Lynne%20Dart

1

• Motor Learning

• Lynne Dart
• Carolyn Taylor
• Candace Skinner

2
Presentation Outline

• Introduction
• Classifying skills
• Theories of motor learning
• Goal setting
• Motor learning v. motor performance
• Individual and performance characteristics of
  skill learning
• Presenting and practicing a skill
• Transfer of Learning
• Feedback
• Stroke and Motor Learning
• GAME!!!!

3
Introduction

• Motor skills are an important part of our
  existence as human beings. Therefore, the focus
  of our presentation is to look at how
  individuals develop and perform motor skills by
  applying the principles of motor learning.
• Motor Learning is a set of cognitive processes
  associated with practice, training, or experience
  that results in relatively permanent changes in
  motor behavior

4
Classifying Skills

• Skills Can Be Classified By Task
• Discrete Skill
• a skill that has a well defined beginning and
  end.
• Serial Skill
• Characterized by several discrete skills
  connected in a sequence, whereby order is often
  crucial
• Continuous Skill
• A skill that has no identifiable beginning or end
  and can often be repetitive.

• Skills Can Also Be Classified By Cognitive and
  Motor Elements
• Motor Skill
• A skill determined by the quality of a
  performers movements
• Cognitive Skill
• A skill for which the primary determinant of
  success is the quality of the performers
  decisions regarding what to do.

5
Classifying Skills cont

• Open Skill
• A skill performed in an environment that is
  unpredictable or in motion that requires
  individuals to adapt their movements in response
  to dynamic properties of the environment.
• Closed Skill
• A skill performed in an environment that is
  predictable or stationary and that allows
  individuals to plan their movements in advance.

6
(No Transcript)
7
Theories of Motor Learning

• Fitts and Posner (1967)
• Cognitive Stage Trial and error, directs
  attention to movements
• Associative reduces amount of cognitive activity
  involved, improvement in success and consistency
• Autonomous Skill is becoming automatic, little
  cognitive attention

8
Theories of Motor Learning

• Gentiles Model
• Initial Stage
• develop a movement coordination pattern for
  successful performance,
• learn to discriminate regulatory and
  non-regulatory conditions
• Later Stages
• Adapt movement patterns to specific demands of
  any performance situation
• Perform skill with economy of effort
• Closed skills require fixation and open skills
  require diversification

9
Goal Setting

• Individuals should have an input in the
  goal-setting process.
• Goal setting guides the progress of therapy.
• Goals should be specific, measurable, attainable,
  realistic and time oriented.
• Three types of goal should be set performance
  goals, process goals and outcome goals.

10
Motor Learning Vs. Motor Performance

• Motor Performance
• Observable attempt voluntary action.
• Level of performance is susceptible to
  fluctuation in temporary factors such as
  motivation, arousal, fatigue, and physical
  condition
• Motor Learning
• Changes in internal processes that determine an
  individuals capability of producing a motor
  task.
• The level of motor learning improves with
  practice and is often inferred by observing
  relatively stable levels of motor performance.

11
Individual Characteristics that Affect Motor
Learning

• Abilities
• Attitudes
• Motivational level
• Previous social experiences
• Prior movement experiences

12
Performance Characteristics of Skill Learning

• Improvement
• Consistency
• Stability
• Persistence
• Adaptability

13
Presenting a Skill

• Demonstration
• Very little research
• Modeling Use of demo to convey information about
  how to perform a skill, same as observational
  learning
• Beneficial when the skill being learned requires
  the acquisition of a new pattern of coordination
• Demonstrator needs to perform skill correctly

14
Demonstration Contd

• Observing unskilled demonstrators can be useful
  if learner is unaware they are unskilled
• Useful only if model and demonstrator are both
  beginners

15
How frequently should you demonstrate a skill?

• Should be demonstrated before beginner attempts
  skill
• During early part of learning, skill should be
  demonstrated as often as necessary
• As skill progresses, learner should not need
  demonstration as frequently

16
Cognitive Mediation Theory

• Explains benefit of a demonstration
• Learner observes skilled model
• Learner translates the observed movement
  information into cognitive code
• Learner stores cognitive codes in memory and uses
  them when they perform the skill

17
Verbal Instructions and Cues

• Evidence supports this method of instruction
• Must consider that learner has limited attention
  capacity
• Beginner may have difficulty paying attention to
  more than 1 or 2 instructions at a time

18
Verbal Instructions Contd

• Direct learners focus to features of skill or
  environment that will enhance performance
• Performance of open skills requires direction of
  attention to aspects of the environment that will
  help learner
• Learners frequently attend to environmental cues
  without conscious awareness

19
Verbal Cues

• Verbal instructions may be too short or too long
• They may provide too much or too little
  information
• May not provide learner with information they
  need to perform the skill

20
Verbal Cues

• Short concise phrases
• Direct attention to information relevant to
  performing skills
• Prompt key movement-pattern elements of
  performing skills
• Cues are effective in facilitating learning new
  skills as well as performing well-learned skills

21
When to give verbal instruction

• Verbal cues can be given at the same time as a
  demonstration
• Can be given to help learners focus on critical
  parts of skills
• Learners can also use verbal cues themselves when
  performing a skill

22
How do you practice a skill?

• Whole vs. part
• Mass vs. Distributed practice
• Speed/accuracy tradeoff
• Transfer positive and negative

23
Whole vs. Part

• Low in complexity and high in organization (i.e.
  whole practice)
• Eg. Buttoning a button, throwing a dart
• High in complexity and low in organization (i.e.
  part practice)
• Eg. Serving a tennis ball, reaching for, grasping
  and drinking from a cup, driving a stick shift

24
Practicing Parts of a Skill

• Wightman and Lintern (1985) classified three
  part-task strategies
• Fractionization
• Segmentation
• Simplification

25
Speed/Accuracy Trade-off

• Characteristic of motor skill performance in
  which the speed at which the skill is performed
  is influenced by movement accuracy demands
• When the person emphasizes speed, accuracy is
  reduced
• When the person emphasizes accuracy, speed is
  reduced

26
Practice Mass vs Distributed

• Massed practice
• a practice schedule in which the amount of rest
  between practice sessions or trials is very short
• Distributed practice
• a practice schedule in which the amount of rest
  between practice sessions or trials is relatively
  long
• Baddely and Longman (1978) Postal Workers on a
  mail-sorting machine
• Shea et al. (2000) continuous dynamic balance
  tasks and discrete key-press timing

27
Transfer of Learning

• the influence of having previously practiced or
  performed a skill or skills on the learning of a
  new skill
• Positive transfer beneficial effect of previous
  experience on the learning or performing of a new
  skill, or on the performance of a skill in a new
  context
• Negative transfer negative effect of prior
  experience on the performance of a skill so that
  a person performs the skill less well than he or
  she would have without prior experience
• Bilateral transfer transfer of learning that
  occurs between limbs

28
Why does transfer occur?

• Positive 2 prominent hypotheses
• Transfer occurs because the components of the
  skills and/or the context is the same
• Transfer occurs because of similarities between
  the amounts and types of learning processes
  required
• Similarity of cognitive processes required

29
Why does transfer occur?

• Negative an old stimulus requires a new but
  similar response
• Environmental context characteristics of two
  performance situations are similar but the
  movement characteristics are different
• Change in spatial locations of a movement ie
  drive a car different than your own
• Change in the timing structure of the movement ie
  dance

30
Clinical Implications

• Determine method based on skill complexity
• ie whole vs part
• Distribute therapy sessions, encourage practice
  sessions throughout the day and week, discourage
  mass practice before a therapy session
• Demonstrate the skill several times before your
  client attempts

31
Clinical Implications Contd

• Verbal instructions should be short, and the
  skill broken down
• Use verbal cues that are short, direct attention
  and prompt key components
• Encourage transfer of skills by mixing it up!
• Practice with unimpaired limb during initial
  training especially right after surgery

32
Food For Thought

• An occupational therapist is frustrated and
  confused. Her job is to oversee therapy for a
  number of stroke patients, who are trying to
  recover their functional abilities. The therapist
  wants to provide as much assistance as possible,
  but given the number of patients she must work
  with and working in an acute setting, she is
  unable to provide a lot of feedback to any
  particular individual. As a result, the
  therapists patients must spend most of the time
  practicing on their own.

33
Feedback

• Questions We Need to Consider
• How and when should an occupational therapist
  provide feedback for patients?
• What kinds of information should be conveyed to
  them about their performance?
• Should the therapist attempt to provide feedback
  about more then one aspect of a patients
  movement at a time?
• When assisting a particular individual, should
  the therapist give feedback after each
  performance attempt or wait until after the
  person makes several attempts before providing
  feedback?

34
(No Transcript)
35
Knowledge of Results

• It is extrinsic, verbal information that tells
  learners about the success of their actions with
  respect to the intended goal.
• This form of feedback is often a repetition of
  intrinsic feedback.
• Extrinsic feedback is essential when a persons
  intrinsic feedback sources are diminished or
  distorted, as in the case of some patients who
  suffer from neurological impairments.

36
Knowledge of Performance

• It provides performers with information about the
  pattern of their movement.
• It focuses on the quality of the produced
  movement.
• Very important for every day tasks

37
Benefits of Feedback

• Provides Motivation for Clients
• It provides reinforcement for an action
• Information for learners so that they may perform
  an action more effectively.
• BUT.It can create dependency in the client.

38
WHEN DO WE PROVIDE FEEDBACK ?

• Whether to provide feedback at all?
• What information do we provide?
• How much information is necessary?
• How precise should that information be?
• How often should we provide feedback?

39
Whether to provide feedback at all?

• Clients can pick up many forms of sensory
  information.
• There is a hierarchy of intrinsic information
  that an individual must be aware of to produce an
  effective movement, therefore it is important
  when providing instructional feedback that we
  ensure that the individual becomes in tune with
  that information.
• Also, important to look at what the individual
  must learn before they decide whether or not to
  provide feedback.

40
What information do we provide?

• Program feedback
• This is error information about the fundamental
  movement pattern.
• Parameter feedback-
• This form of feedback provides a person with
  error information about the parameter values
  (e.g. amplitude, speed, force).
• Visual feedback
• Videos can also be used to give a person visual
  feedback as opposed to verbal.
• Descriptive feedback-
• It describes the errors an individual makes
  during the performance of a skill.
• Prescriptive feedback-
• This form of feedback describes errors made
  during the performance of a skill and suggests
  something the learner might do to correct it.

41
How much information is necessary?

• Summary feedback
• It is given after a series of performance
  attempts that provides the learner with
  information about each of the attempts in the
  series. The number of performance attempts a
  practitioner should summarize in a feedback
  statement depends on the complexity of the task.
• Average feedback
• Feedback that is given after a series of practice
  attempts that provides learners with information
  about their average performance in the series.
• Both of these methods are a good way to block
  dependency on feedback

42
How precise should that information be?

• Early in practice, errors are so large that
  precise information about the size of the error
  does not matter, but with time more precise
  feedback is better as the individual progresses
  in treatment.
• Bandwidth feedback
• The instructor will only provide feedback when an
  individuals movement falls outside an acceptable
  range of correctness or bandwidth.

43
How often should we provide feedback?

• Absolute feedback frequency
• The total number of feedback presentations given
  for a series of performance attempts
• Relative feedback frequency
• The proportion of performance attempts for which
  feedback is given equal to absolute feedback
  frequency divided by the number of performance
  attempts and multiplied by 100.
• Faded feedback
• An approach that uses a schedule for providing
  extrinsic feedback in which relative frequency of
  feedback is high during initial performance
  attempts and it diminishes during later learning.
  Feedback can be adjusted to the proficiency rate
  and improvement of each learner.

44
Stroke and Motor Learning

• Stroke is the most important single cause of
  disability of people living in their homes
• An important goal in management of stroke is
  rehabilitation
• Rehabilitation should start within 48 hours if
  client is medically stable
• What is effective rehabilitation?

45
Stroke and Motor Learning

• Need to teach clients how to perform tasks using
  spared motor functions
• Client will most likely have to learn how to
  perform the task differently then they performed
  it pre-stroke
• Role of motor learning in stroke rehab has not
  been extensively studied

46
Stroke Literature Hanlon

• Retention and transference varies as a function
  of training style or practice schedule
• If retention is goal, it is important to teach
  distributed practice (Intersperse activity with
  other tasks)

47
Blocked v. Random Trials Hanlon

• Blocked Practice AAABBBCCC
• Low contextual interference
• Random Practice ABACCBACB
• High contextual interference
• Random practice is more effective because of the
  effort required to distinguish between the
  performance requirements of several tasks during
  acquisition
• Blocked practice allows client to use the same
  solution on each trial without having to generate
  it on each trial

48
Sabari Motor Learning Intervention for
Hemiplegia

• Important to teach motor programs in meaningful
  contexts so that transference is more likely
• Clients need opportunity to practice skills in
  various regulatory conditions so they can develop
  motor schema that versatile to meet daily
  situations
• Differences in cognitive style require
  individualized motor training to develop
  effective encoding strategies

49
Sabari Contd

• Problems encountered in adults with hemiplegia
• Ineffective or absent motor programs
• Impaired motor memory
• Impaired feedback mechanisms
• Impaired feed-forward mechanisms
• Goal of programs are to teach individuals to
  develop problem solving strategies rather than
  develop specific motor skills

50
Jarus Motor Learning and OT

• Knowledge of effects of changing the order of
  presentation of different motor tasks can be used
  to facilitate retention and transfer of motor
  skills
• Important for planning OT treatment, we do not
  want the most effective performance, we want to
  maximize transference and retention
• Need to increase the difficulty of learning
  context - most transferable to everyday
  situations

51
Case Mr. Taylor

• 50 year old male, right side dominant
• Experienced left hemisphere stroke October 2004
• Affected
• speech (expressive aphasia)
• paralysis of right arm
• memory
• number of other elements

52
Questions

• Aphasia affected his speech and also his writing,
  however he initially started writing again with
  his left handthis would help with what concept
  discussed earlier?
• As Gord regained movement of his right side, how
  could we as OTs help him to re-learn to write?

53
References

• Baddeley, A. D., Longman, D. J. A. (1978). The
  influence of length and frequency training
  session on the rate of learning to type.
  Ergonomics, 21, 627-635.
• Magill, R. A. (2001). Motor Learning and
  Control Concepts and application, 7th ed.
  Toronto, Ontario McGraw and Hill.
• Shea, Lai, Black, Park. (2000). Spacing
  practice sessions across days benefit the
  learning of motor skills. Human Motor Science,
  19, 737-760.
• Wightman, D. C. Lintern, G. (1985) Part-task
  training strategies for tracking and manual
  control. Human Factors, 27, 267-283.

54
References

• Carr, J. Shepherd, R. (2003). Stroke
  rehabilitation Guidelines for exercise and
  training to optimize motor skill. China
  Butterworth Heinemann.
• Hanlon, R. E. (1996). Motor learning following
  unilateral stroke. Archives of Physical Medicine
  and Rehabilitation, 77, 811-815
• Jarus, T. (1994). Motor learning and
  occupational therapy The organization of
  practice. The American Journal of Occupational
  Therapy, 48, 9, 810-815.
• Marley, T. L., Ezekiel, H. J., Lehto, N. K.,
  Wishart, L. R., Lee, T. D. (2000). Application
  of motor learning principles The physiotherapy
  client as a problem-solver. Physiotherapy
  Canada, 315-320.
• Schmidt, R. A. Wrisberg, C. A. (2000). Motor
  learning and performance A problem-based
  learning approach. United States of America
  Human Kinetics.
• Shapero Sabari, J. (1991). Motor learning
  concepts applied to activity-based intervention
  with adults with hemiplegia. The American
  Journal of Occupational Therapy, 45, 6, 523-530.