Motor Learning and
T
Occupational Therapy:
The Organization of
Practice
Tal Jarus
Key Words: memory. motor control
This article addresses implications for the practice of
occupational therapy when that therapy is guided by
theories of motor learning. In occupational therapy,
clients must learn or relearn motor skills through the
use of activities. The occupational therapist must pre-
sent activities in a manner that elicits the retention
and transfer of the desired skills for use in functional
settings. Therefore, the therapist should strive for ac-
quisition conditions that facilitate retention and
transfer of the learned skills. The processes that under-
lie motor learning should guide therapy. Three major
factors that affect motor learning are environmental
conditions, cognitive processes, and movement organ-
ization. Examination of the clinical implications of
these factors, however, results in contradictmy predic-
tions regarding optimal practice conditions for motor
skills. This article explores the successful integration of
these factors and its application in occupational ther-
apy practice. It is suggested that increasing the diffi-
culty of the learning context during practice is benefi-
cial for retention.
Tal Jarus, PhD. OTR, is Assistant Professor, Sackler Faculty of
Medicine, Occupational Therapy Department, Tel Aviv Univer-
sity, POB 39040, Ramat Aviv, 69978, Tel Aviv, Israel.
This article was accepted for publication March 28, 1994.
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wo propositions are central to theories of occupa-
tional therapy: (a) the client must be an active
participant in the therapeutic process, and (b) in-
tervention should consist of purposeful activities in a
structured environment (Ayres, 1972; Breines, 1986; Co-
hen, 1989; King, 1978; Mosey, 1981; Trombly, 1989). Both
of these propositions focus on the interaction of the cli-
ent with the surrounding environment, an approach that
is relevant to occupational therapy practice (Gliner,
1985). The therapist's skillful structuring of the client-
environment interaction facilitates development of new
skills (Ayres, 1972; Clark, 1979; Fidler & Fidler, 1978;
Gilfoyle, Grady, & Moore, 1981; Llorens, 1986; Mosey,
1981; Trombly, 1989). Adaptation of the environment and
task presentation should produce desired responses in
the client (Trombly, 1989).
There are common threads between occupational
therapy and the field of motor learning and control (Bur-
gess, 1989; Gliner, 1985; Poole, 1991a; Schmidt, 1991).
Motor learning refers to a set of internal processes that
are associated with practice or experience and that lead
to relatively permanent (i.e., long-lasting) changes in
motor behavior (Schmidt, 1988). Because permanent
changes are the desired outcome, the ability to retain the
learned task is of great importance. Practice conditions
affect the transfer of training (Salmoni, Schmidt, & Wal-
ter, 1984; Sage, 1984; Schmidt, 1988). Transfer enables a
client to draw on past experience to perform a new task
(Schmidt, 1988). For example, a client who learns to put
on a hospital shirt should be able to transfer this learning
and put on different shirts after being discharged. The
acquisition phase may indicate performance, but the re-
tention and transfer phases may indicate learning (Magill,
1989; Sage, 1984; Schmidt, 1988, 1991).
Clients in rehabilitation must relearn voluntary con-
trol over injured muscles or learn new motor skills
through the use of functional activities (Gliner & Davis,
1984; Katz, 1985; Mosey, 1981; Mulder & Hulstyn, 1984;
Trombly, 1989). Therefore, the occupational therapist
must structure functional activities to enable the client to
learn and retain the desired skill. Principles of motor
learning can assist the therapist in structuring these ac-
tivities. For occupational therapy, in which the client
must learn or relearn motor skills and perform them effi-
Ciently later in different contexts, the therapist should
strive for acquisition conditions that produce optimal re-
tention and transfer of the learned skills. For example,
during practice of a motor task with a client, giving limit-
ed feedback will facilitate maximum retention, even
though feedback would enhance performance in this
practice phase (Schmidt, 1988). Clients will achieve maxi-
mal progress when therapy is guided by principles of
motor learning. This article discusses how a therapist
should structure the activities in a treatment session.
September 1994, votume 48, Number 9
 Factors That Influence Motor Learning
Movement Organization
In the past, motor learning theories focused on descrip-
tions of movement organization, stressing the coordina-
tion of the neuromuscular systems that control move-
ments (Adams, 1971, 1977; Arbib, 1985; Schmidt, 1975).
From this perspective evolved the theory that movement
patterns are stored in memory as a schema or an abstrac-
tion of the general characteristics of a movement
(Schmidt, 1975). However, Schmidt (1988) referred to
the schema as a generalized motor program that serves as
the memory representation for a class of movements,
rather than for anyone action or movement.
A movement class is defined by the invariant charac-
teristics of actions. Invariant characteristics are "aspects
of movements that appear to be fL,ed even though other,
more superficial features can change" (Schmidt, 1988,
p. 266), When a group of actions have common invariant
characteristics, they are considered to be in the same
movement class and are therefore represented in and
controlled by the same generalized motor program. For
example, signing one's name is a generalized motor pro-
gram, Whether one signs on paper or on a blackboard,
using hands or feet, the gUiding rules in this action are
identical. The pattern of the signature or the shape of the
letters, which will be similar in any of these actions, are
invariant, yet the size of the letters and the specific mus-
cles used vary,
Several different movement characteristics have
been proposed to be the invariant characteristics of a
motor program, such as the relative timing of the compo-
nents of the action, the relative force produced by the
components of the action, the sequence of events in-
volved in the action (Schmidt, 1988), and spatial configu-
rations (Bernstein, 1967), Currently, however, there is no
general consensus concerning the characteristics of mo-
tor programs (e.g., Gentner, 1987, 1988; Heuer, 1988;
Heuer & Schmidt, 1988). Furthermore, the generalized
motor program theory has been criticized for its failure to
prove the existence of additional invariant features
(Horak, 1991; Poole, 1991b).
From Schmidt'S (1975; 1988) viewpoint, the strength
of a generalized motor program is directly related to the
variability in practice of different tasks that belong to the
program's movement class. For example, practicing
transfer to different types of chairs allows the client to
practice the motor program of transferring to a chair,
whereas the timing of the action, the force produced by
the muscles during the motion, and the size of the motion
(the spatial configurations) differ according to the width,
height, and shape of the chairs. Hence, Schmidt predict-
ed that variability in practice is beneficial for retention
and transfer of a motor skill. Catching halls of varying size
or grasping objects of different shapes are two other ex-
amples of variable practice,
The American ]oumat o[ Occupationat Therapy
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Studies investigating the effects of practice variability
(e,g., Kerr, 1982; Magill & Reeve, 1978; McCracken &
Stelmach, 1977; Newell & Shapiro, 1976; Wrisberg &
Ragsdale, 1979) compared constant practice of a single
task to variable practice in either a predictable or unpre-
dictable presentation order. Studies in which variable
practice tasks were presented in a predictable order
found limited support for the theory that variability en-
hance.'; retention and transfer (Kerr, 1982; Magill & Reeve,
1978; Newell & Shapiro, 1976), Studies in which variable
practice was presented in an unpredictable order
(McCracken & Stelmach, 1977; Wrisberg & Ragsdale,
1979), however, did support the theory,
Environmental Factors
Environmental factors influence motor learning, The
therapist must consider the nature of the environment
because different environmental factors elicit different
motor reactions (Gentile, 1972, 1987). To be successful,
movements should correspond with certain factors of the
environment. For example, the movement of picking up a
cup to drink must be adapted to the environmental fac-
tors of the shape of the cu p, its distance from the person,
and the volume of liquid. The object, in this case the cup,
determines the spatial arrangement of the movement, In
some cases, timing of the movement is im portant, such as
in the act of catching a ball. The goal of the action deter-
mines the environmental factors (regulatory conditions)
that are critical for performance (Gentile, 1972, 1987)
Motor skills may be classified according to their spa-
tial and temporal environmental factors (Gentile, 1972,
1987), When temporal environmental factors are station-
ary, only the spatial factor of the movement is controlled
by the environment, For example, the spatial factors of
picking up a newspaper are different for lifting a Sunday
newspaper than for lifting a weekday newspaper. Timing
is not specified -lifting the paper is a self-paced action,
Tasks in which temporal environmental factors remain
stationary and fixed from trial to trial are termed closed
tasks Tasks in which the temporal factors of the environ-
ment are stationary but the spatial factors of the task,
such as the size or location of objects, vary from trial to
trial, are called variable motionless tasks, These include
walking on different surfaces, picking up a cup from dif-
ferent locations on a table, and buttoning a shirt with
different types of buttons.
When environmental factors include objects or per-
sons that ar":: moving, both spatial and temporal factors of
the movement are determined by the environment. For
example, when catching a ball or stepping onto an escala-
tor, a person needs to predict where the object will be.
Tasks in which these environmental factors change from
trial to trial are termed open tasks For some tasks, the
pace of the movement is constant while the environment
is moving, These tasks, termed consistent motion tasks~
811
 are associated with mechanical devices such as escalators
and assembly line belts.
Skill acquisition, according to Gentile (1972, 1987),
involves two stages: (a) trial and error, in which the move-
ment p~tterns ~re not consistent; and (b) task dependent,
in which the four types of tasks are learned differently and
therefore should be taught differently. As practice pro-
gresses in closed and consistent motion tasks, movement
patterns are refined and retained. The movement pattern
should become consistent because the environmental
conditions are static (Higgins & Spaeth, 1972; Hobart,
Vorro, & Dotson, 1978). Therefore, Gentile (1972, 1987)
recommended using a predictable environment to teach
persons to develop a consistent motOr pattern in re-
sponse to stationary input.
As practice progresses in the open and variable mo-
tionless tasks, movement patterns should become diver-
sified. The client must respond to the varied environmen-
tal stimuli (Higgins & Spaeth, 1972; Hobart et aI., 1978).
Therefore, Gentile (1972, 1987) recommended teaching
open and variable motionless tasks in an unpredictable,
changing environment to develop diversification of the
motOr pattern.
Cognitive Processes
Motor learning theories have been criticized for their
tendency to focus on internal neuromuscular movement
organization while underestimating the importance of
cognitive processes in retention and transfer of motor
behavior (Battig, 1979; Lee & Magill, 1983b; Salmoni et aI.,
1984). Learning theory suggests that skill acquisition in
unpredictable environmental conditions is beneficial for
memory and transfer (Battig, 1979; Craik & Lockhart,
1972; Shea & Zimny, 1983; Tulving, 1979). Battig (1979)
claimed that presenting several motor tasks tOgether in
certain contexts can facilitate cognitive processes benefi-
cial to memory improvement. He termed the difficult
learning context, such as an unpredictable situation, a
context with high contextual interference. Performing a
motor task in a difficult learning context forces the client
to use multiple and variable processes to overcome the
difficulty of practice (Battig, 1979; Shea & Zimny, 1983;
1988). Despite its sloWing of the acquisition phase, per-
forming in a difficult context leads to the development of
more elaborate and distinctive memory representations
of the movements practiced, which is beneficial for reten-
tion (Battig, 1979; Shea & Zimny, 1983; 1988). The teach-
er can create high contextual interference by presenting
trials of several tasks in a random order. That is, if each
task is assigned a different letter, the order of tasks might
be ABACBACABBC. For example, random practice with
transferring to a chair would involve introducing a differ-
ent chair to the client in different trials.
Lee and Magill (1985) suggested that the presenta-
tion of motor tasks in an unpredictable context causes the
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client to forget certain aspects of the way he or she per-
formed the tasks before. The time lapse between the
presentation of different tasks (e.g., different chairs)
causes the client to forget the way he or she performed
the movements before, forcing the client to reconstruct
movements for each subsequent attempt. As a result,
further practice is imposed on the client, which facilitates
retention. Several studies supported this reconstruction
view (Lee & Magill, 1983a, 1985; Magill, Meeuwson, Lee, &
Mathews, 1992; Shea & Wright, 1991). The findings of Del
Rey, Wughalter, and Carnes (1987) did not suPPOrt Lee
and Magill's (1983b, 1985) explanations, because the in-
terfering activity they used to facilitate this type of forget-
ting did not influence retention or acquisition.
The easy learning context, termed one with low con-
textual interference, such as a predictable situation, does
not force the client to use elaborate encoding processes,
leaVing weaker memory representations of the move-
ments practiced (Battig, 1979; Shea & Zimny, 1983; 1988).
As a result, although low contextual interference may
speed the process of acquiring a skill, it does not help
retention to the same extent as high contextual interfer-
ence. Low contextual interference can be created by pre-
senting tasks in a blocked order, so that practice of the
first task must be completed before the client advances to
the second task, and so on (i.e., AAABBBCCC). For exam-
ple, in the activity of transferring to a chair, the client
would practice transferring to a specific chair repeatedly
until that task was mastered. Only then would the client
practice transferring to another type of chair, and so on.
The feedback given to the client about the conse-
quences of a movement, such as the extent to which the
intended goal was achieved, can be referred to as knowl-
edge a/results (Sage, 1984; Schmidt, 1988). Knowledge of
results can be telling the client "You burned the egg,"
"You put the peg in the right hole," "You missed the
target by 2 inches," or "You buttoned your shirt wrong."
Jarus (1988) and Lee and Magill (1983b) suggested that
the effect of the level of knowledge of results during the
acquisition phase may be similar to the effect of high
contextual interference. Several studies have found that
clients given constant knowledge of results in the acquisi-
tion phase do not do as well in the retention phase, when
knowledge of results is eliminated, as do clients given less
frequent knowledge of results in the acquisition phase
(Baird & Hughes, 1972; Ho & Shea, 1978; Jarus, in press;
Schmidt, Young, Swinnen, & Shapiro, 1989; Winstein &
Schmidt, 1990; Wulf & Schmidt, 1989). Schmidt (1988)
stated that knowledge of results can be viewed as a crutch
that guides performance. Under conditions with limited
knowledge of results, the client is forced to rely on other
relevant cues of the task, such as sensory feedback, to
improve performance (Salmoni et aI., 1984; Schmidt,
1988). The client can subsequently perform the acquired
task without knowledge of results.
This reasoning is consistent with the contextual vari-
September 1994, Volume 48, Number 9
 ety hypothesis (Battig & Shea, 1978). That is, predictable
practice in a blocked order, or with constant knowledge
of results, is beneficial for acquisition, yet detrimental to
retention. Unpredictable practice in a random order, or
with lower knowledge of results frequency, is detrimental
to acquisition, but beneficial for retention and transfer.
Thus, the level of contextual interference and the level of
knowledge of results during acquisition of motor skills
influences the abilities to retain the learned material and
to perform a transfer task (Battig, 1979; Magill & HaJ],
1990).
Discussion
Both Schmidt's (1988) generalized motor program the-
ory and the contextual interference effect theory address
the concept that variability in practice is related to im-
proved retention and transfer. According to Gentile
(1972, 1987), however, the acquisition of motor skills
depends on the type of task being learned. Therefore, it is
relevant to compare the concepts of variability in practice,
practice schedule, and task classification, and their re-
spective implications for clinical practice.
Variability in Practice and Practice Schedule
Schmidt (1975, 1988) made no predictions about the
practice schedules that can be developed for variability in
practice. In the traditional approach to testing the prac-
tice variability hypothesis, one group (the constant
group) learned only one task, whereas the second group
(the variable group) learned several tasks. Both groups
had the same total number of trials. The number of tasks
practiced by subjects differed (i.e., the amount ofvariabil-
ity differed), and little or no attention was given to the
order of the tasks (i.e., schedule of practice). In the con-
textual interference approach, however, the number of
tasks was held constant for all clients (i.e., the amount of
variability was constant) but the order in which these
tasks were presented (i.e., schedule of practice) varied.
That is, one group learned several tasks in a random
order, whereas the other group learned the same tasks in
a blocked order.
Several studies (Lee, Magill, & Weeks, 1985; Turnbull
& Dickinson, 1986; Wulf & Schmidt, 1988) have tried to
assess whether the advantages of variability in practice
result from generalized motor program formation or
from enhanced information processing (caused by higher
contextual interference), but these studies were either
inconclusive or involved questionable experimental de-
signs (Magill & Hall, 1990). There is apparently insuffi-
cient empirical evidence of the relationship between vari-
able practice and practice schedule.
MagiJl and Hall (1990) hypothesized that the contex-
tual interference effect differs for skill variations con-
trolled by the same or different motor program. Accord-
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ingly, when the skill variations to be learned require
different motor programs, manipulating the practice
schedule creates different levels of contextual interfer-
ence, which results in varying retention and transfer ef-
fects (i.e., the higher the level of interference, the better
the effect). Similarly, when the skill variations involve
parameter modifications of the same motor program, the
contextual interference effect wiJl not be found. For ex-
ample, if a person practices throwing a baJ] at a target and
uses three different thrOWing patterns, such as overhand,
underhand, and sidearm, then three different motor pro-
grams are involved and the contextual interference effect
would be found (MagiJ] & Hall, 1990). However, if only
one throWing pattern is used but three different ball
speeds are practiced, then only one motor program is
involved although the overall limb speed parameter must
be modified to produce the different ball speeds. In this
case, the contextual interference effect would not be
found (Magill & Hall, 1990). This hypothesis was explored
by Magill and Hall (1990) and requires further research.
Practice Schedule and Task Classification
The effects of blocked versus random practice have been
studied considerably in the past decade (Magill & Hall,
1990). However, researchers who tested the premise of
contextual interference theory in motor learning (Del
Rey, 1982; Goode & Magill, 1986; Lee & Magill, 1983b;
Young, Cohen, & Husak, 1993) used either a closed task
or an open task exclusively. None of these studies investi-
gated whether the effect of contextual interference differs
between open and closed tasks. Studies in which the
subjects learned a closed task (Shea & Morgan, 1979;
Young et aI., 1993) supported the contextual interference
theory. Subjects in the group that practiced variations of a
closed task in random order retained the task better than
subjects in the group that practiced variations of a closed
task in blocked order. Studies in which the subjects
learned an open task (Del Rey, 1982; Del Rey, Whitehurst,
& Wood, 1983; Del Rey, Whitehurst, Wughalter, & Barn-
well, 1983; Del Rey, Wughalter, Du Bois, & Carnes, 1982;
Del Rey, Wughalter, & Whitehurst, 1982) partially sup-
ported the contextual interference theory. Subjects who
learned an open task in the random group did not always
differ significantly from subjects who learned the task in
the blocked group in their ability to retain the task.
To differentiate between the effects of contextual
interference on the two types of tasks, a study must in-
clude both open and closed tasks, which can be present-
ed under conditions of either low (blocked practice) or
high (random practice) contextual interference. Holding
all other factors constant will enable an investigation of
the interaction between contextual interference and mo-
tor tasks of different classifications.
In a study that manipulated both the task classifica-
tion and the contextual interference, subjects performed
813
 a tracking task by moving their heads as they watched a
16-in. computer-generated video display containing a cur-
sor and a target (Tarus, 1988) The subject, who controlled
the cursor by performing head movements, had to posi-
tion the cursor in the target. In the open task, the target
was in motion throughout the 5-sec trial. In the closed
task, the target remained stationary. Three target loca-
tions were provided for both the open and closed tasks,
to enable manipulation of the practice schedule. The sub-
jects were divided randomly into four groups: open task-
random order, open task-blocked order, closed task-
random order, and closed task-blocked order. Results
indicated that the high level of difficulty encountered
when practicing the open task (in both random and
blocked order) created high contextual interference,
which is beneficial for retention and transfer (Tarus,
1988). Subjects who learned the open task appeared to
be less dependent on the context in which the initial
encoding occurred. It seems that the open task better
prepared subjects to develop movement strategies or pat-
terns in an unpredictable environment, allowing better
retention and transfer to a new task. The closed task
facilitated the development of fixed movement patterns,
which resulted in inflexibility when a new task was en-
countered (Tarus, 1988).
These findings illustrate that there is no unique
method of creating high contextual interference to facili-
tate retention and transfer. In addition to presenting tasks
in an unpredictable order or with lower knowledge of
results frequency, open tasks, in which critical factors in
the environment are moving, can also create high contex-
tual interference. That is, predictable practice, such as
practice in a closed environment, in a blocked order, or
with constant knowledge of results, is beneficial for acqui-
sition yet detrimental to retention and transfer, whereas
unpredictable practice in an open environment, in a ran-
dom order, or with lower knowledge of results frequency
is detrimental to acquisition but beneficial for retention
and transfer.
Clinical implications
Contextual variety, open environment, and low knowl-
edge of results frequency apparently facilitate cognitive-
motor functioning during motor skill acquisition, thereby
enhancing retention and transfer. Open tasks, unpredict-
able schedules, and limited knowledge of results reljuire
clients to adapt strategies and solve problems, which de-
mand greater cognitive effort. Such activities facilitate re-
tention and transfer of the acquired skill, because clients
are forced to draw on information other than knowledge
of results and must either develop an elaborate encoding
process or reconstruct movement plans for each practice
trial.
For example, difficulty can be increased by teaching
an open task. Throwing bean bags at a target can become
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an open task if the target or the client is placed on a
moving scooter. Climbing the stairs can become an open
task if practiced on moving escalators. Throwing a ball to
the client is an open task whose unpredictability can be
increased if the client sits on an equilibrium board. Using
a wheelchair in a busy corridor rather than an empty one
is an open task.
During treatment, the therapist should try not only
to present open tasks but also to organize the session so
that several tasks are learned simultaneously and ran-
domly, avoiding repetitions. For example, the session
could involve throwing a ball to the client from different
angles, asking the client to throw bean bags to several
targets, practicing transfers from a wheelchair to a bed
from different angles or to beels of different heights or
firmness, or alternating between practicing activities of
daily living and eye-hand coordination. The therapist can
make the client do different tasks during each trial, alter-
nate tasks, and introduce interfering activities that cause
the client to forget the solutions so that the client must
reconstruct the solutions when he or she tries the task
again. Although this random presentation may be detri-
mental to performance, research suggests that it is benefi-
cial for retention and transfer of the acquired task (Magill
& Hall, 1990). The exception to this guideline might be in
the very early stages of practice, when the client is just
learning the basic concept of the task. At this time,
blocked practice might be slightly more effective than
random practice (Shea, Kohl, & Indermill, 1990). Once
the client can perform the movement at all, random prac-
tice can be initiated (Schmidt, 1991).
Educating clients about these principles can height-
en their understanding that these types of activities are
beneficial for their long-term treatment goals. According-
ly, the clients may be less frustrated by a challenging or
difficult therapy session.
Conclusion
Knowledge of effects of changing the order of presenta-
tion of different motor tasks, based on the different motor
learning theories reviewed, can be used to facilitate reten-
tion and transfer of motor skills. Occupational therapists
may use this information when planning treatment. The
treatment goal should not necessarily be to achieve the
most effective performance during therapy, but to maxi-
mize retention and transfer of the acquired skill. When
the treatment goal is to enhance motor skill retention or
transfer, increasing the difficulty of the learning context
during practice is beneficial. Increased difficulty can be
achieved by teaching an open task, presenting tasks in a
random order, or providing infrequent knowledge of
results.
Use of difficult practice contexts in occupational
therapy is beneficial for the treatment process. In addi-
tion, such situations correspond more closely to the
September 1994, Votume 48, Number 9
 kinds of everyday situations clients encounter, which are
the core concern of occupational therapy (Breines, 1986;
King, 1978; Meyer, 1977). This teaching method might
support the fundamental assumptions of occupational
therapy, which suggest that the focus of treatment should
be the types of activities encountered in daily life (Dijo-
seph, 1982; Katz, 1985; King, 1978). These activities usu-
ally require the ability to respond to unpredictable events
on the basis of limited information.•
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September 1994, Volume 48, Number 9