Clinical Bottom Line
“How should I apply this information?”
As therapeutic interventions move toward more functional approaches, changing the constraints of a task and/or environment during movement practice is emphasized. This study examined parameters of the “fit” of a child's movement to the constraints of their environment. It is important that both the task and the environment match the movement parameters needed for successful task completion. One can guess or experiment as to which task constraints will result in successful task completion, or one can use specific constraints that will result in successful task performance. This study represents an important start by quantifying the establishment of a critical ratio to determine shifting unimanual or bimanual movement patterns. This knowledge can be used to promote consistent unimanual or bimanual practice of reach to grasp activities in a therapy session without verbal directions or prompts. It is important to remember that exploratory movement behaviors and practice lead to enhanced task performance. Thus, a “just-right challenge” should allow for a range of practice opportunities both above and below the critical ratio to provide opportunity for such problem solving. This approach may optimize transfer from the clinic into real-world settings.
“What should I be mindful of in applying this information?”
Therapists should also be mindful of the type of movement that a child is asked to practice during a therapy session. A movement should be evaluated in relation to transfer from the therapy session to a functional movement to be performed in a real-world setting. This can be referred to as practice specificity. Thus, bimanual practice should be necessary to improve bimanual performance and unimanual practice for improvement of unimanual performance in real-world tasks.
Jeanne Charles, PT, MSW, PhD
University of New England, Portland, Maine
Andrew M. Gordon, PhD
Teachers College, Columbia University, New York, New York