Chapter 16: Application of Motor Control and Motor Learning

Motor Control and Motor Learning

 Motor control: how the body directs movement and how the musculoskeletal system
interacts to carry out movements
 Motor learning: refers to strategies and techniques used to teach others how to move;
process
o conditions, rate in which person learns motor skills
o provides evidence to support how and when therapists provide direction,
feedback and cues
 Movement deficits occur in numerous conditions - may present as poor coordination,
timing, balance, sequencing, bimanual control, balance, SP, motor planning
o CP  difficulty with postural control, abnormal muscle tone and spasticity
interfere with voluntary movement
o Down’s syndrome  poor timing, decreased strength, decrease postural control
and delayed visual orientation

Dynamic Systems Theory

 Propose that movement derives from a variety of sources and takes place in natural and
meaningful environments
 Interaction between Person, Task, Environment = motor performance/motor control
(Fig. 16.3)

 Dysfunction: when lack adaptability to accommodate task and environment demands

  Order parameters: main components of movement that make it different from others
(grasp vs. reach)
 Control parameters: quality of motor pattern (speed, force)

Ecological Theory
 Emphasizes the interaction between person and environment (tasks and constraints)
and assist in understanding factors with goal directed motor actions
 Utilizes functional approach (and examines the purpose of perception in everyday
activities
 Gibson’s ecological theory emphasizes components of perceptual learning that are
critical for learning actions in the context of functional activities
 Three hallmarks of human behavior:
o Agency: self as a controlling force
 refers to discovery of ability to control aspects of event through action,
rewarding
o Proceptivity: forward looking
 predictive component of actions, plan to know how to perform action
o Flexibility:
 ability to transfer strategies from familiar situations to new ones
 Principles of Ecological Theory (box 16.4 pg. 398)
o Children are sensitive to and perceive information from environment
o Goals are externally and internally motivated
o Motor actions are guided by perception-action information
o For goal directed action, children must perceive accurately or with close
approximation their possibilities for actions (aka affordance)
o Affordance: purposefulness of object (fav toy --> flying toy helicopter)
o At any moment, children must select action and decide how to carry them out
o Interaction between children and environment involves active perception.
perception requires series of learning
o Two actions guided by perceptual content:
 Exploratory action: search for information
 Performatory action: executing
o Learning involved functional analysis of what’s available in environment
o Perceptual information and ultimately learning is result of events
o Children use exploratory movements to seek information so they can plan motor
actions

Principles of Motor Control

 General principles of motor control approaches:
o Movement is result of interaction among systems (person, occupation,
environment)
o There is variability within the systems
  Systems are adaptable and flexible
 Lack of adaptability and environmental constraints leads to motor
dysfunction
 Tasks modifications and adaptations may change the child’s ability to
engage in desired occupations
o The process of motor learning includes the importance of engagement in
meaningful activities within a supportive environment which allows the child to
problem solve

Interaction Among Systems that relate to motor control

 Ecological Approach:
o agency
o Affordance: purposefulness of object (fav toy --> flying toy helicopter)
o Flexibility
 Perceiving affordances: activities targeting learning result from interactive engagement

Person
 Cognition: attention, motivation, problem-solving, and self-efficacy
o self-efficacy: one’s belief about his or her own abilities
 Musculoskeletal: symmetry of left and right side, muscular structures (ROM), physical
stature, muscle tone, strength, posture
o Muscle tone: resting state of muscles
o Excessive muscle tone = limited movement
o Strength: voluntary recruitment of muscle fibers
o Posture: one’s core ability and involves trunk and neck musculature
 Should be examined in stationary and dynamic movements
 CP, DCD have difficulty w postural control
 Sensory: visual, auditory, vestibular, kinesthesia, proprio, tactile
o Visual: motivates children to move and provide cues from environment for
balance, positioning and motor planning
o Auditory: may motivate children to respond and explore environment by turning
and locating the source of the noise
o Vestibular processing: sense change in movement or position that allow the
body to respond
 Perception: ability to make sense of sensory stimuli with cognition and sensory
awareness
o Body schema: neural substrate for body awareness (homunculus)
o Body image: image of one has of oneself as a physical entity
o Body awareness: ability to visually discriminate and ID levels for various aspects
of body's physical and motor dimensions
 Social-Emotional factors: psychological state may affect motor performance (negative
emotions
affect performance)
• Children learn best when success is achievable and they are emotionally ready to problem-
solve

Task
 Refer to nature, object properties, goals, rules
 Complex enough to challenge but also possible to solve
 Ambiguity: possibilities for accomplishing task successfully or not
 Open task - surfaces, objects or people that are in motion
 Closed task - stationary objects and people
 Object affordance: property of object or environment that allows an individual to
perform action
 Environmental Context
o Physical, social, cultural, temporal, virtual, personal influence motor
performance
o Analysis of tasks, environment, person - OT establish strengths and weakness

Variability
 Each system is adaptable and flexible
 Varying task constraints can facilitate learning
o Lack of adaptability and environmental constraints  motor dysfunction
 OT can change or modify movement or task so children successful
 Degrees of freedom: possible planes of motion in joints controlled by musculoskeletal
and CNS
o Ex. Decrease degrees of freedom for more functional movement with orthosis
 Attractor state: describe tendency to stay in the patterns of the status quo, preferred
state, or state of fewest degrees of freedom
o Ex. Child has habit of W sitting; OT corrects that
 Perturbation: force that alters movement pattern
o Can be psychological (ex. Internal motivation) or physical (ex. body feels
unaligned so child corrects himself)

Process of Motor Learning

 Importance of engagement in meaningful activities within a supportive environment
which allows the child to solve problems
 How children develop skills and transfer learning to other contexts, type of feedback,
amount of practice to learn motor skills, error-based info, timing, mental rehearsal
 4 principles associated with improving performance:
o Giving clues
o Explaining why
o Providing rhythm
o Asking about understanding
Meaning
 Motor task participation is influenced by extent to which he or she can ID own interests
 Quality and longer periods - activities meaningful
 Meaning derived from experience a viewpoint

Whole task training

 Whole activity or motor task is more effective than learning only part of movement
 Children engage in whole task longer
 More areas of brain activated when engaging in meaningful whole task vs. part task
 Promote variability - respond in multiple ways

Part Task training

 Effective with tasks that require multiple steps
 Shaping child's ability so they may perform a task
 Creates conditions of learning a plan through the process of exploration, agency and
perceiving affordance

Variability
 Adapt to changes within and between systems
o ex. Blocks vs marbles
 OTs encourage kids to move in variable ways because it is essential to functional
movement
 Excessive variability in ADHD & dyslexia = interfered with consistency in handwriting
 CP kiddos experience more variability in reaching patterns that interfere with ability to
complete bimanual activities effectively
 Findings support need to encourage more accuracy in movements while allowing
variability for functional performance

Problem Solving or Error Based Learning

 Self-correcting enables children to rely on internal cues to help them adapt
o Learn and retain motor skills better
 OT gives opportunity for errors in controlled setting for learning
o Children learn from error and mistakes

Transfer of Learning (Generalization)

 Applying learning to new situations, clinic --> home
 Best transfer motor skills when practiced in real world situation or functional activity
 Children learn best when skill was learned in natural setting
o Learn best. When it’s durinf functional activity or occupation

Sequencing and Adapting

 Discrete tasks - definite beginning and end
  Continuous - ongoing ex. Walking
 Closed task: environment stationary during task performance
 Open task: environment changing or in motion
 Task with fewer steps is completed more readily. That multi steps
 Unstructured environment: variability and extraneous stimuli = more difficult
 Structured environment – less difficult
 Table 16.1

Practice Levels
 Massed practice/blocked: period performing movement greater than rest
 Distributed: test between trials is greater than time of the trial ex. Tag while picking up
bean bags, practice grasp and release and also posture control and vestibular
 Variable/random: final state repeats same patterns but make small changes as
necessary
 Short frequent practice better than longer less frequent practice - closely related to
actual occupation

Feedback
 Intrinsic: most effective, goal; allows child to self-correct, OT allows exploration and
errors
 Extrinsic: verbal cuing and guidance (early stages)
 Demonstrative: modeling; best before actually practices movement and early stages
without verbal feedback
 Positive feedback results in better motor learning and perceived competence

Knowledge of Performance
 How they performed the desired movement to help refine, descriptive feedback vs
prescriptive
 Descriptive feedback is used, more helpful for experienced performers than beginners
 Complexity of task determines feedback frequency

Knowledge of Results
 Motivating, when learning new tasks , provide specific info about goal ex. Each button is
lined up
 Should not be provided after each trial
 better than "good job"

Verbal Feedback
 Praise and reinforcement best if provided immediately after completion of task, 1-3 cue
words

Mental Practice/Imagery
  Mental practice/rehersal - performing the skill in one's imagination without any action
 Role playing, video, imagine
 To learn motor skills, should be combined with physical practice
 May result in lack of motivation, should use with actual performance after
 Mental and practice combo - improve motor learning

Application of Motor Control/Learning Theory of Occupational Therapy Practice

Occupation-Centered Practice Models
 MOHO, PEOP, OA, Canadian Model
 Children learn movement most effectively when:
o The movement is taught whole
o The movement id performed in variable situations
o The child is allowed to actively problem solve
o The activity. Is meaningful

Task Specific Training

 Involves practicing the specific actions or activity (task) while considering the concept of
motor learning
 Guidelines:
1. Training is relevant to client and context
2. Practice sequences are randomly ordered
3. Training is repetitive
4. Goal is for client to complete whole task (occupation)
5. Client should be positively reinforced

Framework of Occupational Graduation (strength training + dynamic systems

approach)
 Provides a systematic process for treating persons with CNS impairments that align with
dynamic systems theory
 Based on strength training and practice of meaningful occupations

Cognitive orientation to Daily Performance (CO-OP)

 Engages children in goal setting and problem solving
 Congruent with dynamic systems theory
 Effective with improving movement for children with DCD

Constraint-Induced Movement Therapy (CIMT)

 Therapeutic treatment approach used for children with unilateral motor weakness
 Requires restraint of the unaffected upper limb. Combined with 3+ hours a day of
intensive task practice using the affected upper limb
 Includes mass practice and shaping for 2 weeks Consecutively
  Elements of CIMT:
o Restraint of unaffected UE
o Task oriented mass practice of specific motor activities
o Shaping of more mature movement.
 Aim: reverse developmental disregard or learned nonuse of affected UE
 Conducive to active problem solving and increasing DOF
 Positive reinforcement and knowledge of results motivates child to engage and perform
 Table 16.3 (pg. 416)

Intensive Bimanual Therapy

 retains the intensive structure and task practice at CIMT
o focuses on improving the ability. To perform bimanual activities
 carefully planned repeated practice of two handed or bimanual games and activities
 involves high dosage, intensive, mass practice (>30 hours)
 provided through individual or group therapy
 Hand-Arm Bimanual Intensive Therapy (HABIT)
o Specific type of intensive bimanual therapy
o Difference between HABIT & intense bimanual is the level of individualized
nature of progressing through activities and the intensity of protocol