Mayo Clinic Motor Learning Theories PDF

MOTOR LEARNING THEORIES AND APPLICATION MOVEMENT SCIENCE I Sarah Economides, PT, DPT, PCS Year I Fall Semester 2024 ©2024 Mayo Foundation for Medical Education and Research | slide-1 REFERENCES Shumway-Cook A, Woollacott MH. Motor Control: Translating Research...

MOTOR LEARNING THEORIES AND APPLICATION MOVEMENT SCIENCE I Sarah Economides, PT, DPT, PCS Year I Fall Semester 2024 ©2024 Mayo Foundation for Medical Education and Research | slide-1 REFERENCES Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. 6th Edition. Wolters Kluwer; 2023. Ch. 2, 3, 4, 7 Fulk GD, Chui KK. O’Sullivan & Schmitz’s Physical Rehabilitation. 8th Edition. F.A. Davis; 2024. Ch. 10 Trew M, Everett T. Human Movement: An Introductory Text. 4th Edition. 2001. Plack, MM, Driscoll, M. Teaching and Learning in Physical Therapy. 2017. Ch. 8 Wulf G, Lewthwaite R. Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychon Bull Rev. 2016;23:1382-1414. DOI: 10.3758/s13423- 015-0999-9 ©2024 Mayo Foundation for Medical Education and Research | slide-2 OBJECTIVES Differentiate between implicit and explicit learning, and declarative and nondeclarative memory Describe classical and operant conditioning Define motor plan, motor program, and motor learning Differentiate between intrinsic and extrinsic feedback Define knowledge of performance and knowledge of results Describe and open loop vs. closed loop system Describe feedback schedules Know different practice schedules Describe different motor learning theories Schema theory Ecological theory Fitts & Posner’s 3-Stage model Bernstein’s 3-Stage approach Bressen & Wollacott Adaptive Skill Acquisition Gentile’s 2-stage Model Describe strategies for effective learning ©2024 Mayo Foundation for Medical Education and Research | slide-3 COMPONENTS OF MOTOR LEARNING ©2024 Mayo Foundation for Medical Education and Research | slide-4  MEMORY Motor Control, p. 25 Fig. 2.1 ©2024 Mayo Foundation for Medical Education and Research | slide-5  TWO LEARNING SYSTEMS WITHIN THE BRAIN Implicit Learning = Explicit Learning = Nondeclarative Memory Declarative Memory Associative Learning Facts and events Classical conditioning Priming Operant conditioning Motor imagery; mental Procedural Learning rehearsal Habits Nonassociative learning uses reflex pathways Habituation Sensitization ©2024 Mayo Foundation for Medical Education and Research | slide-6 IMPLICIT VS. EXPLICIT MEMORY Implicit Does not require awareness, attention, or other higher cognitive process Requires frequent repetition for success Explicit Consciously recalled knowledge/learning Requires awareness, attention, and reflection ©2024 Mayo Foundation for Medical Education and Research | slide-7  ASSOCIATIVE LEARNING: CLASSICAL CONDITIONING Classical Conditioning: Predicting relationships of one stimulus to another Pavlov’s Dog: Food causes salivation Bell ringing (stimulus) does not cause salivation Ringing bell presented simultaneously with food, associating the bell with salivation After conditioning, ringing bell alone will cause salivation Therapy example: Pairing a verbal cue with manual assistance. Desired movement continues to occur with only verbal cues after practice. - More likely to learn in meaningful environments ©2024 Mayo Foundation for Medical Education and Research | slide-8 ASSOCIATIVE LEARNING: OPERANT CONDITIONING Operant Conditioning – Trial and error learning Associating a certain response with a consequence Introduction of rewards and punishments to achieve desired behavior Rewarded behaviors tend to be repeated Behaviors resulting in aversive stimuli tend to be avoided Therapy example: Elderly adult falls (“punishment/negative stim”) while walking in the community → less likely to go walking again Praise from therapist (reward) and successful completion of walks can encourage the patient to engage in activity again ©2024 Mayo Foundation for Medical Education and Research | slide-9  ASSOCIATIVE LEARNING: OPERANT CONDITIONING Definitions: Punishment: To decrease the probability of a behavior occurring in the future Discourages the target behavior. Reinforcement: To increase the probability of a behavior occurring in the future Encourages the target behavior. Positive: when something is added or introduced. Negative: when something is subtracted or removed. ©2024 Mayo Foundation for Medical Education and Research | slide-10  IMPLICIT MEMORY: PROCEDURAL LEARNING Procedural Learning – automatic tasks that don’t require attention or thought Develops slowly Requires multiple repetitions Motor learning – repeating a skill under multiple conditions Ex. Typing your password Habits This type of learning eventually causes movement patterns to become habit Able to be performed without thinking about it PT example: Practicing transfers with a patient Learning new motor patterns or using an assistive device ©2024 Mayo Foundation for Medical Education and Research | slide-11 NONASSOCIATIVE LEARNING Habituation – Decrease in responsiveness that occurs as a result of repeated exposure to a nonpainful stimulus (i.e. to treat dizziness) Normal stimulus that should not be noxious Goal of decreasing adverse symptoms Sensitization – Increased responsiveness following a threatening or noxious stimulus. Falls training - Increase a patient’s awareness of stimuli indicating likelihood for impending falls. ©2024 Mayo Foundation for Medical Education and Research | slide-12 IMPLICIT LEARNING/MEMORY: BRAIN REGIONS Cerebellum, Classical Controlling deep cerebellar Conditioning reflexes nuclei Cerebellum Adaptation Conditioned fear involving Amygdala of falling emotions Sensory/ Lateral dorsal motor premotor areas association of cortex ©2024 Mayo Foundation for Medical Education and Research | slide-13 DECLARATIVE/EXPLICIT LEARNING Conscious, verbalizable knowledge of facts and events Supported by declarative memory Memory for words, scenes, faces, stories, Assessed by conventional tests of recall and recognition Facts Events ©2024 Mayo Foundation for Medical Education and Research | slide-14 DECLARATIVE MEMORY PROCESSING You know how to do something and can describe it Ex. Describing strategies for transfers to patients Requires awareness, attention, and reflection Goal: Movement eventually becomes automatic Neural Circuitry Sensory association cortices – long term memory Medial temporal lobe areas Hippocampus Right = spatial representation Left = words/objects Subiculum ©2024 Mayo Foundation for Medical Education and Research | slide-15 DECLARATIVE MEMORY PROCESSING 4 different types of processing for long term memory Encoding – requires attention, involves neural circuitry Ability to associate the memory with meaningful information already in long Consolidation – structural changes in neurons Making information stable for long term memory storage Storage Long term retention of memories Large long-term capacity Limited short-term/working memory capacity Retrieval Recall of information from long term storage sites ©2024 Mayo Foundation for Medical Education and Research | slide-16 GENERAL CONCEPTS Motor Plan OF MOTOR CONTROL Motor Plan: An overall strategy for Motor program movement Motor program An action sequence requiring the coordination Motor of a number of motor Program programs Example – getting dressed Motor Behavior ©2024 Mayo Foundation for Medical Education and Research | slide-17 GENERAL CONCEPTS OF MOTOR CONTROL Motor program Set of pre-structured muscle commands that, when initiated, results in the production of a coordinated movement sequence Learned task Can be carried out largely uninfluenced by peripheral feedback Requires active problem-solving/processing Adaptive to specific environmental demands (regulatory conditions) Closed environment – Fixed, nonchanging Open environment – Variable, changing ©2024 Mayo Foundation for Medical Education and Research | slide-18 MOTOR LEARNING/RELEARNING Motor learning is a change in the capability of a person to perform a skill Accuracy, consistency, efficiency The result of practice or experience. Lasts over time/permanent (Know) Defined as understanding the acquisition and modification of movement Motor learning traditionally has been studied on healthy people Recovery of function referred to as re- acquisition of movement skills lost thru injury ©2024 Mayo Foundation for Medical Education and Research | slide-19 ©2024 Mayo Foundation for Medical Education and Research | slide-20 MOTOR LEARNING AND RELEARNING Measures of motor learning include: Performance: An observable motor behavior Level of automaticity Level of effort Speed of decision making Retention: The ability to demonstrate the skill after a period of no practice Generalizability: The acquired capability to apply what has been learned to other similar tasks Transfer tests Resistance to contextual change: Acquired capability to apply what has been learned to other environmental contexts. ©2024 Mayo Foundation for Medical Education and Research | slide-21 PERFORMANCE VS. LEARNING Learning = Permanent change in behavior Performance = Temporary change in motor behavior during practice sessions. Learning is not evaluated during practice Learning is assessed during special sessions called retention or transfer sessions. ©2024 Mayo Foundation for Medical Education and Research | slide-22 FEEDBACK ©2024 Mayo Foundation for Medical Education and Research | slide-23 FEEDBACK Feedback – All sensory information available as result of movement that a person has produced 2 classes of response-produced feedback Intrinsic feedback Extrinsic feedback Information about the movement that the learner receives during and after performing the task Updates control centers about the correctness of movement while it progresses Shapes ongoing movement Allows motor responses to be adapted to the demands of the environment ©2024 Mayo Foundation for Medical Education and Research | slide-24  INTRINSIC FEEDBACK The feedback normally received from various sensory systems during the execution of movement (e.g. visual, auditory, somatosensory, vestibular) Somatosensory = tactile and proprioception Somatosensory information about position of limbs during movement Visual information about accuracy Learner attends and responses to proprioceptive input generated by movements (modifies movement after slipping on a slippery surface) ©2024 Mayo Foundation for Medical Education and Research | slide-25 EXTRINSIC FEEDBACK Feedback normally received during a movement task and comes from an external source Referred to as augmented feedback Information that supplements intrinsic feedback Verbal, visual, or auditory feedback from PT to patient Can be added visual through real time (computer/video display) or video play back Offered to patient concurrently with task After the task is completed = terminal feedback ©2024 Mayo Foundation for Medical Education and Research | slide-26 KNOWLEDGE OF PERFORMANCE (KP) KP is extrinsic or augmented feedback related to movement pattern used to reach the goal Information about the process vs. end result or product Movement characteristics “You are bending your elbow instead of straightening it.” Examples: video feedback, kinematic, biofeedback (visual or auditory feedback of EMG) ©2024 Mayo Foundation for Medical Education and Research | slide-27 KNOWLEDGE OF RESULTS (KR) KR is a form of extrinsic/augmented feedback Terminal feedback about outcome of movement in terms of overall movement goal KR is different from Knowledge of Performance (KP) Examples right or wrong movement long versus short defined level of “correctness” ©2024 Mayo Foundation for Medical Education and Research | slide-28  OPEN-LOOP SYSTEM A control system with preprogrammed instructions to an effector (e.g. muscle) that does not use feedback information and error-detection processes Stereotypical and rapid, short-duration movements which do not allow sufficient time for feedback to occur Schmidt and Lee, 2005 ©2024 Mayo Foundation for Medical Education and Research | slide-29 CLOSED-LOOP SYSTEM A control system employing feedback Reference for correctness, a computation of error, and subsequent correction in order to maintain a desired state Proprioception allows the brain to get feedback about what is happening across joints and within muscles. Schmidt and Lee, 2005 ©2024 Mayo Foundation for Medical Education and Research | slide-30  FEEDFORWARD Readies the system in advance of movement Anticipatory responses that adjust the system for incoming sensory feedback or for future movements Preparatory postural adjustments Postural systems include: Musculoskeletal Muscle synergies Cognitive resources & strategies Sensory systems & organization ©2024 Mayo Foundation for Medical Education and Research | slide-31 ©2024 Mayo Foundation for Medical Education and Research | slide-32 FEEDFORWARD VS. FEEDBACK ©2024 Mayo Foundation for Medical Education and Research | slide-33 FEEDBACK SCHEDULES Instantaneous – Moment by moment Every Trial Summed – After set number of trials Fading – More frequent in the beginning, decreasing towards the end Bandwidth – If responses outside a designated range Especially used with KR Variable – Inconsistent time ©2024 Mayo Foundation for Medical Education and Research | slide-34  INTERACTIVE METRONOME (IM) Use of auditory and visual feedback for motor planning & sequencing (timing and rhythmicity) Example of near instantaneous feedback Used with children with sensory processing problems Adults with stroke, Parkinson Disease, brain injury http://www.youtube.com/watch?v=h3be8GuuwuM ©2024 Mayo Foundation for Medical Education and Research | slide-35 PRACTICE CONDITIONS Massed vs. Distributed Constant vs. Variable Random vs. Blocked Serial Whole vs. Part Transfer Mental practice (imagery( Guided vs. Discovery learning Contextual factors Closed vs. Open Environment ©2024 Mayo Foundation for Medical Education and Research | slide-36  PRACTICE CONDITIONS Blocked practice Practice of a single motor skill repeatedly Repetitive practice Serial practice Practice of a group or class of motor skills in serial or predictable order. Random practice Practice of a group or class of motor skills in random order No predictable order ©2024 Mayo Foundation for Medical Education and Research | slide-37  PRACTICE CONDITIONS Massed practice Relatively continuous practice in which the amount of rest time is small Rest time is less than the practice time) Document practice time Consider a patient seen in acute care versus as an outpatient Distributed practice Practice in which the rest time is relatively large Practice time is less than rest time ©2024 Mayo Foundation for Medical Education and Research | slide-38 PRACTICE CONDITIONS Variable practice Practice of a varied motor skill in which the performer is required to make rapid modifications of the skill to match the demands of the task. Different context Constant Practice Practicing one skill the same way every time No change in context Mental practice Cognitive rehearsal of a motor skill without overt physical performance (priming) Mental imagery Mental rehearsal ©2024 Mayo Foundation for Medical Education and Research | slide-39 PART VS. WHOLE PRACTICE A learning technique in which a complex motor task is broken down into its component parts for separate practice before practice of the integrated whole. Ex. Gait – practice foot placement, wt shift, swing phase separately and repetitively ©2024 Mayo Foundation for Medical Education and Research | slide-40 PARTS OR THE WHOLE? ©2024 Mayo Foundation for Medical Education and Research | slide-41 SIT TO STAND ©2024 Mayo Foundation for Medical Education and Research | slide-42 TRANSFER The effects of having previous practice of a skill or skills upon the learning of a new skill or upon performance in a new context Generalizing performance to different settings/contexts Amount of transfer depends on similarity of environments Transfer may be either positive (assisting learning) or negative (hindering learning) Part-whole transfer ©2024 Mayo Foundation for Medical Education and Research | slide-43 THE FACES OF WALKING CONTEXTUAL FACTORS ©2024 Mayo Foundation for Medical Education and Research | slide-44 BILATERAL TRANSFER Improvement in movement skill performance with one limb results from practice with the opposite limb. ©2024 Mayo Foundation for Medical Education and Research | slide-45 MOTOR LEARNING THEORIES ©2024 Mayo Foundation for Medical Education and Research | slide-46 MOTOR LEARNING THEORIES Schema Theory – Richard Schmidt (1970s) Ecological Theory of Motor Learning – Karl Newell (1991) Fitts & Posner’s 3-Stage Model of Motor Learning (1967) Adaptive Skills Acquisition – Bressen & Woollacott (1982) Bernstein’s 3-Stage Approach to Motor Learning (1967) Gentile’s 2-Stage Model of Motor Skill Acquisition (1972, 1987) OPTIMAL Theory of Motor Learning – Wulf & Lewthwaite (2016) ©2024 Mayo Foundation for Medical Education and Research | slide-47 SCHEMA THEORY Richard Schmidt, 1970s Equivalent to motor programming theory of motor control Emphasis: Open loop control processes Generalized motor program concept Practice produces cumulative continuous change in behavior due to buildup of motor program strength over time 2 Short term memory storage schemas: Recall schema (motor) – to select a specific response Recognition schema (sensory) – to evaluate the response ©2024 Mayo Foundation for Medical Education and Research | slide-48 SCHEMA THEORY Expectations: Variable practice (not fixed) will improve motor learning/motor programs Movement may be performed accurately in absence of experience if similar to previously practiced movement Clinical Implications: Requires multiple different practice conditions Stronger support for variable practice in children vs. adults ©2024 Mayo Foundation for Medical Education and Research | slide-49 ECOLOGICAL THEORY Karl Newell, 1991 From Systems theory and Ecological theory of Motor Control Premise: Motor learning is a process that increases the coordination between perception and action that is consistent with the task and environmental constraints Practices searches for optimal strategies using the most effective perceptual cues to solve a task Regulatory cues = perceptual cues critical to task execution ©2024 Mayo Foundation for Medical Education and Research | slide-50 ECOLOGICAL THEORY Role of perceptual information Prescriptive – demonstration Feedback Knowledge of performance → during movement Knowledge of results → after movement Develop optimal task-relevant mapping of perceptual/motor strategies Clinical application: Practice tasks in a variety of settings Learn to disregard nonregulatory cues that have no bearing on performance of tasks ©2024 Mayo Foundation for Medical Education and Research | slide-51  FITTS & POSNER’S 3-STAGE MODEL 3 main phases/stages in skill learning 1. Cognitive stage – What is to be done? Strategies & attention 2. Associative stage – How to do the action/strategy? 3. Autonomous stage – Automatic, multi-tasking Fig. 2.2 Shumway-Cook & Woollacott p. 30-31 ©2024 Mayo Foundation for Medical Education and Research | slide-52  COGNITIVE STAGE Understand task Requires increased attention and focus Learner experiments with new strategies Develop strategies to carry out task/exploration Determine how to evaluate task Large amount of progress in shorter time Keep the good strategies, discard the inappropriate ©2024 Mayo Foundation for Medical Education and Research | slide-53  What must the learner understand? ©2024 Mayo Foundation for Medical Education and Research | slide-54 ASSOCIATIVE STAGE Learner has developed an appropriate strategy for performing task and now begins to refine the skill Less variability in performance Improvement occurs more slowly Learner focuses more on particular pattern than strategy Stage lasts from days, weeks to months ©2024 Mayo Foundation for Medical Education and Research | slide-55 ©2024 Mayo Foundation for Medical Education and Research | slide-56 AUTONOMOUS STAGE Low degree of attention required for performance Learner can devote attention to other things in the environment Focus on secondary task (dual tasking) Focusing specifically on the methods of the task can actually decrease accuracy/performance Cognitive Associative Autonomous ©2024 Mayo Foundation for Medical Education and Research | slide-57 MULTI-TASKING ©2024 Mayo Foundation for Medical Education and Research | slide-58 ADAPTIVE SKILL ACQUISITION Bressen & Woollacott, 1982 Skill construction – Retrieved from long term memory and tried out in different conditions Skill stabilization – Success attempts become more frequent and movement patterns will become more consistent Skill differentiation – The movement is well established and attention can be allocated to other higher processes. Very similar to Fitts & Posner Trew & Everett (4th ed), p138-139 ©2024 Mayo Foundation for Medical Education and Research | slide-59 ADAPTIVE SKILL ACQUISITION Skill construction – 2 levels 1. Perceiving – requires cortical involvement to put together a conscious approximation of a skill 2. Patterning – practiced enough that we have rough synergies/automatic control Lower centers of cerebellum and spinal cord Skill Stabilization – mastery of the new motor program 1. Accommodating Re-involves the cortex as primary center for control of movement Consciously adjusts performance based on environment 2. Refining – repetitive practice under constant conditions Increased efficiency of movement ©2024 Mayo Foundation for Medical Education and Research | slide-60 ADAPTIVE SKILL ACQUISITION Skill Differentiation – creating new challenges to continue to improve 1. Renewal of cortical involvement Varying – Initiating changes in the environment Improvising – making instantaneous adjustment to spontaneous environmental changes Composing – creating new movement patterns, sequences, or performance context ©2024 Mayo Foundation for Medical Education and Research | slide-61 BERNSTEIN’S 3-STAGE APPROACH: MASTERING DEGREES OF FREEDOM Resulting from dynamical systems theory and motor development (1967) Emphasis: controlling degrees of freedom is essential for learning new skills Stage 1 - Novice Freezing degrees of freedom to minimum to learn novel movements Decreased joint ROM Ex. Infant learning to walk/reach with stiff limbs Stage 2 – Advanced Releasing degrees of freedom Muscle synergies for well-coordinated movement ©2024 Mayo Foundation for Medical Education and Research | slide-62 BERNSTEIN’S 3-STAGE APPROACH Stage 3 – Expert Fully released degrees of freedom to perform task in most efficient and coordinated way Assumes exploitation of movement Efficient use of energy Reduction of fatigue Clinical implications Explains co-contraction when learning new skills Offers new rationale for using developmental strategies in rehab Importance of providing external support during early phase of learning Especially with patients with coordination issues Less research exists on expert stage ©2024 Mayo Foundation for Medical Education and Research | slide-63 GENTILE’S 2-STAGE MODEL: MOTOR SKILL ACQUISITION Gentile, 1972, 1987 Describes the goal of the learner in each stage Stage 1 – Develop understanding of task dynamics Understand task goal Develop movement strategies Understand environment Distinguish relevant/regulatory features of the environment from nonregulatory features Stage 2 – Fixation/Diversification Learner goal is refining movement Develop adaptability for changing task/environment demands Perform task consistently and efficiently ©2024 Mayo Foundation for Medical Education and Research | slide-64 GENTILE’S 2-STAGE MODEL Open skills – require movement diversification due to changing environment Closed skills – minimal environmental variation Movement fixation Figure 2.3 Schematic representation of movement patterns associated with closed (A) versus open (B) motor skills. - Closed skills require refinement of a single or limited number of movement patterns (movement consistency) - In contrast, open skills require a diversity of movement patterns (movement diversity). ©2024 Mayo Foundation for Medical Education and Research | slide-65 OPTIMAL THEORY OF MOTOR LEARNING Wolf & Lewthwaite, 2016 OPTIMAL = Optimizing Performance Through Intrinsic Motivation and Attention for Learning Emphasis: Motivation Autonomy Enhanced expectancies Attention – external focus Feedback ©2024 Mayo Foundation for Medical Education and Research | slide-66 OPTIMAL THEORY Motivation Autonomy Self-controlled feedback, assistive device, amount of practice, etc. Small and incidental choices Autonomy-supported instructions Enhanced expectancies Positive feedback – even after good trials Positive affect Define success/task difficulty Proximal, measurable goals Success with challenge – “just right challenge” Beliefs, illusions, placebos ©2024 Mayo Foundation for Medical Education and Research | slide-67 OPTIMAL THEORY Attention External Focus Instructions/feedback that focus concentration on movement effect Motion of implement: golf club, ball, bat, etc. Motion of environment: water, ground, target, etc. Decrease emphasis on self-focus ©2024 Mayo Foundation for Medical Education and Research | slide-68 OPTIMAL THEORY ©2024 Mayo Foundation for Medical Education and Research | slide-69 STRATEGIES FOR EFFECTIVE LEARNING ©2024 Mayo Foundation for Medical Education and Research | slide-70 STRATEGIES FOR EFFECTIVE LEARNING Feedback given after every trial improves performance Variable feedback improves learning and retention Supportive feedback (reinforcement) can be used to shape behavior and motivate patient (implicit learning) Early training should focus on visual feedback (cognitive phase of learning) while later training should focus on proprioceptive feedback (associative phase of learning) Does this work for patients with neurological deficits? ©2024 Mayo Foundation for Medical Education and Research | slide-71  STRATEGIES FOR EFFECTIVE LEARNING Reduce extraneous environmental stimuli early in learning (e.g. closed environment) while later learning focuses on adaptation to environmental demands (e.g. open environment) Assist learner in recognizing/pairing intrinsic feedback with movement responses (self-aware) Provide augmented feedback (KR and KP) Early in learning focus feedback on correct aspects of performance (the good/praise) Later in learning focus feedback on errors as they become consistent (the poor) Feedback after every trial improves performance, useful during early learning ©2024 Mayo Foundation for Medical Education and Research | slide-72 STRATEGIES FOR EFFECTIVE LEARNING Transition to use of variable feedback (summed, fading, bandwidth) to improve retention, increase depth of cognitive processing. Extrinsic fade with Intrinsic maximized. Avoid feedback dependence: Reduce augmented feedback as soon as possible to foster active introspection and decision making by learner ©2024 Mayo Foundation for Medical Education and Research | slide-73 STRATEGIES FOR EFFECTIVE LEARNING Establish practice schedules Use distributed practice when: Superior performance is desired, Motivation is low The learner has short attention Poor concentration Fatigues easily Use variable practice of a group of functional tasks rather than constant practice to improve learning (promote retention and generalizability). For example squat to stand – picking up item from the floor, loading dishwasher/dryer, sitstand ©2024 Mayo Foundation for Medical Education and Research | slide-74 STRATEGIES FOR EFFECTIVE LEARNING Use random order rather than blocked practice in order to improve learning (retention) Use mental practice to improve learning Have patient verbalize task components and requirements for performance Effective when task has a large cognitive component or to decrease fear and anxiety ©2024 Mayo Foundation for Medical Education and Research | slide-75 STRATEGIES FOR EFFECTIVE LEARNING Use parts to whole transfer: When task is complex Task has highly independent parts When learner has limited memory or attention or difficulty with a particular part Practice both the parts and the integrated whole Example Pre-gait or treadmill training activities followed by gait overground ©2024 Mayo Foundation for Medical Education and Research | slide-76 STRATEGIES FOR EFFECTIVE LEARNING Limit information with learners who have: Attention deficits Mentally fatigue easily Instead: Focus on key task elements Provide frequent rest periods Tasks that have highly integrated components should be practiced as a whole e.g. gait, dressing ©2024 Mayo Foundation for Medical Education and Research | slide-77  STRATEGIES FOR EFFECTIVE LEARNING Transfer of learning is optimized when tasks are highly similar Similar stimuli Similar responses Similar environment) Use guided movement early in learning not late Most effective for slow postural or positioning tasks Find the “just right” next challenge ©2024 Mayo Foundation for Medical Education and Research | slide-78 STRATEGIES FOR EFFECTIVE LEARNING Optimal arousal is necessary for optimal learning Low arousal or intense arousal yield poor performance and learning Involve learner in goal setting Task should be desirable, functionally relevant, important to learn ©2024 Mayo Foundation for Medical Education and Research | slide-79 QUESTIONS? ©2024 Mayo Foundation for Medical Education and Research | slide-80