bEST PRACTICE Recommendations

Current evidence support functional activity based therapy

There is mounting evidence supporting the value of functional activity based therapy in neurological rehabilitation. The evidence is founded in the dynamic systems theory of motor control, psychology of motor skill learning and in the neuroscience of recovery of functions, experience dependent and learning-dependent neural plastic changes in the brain in animals and humans. Thus, physiotherapists treating people affected by a neurological disorder should be prescribing functional activity based exercise in their therapy.

What is functional activity based therapy?

In the neurological rehabilitation literature, the terms functional activity based therapy, task-specific training, task-oriented approach are often used interchangeably without a standard description or consensus. The following is a description of the functional activity based therapy which is now commonly accepted among researchers:

Functional activity based therapy is defined as the therapy where patients practice context-specific functional tasks that focuses on improvement of performance in functional tasks through goal-directed practice and repetition. The therapy uses ‘real-world’ or everyday tasks as the therapeutic medium in functional recovery.

Principles of functional activity based therapy

1.Goal-directed

•The goals should be formulated in consultation with patients.

•The goals of the therapy should always be formulated at the ICF level of activities and/or participation

•The goals are specific, measurable, achievable, relevant and time-bound (SMART)

•Should preferably be determined using a valid and reliable measurement instrument, such as the Goal Attainment Scale (GAS)

2.Task-specific

•The intervention focuses on practicing the activities, which are formulated in the goals

3.Active

•Active involvement of the patients to find solutions, learn motor skills and discover new possibilities

•During therapy, the patient is actively trying to find solutions regarding motor activities.

•The approach is basically hands-off

4.Focused on functionality rather than normality

•The focus of the treatment and the most important goal of the intervention is functionality and not normality.

•It is important that the patient is successful in performing the functional tasks, and the quality of the performance is not the main focus

5.Context-specific

•Therapy takes into account contextual factors that specifically concern the formulated goals, and if possible takes place in the context that is relevant to the patient.

Adapted from:

Mellanie Geijen, Marjolijn Ketelaar, Leanne Sakzewski, Robert Palisano & Eugene Rameckers (2020) Defining Functional Therapy in Research Involving Children with Cerebral Palsy: A Systematic Review, Physical & Occupational Therapy In Pediatrics, 40:2, 231-246 PubMed