Error-reduced object control skills training: from research to practice

Abstract

INTRODUCTION: Children with intellectual disability (ID) display proficiency deficits in object control skills (Westendorp et al. 2011), which should be ameliorated by training. Recent research showed that reducing errors during practice improved the object control skill of throwing in children with ID (Capio et al. 2013). This paper presents how such research finding was evolved into clinically viable training programs that practitioners implement, pushing evidence-based practice. METHODS: Using a mixed-methods design, error-reduced learning was applied in a clinic-situated object control skills training program for children with ID. First, a focus-group discussion (FGD) with 5 physiotherapists of children with ID explored current approaches in movement skills training. Second, 12 children with ID (mean age = 8.5±.79 years) were allocated into one of two groups: training or waiting-control. The training group practiced 5 object control skills (strike, dribble, throw, catch, kick) over 8 weekly sessions. In each session, task difficulty was manipulated to suppress practice errors. The control group had a waiting period of 8 weeks, and received training after the post-test. Object control skill components of the Test of Gross Motor Development-2 (TGMD-2; Ulrich, 2000) were used for pre- and post-test. Third, a process evaluation examined physiotherapists’ clinical notes during the program. RESULTS: The FGD showed that therapists typically train children with ID using graded verbal instructions and physical demonstrations. In part two of the study, non-parametric tests comparing TGMD-2 scores of training and control groups showed: (1) no group differences at pre-test in overall object control and individual skill components (all p>.05) and (2) the training group scored significantly higher than the control group at post-test in overall object control (p=.002) and in 5/6 skill components (p=.026-.002). Finally, the process evaluation showed that to apply error-reduced approach, therapists used (1) small group training, (2) continuous assessment and (3) individualised progression. DISCUSSION: This study brings evidence from experimental research to clinical practice of physiotherapists. Analysis of multiple data sources shows how error-reduced learning may be implemented in a clinical setting, resulting in improved object control skills of children with ID. Moreover, process evaluation has identified guiding principles to support practitioners in implementing the error-reduced approach in training movement skills of children with disability. Further research is warranted to examine related outcomes such as functional independence and play patterns. References Capio CM, et al. (2013). J Intellect Disabil Res, 57(4), 295-305. Westendorp M, et al. (2011). Res Dev Disabil, 32(3), 1147-53. Ulrich D. (2000). Texas: Pro-Ed.