Strategy Training
Description of Intervention (van Heugten et al., 1998)
- Protocol for the strategy training can be found in the Appendix of the study produced by van Heugten et al. (1998) (PDF link below).
- Clients are taught strategies to compensate of their apraxia.
- The client decides what ADL activities to focus on, and these activities are broken down into 3 phases: initiation, execution, and control (Quintana, 2008).
- If the client is having difficulties, the therapist may provide (in the following order, as necessary) instructions, assistance, and feedback (Quintana, 2008).
- The study by van Heugten at al. (1998) involved 33 stroke clients with apraxia being seen for 30 minutes 3 to 5 times a week. The strategy training proved beneficial, as a large and significant improvement was seen in all measures of ADL function (van Heugten at al., 1998). In addition, 84% of participants reported that the treatment had resulted in "complete recovery" or "great improvement" on a perceived treatment effect questionnaire (van Heugten et al., 1998).
- Donkervoort, Dekker, Stehmann-Saris, & Deelman (2001), incorporated the strategy training protocol developed by van Heugten et al. (1998), into the OT rehabilitation program offered to clients with apraxia and compared them to a control group who received only the usual OT program. Donkervoort et al. found that after an 8 week period, the strategy group improved more on ADL functioning than those with the usual OT program (2001). There was no significant effect found with a 5 month follow-up, however the authors suggest this was not due to a decline in ADL functioning in the strategy group but rather to improvement in clients in the usual OT program who in general required more therapy to reach the same level of independence (Donkervoort et al., 2001).
- Geusgens et al. (2006) did a follow up study to determine if the strategy training approach will transfer to untrained tasks (Gillens, 2009). They found that both the strategy training group and the control group improved on untrained tasks, with the strategy training group demonstrating significantly larger change scores (Gillen, 2009).
- van Heugten, C. M., Dekker, J., Deelman, B. G., van Dijk, A. J., Stehmann-Saris, J. C., & Kinebanian, A. (1998). Outcome of strategy training in stroke patients with apraxia: A phase II study. Clinical Rehabilitation, 12(4), 294-303.
- Donkervoort, M., Dekker, J., Stehmann-Saris, F. C., & Deelman, B. G. (2001). Efficacy of strategy training in left hemisphere stroke patients with apraxia: A randomised clinical trial. Neuropsychological Rehabilitation, 11(5), 549-566.
- Geusgens, C., van Heugten, C., Donkervoort, M., van den Ende, E., Jolles, J., & van den Heuvel, W. (2006). Transfer of training effects in stroke patients with apraxia: An exploratory study. Neuropsychological Rehabilitation, 16(2), 213-229.
|
|
|
Example: Brushing Teeth (adapted from example in Molyneux, n.d.)
- If the client has difficulty with this task, provide the following (in the specified order)
- "Take this tooth brush and brush your teeth" (verbal instructions);
- Pantomime toothbrushing activity, pointing to the toothbrush;
- Demonstrate all or part of the task
- Show the client pictures of the someone brushing their teeth;
- Write the instructions on a piece of paper.
- Provide Verbal assistance: by naming the steps of the activity e.g. "Place the toothbrush in your mouth. Brush your teeth in a circular motion. etc."; by directing the client to the task at hand
- Show the client pictures of the steps involved in brushing your teeth
- Provide Physical Assistance: by guiding or positioning the limbs; by taking over the activity until the client starts performing;
- If none of the above are successful, take over the task.
- Verbal feedback: tell the client to consciously use the senses to evaluate the result e.g. "Do your teeth feel clean?" "Does your breathe smell fresh?"
- Physical feedback: place a mirror in front of the patient
- Video record the client's performance and watch it with them.
Stapler Example
Watch the following video. Does the therapist give instructions, assistance, and/or feedback? (Answer below) |
Video clip retrieved from Molyneux (n.d.).
|
Watch the following video of a therapist using Strategy Training to help a client use the stapler with the use of compensatory strategies.
What type of instructions, assistance, and/or feedback does the therapist use? (Answer below) |
Video clip retrieved from Molyneux (n.d.).
|
Answer
Video 1 : The therapist only provides verbal instructions to help the client initiate the task.
Video 2: The therapist adjusts the task by making it easier for the client by giving him a red line to staple (physical feedback in terms of knowledge of result compared to the first video); she provides verbal instructions and demonstrates part of the task; she also provides verbal assistance by naming the steps of the activity; at 0:40 she provides physical assistance by positioning his hands in relation to the stapler and paper.
Video 1 : The therapist only provides verbal instructions to help the client initiate the task.
Video 2: The therapist adjusts the task by making it easier for the client by giving him a red line to staple (physical feedback in terms of knowledge of result compared to the first video); she provides verbal instructions and demonstrates part of the task; she also provides verbal assistance by naming the steps of the activity; at 0:40 she provides physical assistance by positioning his hands in relation to the stapler and paper.