Lynne Dart Carolyn Taylor Candace Skinner

1. Lynne Dart Carolyn Taylor Candace Skinner

2. Presentation Outline Introduction Classifying skills Theories of motor learning Goal setting Motor learning v. motor performance Individual and performance characteristics of skill learning Presenting and practicing a skill Transfer of Learning Feedback Stroke and Motor Learning GAME!!!!

3. Introduction Motor skills are an important part of our existence as human beings. Therefore, the focus of our presentation is to look at how individual’s develop and perform motor skills by applying the principles of motor learning. Motor Learning is a set of cognitive processes associated with practice, training, or experience that results in relatively permanent changes in motor behavior

4. Classifying Skills Skills Can Be Classified By Task Discrete Skill: a skill that has a well defined beginning and end. Serial Skill: Characterized by several discrete skills connected in a sequence, whereby order is often crucial Continuous Skill: A skill that has no identifiable beginning or end and can often be repetitive. Skills Can Also Be Classified By Cognitive and Motor Elements Motor Skill: A skill determined by the quality of a performers movements Cognitive Skill: A skill for which the primary determinant of success is the quality of the performers decisions regarding what to do.

5. Classifying Skills con’t Open Skill: A skill performed in an environment that is unpredictable or in motion that requires individuals to adapt their movements in response to dynamic properties of the environment. Closed Skill: A skill performed in an environment that is predictable or stationary and that allows individuals to plan their movements in advance. Finally Skills Can Be Classified By The Environment In Which They Occur Finally Skills Can Be Classified By The Environment In Which They Occur

7. Theories of Motor Learning Fitts and Posner (1967): Cognitive Stage: Trial and error, directs attention to movements Associative: reduces amount of cognitive activity involved, improvement in success and consistency Autonomous: Skill is becoming automatic, little cognitive attention

8. Theories of Motor Learning Gentile’s Model Initial Stage: develop a movement coordination pattern for successful performance, learn to discriminate regulatory and non-regulatory conditions Later Stages: Adapt movement patterns to specific demands of any performance situation Perform skill with economy of effort Closed skills require fixation and open skills require diversification

9. Goal Setting Individual’s should have an input in the goal-setting process. Goal setting guides the progress of therapy. Goals should be specific, measurable, attainable, realistic and time oriented. Three types of goal should be set; performance goals, process goals and outcome goals.

10. Motor Learning Vs. Motor Performance Motor Performance: Observable attempt voluntary action. Level of performance is susceptible to fluctuation in temporary factors such as motivation, arousal, fatigue, and physical condition Motor Learning: Changes in internal processes that determine an individual’s capability of producing a motor task. The level of motor learning improves with practice and is often inferred by observing relatively stable levels of motor performance.

11. Individual Characteristics that Affect Motor Learning Abilities Attitudes Motivational level Previous social experiences Prior movement experiences Abilities: Finger dexterity, stamina, trunk strength Attitudes: Open, closed or neutral to new experiences Motivational Level: Low, moderate, high Previous Social Experience: One-to-one, small group, large group Prior Movement experiences: Recreational, instructional, competitiveAbilities: Finger dexterity, stamina, trunk strength Attitudes: Open, closed or neutral to new experiences Motivational Level: Low, moderate, high Previous Social Experience: One-to-one, small group, large group Prior Movement experiences: Recreational, instructional, competitive

12. Performance Characteristics of Skill Learning Improvement Consistency Stability Persistence Adaptability Improvement: skill shows improvement over a period of time, person performs at a higher level of skill later as compared to earlier Consistency: skills become more consistently performed, each performance of skill is similar Stability: Skill is not easily disrupted from changes in the person or environment Persistence: improvements in performance capability persist over long periods of time Adaptability: skill is adaptable to a wide variety of performance characteristics, this is what us OT’s want, this is related to transferability, we want our clients to be able to perform a skill in a wide variety of contextsImprovement: skill shows improvement over a period of time, person performs at a higher level of skill later as compared to earlier Consistency: skills become more consistently performed, each performance of skill is similar Stability: Skill is not easily disrupted from changes in the person or environment Persistence: improvements in performance capability persist over long periods of time Adaptability: skill is adaptable to a wide variety of performance characteristics, this is what us OT’s want, this is related to transferability, we want our clients to be able to perform a skill in a wide variety of contexts

13. Presenting a Skill Demonstration: Very little research Modeling: Use of demo to convey information about how to perform a skill, same as observational learning Beneficial when the skill being learned requires the acquisition of a new pattern of coordination Demonstrator needs to perform skill correctly

14. Demonstration Cont’d Observing unskilled demonstrators can be useful if learner is unaware they are unskilled Useful only if model and demonstrator are both beginners - Can discourage modeling of bad habits- Can discourage modeling of bad habits

15. How frequently should you demonstrate a skill? Should be demonstrated before beginner attempts skill During early part of learning, skill should be demonstrated as often as necessary As skill progresses, learner should not need demonstration as frequently

16. Cognitive Mediation Theory Explains benefit of a demonstration Learner observes skilled model Learner translates the observed movement information into cognitive code Learner stores cognitive codes in memory and uses them when they perform the skill

17. Verbal Instructions and Cues Evidence supports this method of instruction Must consider that learner has limited attention capacity Beginner may have difficulty paying attention to more than 1 or 2 instructions at a time Must keep this in mind when working with stroke populations because their attention capacity may be further diminishedMust keep this in mind when working with stroke populations because their attention capacity may be further diminished

18. Verbal Instructions Cont’d Direct learner’s focus to features of skill or environment that will enhance performance Performance of open skills requires direction of attention to aspects of the environment that will help learner Learners frequently attend to environmental cues without conscious awareness Key part of skill learning is where a person directs their conscious attention when performing a skill Important in correcting visual attention and also for transferability, if we can help our clientsKey part of skill learning is where a person directs their conscious attention when performing a skill Important in correcting visual attention and also for transferability, if we can help our clients

19. Verbal Cues Verbal instructions may be too short or too long They may provide too much or too little information May not provide learner with information they need to perform the skill

20. Verbal Cues Short concise phrases Direct attention to information relevant to performing skills Prompt key movement-pattern elements of performing skills Cues are effective in facilitating learning new skills as well as performing well-learned skills

21. When to give verbal instruction Verbal cues can be given at the same time as a demonstration Can be given to help learners focus on critical parts of skills Learners can also use verbal cues themselves when performing a skill Verbal cues aid in directing attention and can guide rehearsal of the skillVerbal cues aid in directing attention and can guide rehearsal of the skill

22. How do you practice a skill? Whole vs. part Mass vs. Distributed practice Speed/accuracy tradeoff Transfer – positive and negative

23. Whole vs. Part Low in complexity and high in organization (i.e. whole practice) Eg. Buttoning a button, throwing a dart High in complexity and low in organization (i.e. part practice) Eg. Serving a tennis ball, reaching for, grasping and drinking from a cup, driving a stick shift Complexity: the number of parts or components and the amount of information-processing demands that characterize a skill; more complex skills have more component parts and involve more information processing demands than less complex skills Organization: when applied to a complex motor skill, the relationships among the components of the skillComplexity: the number of parts or components and the amount of information-processing demands that characterize a skill; more complex skills have more component parts and involve more information processing demands than less complex skills Organization: when applied to a complex motor skill, the relationships among the components of the skill

24. Practicing Parts of a Skill Wightman and Lintern (1985) classified three part-task strategies Fractionization Segmentation Simplification Fractionization: par-task training method related to asymmetic coordination skills that involves practicing each arm or leg separately before performing with them together Segmentation: a part-task training method that involves separating the skill into parts and then practicing the parts so that after one part is practiced, it is then practiced together with the next part, and so on Simplification: a part-task training method that involves reducing the difficulty of specific parts or features of a skillFractionization: par-task training method related to asymmetic coordination skills that involves practicing each arm or leg separately before performing with them together Segmentation: a part-task training method that involves separating the skill into parts and then practicing the parts so that after one part is practiced, it is then practiced together with the next part, and so on Simplification: a part-task training method that involves reducing the difficulty of specific parts or features of a skill

25. Motor Learning and Control Text Speed/Accuracy Trade-off Characteristic of motor skill performance in which the speed at which the skill is performed is influenced by movement accuracy demands When the person emphasizes speed, accuracy is reduced When the person emphasizes accuracy, speed is reduced

26. Practice – Mass vs Distributed Massed practice a practice schedule in which the amount of rest between practice sessions or trials is very short Distributed practice a practice schedule in which the amount of rest between practice sessions or trials is relatively long Baddely and Longman (1978) Postal Workers on a mail-sorting machine Shea et al. (2000) continuous dynamic balance tasks and discrete key-press timing Distinguish practice distribution schedules rather than assign specific amounts of time Postal example: 60 hours total training time, five days each week Found keeping sessions short, only one session per day led to faster learning Only those in distributed schedule group attained the goal of 80 keystrokes per minute…the massed group never achieved the goal Retention tests showed massed group performed worse, others were mostly equal Shea et al. found distributed practice across days resulted in better learning than massing all the session within one day for a continuous dynamic balance task and a discrete key-press timing task Distinguish practice distribution schedules rather than assign specific amounts of time Postal example: 60 hours total training time, five days each week Found keeping sessions short, only one session per day led to faster learning Only those in distributed schedule group attained the goal of 80 keystrokes per minute…the massed group never achieved the goal Retention tests showed massed group performed worse, others were mostly equal Shea et al. found distributed practice across days resulted in better learning than massing all the session within one day for a continuous dynamic balance task and a discrete key-press timing task

27. Transfer of Learning “the influence of having previously practiced or performed a skill or skills on the learning of a new skill” Positive transfer: beneficial effect of previous experience on the learning or performing of a new skill, or on the performance of a skill in a new context Negative transfer: negative effect of prior experience on the performance of a skill so that a person performs the skill less well than he or she would have without prior experience Bilateral transfer: transfer of learning that occurs between limbs Bilateral transfer: Nagel and Rice (2001) tried to determine if they could demonstrate bilateral transfer for a meaningful and purposeful activity that involved a find motor skill Used students without neuro or ortho problems and had them perform a maze task with a ball and a stem Practice group practiced 3x/day with nondominant hand, control group not at all Found bilateral transfer effects between trained and untrained armsBilateral transfer: Nagel and Rice (2001) tried to determine if they could demonstrate bilateral transfer for a meaningful and purposeful activity that involved a find motor skill Used students without neuro or ortho problems and had them perform a maze task with a ball and a stem Practice group practiced 3x/day with nondominant hand, control group not at all Found bilateral transfer effects between trained and untrained arms

28. Why does transfer occur? Positive: 2 prominent hypotheses Transfer occurs because the components of the skills and/or the context is the same Transfer occurs because of similarities between the amounts and types of learning processes required Similarity of cognitive processes required

29. Why does transfer occur? Negative: an old stimulus requires a new but similar response Environmental context characteristics of two performance situations are similar but the movement characteristics are different Change in spatial locations of a movement ie drive a car different than your own Change in the timing structure of the movement ie dance

30. Clinical Implications Determine method based on skill complexity ie whole vs part Distribute therapy sessions, encourage practice sessions throughout the day and week, discourage mass practice before a therapy session Demonstrate the skill several times before your client attempts

31. Clinical Implications Cont’d Verbal instructions should be short, and the skill broken down Use verbal cues that are short, direct attention and prompt key components Encourage transfer of skills by mixing it up! Practice with unimpaired limb during initial training especially right after surgery

32. Food For Thought An occupational therapist is frustrated and confused. Her job is to oversee therapy for a number of stroke patients, who are trying to recover their functional abilities. The therapist wants to provide as much assistance as possible, but given the number of patients she must work with and working in an acute setting, she is unable to provide a lot of feedback to any particular individual. As a result, the therapist’s patients must spend most of the time practicing on their own.

33. Feedback Questions We Need to Consider How and when should an occupational therapist provide feedback for patients? What kinds of information should be conveyed to them about their performance? Should the therapist attempt to provide feedback about more then one aspect of a patient’s movement at a time? When assisting a particular individual, should the therapist give feedback after each performance attempt or wait until after the person makes several attempts before providing feedback?

34. Remind clients to rely and pay attention to intrinsic feedback, especially with the stroke population Intrinsic Feedback: Is sensory information that arises as a result of producing a movement. This feedback may come from within the body (proprioception) or from the outside (extereoception). Extrinsic Feedback: This type of feedback occurs upon movement completion. This is information that is provided to the learner by some outside source about the outcome of the movement. It is under the control of the therapist, and can be provided at different times, in different forms or not at all. Broken down into two types; knowledge of results and knowledge of performance Remind clients to rely and pay attention to intrinsic feedback, especially with the stroke population Intrinsic Feedback: Is sensory information that arises as a result of producing a movement. This feedback may come from within the body (proprioception) or from the outside (extereoception). Extrinsic Feedback: This type of feedback occurs upon movement completion. This is information that is provided to the learner by some outside source about the outcome of the movement. It is under the control of the therapist, and can be provided at different times, in different forms or not at all. Broken down into two types; knowledge of results and knowledge of performance

35. Knowledge of Results It is extrinsic, verbal information that tells learners about the success of their actions with respect to the intended goal. This form of feedback is often a repetition of intrinsic feedback. Extrinsic feedback is essential when a person’s intrinsic feedback sources are diminished or distorted, as in the case of some patients who suffer from neurological impairments.

36. Knowledge of Performance It provides performers with information about the pattern of their movement. It focuses on the quality of the produced movement. *Very important for every day tasks

37. Benefits of Feedback Provides Motivation for Clients It provides reinforcement for an action Information for learners so that they may perform an action more effectively. *BUT….It can create dependency in the client.

38. WHEN DO WE PROVIDE FEEDBACK ? Whether to provide feedback at all? What information do we provide? How much information is necessary? How precise should that information be? How often should we provide feedback?

39. Whether to provide feedback at all? Clients can pick up many forms of sensory information. There is a hierarchy of intrinsic information that an individual must be aware of to produce an effective movement, therefore it is important when providing instructional feedback that we ensure that the individual becomes in tune with that information. Also, important to look at what the individual must learn before they decide whether or not to provide feedback.

40. What information do we provide? Program feedback: This is error information about the fundamental movement pattern. Parameter feedback- This form of feedback provides a person with error information about the parameter values (e.g. amplitude, speed, force). Visual feedback: Videos can also be used to give a person visual feedback as opposed to verbal. Descriptive feedback- It describes the errors an individual makes during the performance of a skill. Prescriptive feedback- This form of feedback describes errors made during the performance of a skill and suggests something the learner might do to correct it.

41. How much information is necessary? Summary feedback: It is given after a series of performance attempts that provides the learner with information about each of the attempts in the series. The number of performance attempts a practitioner should summarize in a feedback statement depends on the complexity of the task. Average feedback: Feedback that is given after a series of practice attempts that provides learners with information about their average performance in the series. *Both of these methods are a good way to block dependency on feedback

42. How precise should that information be? Early in practice, errors are so large that precise information about the size of the error does not matter, but with time more precise feedback is better as the individual progresses in treatment. Bandwidth feedback: The instructor will only provide feedback when an individual’s movement falls outside an acceptable range of correctness or bandwidth. Bandwidth – knowledge of resultsBandwidth – knowledge of results

43. How often should we provide feedback? Absolute feedback frequency: The total number of feedback presentations given for a series of performance attempts Relative feedback frequency: The proportion of performance attempts for which feedback is given; equal to absolute feedback frequency divided by the number of performance attempts and multiplied by 100. Faded feedback: An approach that uses a schedule for providing extrinsic feedback in which relative frequency of feedback is high during initial performance attempts and it diminishes during later learning. Feedback can be adjusted to the proficiency rate and improvement of each learner.

44. Stroke and Motor Learning Stroke is the most important single cause of disability of people living in their homes An important goal in management of stroke is rehabilitation Rehabilitation should start within 48 hours if client is medically stable What is effective rehabilitation?

45. Stroke and Motor Learning Need to teach clients how to perform tasks using spared motor functions Client will most likely have to learn how to perform the task differently then they performed it pre-stroke Role of motor learning in stroke rehab has not been extensively studied

46. Stroke Literature – Hanlon Retention and transference varies as a function of training style or practice schedule If retention is goal, it is important to teach distributed practice (Intersperse activity with other tasks)

47. Blocked v. Random Trials – Hanlon Blocked Practice: AAABBBCCC Low contextual interference Random Practice: ABACCBACB High contextual interference Random practice is more effective because of the effort required to distinguish between the performance requirements of several tasks during acquisition Blocked practice allows client to use the same solution on each trial without having to generate it on each trial

48. Sabari – Motor Learning Intervention for Hemiplegia Important to teach motor programs in meaningful contexts so that transference is more likely Clients need opportunity to practice skills in various regulatory conditions so they can develop motor schema that versatile to meet daily situations Differences in cognitive style require individualized motor training to develop effective encoding strategies

49. Sabari – Cont’d Problems encountered in adults with hemiplegia: Ineffective or absent motor programs Impaired motor memory Impaired feedback mechanisms Impaired feed-forward mechanisms Goal of programs are to teach individuals to develop problem solving strategies rather than develop specific motor skills

50. Jarus – Motor Learning and OT Knowledge of effects of changing the order of presentation of different motor tasks can be used to facilitate retention and transfer of motor skills Important for planning OT treatment, we do not want the most effective performance, we want to maximize transference and retention Need to increase the difficulty of learning context - most transferable to everyday situations Increase difficulty by teaching open task, presenting task in random order or provide infrequent knowledge of results Important for OT, because we want to maximize function in daily life, in which we are required to respond to changing events and contextsIncrease difficulty by teaching open task, presenting task in random order or provide infrequent knowledge of results Important for OT, because we want to maximize function in daily life, in which we are required to respond to changing events and contexts

51. Case: Mr. Taylor 50 year old male, right side dominant Experienced left hemisphere stroke October 2004 Affected: speech (expressive aphasia) paralysis of right arm memory number of other elements

52. Questions Aphasia affected his speech and also his writing, however he initially started writing again with his left hand…this would help with what concept discussed earlier? As Gord regained movement of his right side, how could we as OT’s help him to re-learn to write?

53. References Baddeley, A. D., & Longman, D. J. A. (1978). The influence of length and frequency training session on the rate of learning to type. Ergonomics, 21, 627-635. Magill, R. A. (2001). Motor Learning and Control: Concepts and application, 7th ed. Toronto, Ontario: McGraw and Hill. Shea, Lai, Black, & Park. (2000). Spacing practice sessions across days benefit the learning of motor skills. Human Motor Science, 19, 737-760. Wightman, D. C. & Lintern, G. (1985) Part-task training strategies for tracking and manual control. Human Factors, 27, 267-283.

54. References Carr, J. & Shepherd, R. (2003). Stroke rehabilitation: Guidelines for exercise and training to optimize motor skill. China: Butterworth Heinemann. Hanlon, R. E. (1996). Motor learning following unilateral stroke. Archives of Physical Medicine and Rehabilitation, 77, 811-815 Jarus, T. (1994). Motor learning and occupational therapy: The organization of practice. The American Journal of Occupational Therapy, 48, 9, 810-815. Marley, T. L., Ezekiel, H. J., Lehto, N. K., Wishart, L. R., & Lee, T. D. (2000). Application of motor learning principles: The physiotherapy client as a problem-solver. Physiotherapy Canada, 315-320. Schmidt, R. A. & Wrisberg, C. A. (2000). Motor learning and performance: A problem-based learning approach. United States of America: Human Kinetics. Shapero Sabari, J. (1991). Motor learning concepts applied to activity-based intervention with adults with hemiplegia. The American Journal of Occupational Therapy, 45, 6, 523-530.