NeuroPT - 14 - Organizing Practice, Instruction, and Feedback

practice

________ is a problem solving event in which the individual is faced with a motor or environment problem and the solution requires an appropriately planned and executed movement

1. identify the environmental problem

2. - 3. develop and select motor solution prior to movement execution

4. implement movement execution

5. compare intended outcome to actual outcome

6. if needed, adjust (cerebellum) movement as needed (feedback)

the steps of practice: (read)

**review problem solver and problem creator cards from previous deck

**review problem solver and problem creator cards from previous deck

1. how much practice

2. how to structure practice

3. types of practice

the three questions of practice are

1. how _______ practice?

2. how _______ practice?

3. _______ of practice

novelty/complexity, age of learner, brain health

how much practice is require depends on ________, _______, and _______

physical, mental, observation

the three types of practice are ______, _______, and ________

• massed vs distributed

• variability in task and environment

• part vs whole

• contextual interference organization (blocked, serial, random)

practice can be structured in these different ways (4): (more deets later)

practice

________ is the key ingredient for training/retraining of motor skills

motor learning! yay! (go juggle your items)

all things being equal, more practice trials = more _________

MORE

if a learner is in the cognitive stage with high novelty of the skill, they will need _____ practice

LESS

if a learner is in the automatic stage with a familiar skill, they will need ______ practice

MORE

injury or degeneration to the nervous system would require ______ practice for a task

UNDER DOSING

according to research, in general PTs are _____________

dosing principles apply to all of PT (circle star exclamation point)

dosing principles apply to all of PT (circle star exclamation point)

telling the patient to “lmk when you need a break” instead of constantly offering

PTs can decrease rest breaks by ________________

time between sessions

ex: 5x/week for 2 weeks BETTER than 2x/week for 5 weeks

increased practice in PT can occur by decreased ___________

massed

______ practice is when everything is in one giant continuous time block

distributed

_______ practice is when there is chunked practice with breaks between

• cognitive learners

• overall less time (no rest)

• develop task/skill endurance

massed practice positives (4):

• more errors

• may have decr motivation

• overuse injuries

• incr fatigue

massed practice negatives: (4)

• prevent boredom

• good for complex tasks

• more processing/reflecting time

distributed practice positives: (3)

• decr motivation if breaks too long

• may disrupt learning

distributed practice negatives: (2)

TASK, ENVIRONMENT

think about how you can vary the _______ and _________ to create variability in practice for the patient

SERIAL

part practice can ONLY be done for ______ tasks ONLY

whole

(whole/part) practice is recommended for associative and autonomous learners

whole

(whole/part) practice is used with discrete and continuous tasks

part

(whole/part) practice is recommended for cognitive learners or individuals that require guidance

part

(whole/part) practice is used with serial tasks

WHOLE

part practice MUST be combined with _______ practice for optimal motor learning

contextual interference CI

_________ is how you create challenge to learning by mixing tasks

LOW

in early learning and cognitive stages, there should be (low/high) CI

HIGH

in later learning and autonomous stages, there should be (low/high) CI

blocked → serial → random

the progression of order practice types from easiest to hardest is:

________ → ________ → ________

blocked

______ order practice has no mixing of tasks and practices each one fully before moving to another

serial

______ order practice occurs in a predictable order, like a circuit that is repeated

random

________ order practice occurs in an unpredictable order that increases contextual interference and problem solving

MOTOR LEARNING

more interference → more problem solving → more _____________

mental

________ practice is still a way to get reps in when physical practice is not possible or safe to perform alone

mental

virtual reality is considered a _______ type of practice

observational

__________ practice involves seeing another person perform the desired task or movement, like a clinician demo or group session

COGNITIVE

observational practice allows for ________ processing that could not occur simultaneously with physical practice

physical

observational practice is optimal if combined with ______ practice

instructions, feedback

________ and _______ are some of the hardest things to get right as PTs 😕 (other than dosing)

instructions

_________ are a clinician’s verbal cues during practice that can directly enhance or interfere with motor learning

INTERNAL, EXTERNAL

instructions can either have an _______ or ________ focus of attention

EXTERNAL

_________ focus of attention instructions are better for motor learning

internal

(internal/external) focus of attention instructions are focused on how they are moving

external

(internal/external) focus of attention instructions are focused on the environment or end goal

internal

“hit your heel on the floor first” is an example of (internal/external) focus of attention

external

“step over the lines on the floor” is an example of (internal/external) focus of attention

PROCEDURAL

external focus of attention assists learner in obtaining automatic control through __________ learning

internal

________ focus of attention results in more conscious control that specifically disrupts automatic control processes

internal

“toes toward your nose” is an example of (internal/external) focus of attention

external

“toes toward the ceiling” is an example of (internal/external) focus of attention

forward

feed(back/forward) is available before the movement

back

feed(back/forward) is available as a result of the motion

• proprioception

• vision

• somatosensation

• forces

examples of intrinsic feedback: (4)

• ( HELLO PTs we live here )

• knowledge of performance KP

• knowledge of results KR

• manual guidance

• biofeedback

examples of extrinsic feedback: (4)

intrinsic

_______ feedback is the internal representation of movement, and PTs need to let patients reflect about the movement to get better at this

performance KP

knowledge of (performance/results) is terminal feedback about characteristics of movement

performance KP

knowledge of (performance/results) is more observational

results KR

knowledge of (performance/results) is more data driven

results KR

knowledge of (performance/results) is terminal feedback about the outcome of movement in terms of environment or goal

manual guidance

__________ is extrinsic feedback through manual assistance through a movement, best used in early learning

DOES NOT

manual guidance can assist with achieving the goal of the task and (does/does not) aid learning

TRUE please and ty

T/F: manual guidance should be removed as soon as possible

unable, unsafe

manual guidance is recommended for when a patient is _______ or ______ to complete a movement

**think back to degree of skill acquisition progression

**think back to degree of skill acquisition progression

detrimental 😮

some research says that practice that uses manual guidance for errorless performance is _________ to motor learning

• improved retention of motor skills w feedback

• motivational

• reinforcing

• reference of correctness

positive effects of extrinsic feedback: (4)

• dependency

• interference with error detection development

• maladaptive and inconsistent corrections

• frequent feedback may operate like blocked

negative possibilities of external feedback: (4)

intrinsic!! and SELF REFLECTION

the goal is to shift from extrinsic feedback to _______ feedback → may need to encourage this progression with ___________

concurrent

_______ feedback is given during task performance

delayed

_______ feedback is given at a prescribed interval after the task is completed

delayed

(concurrent/delayed) feedback better allows the learner to process internal feedback

concurrent

(concurrent/delayed) feedback can lead to few or no errors in performance during practice

concurrent

(concurrent/delayed) feedback is LESS effective for learning

delayed

(concurrent/delayed) feedback is MORE effective for learning

decreased

(increased/decreased) frequency of feedback → increased internal problem solving → increased learning

increased

(increased/decreased) frequency of feedback → decreased internal problem solving → decreased learning

descriptive

________ feedback is only describing the errors

prescriptive

_________ feedback is describing the errors and suggesting how to correct them

prescriptive

(descriptive/prescriptive) feedback is MORE effective

descriptive

(descriptive/prescriptive) feedback is LESS effective

WORDS

as PTs, how we use our _______ is important to optimize motor learning!!!

degrades

concurrent feedback _______ learning

delayed augmented

___________ feedback, especially when it summarizes performance over more than one trial, enhances learning

**look over whiteboard of phases and overlap for optimizing motor learning

**look over whiteboard of phases and overlap for optimizing motor learning