Motor Learning and Neuroplasticity Quiz

Facilitation Motor Learning in Patients

• Objectives:
  • Students will understand the basic principles of neuroplasticity related to motor learning.
  • Students will identify motor learning principles and use them to help a person improve a motor skill.
  • Students will learn and implement components to optimize motor learning during a treatment session.
  • Students will define recovery of function and understand motor learning applications to this concept.

Motor Learning Following a CNS Injury

• Focus on Recovery of Function:
  • Reacquisition of movement skills lost through injury.
  • Reorganization of perception and action systems in relation to specific tasks and environments.
  • The injury in the systems results in reorganization of the system components.

Motor Learning Following a CNS Injury (Recovery of Function)

• Person has (potentially) altered system so some structures may not be available.
• Person uses Task Solutions (Ecological Perception Action Theory).
• New strategies are used for perceiving and acting.
• As physical therapists, appropriate use of motor learning can:
  • Maximize recovery.
  • Promote task solutions that involve continued neuroplasticity and learning.

Contemporary View for Facilitating Learning of Motor Skills

• Know the characteristics of the individual learner for optimal challenge.
• Effortful (High-intensity) practice.
• Varied learning styles.
• Active engagement with the task.
• OPTIMAL Learning theory (Wulf & Lewthwaite 2016).

Big Concepts

• Optimize learning when a patient is highly motivated and fully attending to the task and able to integrate new information.
• Law of Effect (operant conditioning):
  • Rewarded behaviors are repeated.
  • Behaviors that have adverse effects are less likely to occur.

OPTIMAL Learning Theory

• Optimize performance through intrinsic motivation and attention for learning (Wulf & Lewthwaite 2016).
• Three components:
  • Autonomy: Learner has choices or control over learning elements
  • External focus: Focusing on external objects to be manipulated rather than the body.
  • Enhancing expectancies: Learning is better when the goal is determined and performance expectations are explicit.

Activity (Task or Skill) Specific Practice Effects

• Evidence supports Activity-Specific Training (Task-oriented approach)
  • Practice tasks improve movement strategies for that task.
  • Activity-Specific Neuroplasticity aids development.
  • Motor learning happens after an injury.
  • Activity-specific physiological effects (muscle strength and endurance, cardiovascular changes)

Task-Oriented Approach to Motor Learning

• Address impairments:
  • Practice movement strategies specific to the task.
  • Adapt the task to changes in the environment.
• Learner learns through interaction and exploration of the environment.
  • Task.
  • Individual.
  • Environment.
  • Movement (strategy).
  • Proficiency/ Effectiveness/ Accuracy/ Efficiency/ Safety.

What is a "Skill"?

• Skill = Task (Activity: ICF)
• Skill (skillful) = Proficiency
• Characteristics of Performance:
  • Accuracy.
  • Correctness.
  • Consistency.
  • Effectiveness.
  • Success.
  • Efficiency.
  • Reduced energy.
  • Adaptability.
  • Ability to detect and correct one's own errors.

Setting up a Practice Session to Maximize Learning

• Task Analysis: Understanding the task (skill or activity) and the environmental demands (where the task will take place).
• Understanding the person's capability: Determining the person's or individual's capability to perform the task in the environment it will be performed.
• Selecting Practice conditions: Choosing the practice conditions to support learning.

Task Classification

• Cognitive versus Motor Skills:

  • Perception, knowledge, and strategy (cognitive) contrasted with performance elements.
  • Skills high on perception, knowledge, or strategy are cognitive, while those high on performance elements are motor.
  • Most skills are combinations of cognitive and motor elements (perceptual-motor or psychomotor skills).

• Organization:

  • Discrete skills (well-defined beginning and end, usually of brief duration).
  • Serial skills (a series of discreet skills in a specific sequence, taking longer to complete.)
  • Continuous skills (repetitive or rhythmic, and continue until a goal is accomplished).

• Control Elements: What elements in the motor control system need to be controlled? Does the task affect movements of the Upper Extremity (UE), Lower Extremity (LE) or Trunk?, or all three? (Mobility, Stability, Manipulation, Task).

Task and Environment Variability

• Closed Movement Tasks: No variability between each execution, and the environment is predictable.
• Open Movement Tasks: Task changes between each execution, and the environment is unpredictable.

Ann Gentile's Taxonomy of Tasks

• Task components, body stability, object manipulation, body transport, etc.
• Includes different levels of demands and tasks in different settings.

Maximizing Learning of Skill

• Environment: Crowded? Quiet? Stationary/ Moving? Who/What is present? Is this a typical environment after physical therapy?

Having a Person Do a Task

• Decisions need to be made before starting the session regarding how to get the person to perform the task.

Maximizing Learning of Skill

• Aspects of the person that need to be considered for learning:
  • Stage of learning.
  • Cognitive Status.
  • Do they have knowledge of the task?
  • Can they attend to tasks and the environment?
  • Are they motivated for this task?
  • ROM.
  • Strength.
  • Balance
  • Functional Mobility.

Performance and Learning

• What stage of learning? (Early or Late).
• Learning changes over time (trials across weeks/months).
• Stages to consider (Acquisition, Retention, New conditions).

Fitts & Posner: Stages of Learning

• Three stages or learning (Cognitive [Planning], Associative [Practice], Autonomous [Automatic]).
• Early (What to do?).
• Intermediate (How to do?).
• Late (How to succeed?).

Timeline for Learning

• Level of attention decreases over time during learning.
• The cognitive stage requires more attention.
• As learning increases, attention is less necessary.
• From Cognitive to Associative then to Autonomous stage, attention declines.

Cognitive Stage of Learning

• Learner develops understanding of the task; determines "what to do" by cognitive mapping.
• Behavior moves from clumsy to organized through use of vision to guide movement.
• Tries many strategies and makes many errors.
• Facilitators/PTs provide clear information, demonstration, and precise feedback.

Associative Stage of Learning

• Learner determines a strategy and practices with adjustments, and works on "how to do."
• Spatial and temporal aspects of tasks create a coordinated pattern.
• Learning involves control over degrees of freedom.
• Facilitators start to allow the learner more autonomy. Give feedback less frequently.

Autonomous Stage of Learning

• Learner practices and refines movement, and understands "how to succeed."
• Spatial and temporal are highly organized.
• Learner achieves increased autonomy with decreased cognitive monitoring.
• Facilitators provide minimal feedback and help to create challenges to further enhance development.

Methods of Analyzing Stages of Learning

• Reaction Time (RT): Care should be taken to measure reaction time (RT), which is the time taken for sensory motor processing before movement.
• Early learning takes more time in searching the environment and selecting the right strategies for performing the task.
• Late learning is faster in scanning and selecting the appropriate strategies.
• Dual-task paradigm: Use to determine if stages of learning are dependent on different processes of learning. Tasks presented together at different learning stages. This may interfere with performance or not.

Motor Cortex Contribution to Procedural Learning

• Learning sequential finger movement task.
• Early stage: No clear knowledge of sequence and increased reaction times for the task.
• Middle stage: Learner recognizes the sequence, but does not state the sequence.
• Late stage: The learner already knows the sequential steps, and the cortical maps are back to baseline.
• Performance is improved, and other areas of the brain increase their role in the task execution.

Complex Motor Learning

• Synaptic efficiency increases between Somatosensory and motor cortex.
• Thalamocortical pathways efficiency increases.
• Motor cortex activation is taken over by the somatosensory cortex when the task is learned.
• Maybe a switch to greater role of information coming from thalamus (bypassing the somatosensory cortex).

Acquisition to Skill: The Shift toward Automaticity

• Automaticity allows attentional resources to be available to other tasks.
• Early learning involves increased activity in widely distributed cerebral cortical structures (prefrontal, sensorimotor, parietal cortices).
• Shift to the automatic stage leads to reduced cortical activity and increased activation in subcortical centers (basal ganglia, cerebellar nuclei, thalamus).

Bernstein's 3 Stage Model

• Stages of learning based on controlling degrees of freedom of a mechanical system, and emphasizes coordination.
• Novice: Simplifies movements and decreases degrees of freedom.
• Advanced: Improves coordination by allowing for more movement (releasing degrees of freedom).
• Expert: Releases all degrees of freedom for efficiency and uses passive and dynamic forces in the system for effective movement.

Timeline for Learning of Bernstein's 3 Stages

• Degrees of freedom increase over time through the stages of learning.
• From Novice to Advanced to Expert, the degree of freedom increases.

Selecting Parameters for Practice

• Not further detailed.

Parameters of a Motor Learning Session: Feedback

• Types of Feedback:
  • Intrinsic: Person's sensory systems relaying info—during and after task.
  • Extrinsic: Supplemental information (knowledge of results [KR] and knowledge of performance [KP]), observational learning.
  • DO NOT provide extrinsic info if it is redundant.

Feedback

• Feedback to be utilized:
  • Type: knowledge of results (KR), knowledge of performance (KP), transitional information
    • Timing: bandwidth, summary, faded, delayed, concurrent.
• Using extrinsic information (feedback): KR is part of the development of Schema or Motor program theory, or Schmidt's Motor learning theory.

Types of Feedback

• Knowledge of Results (KR): Terminal feedback focused on success of movement outcome (often numerical).
• Knowledge of Performance (KP): Feedback focusing on the nature/quality of the movement (ex. 'How did I move?').
• Transitional information: Information that is given to enhance subsequent performance.

Timing of Feedback

• Types of feedback timing: bandwidth, summary, faded, delayed, concurrent.

Feedback Evidence

• Fading feedback (KR) or summary feedback is better than constant feedback (100% of trials).
• This is good for retention and transfer of motor learning.
• More recent research favors self-controlled feedback, when the learner asks for feedback. This is superior to feedback given without prompting.

Parameters of a Motor Learning Session: Practice Schedules

• Types of practice: Single tasks, session length, task order (multiple tasks).
• Schedules may depend on the type of task to be learned.

Types of Practice: Practice Variability

• Constant Practice: Practicing the same task repeatedly. Helps early performance but impairs retention and generalizability.
• Variable Practice: Practicing the same basic task but with variations. Early performance is poor, but retention and generalizability are enhanced. Supported by Motor (Schema) program and Systems Theory.

Gentile's Stages of Practice

• Based on goals of learners and type of skill to be learned (open vs. closed).
• Early practice is the task dynamics stage.
• Late practice is the fixation or diversification stage.

Task Dynamics Stage

• Learner's goal: understand the task.
• Understand the goal of the motor task.
• Develop movement strategies.
• Understand how the environment influences the task.
• Identify what features are irrelevant.

Fixation/Diversification

• Fixation: Related to progress in closed skills where environment is stable.
• Diversification: Related to progress in open skills where environment is changing.

Timeline for Learning

• Practice variability decreases with more practice.
• Early learning is the task dynamics stage.
• Late learning is the fixation/diversification stage.

Parameter of a Motor Learning Session: Amount of Practice in a Session

• Massed practice involves more time in practice than rest (can lead to fatigue, usually relevant in three-time a day athletic training practices, CIMT).
• Distributed practice involves scheduling rest periods into the practice session (beneficial for motivation, attention span, motor planning deficits).

Parameter of a Motor Learning Session: Type of Practice

• Whole practice: Allows learners to understand the entire movement.
• If part practice is done, must ensure learner finishes with whole movement practice.
• Part practice: Suitable for tasks with discrete start/stop points within the task (e.g., serial tasks), when some movement components may need to be separated before whole-body practice.
• Mental rehearsal/imagery: Often completed to begin a certain motor task, and may serve as homework. Mental practice works best combined with physical practice.
• Virtual reality: Simulated environments for learning motor tasks.

Increase time on Task & increase external focus

• Virtual Reality: Motivating, improving adherence to exercise protocols. (Lack of structured exercise, poor health, lack of motivation, musculo-skeletal issues).
• Wii & Kinect: Result from several studies show ADLs, UE movements, static standing, and engagement.

Parameter of a Motor Learning Session: Task Order

• Blocked practice: Performing the same task repeatedly in sequence (1,1,1)
• Serial practice: Performing tasks in a specific sequence (1,2,3...).
• Random practice: Performing tasks in a random order (1,3,2,1…)
• Important point, and remember to match learning task order to what stage of learning the learner is in.

Parameters of a Motor Learning Session: Assessment

• Assess:
  • Performance.
  • Retention.
  • Transfer.
  • Generalizability.
• Outcome assessment and need time for delay before assessing retention.

Important Motor Learning Issues

• Attentional focus: External focus is generally better.
• Motivation & patient autonomy (OPTIMAL theory).
• Patient self-assessment (prior expectations and feedback from therapists).
• Variabilty in practice may improve motor performance.

Other Motor Learning Issues

• Speed/accuracy trade-off (takes practice).

Maximizing Learning of Skill

• Movement identification: The therapist needs to know the appropriate movement and set up the practice session to maximize skill learning.
• Organization of the treatment session: Requires task organization and setting up the environment appropriately.
• How do I set up the environment, provide instruction for learning, vary the task, and provide appropriate feedback?

Summary

• Recovery of function is the reacquisition of lost movement skills through reorganization.
• Optimal challenge point framework: Challenge is balanced with capabilities and learning style.
• Understand cognitive, associative and autonomous learning stage and tailor instructions and practice conditions to meet the needs of the stage.
• How to set up a practice session to enhance learning.
• Types of feedback to use (Knowledge of Results [KR] , Knowledge of Performance [KP], and transitional information).
• Fading feedback is better than constant feedback.
• Emphasize active engagement to maximize autonomy.
• Assess performance, retention, and transfer to different contexts to maximize skill learning.

This quiz explores key concepts in motor learning, focusing on neuroplasticity, recovery of function, and principles essential for optimizing treatment in physical therapy. Test your understanding of how perception and action can reorganize following CNS injuries and the factors influencing effective motor learning.