Motor Learning
Permanent changes in behavior, seen as a result of practice or experience
For Motor Learning to Occur
- Motor strategy is largely unconscious and is specific to task - Task must hold attention of learner - Environment supports learning process - Movements learned in a meaningful context are mastered more quickly and retained longer
Motor Learning Theory
- Performance - Learning
Performance
Acquisition of skill during the session There is no retention after practice and no generalization of this skill to other contexts
Learning
Permanent change following a practice of a skill Learner retains the skill after session and transfers the performance to similar contexts
Prerequisites for Learning New Motor Tasks
- Arousal, Attention, Selective Attention, Sensory Processing & Organization of Info, Motor Planning, Musculoskeletal Alignment, Ability to Execute Movement, Cardiovascular & Cardiopulmponary Systems
Musculoskeletal Alignment
ROM, strength, and postural alignment
Factors Interfering w/ Motor Learning
- Decreased arousal/attention - Decreased ability to process sensory info - Pain that limits ability to concentrate & process sensory info - Medical status impaired - sick or dizzy - Fear, anxiety, depression, behavioral issues - Decreased motivation to learn - Musculoskeletal Issues - Neuromuscular Coordination Deficits - Cardiopulmonary/cardiovascular problems-COPD, fatigue
Factors to decrease arousal/attention
- Anesthesia, pain meds, muscle relaxants, altered sleep cycles, depression
Factors to decrease ability to process sensory info
- Deficits in visual, proprioceptive, tactile discrimination, vestibular - Receptive aphasia (person can hear but may not understand the message)
Stages of Motor Learning
- Cognitive Stage - Associative Stage - Autonomous Stage
4 Variables that Affect Motor Learning Process
- Feedback - Practice Schedules - Type of Task - Learning Stage
Feedback
Sensory information that is available as a result of a movement that a person has produced
Practice Schedule
- Length of Practice - Blocked vs. Random Practice
Blocked Practice
Skill practice repetitively before practicing next skill (A -> B -> C) Practice is performed in same manner again & again
Random Practice
Skills or tasks are practiced in random order (AC, BA, A, ABC, CBA)
Determining Block vs. Random Practice
Factors: - Fatigue level, Safety, Billable Time
Whole Task
Total movement pattern when practicing are better remembered whole Use for motor skills (these should not be broken into parts)
Part Task
Breaking task down into steps prior to learning entire task Practice each component in isolation before combining for the whole task
Closed Tasks
- Environment variables (setting and objects) remain the same
Open Tasks
- Perform in different settings and use a variety of objects in environment
Mental Imagery
- Imagine doing the skill before you do it - mentally practicing the skill - Creates aspects of the experience in the mind
Goal of Session
- Maximize retention and transfer of skills not achieve maximum performance - Emphasize problem solving approach esp. when switching from or between block to random practice
Intrinsic Feedback
- Sensory feedback provided internally to the person as result of movement Somatosensory, visual
Extrinsic Feedback
-Feedback from an external source (i.e. therapist, equipment) - Concurrent or Terminal
Concurrent Feedback
- Extrinsic feedback that is given during the performance of a task
Terminal Feedback
- Extrinsic feedback that is given at the end of the performance of a task
Knowledge of Results
- Extrinsic feedback; terminal feedback about the outcome of the movement - Important learning variable for learning motor tasks
Knowledge of Performance
- Feedback relating to the movement pattern used to complete the task
Extrinsic Feedback
- Used to augment an absent or impaired intrinsic feedback system experienced by client
Example of Knowledge of Results
- Saying "Your sock is inside out" to a client
Example of Knowledge of Performance
- Saying "You did not reach far enough forward to put your sock on" to a client
Verbal Feedback
- Needed for beginners and those w/ cognitive limitations
Visual Feedback cont
- Plays important role in acquisition and control of movement
Example of Visual Feedback
- Videotaping client's performance and reviewing it immediately after therapy
Cognitive Stage
- Conscious thoughts of figuring out how, when and what movements are needed for the action "Get a feel for the task"
Cognitive Stage cont
- At this stage, OT may want to ask the client to repeat instructions given
In cognitive stage, person needs...
- Additional information to complete task - Verbal, Visual-modeling (demonstration), Manual guidance - In early stages of therapy, passive guidance of movement can elicit recognition of movement
Info Given in Cognitive Stage
- Prior to task (verbal instruction), During task (guidance), After task
1st learning a skill in Cognitive Stage, client needs to....
- Focus attention on completing movement Minimum distractions, concentrate on single task, concentrate on the feel of movement
Cognitive Stage Practice
- Emphasis on blocked - client performs single task over & over until they achieve competence in skill - In a closed environment
Feedback in Cognitive Stage
- Continuous; after every trial- detailed, immediate, and frequent
Duration of Cognitive Stage
- Depends on task and the client
Associative Stage
- Perfecting the skills so that it is efficient, consistent, effective, & appropriate to context - Begin to detect errors in performance and how to correct them - Begin to work on adapting skill to the context - Begin to transfer the skill to different contexts
Associative stage cont
- Client needs less external feedback - Ask client to tell most important things needed to remember to do task well - Give guidance only when performance is compromised
Feedback in Associative Stage
- Faded feedback procedure - Summary feedback procedure - Bandwidth feedback procedure
Faded feedback procedure
- reduce feedback - fade out
Summary feedback procedure
- Summarizes after series of trials
Bandwidth feedback procedure
- feedback for movement outside of acceptable band
Associative Stage Practice
-Becomes more random - extinguish blocked - Increase distractions - More complex environment - can vary - Divide attention b/w 2 tasks client is performing simultaneously
Autonomous Stage
- Can perform task w/o paying attention to what they are doing; performance is consistent, effective, effortless, and appropriate
Autonomous stage cont
- Able to perform in altered environments - Can vary speed & force of movement - Perform despite distractions - Therapist becomes a coach and encourages client to perform in therapy and at home
Treatment Principles Using Task-Oriented Approach
- Create environment that uses common challenges of everyday life - Provide decreasing amounts of physical guidance and verbal feedback
Minimizing ineffective and inefficient movement
- Remediate client factor if it is a critical control parameter - Adapt environment, modify task, use assistive technology, reduce effects of gravity - If person has poor control, consider constraining degrees of freedom - If person does not have return of function, consider using constraint induced therapy
Assessments of Intervention Effectiveness
- Baseline performance - Practice performance - Retention performance - Dual Task performance
Baseline Performance
Focuses on what a client does i.e # of times they do something, how long they did something for - Be specific on what you are counting and document count every single time
Practice performance
Error Rate i.e. how many times they drop something
Retention preformance
Looks at performance at a later date or in a different environment
Dual Task performance
Being able to do 2 things @ once i.e. can client have a conversation while performing an activity
Practice Outside of Therapy
- Practice exactly what the person will do in real life - Where will they practice? - How often? - How can you assist pt in follow through?