A task-oriented approach to the treatment of a client with hemiplegia.

7his article was accepted for publica/ion December 18. 1994 ThiS case repon describes a task-oriented approach to the rehabilitation of a 34-year-old woman with left hemiplegia. The task-oriented aprroach is based on a systems model of motor control and contemporary mowr learning theories. Systems models propose that occupational or functional performance emerge,s from the interaction and cooperation of many systems, and that no one system has a logical priority for controlJing or organizing the system (Kamm, Thelen, & Jensen, 1990; Mathiowetz & Haugen, 1994). The idea behind this approach is that, at different times, various systems can control the behavior that emerges from the interaction of systems, The application of this model in rehabilitation emphasizes that effective therapeutic intervention depends on identification of the system that is critical to controlling the occupational rerformance at a specific time. In the task-oriented approach, Mathiowetz and Haugen (1994) have used uniform terminology to propose that occupational performance emerges from the interaction ofsystems (see Figure 1). These systems are grouped into those relating to the person (sensorimotor, psychosocial, and cognitive systems) and those relating to the total environment (cultural, socioeconomic, and physical environment systems), Mathiowetz and Haugen proposed that intervention to alter occupational performance can occur through any or all of these systems, For example, for a person with a physical limitation, occupational performance could be enhanced either by altering the environment or altering the client's ahilities by minimiZing the physical limitation. The selection of one of these interventions would be determined collaborativel)' by the client and the therapist. The treatment in this case report is based on the hypothesis that the sensorimotor system was the critical system limiting this client's occupational performance and that addl'essing this system with concepts from a task-oriented approach would result in improvement in the client's occupational performance. The sensorimotor system includes strength, endurance, range of motion, coordination, sensory awareness, postural COntrol. and perceptual skills (Mathiowetz & Haugen, 1994), Although these components are familiar concerns in rehahilitation, the task-oriented approach focuses on the interactions between these component:-; and uses the concepts of degrees ofFeedom and control parameters,