Table 3.

Early Training Visits

Session description	Assess pre/post vital signs, pain
	Debriefing of preceding Action Plan (“Find a challenging task involving personal hygiene or grooming, or dressing [self-care]. See how many times you can do it before you can no longer accomplish it to your liking. At the next session, be prepared to report back on the task(s) you chose and how many times you can do it right now.”):
	T: “Well, how was your weekend? Tell me what you did?”
	P: “I practiced buttoning my shirt and turning pages in my Bible. But I could not button the smaller buttons on my cuff and collar.”
	Determination of tasks and sequence of activities for the session’s practice:
	T: “That is great that you tried to do the smaller buttons. So what would you like to do today?”
	P: “Practice buttoning shirt and turning pages in the Bible.”
	P chose an activity sequence for the session: hold paintbrush, button/unbutton shirt for time, turn one page at a time in the Bible until fatigue
	P reported self-efficacy for the priority task: 3/10
Task performance and dialogue	T: “What movement in your shoulder is important in painting a wall?”
	P: “Being able to hold my arm up while painting with the brush.”
	[TASK PERFORMANCE: P demonstrated shoulder flexion with compensatory movements of shoulder hiking and trunk lean.]
	T: “So how could we make this difficult?”
	P: “See how far I can raise my arm in standing.”
	[TASK PERFORMANCE: T gave verbal cues for strategies to reduce compensatory movements. P practiced raising arm to shoulder level, demonstrating proper shoulder stabilization and trunk control. First trial, raised arm successfully 5 times; rested, repeated multiple trials. Increased number of successful attempts in one trial to 10 times.]
	T: “How could we make this harder?”
	P: “See how long I could hold my arm at shoulder level?”
	T: “Yes, that is a really good strategy to increase strength.”
	[TASK PERFORMANCE: P raised arm, held at shoulder level for 10 s, rested, repeated movement, and progressed to maximum hold time of 30 s by the 5th trial.]
	T: “Is this getting easier? Do you think you are ready to make the task harder?”
	P: “Yes, what if I hold something and raise my arm?”
	T: “OK, what do you want to hold?”
	P: “I think I could lift this 1-lb weight, at least to start out with, and then I could try more weight.”
Elements/comments	P demonstrated elements of skill and motivation for self-direction in response to the Action Plan activities
	T questions facilitated problem solving without controlling language to support intrinsic motivation
	P identified lynchpin impairments of shoulder strength and fine motor control (through buttoning tasks) to improve capacity to paint a wall
	P and T celebrated the P’s increased confidence with raising the affected limb. Positive feedback provided to enhance self-efficacy
	Principles emphasized: 1–6 and 8

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