Targeted Training: Difference between revisions
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== Description == | == Description == | ||
Targeted Training (TT) is a therapeutic approach which is described as | Targeted Training (TT) is a therapeutic approach which is described as a bio-engineering-based strategy that focuses on the development of upright head and trunk control and function. This in turn aids in the development and improvement of extremity control. It is described as a simplified way of learning motor control in the upright posture.<ref name=":1">OPTIMI Targeted training. Research Evidence for Targeted Training and the upright segmental approach. Available from: https://optimi.org.uk/sample-page/ (accessed 12 May 2023)</ref><ref>Major RE, Johnson GR, Butler PB. . [https://www.researchgate.net/publication/11905294_Learning_motor_control_in_the_upright_position_A_mechanical_engineering_approach Proceedings of the InstitutionLearning motor control in the upright position: a mechanical engineering approach of Mechanical Engineers], Part H: Journal of Engineering in Medicine. 2001 Mar 1;215(3):315-23.</ref> | ||
=== Fundamentals of Targeted Training === | === Fundamentals of Targeted Training === | ||
* TT is focused on the '''[[Biomechanics|biomechanical]]''' analysis of motor development and subsequent control problems.<ref name=":0">Major RE, Johnson GR, Butler PB. [https://www.researchgate.net/publication/11905294_Learning_motor_control_in_the_upright_position_A_mechanical_engineering_approach Learning motor control in the upright position: a mechanical engineering approach]. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2001 Mar 1;215(3):315-23.</ref> | * TT is focused on the '''[[Biomechanics|biomechanical]]''' analysis of motor development in the upright posture and subsequent control problems.<ref name=":0">Major RE, Johnson GR, Butler PB. [https://www.researchgate.net/publication/11905294_Learning_motor_control_in_the_upright_position_A_mechanical_engineering_approach Learning motor control in the upright position: a mechanical engineering approach]. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2001 Mar 1;215(3):315-23.</ref> | ||
* Proposes that motor learning requires '''correct alignment''' | * Proposes that motor learning requires '''correct alignment''' and '''correct control strategies, thus enabling accurate movements.'''<ref name=":0" /> | ||
** '''Correct alignment''': Within normal development infants begin skill acquisition in a predominantly supine position, thus offering multiple points of contact and thus greater stability. This also means that full active control is not always required for a desired motor outcome in this scenario. When moving into | ** '''Correct alignment of the neutral vertical posture''': Within normal development infants begin skill acquisition in a predominantly supine position, thus offering multiple points of contact and thus greater stability. This also means that full active control is not always required for a desired motor outcome in this scenario. When moving into an upright posture, points of stability decrease and constant accurate control is needed. Note that the neutral vertical posture is distinct from 'upright posture'. | ||
** ''' | ** '''Control''' '''strategies''': If correct control strategies are not present, external forces or forces produced within the body as a reaction to gravity may result in inappropriate movements and potentially unstable conditions of posture.<ref name=":0" /> | ||
* ''' | * '''The appropriate extent of support''' is needed to enable the Neutral Vertical alignment and simplify control learning by reducing the number of poorly controlled segments. | ||
* | * Hand/arm support: Care is needed to ensure that during therapy there is no contact of the child's hands or arms and the trunk. This contact provides cross-bracing and trunk control learning may not take place.<ref name=":0" /> | ||
* The intervention itself concentrates on the '''vertical posture''' from the onset without prior need to develop abilities in supine.<ref name=":0" /> | * The intervention itself concentrates on the '''vertical posture''' from the onset without prior need to develop abilities in supine.<ref name=":0" /> | ||
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The main features of TT includes:<ref name=":0" /> | The main features of TT includes:<ref name=":0" /> | ||
* Intervention is performed cephalad-to-caudal: Starting from attaining head control and then moving down the axial skeletal structure. The highest level of active control of the joints is established, from which the segment just below is 'targeted'. | * Intervention is performed '''cephalad-to-caudal''': Starting from attaining head control and then moving down the axial skeletal structure. The highest level of active control of the joints is established, from which the segment just below is 'targeted'. | ||
* Support is provided to the skeletal element directly below the segment being targeted. | * '''Support is provided to the skeletal element directly below the segment being targeted'''. | ||
* Ensuring the orientation of the support surface is important. External forces and anatomical constraints need to be considered. | * Ensuring the orientation of the support surface is important. External forces and anatomical constraints need to be considered to enable the neutral vertical posture. | ||
* Training consists of games and activities | * Training consists of games and activities that challenge both static and active control of the free joints/segments above the support.<ref name=":2" /> | ||
* Perturbations are provided to the system, which then | * Perturbations are provided to the system, which then challenges reactive control learning. | ||
* Input also needs to be provided for sufficient amount of time. | * Input also needs to be provided for a sufficient amount of time. | ||
* Reassessment is performed of the limit of control, i.e. at which segmental level active control has been attained. | * Reassessment is performed of the limit of control, i.e. at which segmental level active control has been attained. | ||
* Support is moved down as active control is gained at the relevant segmental level. | * Support is moved down as active control is gained at the relevant segmental level. | ||
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== Disadvantages == | == Disadvantages == | ||
Without the proper equipment, treatment can be more difficult to administer. TT has been developed with the use of | Without the proper equipment, treatment can be more difficult to administer beyond infancy. TT has been developed with the use of specialized equipment which aids in keeping the child being treated in the optimal vertical position and providing support directly below the highest segmental level at which control is poor or not demonstrated. | ||
A SATCo needs to be done before commencing treatment. Thus, training in the SATCo and TT needs to be done by the initial practitioner. If any reassessment needs to be done, this also needs to be administered by a trained practitioner. | A SATCo needs to be done before commencing treatment. Thus, training in the SATCo and TT needs to be done by the initial practitioner. If any reassessment needs to be done, this also needs to be administered by a trained practitioner. | ||
Latest revision as of 20:54, 23 August 2023
Original Editor - Lauren Heydenrych
Top Contributors - Lauren Heydenrych, Vidya Acharya, Carina Therese Magtibay, Lucinda hampton and Matt Huey
Description[edit | edit source]
Targeted Training (TT) is a therapeutic approach which is described as a bio-engineering-based strategy that focuses on the development of upright head and trunk control and function. This in turn aids in the development and improvement of extremity control. It is described as a simplified way of learning motor control in the upright posture.[1][2]
Fundamentals of Targeted Training[edit | edit source]
- TT is focused on the biomechanical analysis of motor development in the upright posture and subsequent control problems.[3]
- Proposes that motor learning requires correct alignment and correct control strategies, thus enabling accurate movements.[3]
- Correct alignment of the neutral vertical posture: Within normal development infants begin skill acquisition in a predominantly supine position, thus offering multiple points of contact and thus greater stability. This also means that full active control is not always required for a desired motor outcome in this scenario. When moving into an upright posture, points of stability decrease and constant accurate control is needed. Note that the neutral vertical posture is distinct from 'upright posture'.
- Control strategies: If correct control strategies are not present, external forces or forces produced within the body as a reaction to gravity may result in inappropriate movements and potentially unstable conditions of posture.[3]
- The appropriate extent of support is needed to enable the Neutral Vertical alignment and simplify control learning by reducing the number of poorly controlled segments.
- Hand/arm support: Care is needed to ensure that during therapy there is no contact of the child's hands or arms and the trunk. This contact provides cross-bracing and trunk control learning may not take place.[3]
- The intervention itself concentrates on the vertical posture from the onset without prior need to develop abilities in supine.[3]
Indication[edit | edit source]
TT has been developed specifically for children who demonstrate motor control difficulties. The predominant population benefiting from this approach are those diagnosed with cerebral palsy, however, the treatment itself can be used with any child demonstrating movement difficulties stemming from motor control limitations.
Clinical Intervention[edit | edit source]
Assessment[edit | edit source]
A core component of TT is the use of the Segmental Assessment of Trunk Control (SATCo). This is an assessment tool developed in conjunction with the TT approach. It is integral, in that it allows for the discrete testing of each segment in regards to static, active and reactive control. From here, a therapist is able to gauge the level/ segment at which TT should begin.[4]
Active treatment[edit | edit source]
The main features of TT includes:[3]
- Intervention is performed cephalad-to-caudal: Starting from attaining head control and then moving down the axial skeletal structure. The highest level of active control of the joints is established, from which the segment just below is 'targeted'.
- Support is provided to the skeletal element directly below the segment being targeted.
- Ensuring the orientation of the support surface is important. External forces and anatomical constraints need to be considered to enable the neutral vertical posture.
- Training consists of games and activities that challenge both static and active control of the free joints/segments above the support.[4]
- Perturbations are provided to the system, which then challenges reactive control learning.
- Input also needs to be provided for a sufficient amount of time.
- Reassessment is performed of the limit of control, i.e. at which segmental level active control has been attained.
- Support is moved down as active control is gained at the relevant segmental level.
Advantages[edit | edit source]
Equipment can provide the support needed so that specific physiotherapy interventions can be administered in the lay population.[3]
The use of equipment also means intervention can be provided in multiple settings, for example school and home. This also increases the frequency and duration of treatment.[3]
Once in the equipment, therapy has a strong 'play' element to it, making it enjoyable for both child and caregiver.[1]
Disadvantages[edit | edit source]
Without the proper equipment, treatment can be more difficult to administer beyond infancy. TT has been developed with the use of specialized equipment which aids in keeping the child being treated in the optimal vertical position and providing support directly below the highest segmental level at which control is poor or not demonstrated.
A SATCo needs to be done before commencing treatment. Thus, training in the SATCo and TT needs to be done by the initial practitioner. If any reassessment needs to be done, this also needs to be administered by a trained practitioner.
Resources[edit | edit source]
- The Targeted Training home page: https://optimi.org.uk/sample-page/
References[edit | edit source]
- ↑ 1.0 1.1 OPTIMI Targeted training. Research Evidence for Targeted Training and the upright segmental approach. Available from: https://optimi.org.uk/sample-page/ (accessed 12 May 2023)
- ↑ Major RE, Johnson GR, Butler PB. . Proceedings of the InstitutionLearning motor control in the upright position: a mechanical engineering approach of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2001 Mar 1;215(3):315-23.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Major RE, Johnson GR, Butler PB. Learning motor control in the upright position: a mechanical engineering approach. Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine. 2001 Mar 1;215(3):315-23.
- ↑ 4.0 4.1 Curtis DJ, Holbrook P, Bew S, Ford L, Butler P. Functional change in children with cerebral palsy. arXiv preprint arXiv:1811.12490. 2018 Nov 9.
