University of Sto.

Tomas College of Rehabilitation Sciences Physical Therapy Department

Therapeutic Exercise 3 Rachel Ann Z. Lagman, PTRP

MOTOR LEARNING How is motor control different from motor learning and motor development? Motor control Motor learning Motor development

Distinguishing Motor Learning from Motor Performance What is a skill? any human activity which becomes better organized and more effective as a result of practice (Annett 1971) What is motor learning? a change in the capability of a person to perform a skill that must be inferred from a relatively permanent improvement in performance as a result of practice (Magill 1993) What is motor performance? any observable motor behavior (Magill 1993) Controlled processing Slow Attention demanding Serial in nature Strongly volitional Automatic processing Fast Not attention demanding Parallel in nature Not volitional Theories of Motor Learning Adams closed-loop theory Sensory feedback used for the ongoing production of skilled movement Types of memory Memory trace for movement selection and initiation Perceptual trace for movement execution and error-detection Clinical implication Practice the same movement repeatedly to one accurate endpoint Limitations Movements possible without sensory feedback (open-loop movements) Movements possible in presence of deafferentation Accurately performed novel movements are possible Variation in practice improves learning more Impossible to store too many perceptual traces Schmidts schema theory Motor programs contain rules for action Learning is an ongoing process of updating schemas Clinical implication Practice under a variety of conditions Limitations More applicable in children than in adults Unable to account for immediate acquisition of new types of coordination Newells ecological theory During practice, there is a search for optimal strategies to solve the task, given external constraints Both motor and perceptual systems are mapped into an optimal task solution Clinical implication Variability in practice with attention to relevant cues will improve learning Limitation Not yet systematically tested

University of Sto. Tomas College of Rehabilitation Sciences Physical Therapy Department

Therapeutic Exercise 3 Rachel Ann Z. Lagman, PTRP

Stages of Motor Learning Fitts and Posner: COGNITIVE STAGE Large number of gross errors committed Highly variable performance No error-detection and correction mechanisms ASSOCIATIVE STAGE Fundamentals of motor skill already learned Less number of and less gross errors Error-detection mechanisms present Reduced variability in performance AUTONOMOUS STAGE No need for close attention on task during performance Error-correction mechanisms present Small variability in performance Clinical implication Helps us understand skill acquisition based on the amount of attention paid on task performance Systems: NOVICE Learner simplifies movement by freezing degrees of freedom ADVANCED

Performer begins releasing some degrees of freedom

EXPERT Performer released all degrees of freedom Learner takes advantage of the mechanics of the musculoskeletal system and the environment

Clinical implications Explains the stiffness that occurs in joints at the beginning of skill acquisition Suggests importance of providing external support during early phases of learning

Gentile: GETTING THE IDEA OF THE MOVEMENT Understand goal of task Develop movement strategies appropriate to achieve goal Understanding relevant environmental features

MOVEMENT FIXATION/DIVERSIFICATION Adapting movement to changing task and environmental demands Performing task consistently and efficiently Clinical implications Establish the most appropriate movement pattern to achieve a goal Set up different conditions for practice After a brain lesion, skill acquisition resembles the process when someone learns a completely new skill. is closely related to greater movement efficiency arising out of increased muscle strength. does not lead to the reduction of unnecessary muscle activity without the appropriate intervention Recovery of function Recovery versus compensation Recovery is achieving function through original processes while compensation is achieving function through alternative processes. Factors contributing to recovery of function Age Characteristics of the lesion Experience Pharmacology Training

University of Sto. Tomas College of Rehabilitation Sciences Physical Therapy Department

Therapeutic Exercise 3 Rachel Ann Z. Lagman, PTRP

HOW TO MODIFY AUTOMATED BUT SUBOPTIMAL MOVEMENTS Therapists role (as a teacher) in facilitating skill acquisition 1. Goal setting Goals Goals are performance objectives (Magill 1993) Goals are called the motivation hub (Locke 1991) Long-term goals are ideal goals Short-term goals are action goals Effective goals (Tubbs 1986) Reasonably challenging (i.e., difficult but attainable), meaningful, interesting Specific rather than do your best Must be combined with performance feedback Must involve the participant Combined short- and long-term Therapists roles Select appropriate functional task Promote self-efficacy Avoid goal confusion 2. Standard versus Behavioral Coaching Behavioral coaching techniques Instructions Demonstration/modelling Manual guidance Passive movement Physical restriction Giving feedback 3. Feedback Type KR KP 4. Practice Whole versus part practice Random (variable) versus blocked practice 5. Mental Practice Internal vs External Has motivational and cognitive functions Most useful for tasks with high cognitive components Helps both early and late skill learning Better than no practice Advantages Immediate implementation No equipment necessary Possible even when physical movement is restricted Can be performed between visits Produces less anxiety than physical practice Increases concentration and attention Disadvantages Some see it as too simple Affords little opportunity for correction

Frequency Timing Quantitative vs qualitative

Summary Movement is the interaction between individual, environmental and task features. Motor learning is a process that is inferred from a permanent change in performance as a result of practice. Motor learning occurs in a continuum based on the use of attentional resources, release of more degrees of freedom and development of more efficient and consistent movement strategies. References: Shumway-Cook and Woollacott 2001 Carr and Shepherd 2000 Carr and Shepherd 1998 Montgomery and Connolly 1991