Lynne DartCarolyn Taylor

Candace Skinner

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!!!!

Introduction

• Motor skills are an important part of our existence as human beings. Therefore, the focus of our presentation is to look at how individual’s 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

Classifying Skills

Skills Can Be Classified By Task

• Discrete Skill: o a skill that has a well

defined beginning and end.

• Serial Skill:o Characterized by several

discrete skills connected in a sequence, whereby order is often crucial

• Continuous Skill: o 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:o A skill determined by

the quality of a performers movements

• Cognitive Skill: o A skill for which the

primary determinant of success is the quality of the performers decisions regarding what to do.

Classifying Skills con’t

• Open Skill: o 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: o A skill performed in an environment that is

predictable or stationary and that allows individuals to plan their movements in advance.

Theories of Motor Learning

• Fitts and Posner (1967): o Cognitive Stage: Trial and error,

directs attention to movementso Associative: reduces amount of

cognitive activity involved, improvement in success and consistency

o Autonomous: Skill is becoming automatic, little cognitive attention

Theories of Motor Learning

• Gentile’s Modelo Initial Stage:

• develop a movement coordination pattern for successful performance,

• learn to discriminate regulatory and non-regulatory conditions

o 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

Goal Setting

• Individual’s 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.

Motor Learning Vs. Motor Performance• Motor Performance:

o Observable attempt voluntary action. o Level of performance is susceptible to

fluctuation in temporary factors such as motivation, arousal, fatigue, and physical condition

• Motor Learning: o Changes in internal processes that

determine an individual’s capability of producing a motor task.

o The level of motor learning improves with practice and is often inferred by observing relatively stable levels of motor performance.

Individual Characteristics that Affect Motor Learning• Abilities

• Attitudes

• Motivational level

• Previous social experiences

• Prior movement experiences

Performance Characteristics of Skill Learning

• Improvement

• Consistency

• Stability

• Persistence

• Adaptability

Presenting a Skill

• Demonstration:o Very little researcho Modeling: Use of demo to convey

information about how to perform a skill, same as observational learning

o Beneficial when the skill being learned requires the acquisition of a new pattern of coordination

o Demonstrator needs to perform skill correctly

Demonstration Cont’d

• Observing unskilled demonstrators can be useful if learner is unaware they are unskilled

• Useful only if model and demonstrator are both beginners

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

Cognitive Mediation Theory• Explains benefit of a demonstration

o Learner observes skilled modelo Learner translates the observed

movement information into cognitive code

o Learner stores cognitive codes in memory and uses them when they perform the skill

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

Verbal Instructions Cont’d• Direct learner’s 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

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

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

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

How do you practice a skill?

• Whole vs. part

• Mass vs. Distributed practice

• Speed/accuracy tradeoff

• Transfer – positive and negative

Whole vs. Part

• Low in complexity and high in organization (i.e. whole practice)o Eg. Buttoning a button, throwing a dart

• High in complexity and low in organization (i.e. part practice)o Eg. Serving a tennis ball, reaching for,

grasping and drinking from a cup, driving a stick shift

Practicing Parts of a Skill

• Wightman and Lintern (1985) classified three part-task strategieso Fractionizationo Segmentationo Simplification

Motor Learning and Control Text

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

Practice – Mass vs Distributed• Massed practice

o a practice schedule in which the amount of rest between practice sessions or trials is very short

• Distributed practice o a practice schedule in which the amount of

rest between practice sessions or trials is relatively long

o Baddely and Longman (1978) Postal Workers on a mail-sorting machine

o Shea et al. (2000) continuous dynamic balance tasks and discrete key-press timing

Transfer of Learning• “the influence of having previously

practiced or performed a skill or skills on the learning of a new skill”o 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

o 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

o Bilateral transfer: transfer of learning that occurs between limbs

Why does transfer occur?• Positive: 2 prominent hypotheses

o Transfer occurs because the components of the skills and/or the context is the same

o Transfer occurs because of similarities between the amounts and types of learning processes required

• Similarity of cognitive processes required

Why does transfer occur? • Negative: an old stimulus requires

a new but similar responseo 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

Clinical Implications

• Determine method based on skill complexity o 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

Clinical Implications Cont’d

• 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

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 therapist’s patients must spend most of the time practicing on their own.

Feedback

• Questions We Need to Considero How and when should an occupational therapist

provide feedback for patients?

o What kinds of information should be conveyed to them about their performance?

o Should the therapist attempt to provide feedback about more then one aspect of a patient’s movement at a time?

o 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?

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 person’s intrinsic feedback sources are diminished or distorted, as in the case of some patients who suffer from neurological impairments.

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

Benefits of Feedback

1. Provides Motivation for Clients

2. It provides reinforcement for an action

3. Information for learners so that they may perform an action more effectively.

*BUT….It can create dependency in the client.

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?

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.

What information do we provide?• Program feedback:

o This is error information about the fundamental movement pattern.

• Parameter feedback- o This form of feedback provides a person with error information

about the parameter values (e.g. amplitude, speed, force).

• Visual feedback: o Videos can also be used to give a person visual feedback as

opposed to verbal.

• Descriptive feedback- o It describes the errors an individual makes during the performance

of a skill.

• Prescriptive feedback- o This form of feedback describes errors made during the

performance of a skill and suggests something the learner might do to correct it.

How much information is necessary?

• Summary feedback:o 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: o 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

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: o The instructor will only provide feedback

when an individual’s movement falls outside an acceptable range of correctness or bandwidth.

How often should we provide feedback?• Absolute feedback frequency:

o The total number of feedback presentations given for a series of performance attempts

• Relative feedback frequency: o 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: o 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.

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?

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

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)

Blocked v. Random Trials – Hanlon • Blocked Practice: AAABBBCCC

o Low contextual interference• Random Practice: ABACCBACB

o 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

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

Sabari – Cont’d

• Problems encountered in adults with hemiplegia:o Ineffective or absent motor programso Impaired motor memoryo Impaired feedback mechanismso Impaired feed-forward mechanisms

• Goal of programs are to teach individuals to develop problem solving strategies rather than develop specific motor skills

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

Case: Mr. Taylor

• 50 year old male, right side dominant

• Experienced left hemisphere stroke October 2004

• Affected:o speech (expressive aphasia)o paralysis of right armo memoryo number of other elements

Questions

• Aphasia affected his speech and also his writing, however he initially started writing again with his left hand…this would help with what concept discussed earlier?

• As Gord regained movement of his right side, how could we as OT’s help him to re-learn to write?

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.

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.