For an intervention to be goal directed training, it has to begin with a goal, which must be practiced until achieved. But what does goal directed training for patients with disabilities entail?
What is goal directed training?
Goal directed training is, simply put, training on a specific task to be achieved, which is related to various functions in everyday life. For example, it involves learning activities such as using a knife and fork, doing up buttons, tying shoelaces and everything else we do on a daily basis. In order to succeed, it is important that the individual practices goals on a daily, or at least regular, basis.
Goal directed training is also referred to as task oriented therapy, goal focused task practice, or functional therapy (source).
Who is it for?
Goal directed training may be suitable for everyone who has the following characteristics:Different types of cerebral palsy, such as:
- bilateral cerebral palsy, diplegia, hemiplegia, quadriplegia, or unilateral cerebral palsy
- GMFCS I: walks without limitations at home and in the community
- GMFCS II: walks with limitations, difficulties with long distances and uneven surfaces
- GMFCS III: walks using a hand-held mobility device such as crutches or walking frame
- GMFCS IV: usually rely on wheeled mobility with assistance
- GMFCS V: usually transported in a manual wheelchair
- MACS I: handles objects easily and successfully
- MACS II: handles most objects but with somewhat reduced quality and/or speed of achievement
- MACS III: handles objects with difficulty; needs help to prepare and/or modify activities
- MACS IV: handles a limited selection of easily managed objects in adapted situations
- MACS V: does not handle objects and has severely limited ability to perform even simple actions
- CFCS I: effective sender and receiver with unfamiliar and familiar partners
- CFCS II: effective but slower paced sender and/or receiver with unfamiliar and/or familiar partners
- CFCS III: effective sender and receiver with familiar partners
- CFCS IV: inconsistent sender and/or receiver with familiar partners
- CFCS V: seldom effective sender and receiver even with familiar partners
- Movement disorders, such as, ataxia, athetosis, dystonia, hypotonia, and spasticity
- Intellectual ability, ranging from no disability, to severe disability
For you as an occupational therapist or physiotherapist, it is essential that you are involved in setting up strategies and goals together with the individual and the family (source).
What does it involve?
Goal directed training involves practicing specific tasks that are found to be challenging in everyday life. Tasks are chosen by the individual together with family and might involve communication, self-care, gross motor skills or school/work-based activities. It uses principles from both motor learning theory and dynamic systems theory, which proposes that for the child or adult, the task itself and the everyday setting the task is carried out in, all play a vital part in learning or improving a motor or movement skill.
You as a clinician can break down goals in achievable parts, which then are practiced until the main goal is achieved. Practicing in real-life situations is important, so training should ideally be integrated in daily routines. As mentioned above, goal directed training is meant to make it easier to perform daily activities, meaning that goals can vary from trying to strike a ball, to holding different types of objects. What’s important is not what the goals are per se, but that they’re relevant and useful for the person undertaking the training (source).
Assessments and undertaking of goals
Before starting, the individual should get a detailed assessment in order to identify strengths and barriers that may prevent him or her from performing activities. It includes assessing factors such as physical requirements, equipment that is needed, and also, the setting or the environment that the task is performed in. If the goal is to learn to do up shoelaces, the area the activity is usually performed in might be relevant, as there could be space restrictions that needs to be put into consideration.
A second assessment is used to measure whether or the training is actually working and if it is helpful. Two important outcome measures are:
- GAS goals (Goal Attainment Scaling) – measure the extent to which the individual’s goals are achieved
- COPM (Canadian Occupational Performance Measure) – measures the change on everyday activities that has been identified as a problem
These two measures are not only used for assessment, but also to identify goals from the offset (source).
It’s also important that you as a clinician set up measures together with the individual and his or her family, to decide suitable measures. As family and close associates might have good insight into the individual’s environment and daily life, they’re in a position to add valuable input when choosing what goals to pursue.
Goal directed training can be very helpful for individuals with disabilities, as it adds functionality to each person’s everyday life. With the aid of a clinician and their own family, each individual can learn new activities by practicing their specific goals on a daily basis.