13 Motor Learning Theory

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

MOTOR LEARNING THEORY

References: Cole & Tufano, Chapter 19

Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT


Focus

• Replaces Motor Control (NDT, etc.) as a more evidence-based approach to all forms of movement disorders across the lifespan (CP, TBI, CVA, etc.)

• Backdrop for Task Oriented approach defined by Horak (1991), Shumway-Cook & Woolacott (2001) and Mathiowetz, Bass Haugen & Flinn (in Trombly & Radomsky, 2002).


Basic Assumptions

• Motor Control – the ability to regulate or direct the mechanisms essential to movement (Shumway-Cook & Woolacott, 2001). AKA “neuromaturational” or “hierarchical” or “bottom up” theories of re-acquisition of voluntary movement

• Motor learning – Set of processes associated with practice or experience leading to relatively permanent changes in the capacity for producing skilled action (Shumway-Cook & Woollacott, 2001). Combines neuroscience with systems & learning theory.


Assumptions, cont.• Based in principle of neural plasticity – the ability

of the nervous system to modify neural connections to perform more efficiently

• Short term (working memory) – needed for learning new movements

• Long term (save/retrieve) – needed for lasting change

• Motor learning occurs naturally during task performance (supports a task focused approach)


Systems Theory

• Systems approach includes a consideration of – Client factors: health condition, dysfunction or

damage, age, gender, etc.– Occupations: meaningful or preferred tasks– Environment: all relevant contexts

• Systems include sensorimotor, psychosocial, cognitive, and performance contexts (physical, socioeconomic & cultural characteristics of the task itself and the broader environment) (Mathiowetz & Bass Haugen, 1994).

• Consistent with occupation-based models


Learning Theory(Behavior Modification)

• Non-Associative Learning:– Habituation: desensitization that results from

repeated exposure to a nonpainful stimulus (e.g., Ignore stimuli that trigger nonfunctional responses)

– Sensitization: increased responsiveness (e.g., Pay attention to safety features, such as water on the floor, or obstacles in one’s path)


Learning, cont.

• Associative Learning:– Classical & operant conditioning (considers past

and current environmental influences)– Procedural learning: performed without conscious

attention (develops slowly through many repetitions to become habitual, stored in brain as “movement schema”) (e.g., walking)

– Declarative learning: results in knowledge that can be consciously recalled, requiring awareness, attention, and reflection (e.g., words)


Learning, cont.

• Variable practice, using motor/perceptual skills under varying conditions, works best for generalization of learning

• Contextual interference, using motor perceptual skills in random order, increases spontaneous use for new tasks

• Individual characteristics, such as level or experience & intellectual ability influences motor learning

• Transfer of learning occurs more easily when tasks are similar (Toglia – near transfers)


Learning, cont.

• Schmidt’s “schema theory” uses sets of general rules that apply in variety of contexts

• Schema: a generalized motor program that consists of 4 parts:– Initial situation– Parameters used– Outcome (knowledge of result)– Sensory consequence (how movement feels)

• Example: swinging a golf club or donning a coat


Learning, cont.

• Newell’s Ecological Theory clarifies the role of perceptions in motor learning.– Recognition of goal or task– Regulatory cues (sensitize to what is relevant

to the task)– Knowledge of Performance (KP): feedback

during performance, how movement felt– Knowledge of Result (KR): feedback on goal

achievement


FUNCTION & DYSFUNCTION

• Gentile (1992): early & late stages of learning

• Fitts & Posner (1967):– Cognitive stage of motor learning

(understanding of task, experimentation)– Associative stage: refined practice– Autonomous stage: skill relatively automatic– Example: child learning to climb stairs


Function cont.

• Degrees of freedom: refers to gradual increase in smoothness of performance of skilled movement. Example: using a hammer.

• Specific definitions for function & dysfunction have not been defined in occupational therapy (Kaplan & Bedell, 1999).

• Definition of dysfunction in OT must include all three components: person, environment, & occupation.


CHANGE & MOTIVATION

• Holistic approach: OT ALWAYS incorporates practice of perception and movement within the context of SPECIFIC TASKS.

• Client centered: Motivation comes naturally when clients and/or families set priorities for tasks to be accomplished & goals to be achieved.

• Systems approach begins with role performance, considering the best combination of remediation, adaptation, & compensation in order to promote client-identified level of functioning to fulfill desired roles.


Change, cont.

• Change occurs through learning process.

• Recovery may be:– Spontaneous, without benefit of intervention– Forced recovery, function gained through

therapeutic intervention, such as – example?– Adapted or functional recovery, attained

through altering methods or contexts within which client accomplishes a task


Postulates of Change, cont.

• Defined in Pediatrics by Kaplan & Bedell. Motor skills more likely to improve when:– Match between child’s ability, task, & context.– Child understands expectation & receives

clear guidance– Independent problem-solving encouraged– Just right challenge (zone of proximal

development).


Assessment

OT Assessment includes:

• Dynamic evaluation, watching client during occupational performance, including responses to cues.

• Collaboration with client to determine occupational problems and priorities.

• Evaluation of person, task, & context, to determine appropriate OT interventions.


Assessment• OT evaluations may incorporate manual muscle

tests, range of motion, strength & endurance tests, which directly relate to problems with specific task performance.

• Sensory & perceptual evaluations stem from client-identified problems with those aspects of task performance.

• Cognitive evaluations may further clarify difficulties with awareness, goal identification, motor planning, and generalization of learning.


INTERVENTION

• Client-centered role/task selection

• Discussion of OT assessment results

• Collaboration which includes therapeutic use of self in determining and/or raising level of client self-awareness

• Imparting information on current evidence with regard to a choice of approaches

• Practice of needed skills in natural settings


Motor Learning Interventions

• Prevention of injury/dysfunction through splinting, positioning, educating, & sensitization to relevant environmental cues.

• Promoting function through individualized task problem-solving & collaborative experimentation about the best way to accomplish the task.


Interventions, cont.

• Practicing whole tasks, not isolated parts.• Providing skill practice in varied contexts

during daily routines.• Providing randomized practice (changing

parameters or circumstances).• Providing intermittent feedback during task

performance or summarized at end.• Encouraging self-evaluation & error

detection (both KP & KR).


Interventions, cont.

• Modify task demand in order to achieve task goal (use e-mail instead of telephone to communicate with others; use alarm to remember next step).

• Modify contextual factors in order to achieve task goal (use bolsters to position for active movement in playing a game).


Intervention: Constraint-Induced Movement Therapy

• Contemporary variation of task-focused approach for stroke survivors (1 year post-stroke).

• Consists of “constraining” nonaffected arm, forcing use of affected limb for performing daily tasks.

• In 2-week experiment, “constrained” group showed significantly greater motor skills, carry over to life tasks, and maintenance of gains in 2-year follow-up.

• Original study replicated (Blanton & Wolf, 1999) shows that 20% to 25% of clients with chronic stroke symptoms may benefit from this approach.


The End

• Please make your own copy of reserve article. Focus on distinctions made between traditional & contemporary OT approaches.

13 Motor Learning Theory

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