Lecture 3: Movement Analysis III: Promoting Learning that Leads to Functional Improvement

● Improve mobility and optimize motor skill acquisition.
● Teach patients to solve motor problems.
● Adapt movement strategies to changing task and environmental conditions.
● Resolve, reduce, prevent impairments, and promote health.
● Teach effective self-management strategies

General PT Goals for Motor Learning

• The ability of the learner to demonstrate a skill--after a learning period.
  ○ Not given immediately following training.
  ○ Eg: W/c to-from mat transfer

RETENTION TESTS

• The ability of the learner to modify (adapt) their movement in response to changing environmental demands.
  ○ Transfers/Ambulation - different surfaces
  ○ Calm environments to busy environments
  ○ Increased speed
  ○ Dual tasks

ADAPTATION TESTS

● Practice leads to learning
● As skill improves, mvt size decreases, speed increases, efficiency increases

Manipulating Practice to Promote Learning

Ways to Manipulate:

○ Distributed versus Massed
○ Variable versus Blocked
○ Closed vs Open
○ Part-task vs Whole-task
○ Transfer (of learning) training

what is intrinsic feedback for manual contacts and verbal cues?

Pt’s internal knowledge

what is extrinsic feedback for manual contacts and verbal cues?

• Feedback given by a PT.
  i. Delayed FB: Allows for patient self-assessment.
  ii. Faded FB: Amt is decreased (faded) over task training

• Summary Feedback:
  i. Knowledge of performance: Feedback given about errors made.
  1. Concurrent FB: Given during the task.
  ii. Knowledge of results: Feedback given about goal achievement

The Types of Practice to Promote Learning

• blocked vs random

• Part-task/Whole-Task.

• Closed/Open Practice: Practice that occurs in a controlled environment.
  ● Benefit to patients with attention/learning challenges

• Mental practice: Visualize/imagine the task

  • ➢ Activates motor programs

  • ➢ Facilitates learning of skills

what is blocked vs random?

a. Blocked: Constant repetition of a single task.
i. May help those with disorganized mvt.
b. Random: tasks practiced in random order
i. Increased cognitive demand

what is part-task/whole task

a. Part-task: Break down a task into components, train parts.
b. Whole: Practice the entire task

OPTIMAL theory of motor learning:

Optimizing Performance Through Intrinsic Motivation and Attention for Learning

➔ The learner is influenced by enhanced expectancies, autonomy, and, an external focus of attention.

Enhanced expectancies:

a patient’s sense of confidence, based upon past experience.
➢ PT implications: Can augment confidence though compliments

Autonomy:

Practice conditions should support autonomy/ self-determination.
➢ PT implications: Giving choices during therapy benefits performance.
Eg: “show me what you think you should do when you transfer”

External focus of attention:

➢ PT implications: Move the patient’s attention from their own body to
the intended movement effect.
➢ Eg: Move toward a target, exerting force against an object.
➢ Eg: Standing on a rocker board...”Keep the board level”, not “Push your
toes down.” Instead “Push the edge down”

Mobility - Impairments that Drive Abnormal Patterns ➔ Other Considerations:

• Perception/Sensation

  • Vision, hearing, joint and muscle afferents

• Pain

• Cognition

  • Executive function (awareness, attention, memory)

  • Dual-task

Ok, So How Do We Analyze Movement? chart

For Identifying and describing movement

1. Principle 1: Use it or Lose it
2. Principle 2: Use it and Improve it
3. Principle 3: Specificity matters
4. Principle 4: Repetition matters
5. Principle 5: Intensity matters
6. Principle 6: Time matters
7. Principle 7: Salience matters
8. Principle 8: Age matters
9. Principle 9: Transference
10. Principle 10: Interference

Promoting Neuroplasticity Through Experience Dependent Rehab (644!)

Walking - What should we do - History Lesson

● The ability of the learner to demonstrate a skill--after a learning period.
○ Not given immediately following training.
○ Eg: W/c to-from mat transfer

RETENTION TESTS

● The ability of the learner to modify (adapt) their movement in response to changing environmental demands.
○ Transfers/Ambulation - different surfaces
○ Calm environments to busy environments
○ Increased speed
○ Dual tasks

ADAPTATION TESTS

● Learning in enhanced by applying the OPTIMAL Theory of
Motivation and Attention in humans.
● Practice conditions and feedback strategies must be
considered on an individual basis.
● Practice must be specific, intense, and have sufficient to
promote learning
● Learning has not happened unless there is a test
(adaptation or retention) to demonstrate success

Summary