Table 2.

Orientation to ASAP Principles

Session description	Partnership Agreement was signed by T and P. It describes the importance of participation and sharing ideas for challenging task practice, mitt orientation, and outside-of-session action planning
	Identification of 6 meaningful tasks (2 each from dexterity, bimanual, strength categories) for session practice/performance. Tasks identified: tying shoes, turning pages, opening a water bottle, ironing a shirt, using a weed-eater, using a paint brush
	Selection of the priority task: P: “I want to be able to use a paintbrush to paint a wall with my affected hand.”
	P rated self-efficacy for priority task performance (1, “not confident at all I can complete the task”).
	P attempted performance of the priority task
	P/T collaborated on identifying the problem with task performance
Task performance and dialogue	T: “Would you like to give [your priority task] a try with this brush?”
	[TASK PERFORMANCE: Sitting at a table, the participant was unable to grasp a paintbrush from the table top.]
	T: “What do you think is difficult about picking up the brush?”
	P: “I can’t open my hand, … unable to raise my shoulder enough, … can’t seem to keep my hand flat on the table.”
	[TASK PERFORMANCE: P was still unable to pick up the brush.]
	T: “Would a different position be better?”
	P: “I could stand.”
	T: “What do you think is difficult about picking up the brush in this position?”
	P: “I can’t raise my arm.”
	T: “What would you like to work on?”
	P: “Raising my arm.”
Elements/comments	A skill focus and motivational enhancements (for collaboration and choice) are reflected in therapist/participant dialogue
	P was limited in manual dexterity and strength for functional grasp of the brush
	T and coach determined the challenge threshold (for raising the arm) to enhance motor capacity
	P was encouraged to problem solve as the therapist assumed the role of a “coach”
	Principles emphasized: 1, 2, 4, and 6

Abbreviations: ASAP, Accelerated Skill Acquisition Program; P, participant; T, therapist.