Motor behaviors are organized around goals
Dynamic systems theory posits that motor behaviors are organized around functional tasks or goals and that the specific motor solution is influenced by the spontaneous interaction of variables from three sources: child characteristics, task demands, and environmental influences. (Darrah et al 2011)
Child characteristics represent not only the traditional physical impairments considered in the rehabilitation of children with CP (e.g. muscle tone, range of motion, balance) but also non-physical characteristics such as motivation, attention, and cognition.
Task characteristics include the visual information, attention, postural and movement requirements for competing the task
Examples of task characteristics (what the child is trying to do) are height of a step for a stepping up task,t he shape, size, and weight of a ball for the task of throwing.
Environmental considerations are the identification of physical, social, and attitudinal influences that represent barriers to or facilitators of successful completion of the identified task or goal.
Examples include physical accessibility, availability of assistants, and the attitudes of persons within the child’s environment.
Parent identified goal areas were targeted for practice during the therapy session and after further assessment, a home program (HP), which was a detailed goal focussed activity based home practice plan was devised .
The therapist scaffolded all motor tasks, so that the infant could always actively complete at least a part of the task. As performance improved, the challenge was increased by altering the task or environment to a new and appropriate level of difficulty. Manual assistance was provided by the therapist and parent only when necessary for safety or to give the infant the “idea” of the movement. Manual assistance was reduced or withdrawn as soon as the infant demonstrated self-initiated progress with the task; ensuring self-generated motor activity was the focus of all practice.
Once a motor skill was learned, variability of practice was introduced to increase the complexity and generalizability of the skill. Early weightbearing and sit to stand from the parents’ lap were part of each HP even if standing was not identified as a specific goal." Morgan 2015
Rehabilitation research in older children and adults with brain injuries suggest that functional weight bearing exercises can both improve motor control and provide strength training . Given that the expected impairments of CP include weakness and reduced selective motor control, early activation of muscles of the lower limb using both concentric and eccentric exercise could enhance the development of upright mobility. Similarly, practice of reaching and grasping a variety of objects was a standard part of motor training for all infants in order to expose the infants who are expected to be delayed, to a variety of objects to advance grasp and reach behaviours . Morgan 2015
Shepherd R. Cerebral palsy in infancy: targeted activity to optimize early growth and development.Edinburgh: Elsevier; 2013.
Lobo M, Galloway C. The onset of reaching significantly impacts how infants explore both objects and their bodies. Infant Behav Dev. 2013;26:14–24. doi: 10.1016/j.infbeh.2012.09.003. [PubMed] [Cross Ref]
Morgan, C., Novak, I., Dale, R. C., & Badawi, N. (2015). Optimising motor learning in infants at high risk of cerebral palsy: a pilot study. BMC Pediatrics,15, 30. http://doi.org/10.1186/s12887-015-0347-2
Morgan, C., Novak, I., Dale, R. C., Guzzetta, A., & Badawi, N. (2014). GAME (Goals - Activity - Motor Enrichment): protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy. BMC Neurology, 14, 203. http://doi.org/10.1186/s12883-014-0203-2