Adaptive And Remedial Approaches To Perceptual example essay topic

L ITERATIVE REVIEW The purpose of my literature review is to examine the various therapeutic intervention strategies being administered to adult and children who have perceptual, spacial, gross and fine motor proficient disabilities. Furthermore what approaches appear to be working in their rehabilitation process. adults with perceptual dysfunction secondary to brain injury often includes Occupational therapy has been one of the main therapeutic strategies used for perceptual retraining according to (Holzer, Strassny, Sender-Hurley & Lefkowitz, 1982; Hopkins & Smith, 1983; Prigitano, 1986; Siev Freishtat, & Zoltan, 1986; Trombly, 1983, Van Deus en, 1988; Wahlstrom. 1983). A variety of approaches for this retraining has been offered by various occupational therapists.

Several authors have categorized these approaches differently (Abreu & Toglia, 1987; Neistadt, 1988; Siev et al., 1986; Trombly, 1983) It appears that amongst all of these authors only Trombly's and Neistadt go on the common assumptions underlying different treatment approaches, and neither of the two authors have fully explicated the assumptions underlying the classifications. Occupational therapy treatment techniques for perceptual deficits fall into two categories. Adaptive and Remedial. Adaptive, functional occupational therapy approaches, such as the developmental. Adaptive skills, occupational behavior, and rehabilitation treatment paradigms (Hopkins & Smith, 1983), promote adaptation of and to the environment to capitalize on the clients' inherent strengths and situational advantages.

These approaches provide training not in the perceptual skills of functional behavior but in the activity of daily living behaviors themselves. On the other hand remedial approaches, such as perceptual motor training (Abreu, 1985), sensory integration (Ayres, 1972) and neuro developmental treatment (Boba th, 1978) seek to promote the recovery or reorganization of impaired central nervous system functions, specifically. Whereas sensory integration techniques address the sensory processing upon which perceptual discriminations are based. Sensory integration was not developed for clients with frank brain lesions and so they are not applicable, in its entirety, to this population.

But some sensory integration techniques. However can be used cautiously with Some adults with brain injury (Fisher, 1989). Neurodevelopmental treatment deals with proprioceptive and Kinesthetic perceptions as they relate to functional movement patterns. These approaches provide training in the perceptual processing components of functional behavior with perceptual drills or specific sequences of sensorimotor exercises. These are the common assumptions underlying the adaptive and remedial treatments used currently.

Occupational therapy's perceptual retraining literature includes description of both adaptive and remedial approaches. (Siev et al. 1986), for example four perceptual treatment Approaches for adults: A) Sensory integration) Transfer of training) Functional training and D) Neurodevelopmental. Three of these approaches - sensory integration, transfer of training, and neuro developmental can be classified as remedial because their underlying assumptions match the remedial assumption outlined previously such as the retraining sequences. In the sensory integration and neuro developmental approaches, the therapist provides controlled vestibular, tactile, proprioceptive, and ken esthetic stimulation to promote normal central nervous system processing of sensory information. Theoretically, because perceptual motor behaviors are performed in response to the nervous systems interpretation of sensory inputs, normal sensory processing should help the client to make more normal perceptual motor responses.

In the transfer of training approach, therapists have been known to use such activities like puzzles and pegboards to provide practice in the perceptual skills judged to be needed for those activities. The client practices those skills that have been impaired by their brain injury. Improvement in deficit skills is assumed to transfer the other activities requiring that skill. Authors have stated that because all tasks require the use of more than one perceptual skill, it is difficult to know exactly which skills a client is actually using to accomplish functional activities.

The expectation of improvement and transfer of skills implies that tasks used in this approach force the brain repair or recognize itself to effect a successful behavioral response to the perceptual tasks. The functional approach could be classified as adaptive, because its' underlying assumption match the adaptive assumption. In the functional approach, perceptual retraining is included in areas of daily living training. Clients are taught, in the process of such training, how to compensate for whatever perceptual deficits they may have by changing their approaches to functional tasks to take maximum advantage of intact perceptual skills. Authors (Klo noff, H. Clark, & Kloproff. PS 1993) described a cognitive rehabilitation model that views perception from an information processing perspective.

This model can be classified as remedial because its' assumption matches the remedial assumption. In this model, the perceptual process involves: A) Sensory detection) Analysis) Hypothesis formation, that is comparing the analysis "with prior experiences" and relating it To the overall purpose and goal of the activity; D) Response. Responses can be data driven, which are direct responses to external stimuli or conceptually driven, which proceed from external expectations of incoming data. Treatment in the cognitive rehabilitation model is" designed to ameliorate deficiencies along the continuum of the perceptual system". (Abreu & Toglia, 1987, p. 493) by emphasizing the cognitive strategies that underlie the performance of a variety of tasks in different environments with different body positions and active movement patterns.

Strategies are defined as organized sets of rules that operate to select and guide the ability to process information. Treatment strategies include having clients plan ahead, control their speed of response, check their work, and scan from left to right. These strategies can be brought about and emphasized with computer games, gross motor tasks, group activities, games and crafts. The ultimate goal of this treatment is to improve the clients' ability to handle increasing amounts of information by developing efficient mental strategies and an efficient behavioral. This model, then seeks to stimulate improvements in the central nervous systems' perceptual processing capabilities. In light of all the strategies that have been mentioned, (Abreu and Toglia 1987) also discussed other treatment approaches for adults with perceptual deficits.

They named these the functional, sensory integration, and perceptual motor training approaches. The categorization corresponds to Siev at al, s' (1986) functional training, sensory integration, and transfer of training categories, respectively. Trombly (1983) discussed neuro physiological and compensatory approaches to perceptual retraining, which correspond to remedial and adaptive approaches, respectively. In the neuro physiological category, Trombly listed such techniques as sensory retraining and visual scanning training. Also under compensatory education, she listed backward training for specific functional activities and structuring of the environment as techniques.

Wahlstrom (1983) recommended a perceptual retraining program of sensory integration, positioning according to treatment principles, and perceptual retraining with puzzles, pegboards and games for all clients wit head injury, except those experiencing confusion. For confused clients, Wahlstrom recommended a functional approach of self-care training to address perceptual deficits. Wahlstrom earlier recommendation is clearly Remedial; and the latter one is Adaptive. One of the last strategies I would like to mention is known at the Constructional Deficit Approach.

"Constructional skill is the ability to articulate parts into a single entity or object (Benton, 1979) ". This skill is considered essential in drawing, both with or without a model; building blocks, sticks, or shapes from a model; and performing functional activities, such as dressing or setting a table. The successful performance of these activities requires the integration of: A) Visual perception) Motor planning) Motor execution (Banus, 1971; Benton, 1979, Fall, 1987; Leak 1983; Scrub & Black, 1977). All of the occupational therapy literature that I reviewed, relative to constructional deficits offered only remedial treatment exclusively. The treatment is directed at relieving the deficit rather than at accentuating the clients other strengths to compensate for the deficit.

Sieve et a. (1986) suggests that clients who have constructional deficits". practice simple copying or construction tasks, assuming that improvement on one task will transfer to similar tasks". These authors also recommend that the clients draw designs in a clay board rather than with paper and pencil to provide additional proprioceptive and Kinesthetic input. Recommended constructions tasks include: A) Block designs in Frostig teacher book (Frostig & Horne 1973). Koh's. Block designs (Arthur, 1947) on the Wechsler Adult Intelligence Scale (WAIS) (Wes choler, 1955) or parquetry block designs, where the client copies an arrangement made by therapist; B) match sticks designs where the client copies an arrangement made by the therapist; C) pegboards where the client copies a pattern made by the therapist; D) connecting dots with a design in Frostig's workbook (Frostig & Horne.

1973); E) pegboards blocks where a client converts a two dimensional paper pattern to a three - dimensional one; and) puzzles, beginning with large four - piece puzzles of single objects or persons familiar to the client. Most of these recommendation that I have mentioned here have been derived from Siev et.'s (1986) transfer of training approach, which is a remedial approach, oppose to the adaptive one. In addition to some of the assumptions outline here for the remedial approach, there are several others inherent in these proposed activities. One is that materials developed for perceptual training in a pediatric population; for example, Frostig's workbook (Frostig & Horne, 1973), are also appropriate for adults. This assumption is grounded in an assumption that adult recovery from central nervous systems trauma recapitulates the ontogeny of early development. I would also like to mention that another assumption derived from the recapitulation of ontogeny idea is that the stimuli provided to an adult recovering from central nervous system trauma should follow a developmental sequence.

For example because children can accurately draw circles, squares, triangles, and diamonds at ages (3) three, (4) four, (5) five and (7) seven to (8) eight years respectively (Henderson, 1986; Rand, 1973), adults with constructional deficits should be asked to copy simple shapes in that order. In this activity, circles would be regarded as the lowest level of difficulty and diamonds would be the highest level in copying simple two - dimensional shapes. Researchers Bouska, Kauffman and Marcus (1985) also proposed a remedial approach to Constructive deficits. They suggested that the visual analysis synthesis and skills be treated simultaneously because they are often used that way during task performance. Visual analysis skill include four different components. 1) An analysis of similarities and differences 2) An understanding of the relationship of parts to one another 3) Reasoning 4) Deduction about the nature of visual stimuli.

Bouska et a. (1985) also suggest that treatment should follow developmental consideration, progressing from "horizontal to vertical to oblique lines, from two - dimensional to three dimensional designs and from tasks with common objects to tasks involving abstract designs" (pp. 581-582). The tasks that can be varied along these parameters can include simple puzzles; dot to dot tasks; drawing from memory or copy; copying two - dimensional block designs; assembling woodwork projects, to go, or motors; sewing from a pattern; organizing kitchen or library shelves; and setting a table. "The key to effective learning is however, not the task the learner is asked to accomplish, but rather how carefully the therapists organizes it and monitors performance" (Bouska et al., 1985 p. 582). The therapeutic techniques that Bouska et a l., (1985) suggested to organize and monitor these tasks for a client are saturation al cuing and backward chaining. The first step involves the presentation of controlled verbal instruction on task analysis and sequence and presentation of cues on spacial boundaries.

The second step involves the progress of clients from perceptual tasks that are nearly complete, that is all but a few blocks left out of a block design, to perceptual tasks that are incomplete; that is none of the blocks placed in the clients' design. The therapist gradually reduces the number of steps necessary for task completion to increase the challenge to the client. I would like to point out that developmental sequence assumptions underlies this remedial approach. Unlike Siev et al. (1986) however, Bouska et al. (1985) included functional activities in their therapeutic task repertoire.

The aim of the treatment, however, is not to provide training in the tasks themselves, but to train the perceptual processes required for those tasks. This activity analysis approach to remedial task selection is more flexible than reliance on evaluation type tasks, but carries with it an assumption that occupational therapy activity analysis are accurate, reliable and objective. Unfortunately, there is no standardized approach to occupational therapy activity analysis for adults with neurological dysfunction. Consequently, therapists often disagree about which perceptual and cognitive skills are needed for any given activity.

(Rabid eau, 1986). I would like to conclude my literature review by stating that many occupational therapists seem to agree that both adaptive and remedial approaches to perceptual retraining of clients suffering from neurological brain dysfunction has been used successfully. But most of the literature suggests that occupational therapist rely mostly on remedial technique approaches, compared to the adaptive approaches. It appears that more research needs to be done in both areas of remedial and adaptive retraining in general; although more has been published on the remedial approach. Kunstaetter (1988) and I (Nei-stat, 1986), seem to believe that remedial techniques has been more predominant in the treatment of subjects minimal brain dysfunctions. Kunstaetter (1988) and I (Neistadt, 1986) have reviewed and charted numerous occupational therapy treatment modalities, and found that remedial techniques are predominantly practiced.

Most researchers feel that it is hard to know "whether theory is informing practice" or practice is informing theory. Either way most researchers acknowledge that theoretical assumption's that underlie certain practices should be further researched to make critical assumptions toward theory and practice to provide the bests possible services for their clients..