contemporary task-oriented approaches to motor control training

general principles

• remediation of client factors and environmental modifications

• movement is controlled by integration and interaction of multiple systems

principles of contemporary task oriented approach

• occupational performance emerges from interaction of multiple systems

• personal and environmental systems (including CNS) are heterarchically organized

• behavioral changes reflects attempts to compensate

• top down approach

evaluation

• focus on role performance and occupational performance tasks because they are the goals of motor behavior

• after identifying most important role/performance; therapist uses task analysis to identify which subsystem(s) or the person and/or environmental factor(s) are limiting functional performance

carr and shepherd motor relearning program (MRP)

• person is an active participant whose goal is to relearn effective strategies for performing functional movements

• postural adjustments and limb movements are linked together in the learning process

• intervention is not focused on learning specific movements but instead on learning general strategies for solving motor problems

ultimate goal of utilizing motor learning theory

acquisition of functional skills that can be generalized to multiple situations and environments

skill acquisition stage (cognitive stage)

occurs during initial instruction and practice of a skill

skill retention stage (associative stage)

involves “carryover” as individuals are asked to demonstrate their newly acquired skill after initial practice

skill transfer stage (autonomous stage)

involves individual demonstrating the skill in a new context

blocked (constant) practice

repeated performance of the same motor skill

• ex) practice bed mobility several times in a row, then practice sit to stand several times in a row

random (variable) practice

practice of several tasks that are presented in a random order, encouraging reformulation of the solution to the presented motor problem

• ex) practice transfer to multiple surfaces in one session, such as couch, toilet, bench, chair, car

massed practice

practice schedule in which the amount of rest between practice is very small

• ex) constraint induced therapy

distributed practice

practice schedule in which the rest periods between sessions are relatively long

mental practice

cognitive rehearsal of a skill without actually moving

action observation

observes healthy person perform skill/functional task

• based on evidence that similar cortical motor areas are activated by either performance or observation of a task

mirror therapy

place mirror in midsagittal plane between extremities

intrinsic feedback

information (tactile, vestibular, visual, auditory) received by learner as a result of performing the task

extrinsic feedback (augmented feedback)

feedback provided from an outside source

• concurrent vs terminal

concurrent feedback

given during task performance

• ex) while person is standing and reaching for object, therapist says “stand up straight”

terminal feedback

given after task performance

• ex) after the person completes dressing, therapist says “you didn’t line up the buttons correctly”

immediate feedback

given immediately after performance

delayed feedback

feedback delayed by some amount of time

cognitive stage characteristics of motor learning

• learner develops an understanding of task

• cognitive mapping assesses abilities, task demands

• identifies stimuli, contacts memory

• selects responses

• performs initial approximation task

• structures motor program

• modifies initial response

“what to do” decision

associative stage characteristics of motor learning

• learner practices movements, refines motor programs

• spatial and temporal organization

• decreases errors and extraneous movements

• dependence on visual feedback decreases, increases for use of proprioceptive feedback; cognitive monitoring decreases

“how to do” decision

autonomous stage characteristics of motor learning

• learner practices movements, continues to refine motor responses, spatial and temporal highly organized, movements are largely error free, minimal level of cognition monitoring

“how to succeed” decision

knowledge of performance (KP)

verbal feedback about the process or performance itself

• ex) therapist says “next time lean forward more”

knowledge of results (KR)

feedback about the outcome or end product or results of the motor action

• ex) therapist says “you were able to retrieve the cup from the cabinet 3/5 times, you stood for 2 mins longer than yesterday”

retention

ability to perform the same task following an interval of practice

discrete task

specific beginning and end of a single movement

• ex) flipping a switch, hitting piano key

serial task

continuous discrete motor skills to make a “whole” activity

• ex) typing a letter

continuous tasks

arbitrary beginning and end of the action, repetitive movements

• ex) walking, swimming

closed tasks

environment is stable and predictable and methods are performance are consistent over time

• ex) picking up a cup, buttoning a shirt)

variable motionless task

interacting with a stable and predictable environment, but specific features of the environment are likely to vary between performance trials

• ex) performance of ADL outside the usual home

open task

require people to make adaptive decisions about unpredictable events because objects within the environment are in random motion during task

• ex) walking in a park

consistent motion tasks

require individual to deal with environmental conditions that are in motion during activity performance; motion is consistent and predictable between trials

• ex) stepping onto an escalator