Motor Learning Principles
In many of our case simulations, we have provided patient and family education in exercise techniques and safety considerations. How do we optimize our patient/client's chances for mastering the task? How do we evaluate if our instruction led to the intended result? With adequate preparation and applying concepts of motor learning, we can evaluate our effectiveness as patient and family educators.
Suggestions for exercise instruction
- inquire about patients goals and general understanding of therapeutic exercise in rehabilitation
- Assess for patient fears and/or concerns regarding exercise and exercise programming
- choose an environment which is free of distractions
- demonstrate correct and variant forms of movement to create a context for correct technique and common errors
- use multiple modalities (verbal, visual, demonstration/kinesthetic) to optimize skill acquisition for all learners
- evaluate patient performance by repeat demonstration under supervision
- provide specific feedback to optimize the patient/client's ability to self-assess future performance
- design instruction which allows for mastery of simple to more complex tasks.
Taxonomy of Motor Learning
Taxonomies are classification systems to categorize items, animal, activities, etc., using progressively specific terminology. In motor learning, taxonomies are used to help distinguish levels of complexity between movement-based activities.
Closed environments are less complex than open environments. Closed environments are static: objects, people and surfaces do not move. Open environments are dynamic: objects, people and surfaces can move and change between episodes.
Intertrial Variability: is absent when there is no change to the environmental conditions; is present when environmental demands change with each attempt
Desired Outcome of the Action
Body stable actions are less complex than body transport actions. Body stable includes maintaining a stationary/stable position while executing a motor task. Body transport includes activities where the patient/client is moving and changing positions through space
Tasks which do not include object manipulation are less complex than tasks where the person is required to move/manipulate an object
Practice and feedback strategies are selected by the PT/PTA based on the instructional readiness of the patient/client and the complexity of the task demands (person/environment). Your text distinguishes between:
- part vs. whole practice
- blocked practice
- random practice
- random-blocked practice
- physical practice
- mental practice
Consider the intended outcome of the instruction. Performance is enhance by repeated blocked practice, however, skill retention and transferability of skills to multiple conditions and environments benefits most from task variations. The key is to assess each patient/client and select the most appropriate level of practice to allow for incremental, progressive success in motor performance and skill development.
Feedback is categorized by timing, outcome focus (knowledge of performance vs. knowledge of result), and source.
Test your knowledge of effective instructional strategies for therapeutic exercise by matching the strategy with the most likely stage of motor learning
Active learning exercise
Consider a patient who has right ankle stiffness and weakness since an ankle sprain 8 weeks ago due to volleyball injury. The patient walks with a minimal limp, with decreased stride length on the left.The patient is athletic and is eager to return to sport, however, this is the third time the patient has had this injury.
Can you think of a series of progressions, with a focus on motor learning principles as a guiding factor? How will you change practice, feedback, environment and stability versus mobility to demonstrate you are making the task progressively more complex and automatic? Is it something you would be willing to do on your own if you had this injury?
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