Incorporating Motor Learning Strategies

• Motor learning


  The acquisition and reacquisition of movement through a set of processes associated with practice or experience which leads to relatively permanent changes in the capacity for producing skilled action
• Motor learning cannot be measured directly but is inferred from behavior
• Motor learning emerges from a composite of perception, cognition, and action processes while searching for a task solution that emerges from an individual with the task and the environment
• Recovery of function also involves the search for new solutions in relationship to specific tasks and environments given the new constraints imposed on the patient by neurologic pathology
• Understanding the principles that facilitate motor learning enables physical therapists to design intervention sessions that drive neural plasticity in patients with neurologic pathology
• Cognitive stage


  The basic movement pattern is being developed and requires the highest attention demands
• Associative stage


  Refinement of the movement pattern, and less attention is needed
• Autonomous stage


  Performance of the movement is virtually automatic with minimal attention to the task enabling the learner to carry on other tasks at the same time
• Cognitive stage


  • Learner develops an understanding of the task
  • Assesses abilities and task demands
  • Performs initial approximation of task
  • High level of cognitive monitoring required
  • High dependence on visual feedback
• Feedback type and schedule in cognitive stage

  • Emphasize intact sensory systems and intrinsic feedback mechanisms
  • Emphasize visual feedback to establish initial motor program
  • Carefully pair extrinsic feedback with augmented feedback
  • Provide knowledge of performance focused on consistent errors and knowledge of results focused on successful movement outcome
  • Constant feedback improves performance during early learning
  • Variable feedback improves retention but may decrease performance initially
• Practice type and schedule in cognitive stage

  • Use distributed practice to provide adequate rest if task is complex, long, or if learner fatigues easily or has decreased attention
  • Blocked practice of same task improves performance
  • Variable practice of related skills increases retention but may decrease performance initially
  • Use parts-to-whole practice to break down complex tasks into component parts; teach both parts and integrated whole
  • Mental practice can be used to improve performance and learning and reduce anxiety
• Structure of the environment in cognitive stage

  • Reduce extraneous environmental stimuli and distractors
  • Emphasize closed environments initially, gradually progressing to open environments
• Training strategies in cognitive stage

  • Highlight purpose of task in functionally relevant terms
  • Demonstrate ideal task performance to establish a reference of correctness
  • Use manual guidance to initially assist as appropriate
  • Ask learner to evaluate performance and outcomes
  • Assess and modify arousal levels as appropriate
• Associative stage


  • Motor strategies are refined through continued practice
  • Spatial and temporal aspects become organized as the movement develops into a coordinated pattern
  • As performance improves, there is greater consistency and fewer errors and extraneous movements
  • The patient is now concentrating on how to do the movement rather than on what to do
• Feedback type and schedule in associative stage

  • Emphasize proprioceptive feedback to establish an internal reference of correctness
  • Avoid excessive augmented feedback
  • Provide feedback for continuing motivation
  • Continue to provide knowledge of performance
  • Intervene when errors become consistent
  • Continue to provide knowledge of result
  • Stress relevance of functional outcome
  • Focus on use of variable feedback (summed, fading, bandwidth) to improve retention
• Practice type and schedule in associative stage

  • Encourage consistency of practice
  • Focus on variable practice order (serial or random) of related skills to improve retention
• Structure of the environment in associative stage

  • Progress toward changing, open environment
  • Prepare the learner for home, community, work, and real-world environments
• Training strategies in associative stage


  • Manual guidance can be counterproductive during this stage of learning
  • Assist learner in improved self-evaluation and decision-making skills
• Autonomous stage


  • Cognitive monitoring is minimal because the motor programs are so refined that they can almost run themselves
  • Spatial and temporal components of movement have become highly organized resulting in coordinated movement patterns
  • The patient will be able to concentrate on other aspects of performance such as succeeding in difficult environments
  • Movements are largely error free, with little interference from environmental distractions such that the patient can perform them equally well in a stable, predictable environment and in a changing, unpredictable environment
• Feedback type and schedule in autonomous stage

  • Learner demonstrates appropriate self-evaluation
  • Provide occasional feedback (knowledge of performance or knowledge of results) when errors are evident
• Practice type and schedule in autonomous stage

  • Stress consistency of performance in variable environments with variations of tasks
  • High levels of practice (massed practice) are appropriate
• Structure of the environment in autonomous stage

  • Vary the environments to challenge learner
  • Ready the learner for home, community, and work environments
  • Practice in real-world environment when possible
• Training strategies in autonomous stage


  • Assess need for conscious attention, automaticity of movements
  • Focus on competitive aspects of skills as appropriate (e.g., adaptive sports)
• Mastering degrees of freedom


  Learners go through stages until they have mastered controlling the degrees of freedom of the body segments involved in the movement
• Freezing the degrees of freedom


  • When initially learning a new motor skill, learners reduce the number of degrees of freedom of the joints controlled to a minimum in order to make the task easier
  • Constraining or coupling multiple joints to move in unison, fixing joint angles to make task easier
• Degrees of freedom


  Different ways in which body segments can be combined to accomplish a task
• Mastering degrees of freedom

  1. Reducing degrees of freedom to a minimum initially

  2. Gradually releasing degrees of freedom as control improves

  3. Releasing all necessary degrees of freedom in final stage
• Gradual release of degrees of freedom

  Reduces co-contraction of agonist and antagonist muscles, allows more adaptable movements
• Coactivation of muscles


  • Stiffens joints, constrains degrees of freedom
  • Seen in early stages of motor skill acquisition and in patients unable to control limb segments
• Physical therapists can provide external support to constrain degrees of freedom in early learning, then systematically reduce support
• Perception and action motor learning

  Increasing coordination between perception and action to match task and environmental constraints
• Relevant perceptual cues


  Cues like size, slipperiness, fullness of object that need to be recognized to select appropriate motor strategy
• Inability to recognize perceptual cues leads to suboptimal motor strategies
• Patients with neurologic pathology have deficits in isolating joint movements and combining them appropriately
• Factors to consider in intervention design

  • Practice frequency
  • Feedback
  • Practice conditions
  • Variability of practice
• Patients with neurologic conditions require more repetitions than healthy people for motor learning
• Extending practice beyond therapy sessions through home programs is important
• Guidance learning


  Physical therapist guides patient through task using manual cues
• Discovery learning


  Patient actively involved in problem-solving to find movement solutions
• Guidance learning enhances immediate performance but is less effective for long-term retention and motor learning