CIMT

1. Dr. Madhu

2. BACKGROUND
 Contemporary task oriented approach is a
restorative, therapeutic training based on a
systems model of motor control and theories
of motor learning.
 This was given by bernstein in 1967 to retrain
the patients with movement disorders.
 This approach attempts to understand the
problems faced by the nervous system to
control movements.
 It utilizes a training program that focuses on
specific functional tasks to promote and
restore optimal functional capacity.

3. INTRODUCTION
 Movement emerges from interactions of
many systems.
 Personal characteristics and environmental
context interact to achieve functional goal.
 Systems are dynamical, self organised and
heterarchial.
 Movement patterns for a given task are
stable and the preferred means for achieving
a functional goal.
 Control parameters or changes in one or
more systems can shift behaviour from one
movement pattern to another.

4. THEORIES
1. Contemporary developmental theories-
(a)Changes in motor development are due to multiple
factors or systems such as maturation of the
nervous system, biomechanical constraints and
resources and the impact of the physical and social
environment.
(b) Normal development is the search for optimal
solutions to functional problems and does not follow
a rigid sequence(intertask) as the motor milestones.
 Childrens follow variable developmental sequences
owing to their unique personal characteristics and
environmental contexts.
 Intratask sequences provide guides for age
appropriate movement patterns.

5. THEORIES
2. Contemporary motor learning theories-
(a) Learning is defined as relatively
permanent changes in performance
due to practice or experience.
(b) Learning is enhanced through practice
of whole tasks in varied contexts and
summary, less frequent feedback.

6. Main goal
 Find optimal movement patterns for task
performance.
 To use the actual activities and tools for
therapy that you would use in daily life.

7. Major concepts
 Functional tasks help organise motor behaviour.
 Occupational performance emerges from the interaction
of multiple systems that constitute the unique
characteristics of the person and environment.
 Practice and experimentation with multiple strategies and
in various contexts are needed to find the optimal solution
for motor problems and enhancing skills and
performance.
 After CNS damage or other changes in personal or
environmental systems, clients behaviour role changes
reflect attempts to achieve functional goals.
 The art of the task oriented approach is the identification
of interventions for the unique needs of each client, taking
into account unique personal and environmental systems
and roles that have importance and meaning for the
individual . Thus treatment planning cannot be
prescriptive.

8. ASSUMPTIONS
1. Personal and environmental systems, including the CNS
are heterarchically organised.
2. Behaviours seen after CNS damage or changes in other
systems reflect attempts to compensate and achieve
task performance.
3. Functional tasks help organise behaviour.
4. Occupational and role performance emerge from the
interaction of multiple personal and environmental
systems.
5. Practice and experimentation with varied strategies are
needed to find the optimal motor solutions and to
develop skill.
6. Recovery from CNS damage will be variable because of
each patients unique personal and environmental
systems.

9. EVALUATION
1. Occupational and role performance.
Tasks are selected by considering a clients
occupational roles and their meanings.
2. Patient centered identification of
problematic and important tasks.
3. Preferred movement pattern for given tasks
in varied contexts.
4. Systems which can cause transition from
one pattern to another.
5. Secondary evaluation of subsystems which
are interfering with performance.

10. PRINCIPLES OF
TREATMENT
 Client centered
 Occupation based
 Person and environment
 Practice and feedback
 General treatment goals

11. Client centered –
 Adopt a client centered focus in
treatment.
 Elicit active participation of the client
during treatment.

12. Occupation based-
 Use functional tasks as the focus in
treatment.
 Select tasks that are meaningful and
important to the client’s roles.
 Describe the movements used for task
performance.
 Analyse the movement patterns and
functional outcomes of task performance.

13. Person and environment-
Identify the personal and environmental
factors that serve as major influences on
occupational performance.
Adapt the task or broaden the environment
to promote optimal occupational
performance.

14. Practice and feedback-
 Structure practice of the task to promote
motor learning.
 Design the practice session to fit the
type of task and learning strategies.
 Provide feedback that facilitates motor
learning and encourages
experimentation with solutions to
occupational performance problems.

15. General treatment goals-
 Discover the optimal movement patterns
for task performance.
 Achieve flexibility, efficiency and
effectiveness in task performance .
 Develop problem solving skills with
clients so they can identify their own
solutions to occupational performance
problems in home and community
environments.

16. Strength of the approach
 Use of real objects and natural
environment.
 Focus on meaningful tasks and
functional goals.
 Client centered
 Intervention not limited to one strategy.
 Efficient and focused.
 Enables problem solving skills in the
client.

17. Limitations
 Conflicting evidence
 Not yet fully developed or refined
 Efficacy studies are needed.
 Limited application in acute settings.
 Limited application for clients with significant
cognitive impairment.
 Difficult to stimulate natural environments or
some tasks in clinical settings (interventions
should ideally occur in the acute settings ….ie
home, school, at work etc….
 Difficult to measure improvements.