Journal Review on Task Specific Training

Better Rehab occupational therapists outline the benefits of this commonly used rehabilitation intervention and explain how the 5 recommended strategies for its application can be actioned in therapy sessions.

What is task-specific training and how can it help participants? 

Task-specific training is an occupational therapy intervention that is implemented to help participants with neurological damage rehabilitate and gain and/or regain the ability to perform daily activities. More specifically, task-specific training is implemented to improve the participant’s performance of functional tasks ‘through goal-directed practice and repetition’. And the focus throughout is on the ‘training of functional tasks rather than impairment, such as with muscle strengthening.’ 

Consistent with a learning-dependent model of neural plasticity, task-specific training can restore function by using spared (non-affected) parts of the brain, which are generally adjacent to the lesion and/or recruiting supplementary parts of the brain. 

In task-specific training – also called repetitive functional task practice, task-related training, and task-orientated therapy – a therapy program is created to help participants improve their competency in functional tasks through practice and repetition. Functional tasks are the activities of daily living, such as walking, bathing, dressing, using cutlery, lifting grocery bags, and getting up from the floor, and most require multiple capabilities such as coordination, muscle strength, hand dexterity and grip, and range of motion. 

Task-specific training is a commonly used OT intervention for participants with cerebral palsy, autism, spinal injuries, and traumatic and acquired brain injuries such as stroke. As this intervention was devised to help participants enjoy a better quality of life, it’s not surprising that many occupational therapists, medical professionals and academic researchers believe that task-specific training should be participant focused, involve the participant in goal setting and the program delivery, and include the practice of tasks that are meaningful to the participant.  

Our occupational therapists are experienced in a variety of widely practiced interventions and keep abreast of the latest evidence-based research findings. This knowledge bolsters their expertise in creating effective and personalised therapy programs to help participants lead more independent and fulfilled lives.  

An example of their commitment to staying up to date with findings on new interventions, and the effectiveness of existing OT interventions, is their review of the Occupational Therapy International article ‘Task-specific training: evidence for and translation to clinical practice’, authored by leading experts* in the fields of occupational therapy, neurology, neuroscience, and stroke rehabilitation and research. Within this article are the authors’ recommendations for implementing task-specific training in therapy sessions, now knowns as the 5 Rs, which our OTs explain below. 

The 5 Rs of task-specific training 

The five implementation strategies, which have become known as the 5 Rs of Task-specific Training, are: – 

  1. Be Relevant to the participant and to the context 
  1. Be Randomly assigned 
  1. Be repetitive and involve massed practice 
  1. Aim towards Reconstruction of the whole task 
  1. Be Reinforced with positive and timely feedback 

How each of the 5 Rs can be implemented in OT programs 

1: Task-specific training should be relevant to the participant and to the context 

This can be achieved by – 

  • Involving activities that are meaningful to the participant. 
  • Using the Canadian Occupational Performance Measure (COPM) to identify tasks and as an outcome measure. 
  • Choosing ‘real world’/context specific tasks. 
  • Setting up the treatment environment to reflect the participant’s usual home and community setting. 

2: Task-specific training practice sequences should be randomly assigned, ie. ordered 

According to the journal article’s authors, randomly ordered task practice facilitates retention and transfer of skill, increasing the task’s generalisability (ability to be applied in different situations) 

This can be achieved by  

  • Task specific training using different contexts/settings – differing occupational demands and sequences. 
  • Randomly scheduling therapy routines and task selection. 

3: Task-specific training should be repetitive 

Massed practice – the continuous practice of a task without rest – is key to achieving optimal outcomes with task-specific training. 

The more a task is practiced, the better the overall performance, however it is also argued that task specificity is clinically more significant than intensity. 

The maximum amount of repetition feasible should be prescribed in task specific interventions. 

4: Task-specific training should aim towards reconstruction of the whole task 

When formulating a therapy program, OTs are advised to – 

  • Deconstruct a task into its component parts. 
  • Assess the participant’s performance of the whole task and of its component parts. 
  • Identify which skills and/or component parts are adversely affected and why. 
  • Formulate a treatment plan targeted at the mismatch between ‘can do’ and ‘need/want to do’. 

Task-specific training should start with skills acquisition and massed practice of the individual component parts (shaping), moving towards the regrouping and normal sequence of some, most, and, if feasible, eventually all of the task’s component parts. 

However, in the midst of all the planning, prescribing, goal setting, and documenting, the achieving of whole tasks may become lost in the day-to-day activity of the neurorehabilitation setting.  Nevertheless, the overriding goal should be the reconstruction of the whole task to maintain focus and motivation. 

The article’s authors also state that it is ‘unwise’ to prescribe exercises that do not help the participant master a task that is important to them. This is because they can lose interest and motivation in performing the exercises as they deem them irrelevant. 

5: Reinforced: task-specific training should be positively reinforced 

Rather than random or generalised, it is recommended that feedback should be timely and positive, and pared back to decrease dependency. 

* The authors of the journal article ‘Task-specific training: evidence for and translation to clinical practice’ include: Dr Isobel Hubbard, a retired Occupational Therapist, author and academic researcher at the University of Newcastle (where she is responsible for the post-graduate stroke-specific courses). Dr Hubbard supports an evidence-based, multi-professional, person-centred and integrated approach to therapy for those recovering from stroke. 
– Dr Mark Parsons, a researcher and internationally recognised leader in stroke medicine and neurology professor at UNSW and University of Melbourne, and Conjoint Professor at the University of Newcastle. 
– Cheryl Neilson, an Occupational Therapist and university Occupational Therapy lecturer at Latrobe Rural Health School in Victoria. 
– Professor Leanne Carey, an Occupational Therapist, researcher, neuroscientist in occupational therapy and stroke rehabilitation and recovery and leading founder of the Neurorehabilitation and Recovery research group at Melbourne’s Florey Institute of Neuroscience and Mental Health. 

You can learn more about what is discussed in this article from the sourced journal article.

https://onlinelibrary.wiley.com/doi/epdf/10.1002/oti.275

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