Why is fluency so important in OT?

As an OT with over 20+yrs of experience, the one thing I have learned is that we need to rethink the way we teach our clients life skills.  My mantra now is…

“Don’t just teach a skill.  Teach it to fluency!”

Has this ever happened to you?  You work effortlessly on teaching a student a life skill ( shoe-tying, buttoning etc.) and the student masters the goal by then end of the school year; but then the following year, they come back…. and have forgotten everything!!!!   

Now it’s back to the drawing board…… 

Now you have to re-teach this skill again, plus work on the new goals for this year.  Arghhh!

Why is this happening?  Well…the problem is that our goals may indicate that the student has met the criteria in that moment in time… but they may not have truly MASTERED the goal. 

We are so accustomed to writing a lot of our goals as percentage correct and have accepted that as the gold standard of mastery, without question.  But is it ?   It is time to take a closer look…

 

So what exactly is the problem with percent correct?

Let’s take an example: If Johnny and Susie take the same math quiz on fractions and they both get the same score of 10/10.  You might say they have both mastered fractions.  Correct?  

Now, what if I told you that Johnny took 20 minutes to complete his test and it took Susie only 5 minutes.  Would that change your mind?  Would you still say they have both mastered the concepts?  And who do you think is more likely to retain that information?  Johnny or Susie?

While Johnny may have studied fractions well enough to get a good grade in that moment….it’s Susie who has truly mastered the concepts for long term results.

So think of the word fluency, and write out some adjectives that crop up in your mind…..

 

Musicians understand the importance of fluency, as do dancers and athletes.    When asked about skill acquisition, John Wooden, the famous UCLA basketball coach stated the following:

“Skill. as it pertains to basketball, is the knowledge and the ability, quickly and properly, to execute the fundamentals. Being able to do them is not enough. They must be done quickly. And being able to do them quickly isn’t enough, either. They must be done quickly and precisely at the same time. You must learn to react properly, almost instinctively”  – Binder 2003

In the therapeutic setting, we are so focused on accuracy and percentage correct, which is why we are missing the mark.  It is not just about being accurate, and it’s not about being fast, it’s the combination of accuracy + speed that truly sets the stage for effective learning….

This time-based understanding of competency and mastery is something we as therapists need to use to our advantage.  Here are some suggestions on how you can incorporate fluency when teaching any skill:

 

🧱 #1 Breakdown the skill into small components

Knowing that to truly master a skill, it requires us to be fluent in the smaller segments of component skills.  For example, in order to be fluent in handwriting, we need to be quick, smooth and efficient with the smaller foundational skills and components of handwriting as a skill (for example, paper positioning and imitating strokes).  

This is where  delving deeper into an activity analysis and identify the smallest of small component skills and motor skills is so important.  Below is an example of the component and motor skills required for Pre-writing skills.

🥅 #2 Figure out a fluency goal

So now you may be willing to look at fluency as a measure and you might be wondering…  how do I figure out the fluency goal for all these skills?  Well there are 2 ways.  The first is that you can access normative fluency data that has been compiled by Dr. Kubina, on a variety of skills from reading to handwriting etc.  This is a nice reference table to give you a general idea.  However, another easier option is to simply perform the skill yourself (at a regular pace)  or even better still….. ask a typical student to perform the skill.  

All you would need it to have them demonstrate the skill for 15 seconds and then multiply the score by 4 to get a per minute fluency goal.   

This would provide a range of what the fluency goal should be for your client.  

 

🥇#3 Set your client up for success

Once you have the fluency goal, it’s time to ask your client to perform the observable skill during a 15- 30 second timing.  This would be your baseline data before you put any interventions into place. 

Remember, while your fluency goal is written in a responses/ minute format; you don’t need to measure the skill for that duration.  It depends on the client’s abilities, endurance and the actual skill you are measuring.  Typically, I start with a 15 – 30 second assessment.  Simply because  the skill I am teaching is probably one that is very difficult for the client and I do not want to frustrate the client.   I also start interventions ( timings) at 15 seconds to ensure that they have the endurance to perform the skill and then build up from there.

It’s all about creating the ‘ just right challenge’ & setting the client up for success.

 

#4 Provide opportunities for timed practice  

I know what most OTs are thinking… do you want us to spend the entire time working on practicing a skill repetitively?  Not at all.  The beauty of using the science of fluency is that you only need to run 15 seconds or 30 seconds or 1 minute timings, which means you can practice skill on 3 or 4 occasions in a session and it will take you a total of maybe 5 minutes or less. 

Then you have the rest of session to do all the traditional OT activities to further address the students needs.

 

📈 #5  Analyze your data

This is where the standard celebration chart comes in so handy. Once you know how to plot your data, it takes just a few seconds to analyze the data.  All you would need to do is look and see if the scores are increasing, decreasing or staying the same.  If your student is making steady progress then you keep going;  but if there is no sufficient progress or if your student’s scores are plateauing, then it time to change your intervention.   

Remember, you will be taking data on the fluency building of the component skills, but you can also take data on the overall goal, this will tell you if building fluency in these small skills is making a difference on the overall goal. 

 

 🏆 #6 Don’t forget to show off your hard work

This is the next best thing about building fluency is that, you can actually showcase your progress in just a few minutes.  I often share ‘before and after’ videos of fluency building with pencil grip, shoe tying, imitating strokes etc.  This such a great way for parents to ‘see’ the progress.

Plus, if you chart this data on the SCC, then is that you can easily show of progress in any meeting.  Last year, I actually had a student present his own fluency in typing at his own IEP meeting.  It took all of 5 mins, and the student/ family beamed with pride.

 

In conclusion,  let’s remember that practice makes perfect.. but it also makes the skill permanent.

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