Teaching New Techniques

Teaching New Techniques

 

When working with a client, as they progress from the basics to more complex activities, a close eye on their technique and motor skills is extremely important in order to maximize their "gains" while avoiding injury.  There are three stages of motor skill development.  The first stage, called the Cognitive Stage, provides constant external coaching by you, the instructor.  You introduce the new technique and then provide the visual, verbal and manual cues to your client in order for them to perform the activity properly.  You may have to place your hands on your client to correclty move them or cue them on stability at this time.  Body Awareness and proprioception are touched on here, but they are not the main focus yet. 

The second stage is the Motor Stage.  During this phase, your client is performing the technique efficiently and consistently.  They know when they make a mistake and can adjust appropriately.  Body Awareness for the skill and proprioceptive feedback become the prevalent form of feedback.  This is when I begin to reduce the use of mirrors and visual/manual feedback.  I stand back and only assist to prevent injury.  This is the "practicing stage."  To move onto the next stage, your client must practice the activity frequently. 

The third stage is the Automatic Stage.  Here, your client is able to perform the activity properly, efficiently and with minimal assistance by you.  Know which stage your client is in, because giving too much feedback can be just as bad as too little feedback.



Too much tactile cueing may not be good

I have spoken of the importance of using tactile cues in order to get a particular muscle contraction or movement to occur.  However, continuing from the previous entry, when dealing with older clients/patients, sometimes too much manual cues may be detrimental.  When you are performing the higher risk exercises mentioned before (standing exercises without support), you are trying to build your patient's self-confidence --- SELF- Confidence.  They must rely on THEMSELVES.  You are there to perform a job, and usually can only work with your patient for a limited time, so you really want them to be safe when you are not there.  Having them walk or perform exercises with your hand on them for security purposes, when they do not really need that much assistance, provides a false sense of security.  When you are not there, they do not feel your support, so their self-confidence may be greatly diminished.  If they do not need it, do not provide it.  I feel the same way about gait belts.  Many therapists use gait belts no matter what.  Usually, a clinic or hospital makes it protocol for liability purposes.  But when the patient is discharged, they will be walking on their own without that gait belt -- without that sense of security.  Use common sense.  If your patient needs the assistance, provide only what they need.  Do not over-assist because you will be under-rehabilitating.  Sometimes you are causing more harm than good by training your patient in an overprotected environment.