Motor Learning Theory: References: Cole & Tufano, Chapter 19 Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT

MOTOR LEARNING THEORY
References: Cole & Tufano, Chapter 19
Reserve Article: Mathiowetz & Bass Haugen

(1994) AJOT
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.
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.

Motor Learning Theory: References: Cole & Tufano, Chapter 19 Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT

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Motor Learning Theory: References: Cole & Tufano, Chapter 19 Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT

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MOTOR LEARNING THEORY

References: Cole & Tufano, Chapter 19

Reserve Article: Mathiowetz & Bass Haugen

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