O
ccupational therapists are involved in the train-
Application of Motor
Learning Principles in
Occupational Therapy
Janet L. Poole
Key Words: motor activity (physiology) •
motor skills. movement analysis. movement
patterns. occupational therapy services
The processes under(ying skill acquisition depend on
the nature of the task and the stage of the learner, In
addition, feedback and practice are two potent learn-
ing variables when used appropriately in the instruc-
tion of motor tasks. Occupational therapists involved
in the training and retraining of motor skills can
benefit }i-om knowledge of instructional methods used
by coaches and physical educators, This paper reviews
commonly accepted princzples of motor learning and
applies these principles to occupational therapy treat-
ment. The stage of the learner, type of task, feedback,
practice, and facilitation of skill acquisition are em-
phasized. Specific examples of how occupational
therapists can use motor learning principles in treat-
ment are given.
Janet L. Poole, MA, OTRJL, is a doctoral student in motor learn-
ing, Department of Health, Physical, and Recreation Educa-
tion, and Assistant Professor of Occupational Therapy, School
of Health Related Professions, University of Pittsburgh, 116
Pennsylvania Hall, Pittsburgh, Pennsylvania 15261.
This article was accepted for publication janumy 24. 1991
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ing and retraining of motor skills and motor
tasks. The therapist's role is to intervene in the
learning process to assist patients in achieving indepen-
dence in the performance of daily living skills. Ideally,
intervention would be done in the actual environment in
which the skill will be performed, such as in the home or
on the work site. Because this is not always feasible,
however, the skills that patients master in the occupation-
al therapy clinic are expected to transfer to the patients'
home and work environments. Although occupational
therapists teach motor skills, most therapists are not
trained as extensively in skill acquisition strategies as are
physical educators and coaches. Mosey (1986) attributed
this lack of attention to the teaching-learning process to
therapists' desire to disassociate themselves from the im-
age of being teachers. Being a therapist is regarded as
more prestigious than being a teacher. With the excep-
tion of Mosey and Trombly (1989), occupational therapy
textbooks devote little space to motor learning and teach-
ing (Hopkins & Smith, 1988; Pedretti, 1990; Pratt & Allen,
1989).
Some rehabilitation disciplines have already begun
to apply motor learning principles to the functional re-
training of patients with neurological impairments (Carr
& Shepherd, 1987b; Carr, Shepherd, Gordon, Gentile, &
Held, 1987). Although these principles are in the early
stages of validation for patients with pathology, they may
offer new ideas on how to improve performance. The
purpose of the present paper is to describe some of the
commonly accepted principles of motor learning and to
apply these principles to occupational therapy treatment.
Specifically, the paper focuses on variables that affect
motor learning, such as stages of motor learning, types of
tasks, feedback, practice, and, with regard to occupation-
al therapy, facilitation of motor skills.
Van abies Affecting Motor Learning
Schmidt (1988) defined motor learning as "a set of pro-
cesses associated with practice or experience leading to
relatively permanent changes in the capability for re-
sponding" (p. 346). The relatively permanent change in
behavior is what differentiates learning from temporary
improvements in performance. For example, after prac-
ticing a transfer several times, a patient may remember
how to do it and thus exhibit an improvement in perform-
ance. If the patient cannot remember how to execute the
transfer the next day, however, the task has nOt been
learned. Thus, to estimate learning or relatively perma-
nent changes, performance should be assessed again lat-
er (Schmidt, 1988).
Four factors influence motor learning: (a) the stages
of learning, (b) the type of task, (c) feedback, and (d)
practice. Although all of these factors must be considered
by therapists in designing treatment programs, feedback
531
 and practice are thought to be the two most potent learn-
ing variables (Schmidt, 1988).
Stages of Motor Learning
Fitts and Posner (1967) defined three sequential stages
involved in the motor learning process: cognitive, associ-
ative, and autonomous. In the cognitive stage, the learner
tries to understand the requirements of the motor task.
The learner has a vague idea of the task but is unsure of
how to do it. Performance is usually inconsistent because
the learner is tl)'ing many different strategies to do the
task. Adams (1971) called this the verbal motor stage,
because learners may need to verbalize the movement
strategies. For example, a patient with an above-elbow
amputation learning to use a prosthetic arm to grasp
objects may initially use awkward whole-body positions
while attempting the task. VerbaliZing the sequence of
prepositioning the terminal device, positioning the el-
bow, and locking the elbow joint may be necessal)' to get
the terminal device in the right position to grasp the
object. During this first stage, the learner must begin to
attend to the relevant information related to the skill
(Gentile, 1972). In learning one-handed typing, a secre-
taI)' who has had a stroke understands the task but needs
to attend to new finger-key assignments.
In the associative stage, or intermediate stage,
learners begin to refine their skills. Through continu-
ous practice and repetition, the learner's movements
become more consistent and errors begin to decrease.
During this stage, the structure of the practice period is
an important consideration (Fitts & Posner, 1967). Er-
ror-free practice has been advocated by some theorists
so that the learner develops an internal reference of
correctness, or sensol)' feedback of the correct move-
ment (Adams, 1971; Kottke, 1980). Incorrect practice of
a task will require unlearning with interference in sub-
sequent attempts to respond correctly (Adams, 1971;
Lawther, 1977). Learners may use information about
errors, however, to adjust subsequent movements that
may increase the ability to generalize to new motor
tasks. Edwards and Lee (1985) showed that subjects
who were allowed to make errors while learning a task
performed better on a novel task than did subjects who
had practiced in an errorless learning situation.
Guidance is decreased as the learner begins to form
appropriate associations between the movement plan
and the sensol)' consequence, that is, the learner learns
what feels right (Winstein, 1987). Feedback should be
more precise, but it should start to decrease so that the
learner becomes less dependent on it (Bilodeau & Bilo-
deau, 1958). Learners are encouraged to develop their
own error-detection mechanisms (Winstein, 1987). With
practice, the person with an amputation begins to learn
what feels right, and the movements to operate the termi-
nal device become more subtle and smooth. The secre-
532
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tal)' who has had a stroke begins to feel more comfortable
with the new hand placement on the keyboard, and her
performance becomes more accurate and consistent. It
may take the secretaI)' longer to develop automaticity
than it would a new learner, because the old patterns of
finger-key aSSignment may be detrimental to new learn-
ing (Schmidt, 1988).
In the final stage, the autonomous stage, the skill
becomes automatic. The skill requires little, if any, cogni-
tive processing, so it is less susceptible to interference
from other ongoing activities or distractions in the envi-
ronment. Once control of the prosthesis has become
automatic, the patient can hold and eat an ice cream cone
and walk down a crowded hall without crushing the cone.
Instructions in this phase focus on a particular aspect of
the skill. As long as some parts of the skill are automatic, a
person can focus on other aspects of performance. The
secretaI)' will be able to look at the material to be typed
rather than the keyboard, and practice would be focused
on increasing speed without sacrificing accuracy.
Types a/Tasks
Tasks can be classified along a continuum based on the
type of environment in which they are performed (Gen-
tile, 1972; Poulton, 1957). The environment may range
from stationary for closed tasks to constantly in motion
for open tasks. Critical features of the environment deter-
mine the spatial and temporal arrangement of a perform-
er's movements. For example, the shape, size, and type of
handle on a cup will determine the configuration of the
person's hand prior to grasping the cup. Another exam-
ple is how, when attempting to cross a busy street, a
pedestrian's path and speed of movements are con-
strained by the street terrain and by the speed, location,
and number of moving vehicles.
In closed tasks, the critical features, such as objects,
people, and the terrain, are stationary, and a performer is
constrained by the spatial features of the environment.
Quite different movements would be reqUired to position
a pencil for writing when the pencil is upright, lead side
down, in a pencil holder than when it is lying flat on a
desk. Timing is not specified in closed tasks, because they
are self-paced and the learner deCides the start, finish,
and duration of the task. Many tasks in the home are
closed. One usually stores grooming and hygiene materi-
als in the same location, using consistent movement pat-
terns to perform grooming tasks. The spatial features of
the environment, however, may vary across trials. Gentile
(1987) referred to tasks in which the objects or tools vary
in position across time but are stationary during perform-
ance as variable motionless tasks. For example, eating,
using the toilet, and some aspects of dressing are often
routinely performed in places other than the home envi-
ronment. Thus, one may have to deal with different styles
of dishes or types of food, different heights of toilets, and
June 1991, Volume 45, Number 6
 different articles of clothing and surfaces available to use
while dressing.
In open tasks, the supporting surfaces, objects, or
people in the environment are in motion from one trial to
the next (Gentile, 1972). The external environment con-
trols the spatial and temporal features of the movement
and makes predictive demands on the performer. If the
environment is in motion but the motion remains the
same across trials, the task is referred to as a consistent
motion task. Stepping on to an escalator, lifting luggage
from a conveyer belt, and sealing boxes moving on an
assembly line are examples of consistent motion tasks.
These tasks require mechanical devices that control a
constant rate of motion in the environment. In a true
open task, the changes are not predictable, as in catching
a fly ball, walking down a crowded hall, and driving a car.
Successful performance of open tasks is determined by
the performer's ability to adapt quickly to the changing
environment.
Routine homemaking tasks may have an open ele-
ment to them. For example, the presence of animals or
young children in motion within the home could force
predictive demands on the performer. The performer
may have to anticipate the location of the children or
animals to avoid tripping over them or, in some instances,
the performer may have to catch the moving object. Many
occupations, such as driver, crane operator, and food
service worker, involve open tasks. Moving cars, trucks,
and people and shifting loads make ongoing attentionaJ
demands on the performer.
The multitude of tasks that a person engages in dur-
ing any given day vary along a continuum from open to
closed. Outside the home, for example, in the workplace,
school, or community environment, continual monitor-
ing of the environment of both stationary and moving
objects is necessary. The therapist's responsibility is to
train the person to do the task in the environment most
appropriate to that task. For closed and consistent mo-
tion tasks, practice should occur under fIxed environmen-
tal conditions to develop movement consistency in attain-
ment of the goal. Exposure to all possible sets of
environmental conditions that one may encounter in real
life is necessary to improve the performance of open and
variable motionless tasks (Gentile, 1987; Spaeth-Arnold,
1981)
Feedback
Feedback, along with practice, is considered to be a po-
tent learning variable (Bilodeau & Bilodeau, 1958; Sal-
moni, Schmidt, & Walter, 1984; Schmidt, 1988). Feedback
may be intrinsic or extrinsic. Intrinsic feedback is inher-
ent sensory information from receptors in the muscles,
joints, tendons, and skin as well as receptors in the visual
and auditory systems. Intrinsic feedback may occur dur-
ing or after movement production. For example, a patient
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senses that his body weight is equally distributed over
both legs while standing or sees that he has missed a cup
with his hand. Conversely, extrinsic feedback is informa-
tion from an external source that augments the intrinsic
feedback. The external source may be a therapist or a
device such as a biofeedback machine or a timer. Feed-
back is used in early learning to generate or modify each
successive movement pattern. Later feedback helps com-
pare the movement executed to the reference of correct-
ness (Adams, 1971; Schmidt, 1975). The more sensory
channels through which feedback is provided, the stron-
ger the reference of correctness will be (Adams, 1971;
Mulder & Hulstijn, 1985).
In the patient with impaired sensation, extrinsic
feedback can be used to augment the absent or impaired
intrinsic feedback. Studies have shown that motor learn-
ing can occur in the absence of intrinsic feedback. In the
classic study by Rothwell et al. (1982), the deafferented
subject learned new motor tasks while receiving extrinsic
visual feedback through the use of an oscilloscope. When
the visual feedback was removed, the subject could per-
form the tasks, but his performance decayed over time.
The authors concluded that feedback was needed at
some later point in time to update the central nervous
system about the success and overall accuracy of the
movement.
Two kinds of extrinsic feedback can be provided to
learners: knowledge of results and knowledge of per-
formance. Knowledge ofresults is verbal augmented feed-
back about movement outcome that is given after a move-
ment (Schmidt, 1988). Knowledge of results provides
information about errors, thus providing the learner with
information on how to modify the movement on the next
attempt. Examples used by therapists may be, "You land-
ed too near the edge of the bed," "Your shirt is on back-
wards," and "You put your left leg in your right pant leg."
Knowledge ofperformance is verbal feedback about
the nature of the movement that is given after a response
(Schmidt, 1988) Winstein (1987) suggested that thera-
pists use knowledge of performance more often than
knowledge of results to proVide information that the per-
former may not be aware of and that is directed toward
correcting the movemem pattern rather than just the
movement outcome. Examples of knowledge of perform-
ance are, "You need to shift your weight more to your
right leg," "Your hand did not open soon enough," and
"Bend your knees and keep your back straight."
Feedback of either type helps to facilitate and accel-
erate the learning process. Carr and Shepherd (1987a)
and Gentile (1987) believed that therapists have not
placed enough emphasis on verbal feedback for knowl-
edge of performance and visual feedback for knowledge
of results. Vision has been reported to play an important
role in the acquisition and control of movement (Keele &
Posner, 1968; Zelaznik, Hawkins, & Kisselburgh, 1983).
Furthermore, when visual and verbal feedback were
533
 eliminated, movement accuracy was impaired, even
though augmented proprioceptive feedback, in the form
of resistance, was provided (Williams & Stelmach, 1968).
The amount and frequency of feedback is determined by
the type of task the performer is engaged in and [he 5[age
of learning.
Practice
Practice is a second important variable in motor learning
(Schmidt, 1988). Skill has been shown to increase directly
in relation to the amount of practice (Newell & Rosen-
bloom, 1981). In the clinic, practice of motor skills is
limited to time spent in the treatment session, which may
be only 1 hr daily or less. Yet studies of skill learning show
that it takes many trials to develop skill (Crossman, 1959;
Kottke, 1980). Practice, however, involves more than
mere repetition of a movement. It also means the formu-
lation of "new plans of action to solve motor problems
posed by the environment" (Whiting, 1980, p. 545).
Motor learning researchers have devoted consider-
able effort to determining the best way to structure prac-
tice (for a review, see Schmidt, 1988). One can manipu-
late the scheduling of rest periods, the order of the
movements or skills practiced, the conditions of the task,
or the amount of the task that is practiced.
Rest periods can be scheduled such that the rest
time is less than the practice time, called massed prac-
tice, or greater than the practice time, called distributed
practice. Massed practice is probably not appropriate in
acute rehabilitation for patients who fatigue easily or who
can control the pace of their daily schedule. Massed prac-
tice, however, may be appropriate in industrial or voca-
tional rehabilitation, specifically, for the injured worker
who will be returning to a work environment that de-
mands task repetition or task performance over a certain
time period.
The order of the tasks practiced can remain the
same, called blocked practice, or differ, called random
practice, across trials. In blocked practice, a patient
might practice grasping styrofoam cups for several tri-
als, then pick up coins for several trials; this pattern is
then repeated. Random practice, which might require
the grasping of a styrofoam cup, followed by the grasp-
ing of a coin, a coffee mug, and a pencil, requires the
learner to be more alert, because the object grasped on
each trial is different. The advantage of blocked trials is
that performance improves faster than with random
practice. The disadvantage is that the learner may not
attend to the task because he or she knows what to
expect (Lee & Magill, 1983; Shea & Morgan, 1979).
Moreover, learning and recall have been found to im-
prove more with random practice than with blocked
practice (Shea & Morgan, 1979).
The conditions of the task may vary across trials,
called variable practice, or may remain the same, called
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constant practice. Feeding oneself different textures of
foods with different utensils, rising from different chair
heights, and putting on different styles of front-opening
upper extremity garments are examples of variable prac-
lice, whereas keeping the food, utensils, chair height, and
style of garment the same across trials are examples of
constant practice. Practicing under variable conditions
has been shown to increase generalizability to novel situa-
tions (Shapiro & Schmidt, 1982). Because it is impossible
for patients to practice every task they may encounter
after discharge, variable practice may help with adapta-
tion to a new situation.
The amount of a skill practiced can range from a
subset of components constituting a task, called part
practice, to practicing the task in its entirety, called whole
practice. The logic behind part practice is that learning
can proceed more efficiently, especially when the task is
complex (Schmidt, 1988; Singer, 1980). The learner can
spend less time on the parts of the task that were already
mastered. Examples of part practice include practice with
only one article of clothing, buttoning buttons on a button
board, practicing shoe tying one step at a time, practicing
typing with one hand in isolation of the other hand, and
using simulators for driving and work-related tasks. Pall
practice appears to be effective when the task can be
broken down into steps that are not temporally coordi-
nated with each other (Wightman & Lintern, 1985). For
example, the timing of the steps in tying a shoe or putting
on a shirt is not crucial to performance of the task, where-
as in walking or steering a car, many of the steps that can
be isolated interact and are performed simultaneously.
At the heart of practice is the issue of transfer. Do the
skills that patients learn in the cliniC transfer to the home
and work environments? For example, do patients actual-
ly use joint protection or body mechanics principles out-
side the clinic? Is the patient who is independent and safe
getting into and out of the bathtub in the clinic also safe
and independent at home? Stallings (1982) defined trans-
fer as "the effect previous practice has on subsequent
learning or performance" (p. 203). In this respect, trans-
fer involves not only transfer from practice in the clinic to
performance in the home or on the job, but also transfer
from one motor skill to another and from limb to limb.
For transfer to occur, the learner must have adequate
experience with the original task and conditions sur-
rounding learning a movement. Practice must simulate
the real-life performance situation as closely as possible
(Stallings, 1982). This implies specificity of training or
practice of the task under the same conditions under
which the task will be performed. Therefore, if patients
are to use correct body mechanics on the job, they should
practice the techniques while actually doing the task.
Thus, the use of an activity requiring prolonged tool use
and overhead reaching to simulate an auto mechanic's
job may not necessarily enable the person to return to his
or her job.
June 1991, Volume 45, Numher 6
 For most sports, the practice of drills or parts of a
whole task in isolation does not transfer to the real game
situation (Stammers, 1982; Wightman & Lintern, 1985).
Likewise, the practice of isolated exercises for increasing
weight bearing on a hemiplegic lower extremity did not
result in more equal weight distribution during actual gait
(Winstein, Gardner, McNeal, Barto, & Nicholson, 1989),
and electromyographic biofeedback training on specific
movements of the hemiplegic upper and lower extremity
did not improve functional use of the extremity (Mulder
& Hulstijn, 1988; Wolf & Binder-Macleod, 1983). Newell
(1981) suggested that some breakdown of tasks, in which
there are natural subtasks and in which timing is not
crucial, may be appropriate for persons with brain dam-
age. He recommended that part practice be used only to
acquire the most basic component of a task and should be
followed by whole practice in which the person concen-
trates on the component. When practicing only part of a
task, the learner may have difficulty integrating the ele-
ments and timing in the whole task. These findings sug-
gest the need for treatment programs to be more specific
in terms of the environmental conditions and underlying
processes. Ideally, therapy would be done in the work or
home environment. A recent study by McCauley (1990)
incorporated individualized on-the-job instruction in
body mechanics with traditional lecture instruction. The
subjects did improve in their use of body mechanics over
a 4-week period.
Mental practice, or imagining task performance with-
out any overt action, is another practice technique. Re-
search indicates that mental practice is better than no
practice at all but is not as effective as actual practice
(Feltz & Landers, 1983; Weinberg, 1979). This type of
practice has been found to activate cortical areas associat-
ed with the particular movement (Decety, Philippon, &
Ingvar, 1988; Ingvar & Philipson, 1977; Roland, Larsen,
Lassen, & Skinhoj, 1980). Carr and Shepherd (1987b)
suggested that mental practice may be beneficial follow-
ing a stroke, at which time the patient has very little
muscular activity. Mental practice allows persons to prac-
tice on their own even before active muscle contractions
can be activated.
Facilnation of MOLOr kill Acquisiti n
In the initial stages of learning, it is extremely important
that the learner understand the goal. The therapist can
use verbal instruction, demonstration, or manual guid-
ance to give the patient an idea of the movement. Video-
tapes or photographs can clarify understanding. The
therapist's instructions, however, should focus on the
important perceptual cues and essential aspects of the
skills. In teaching correct lifting techniques, the therapist
may instruct the patient to test the load and to assess the
path and destination of the load before beginning the lift.
A patient with a visual-field deficit may be cued to turn the
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head to the side before commencing a task. The patient
with an amputation may be instructed to look for the flat
surface of objects before deciding how to pre-position the
terminal device on the prosthesis. For all tasks, relevant
features of the environment could be enhanced with the
use of color, markings, or a contrasting background.
Typewriter keys could be color coded according to which
finger is assigned to which key for the beginning one-
handed typist. In addition, with open tasks, as the instruc-
tor identifies the relevant cues, the learner could observe
the motion in the environment before attempting a task
(Gentile, 1987; Spaeth-Arnold, 1981). For example, a per-
son learning to steer an electric wheelchair might observe
the events in a crowded hallway as the therapist points
out people's walking speeds, door locations, and inter-
sections where moving people may suddenly stop, turn,
or emerge.
In initial learning, constant and blocked practice may
be indicated to increase performance. The learner needs
to practice the same movement a few times to get the
idea of it. For example, transfers to the same chair can be
practiced before proceeding to different heights or types.
When training a confused patient, the therapist may also
prefer to use a constant schedule. For example, dressing
training might start with only one style of shirt, pants, and
shoes. Nter a few days of practice with one particular
style of clothing, the patient would need to practice with
other styles.
Through trial and error and numerous attempts to
complete the task, the learner begins to develop success-
ful movement patterns. To facilitate learning, the move-
ments should be practiced in whole rather than part, so
that the movements are practiced in the context of the
entire task (Schmidt, 1988). If learners accomplish the
goal or execute the desired movement, they are encour-
aged to repeat the same performance. If the learner is
unsuccessful, then feedback from the therapist regarding
the general features of the movement should be given. In
early learning, feedback should be given frequently so
that the learner develops a reference of correctness in-
stead of incorrect or compensatory movement patterns
(Adams, 1971; Gentile, 1987; Kottke, 1980; Schmidt,
1975). Feedback should be delayed a few seconds after
the movement is made so that the learner can process
intrinsic feedback (Gentile, 1987).
Practice in the later stages of learning becomes more
task dependent. Specificity of training and a constant
practice format are often advocated for closed and consis-
tent motion tasks in which the environment is stable and
predictable. However, motor learning research shows
that even for closed tasks, variable practice schedules
improve learning and transfer (McCracken & Stelmach,
1977; Shapiro & Schmidt, 1982). Feedback in the later
stages of learning should be precise but should become
less frequent so that the learner becomes less dependent
on feedback (Salmoni et aI., 1984). For closed and consis-
535
 tent motion tasks, knowledge of performance is more
appropriate, because the goal is successful goal attain-
ment with the use of a consistent movement response
(Gentile, 1987). For example, when training keyboard
operators to reduce forceful, repetitive finger exertions,
the therapist might provide feedback to not lift the finger
so high off the keyboard.
In later stages of learning for open and variable mo-
tionless tasks, variable practice schedules under diverse
environmental conditions are indicated (Siegel & Davis,
1980). The learner must develop flexibility and a reper-
toire of strategies to match changing and often novel
environmental conditions. Therefore, the instructor must
systematically change environmental conditions during
practice to encompass all possible sets of constraints
(Spaeth-Arnold, 1981). For example, mObility training
should be done in empty hallways and sidewalks as well
as in crowded hallways and sidewalks. Dressing should be
done with all styles of clothing that the person normally
wears, and patients should practice lifting objects of var-
ious sizes, shapes, and weights to and from different
heights. For practice to be effective, Gentile (1987) rec-
ommended that the therapist change conditions after
every two trials rather than after every trial. The second
trial allows the learner to correct errors immediately.
Feedback for variable motionless and open tasks should
focus on how well the performer anticipated the environ-
ment and selected the movement pattern. Feedback
about the prior movement is not valuable, because a new
movement may need to be generated on the next trial.
Automaticity is not possible with open and variable mo-
tionless tasks because there is always an element of un-
certainty that must be monitored continually.
ummary
Principles of motor learning have much to offer occupa-
tional therapists in designing treatment programs aimed
toward the learning or relearning of motor skills. Feed-
back, necessary for both the acquisition and the reacqui-
sition of motor skills, depends on the stage of the learner.
More feedback is needed in the early stages of learning
than in the later stages. During the later stages, feedback
should be more precise and should decrease in frequen-
cy. In addition, extrinsic feedback in the form of knowl-
edge of performance or knowledge of results can be used
to augment intrinsic sensory feedback. By providing in-
formation about how movements are executed (i.e,
knowledge of performance) as well as the movement
outcome (i.e., knowledge of results), the therapist gives
the learner information about how to correct the move-
ment pattern on the next attempt.
The findings from research on motor learning also
support a functional approach to treatment in which
movement patterns and components of tasks should pri-
marily be practiced in relation to functional tasks. Tradi-
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tional methods using verbal instructions to teach joint
protection, body mechanics, or assistive device usage will
probably not result in carryover to the home or work
environment. Persons should be trained in the environ-
ment most appropriate to the type of task and to where
the task will be performed in the real world. RecogniZing
that this suggestion is not always feasible to implement,
therapists can use random and variable practice condi-
tions in which the task or environment changes on each
trial. These two conditions allow patients to practice and
solve a wide variety of motor problems to facilitate gener-
alization and transfer of motor skills to the home or work
environment...
Acknowledgmen t.
I wish to thank Joan C. Rogers, PhD, William D. Stofer, PhD,
George E. Carvell, PhD, and Carol A. Wood, PhD, for their many
helpful suggestions during the preparation of this paper.
Rt:ferences
Adams,]. A. (1971). Aclosed-loop theory of motor learning.
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