2019-motor learning PP_1__1_ FULL INFO.pdf

Motor Learning Theory References: Cole, Chapter 6 Trombly, 2008 Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Focus — — Replaces motor control (NDT, etc.) as a more evidence-based approac...

Motor Learning Theory References: Cole, Chapter 6 Trombly, 2008 Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Focus — — Replaces motor control (NDT, etc.) as a more evidence-based approach to all forms of movement disorders across the lifespan (CP, TBI, CVA, etc.) Backdrop for task-oriented approach defined by Horak (1991), Shumway-Cook & Woolacott (2001), and Mathiowetz, Bass-Haugen & Flinn (in Trombly & Radomsky, 2002) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Basic Assumptions — — Motor Control—The ability to regulate or direct the mechanisms essential to movement (Shumway-Cook & Woolacott, 2001). ◦ i.e., “neuromaturational,” “hierarchical,” or “bottom up” theories of re-acquisition of voluntary movement Motor learning—A set of processes associated with practice or experience leading to relatively permanent changes in the capacity for producing skilled action; combines neuroscience with systems and learning theory (Shumway-Cook & Woollacott, 2001). Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Assumptions (Continued) — — — — Based in principle of neural plasticity—The ability of the nervous system to modify neural connections to perform more efficiently Short term (working memory)—Needed for learning new movements Long term (save/retrieve)—Needed for lasting change Motor learning occurs naturally during task performance (supports a task focused approach) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Systems Theory — — — Systems approach includes a consideration of: ◦ Client factors (e.g., health condition, dysfunction or damage, age, gender, etc.) ◦ Occupations: Meaningful or preferred tasks ◦ Environment: All relevant contexts Systems include sensorimotor, psychosocial, cognitive, and performance contexts (physical, socioeconomic, and cultural characteristics of the task itself and the broader environment; Mathiowetz, & Bass Haugen, 1994). Consistent with occupation-based models Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Learning Theory (Behavior Modification) — Non-associative learning: ◦ Habituation: Desensitization that results from repeated exposure to a nonpainful stimulus (e.g., ignore stimuli that trigger nonfunctional responses) ◦ Sensitization: Increased responsiveness (e.g., pay attention to safety features, such as water on the floor, or obstacles in one’s path) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Learning (Continued) — Associative Learning: ◦ Classical and operant conditioning; considers past and current environmental influences ◦ Procedural learning: Performed without conscious attention; develops slowly through many repetitions to become habitual, stored in brain as “movement schema” (e.g., walking) ◦ Declarative learning: Results in knowledge that can be consciously recalled, requiring awareness, attention, and reflection (e.g., words) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Learning (Continued) — — — — Variable practice, using motor/perceptual skills under varying conditions, works best for generalization of learning Contextual interference, using motor perceptual skills in random order, increases spontaneous use for new tasks Individual characteristics, such as level or experience and intellectual ability influences motor learning Transfer of learning occurs more easily when tasks are similar (Toglia—Near transfers) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Learning (Continued) — — — Schmidt’s “schema theory” uses sets of general rules that apply in variety of contexts Schema—A generalized motor program that consists of four parts: ◦ Initial situation ◦ Parameters used ◦ Outcome (knowledge of result) ◦ Sensory consequence (how movement feels) Example: Swinging a golf club or donning a coat Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Learning (Continued) — Newell’s Ecological Theory clarifies the role of perceptions in motor learning. ◦ Recognition of goal or task ◦ Regulatory cues (sensitize to what is relevant to the task) ◦ Knowledge of performance (KP): Feedback during performance, how movement felt ◦ Knowledge of result (KR): Feedback on goal achievement Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Function & Dysfunction — — Gentile (1992): Early and late stages of learning Fitts & Posner (1967): ◦ Cognitive stage of motor learning (understanding of task, experimentation) ◦ Associative stage: Refined practice ◦ Autonomous stage: Skill relatively automatic ◦ Example: Child learning to climb stairs Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Function (Continued) — — — Degrees of freedom: Refers to gradual increase in smoothness of performance of skilled movement (e.g., using a hammer) Specific definitions for function and dysfunction have not been defined in occupational therapy (Kaplan & Bedell, 1999). Definition of dysfunction in OT must include all three components: person, environment, and occupation Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Change & Motivation — — — Holistic approach: OT always incorporates practice of perception and movement within the context of specific tasks. Client centered: Motivation comes naturally when clients and/or families set priorities for tasks to be accomplished and goals to be achieved. Systems approach begins with role performance, considering the best combination of remediation, adaptation, and compensation in order to promote client-identified level of functioning to fulfill desired roles. Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Change (Continued) — — Change occurs through learning process. Recovery may be: ◦ Spontaneous, without benefit of intervention ◦ Forced recovery, function gained through therapeutic intervention, such as—Example? ◦ Adapted or functional recovery, attained through altering methods or contexts within which client accomplishes a task Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Postulates of Change — — Defined in pediatrics by Kaplan & Bedell Motor skills more likely to improve when: ◦ Match between child’s ability, task, and context ◦ Child understands expectations and receives clear guidance ◦ Independent problem solving encouraged ◦ Just right challenge (zone of proximal development) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Assessment OT assessment includes: — Dynamic evaluation, watching client during occupational performance, including responses to cues — Collaboration with client to determine occupational problems and priorities — Evaluation of person, task, and context, to determine appropriate OT interventions Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Assessment — — — OT evaluations may incorporate manual muscle tests, range of motion, and strength and endurance tests, which directly relate to problems with specific task performance. Sensory and perceptual evaluations stem from client-identified problems with those aspects of task performance. Cognitive evaluations may further clarify difficulties with awareness, goal identification, motor planning, and generalization of learning. Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Intervention — — — — — Client-centered role/task selection Discussion of OT assessment results Collaboration which includes therapeutic use of self in determining and/or raising level of client self-awareness Imparting information on current evidence with regard to a choice of approaches Practice of needed skills in natural settings Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Motor Learning Interventions Prevention of injury/dysfunction through splinting, positioning, educating, and sensitization to relevant environmental cues — Education and prevention may be the focus of groups — Promoting function through individualized task problem solving and collaborative experimentation about the best way to accomplish the task — Group interventions increase members’ opportunities for group problem solving and learning from one another — Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Interventions (Continued) — — — — — Practicing whole tasks, not isolated parts Providing skill practice in varied contexts during daily routines Providing randomized practice (changing parameters or circumstances) Providing intermittent feedback during task performance, or summarized at end Encouraging self-evaluation and error detection (both KP and KR) Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Interventions (Continued) — — — Modify task demand in order to achieve task goal (e.g., use e-mail instead of telephone to communicate with others; use alarm to remember next step) Modify contextual factors in order to achieve task goal (e.g., use bolsters to position for active movement in playing a game) Recently learned techniques may be practiced in groups for added motivation and support Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. Intervention: Constraint-Induced Movement Therapy Contemporary variation of task-focused approach for stroke survivors (1 year post-stroke) — Consists of “constraining” nonaffected arm, forcing use of affected limb for performing daily tasks — In 2 week experiment, “constrained” group showed significantly greater motor skills, carryover to life tasks, and maintenance of gains in 2 year follow-up — Original study replicated (Blanton & Wolf, 1999) shows that 20% to 25% of clients with chronic stroke symptoms may benefit from this approach — Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated. The End — — — Look up constraint induced therapy to gain a better understanding of its applications Find recent group examples using this approach in the OT Practice or other OT Journals or newsletters Focus on distinctions made between traditional and contemporary OT approaches Cole, M. B. Group Dynamics in Occupational Therapy: The Theoretical Basis and Practice Application of Group Intervention (4th ed.). © 2012 SLACK Incorporated.