directed
training it must begin with a goal and then the goal
must be practiced until it is achieved.
• The goals should be SMART ; Specific ;
Measurable ; Attainable ; Relevant ; Time based
7. Cornerstones of goal attainment therapy :
1. Tasks can be defined as units of action that have a
beginning and an end that are oriented towards achieving a
goal.
2. A child's behaviour and ability to perform a task is
determined by the interaction between the tas, the child and
the environment.
3. Not-yet thinking opens possibilities
4. The OPTIMAL approach to motor learning
5. Cognizance of the impact of temperament and behavioural
inhibition as a temperament style on experience and
willingness to engage in a task.
Temperament drives a child's willingness to take on or avoid
challenges, persist in the face of failure and tolerate the
strong sensations that arise from the body in effortful physical
8. Cornerstones of goal attainment therapy
1. Tasks can be defined as units of action that have a beginning and an end
that are oriented towards achieving a goal.
2. A child's behaviour and ability to perform a task is determined by the
interaction between the task (T) the individual child (I) and the environment
(E).
3. Not-yet thinking opens possibilities
4. The OPTIMAL approach to motor learning
5. Cognizance of the impact of temperament and behavioural inhibition as a
temperament style on experience and willingness to engage in a task.
Temperament drives a child's willingness to take on or avoid challenges,
persist in the face of failure and tolerate the strong sensations that arise
from the body in effortful physical activity.[40]
Implementation of task oriented therapy
1. Start with a task that the child and family would like to improve
2. Identify the structure of the task and all the T-I-E elements that contribute
to task performance
3. Identify the visual information that is needed at each step along the way.
4. Think about ways the task can be adapted to make it easier to perform,
ie, adapt the task demands.
5. Practice the adapted task - provide support and encouragement as
needed.
6. Provide task specific praise.[40]
10. Unique Properties of Water That
PromoteRehabilitation
1. Buoyancy
Buoyancy is what decreases the effect of gravity and keeps
individuals afloat when submerged in water.
It makes feel weightless and relieves pressure off the joints,
which makes it easier for individuals to focus on their
movements. It may even allow you to stand when you would be
unable to do so on land due to lower body weakness.
2. Viscosity
Another beneficial property of water is viscosity.
Viscosity is what makes it challenging to walk quickly
underwater. There’s much more resistance when walking in
water than walking on land.
Because individuals have to push against the resistance of
water to move, practicing exercises in a pool can help develop
strength.
11. 3. Hydrostatic Pressure
Hydrostatic pressure refers to the pressure of water on the
body from all different directions.
Consistent pressure on the body helps decrease swelling and
improve circulation. This can be especially helpful for
individuals with cerebral palsy whose motor impairments
make it challenging to get enough physical activity throughout
the day or who are unable to move certain areas of the body.
4. Heat
Often, aquatic therapy takes place in a heated pool, which
provides additional therapeutic benefits for individuals with
cerebral palsy.
Heat helps increase the elasticity of soft tissue, relaxes the
muscles, and reduces pain.
12. AQUATIC TRAINING
• Aquatic physical therapy is used to treat cardiopulmonary,
neuromuscular and musculoskeletal impairments and
includes an individualized treatment plan with measurable
goals and functional outcomes.
• Water treatment with a physical therapist can decrease
muscle spasms and promote relaxation for neurological
conditions as well as decrease pain for those with arthritic
joints, healing fractures and chronic pain conditions.
• Aquatic treatment can increase range-of-motion especially
for pre-natal mothers, postsurgical patients and individuals
with orthopedic injuries and back pain. It also can improve
muscular strength and cardiovascular conditioning
13. • The special characteristics of water provide a desired
environment for children and adolescents with CP.
• Activities in water can also be more fun and different for
children, possibly increasing motivation and interest.
• Aquatic therapy for cerebral palsy can involve various
water-based exercises, including:
Walking (or skipping, galloping, or running) in shallow/deep
water
Aquatic yoga
Swimming
Floating
Motion exercises
Resistance exercises
Balance exercises
Games
Deep breathing exercises
14. Aquatic therapy for cerebral palsy can
involve various water-based exercises,
including:
• Walking (or skipping, galloping, or running) in
shallow/deep water
• Aquatic yoga
• Swimming
• Floating
• Motion exercises
• Resistance exercises
• Balance exercises
• Games
• Deep breathing exercises
• Stretching
15. Benefits of Aquatic Therapy for Cerebral Palsy:
• Gait
• Gross motor function
• Joint range of motion
• Cardiovascular endurance
• Posture
• Balance
• Spasticity reduction
• Circulation
