Quiz

Compare and contrast declarative

(explicit) vs. procedure (implicit or
non-declarative) memory. Address
the following:
1. What is learned? Give examples.
2. What brain areas are involved in
the formation of memory?
3. Where is the memory stored?

PTP 512
Neuroscience in Physical Therapy
Motor Learning: Theories and
Practical Applications
Reading Assignments
Shumway-Cook: 21-39
Min H. Huang, PT, PhD, NCS

Outline for todays lecture

Define motor learning and learning

Procedural learning
Declarative and associated learning
Adams theory
Schmidts theory
Ecological theory
Motor learning occurs in stages
Measuring learning outcomes
Transfer of learning
Feedback and giving augmented feedback
Practice conditions

DEFINING MOTOR
LEARNING

Motor Learning
Motor learning is the understanding of
acquisition and/or modification of
movement.
As applied to patients, motor learning
involves the reacquisition of previously
learned movement skills that are lost
due to pathology or sensory, motor, or
cognitive impairments. This process is
often referred to as recovery of
function.

PT Implications
How can I best structure practice
(therapy) sessions?
How often should my patient practice?
Will the motor skill learned in one
context transfer to another?
Will my patient be able to walk safely
at home/community after therapy?
Should I simply the task?
Should my patient practice weight
shifting in the // bars vs. walking in the
gym (part vs. whole practice)?

Learning vs. Motor Learning

Learning is a relatively permanent
change in behavior due to practice, or
the process of acquiring knowledge
about the world.
Motor learning: a set of processes
associated with practice leading to a
relatively permanent change in the
capacity for skilled actions.

Concepts of Motor Learning

Learning is a process of acquiring the
capacity for skilled action
Learning results from experience or
practice
Learning cannot be measured or observed
directly; it is inferred from behavior
Learning produces relatively permanent
changes in behavior; short term change is
not learning)

Motor Performance
Learning

Motor

Motor Performance is the temporary

change in motor behavior seen during a
practice session
e. g. A patient learns how to shift more
body weight over the weaker leg at the
end of the therapy session. However,
the patient still bears more weight on
the unaffected leg at the next visit to
PT. Learning has not occurred.

Motor Performance Motor

Learning
Performance may be influenced by
many other variables, e.g. fatigue,
level of learning/skills, anxiety,
motivation, cues or manual guidance
given to the learner
Motor Learning is a relatively
permanent change in motor behaviors
that are measured after a retention
period and only result from practice.

FORMS OF MOTOR
LEARNING

Nondeclarative (Implicit)
Learning:
Non-Associative Learning

A single stimulus is given repeatedly

and the nervous system learns about
the characteristics of the stimulus
Habituation
response to the stimulus, e.g.
exercises to treat dizziness in patients
Sensitization
response to the stimulus, e.g.
training to enhance awareness of loss
of balance

http://www.youtube.com/watch?v=voZXtTU
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Nondeclarative (Implicit)
Learning: Associative
Learning

Classical Conditioning
learn to predict relationships
between two stimuli
e.g. before learning: verbal cues +
manual guidance stand up; after
learning: verbal cue stand up
patients are more likely to learn if the
associations are relevant and
meaningful

Nondeclarative (Implicit)
Learning: Associative
Learning

Operant Conditioning
learn to associate a certain response,
from among many that we have, with
a consequence; trial and error
learning
e.g. relearn stability limits after ankle
sprain; verbal praise from PT
behaviors that are beneficial and
rewarded tend to be repeated

Procedural Learning
Does NOT require attention, awareness, or
other higher cognitive processes
One automatically learns the rules for
moving, i.e. movement schema
Learning requires repeating a movement
continuously under a variety of situations
Patients with damage to cortex (e.g. TBI,
dementia, aphasia) can still performance

Declarative (Explicit)
Learning

Require attention, awareness, and

reflection
Results in knowledge or facts (e.g.
objects, places, events) that can be
consciously recalled and expressed in
declarative sentences, e.g. 1st I move
to the edge of chair. 2nd I lean forward
and stand up; instruction from PT;
mental rehearsal; motor imagery

Declarative (Explicit)
Learning
Practice can transform declarative into
procedural or nondeclarative
knowledge
e.g. a patient first learns to stand up may
verbally repeat the instruction; after
repeated practice, the patient may be
able to stand up without instruction
Processes of declarative learning: encoding
consolidation storage retrieval

Think-Pair-Share
When helping a patient to relearn
motor skills, should the PT
emphasize non-declarative
(implicit) or declarative explicit)
learning?

THEORIES OF MOTOR
LEARNING

Adams Closed-Loop Theory

In motor learning, sensory feedback
from the ongoing movements is
compared with the stored memory of
the intended movement
Memory trace selects and initiates a
movement
Perceptual trace, built-up over
practice, is the internal reference of
correctness

Adams Closed-Loop Theory

Clinical Implications
Accuracy of a movement is
proportional to the strength of the
perceptual trace
Patient must practice the movement
repeatedly to the perceptual trace
Limitations
Cannot explain open loop movement
or novel movements

Schmidt Schema Theory

Emphasizes open-loop control
processes and generalized motor
program
Schema is a generalized set of rules
for producing movements that can be
applied to a variety of contexts
Equivalent to motor programming
theory of motor control

Schmidt Schema Theory

Information stored in short-term memory
after a movement is produced
1.Initial movement conditions, e.g. body
position, weight of an object, step height
2.Parameters of a generalized motor
program
3.Outcome of the movement, in terms of
knowledge of results
4.Intrinsic sensory feedback of the
movement

Schmidt Schema Theory

Information stored in short-term
memory is converted into two schemas
1.Recall schema selects a specific
response and contains rules for
producing a movement
2.Recognition schema evaluates the
response correctness and informs the
learner about the errors of a movement

Schmidt Schema Theory

Clinical Implications
Variability of practice learning and
generalized motor program rules
Novel movement can be made accurately
based on previously learned rules
Limitations
Vague; no consistent research finding in
support of variable practice
Cannot account for one-trial learning (In
the absence of a schema)

Ecological Theory
Learning involves the exploration the
perceptual and motor workspace
1.Identify critical perceptual variables,
i.e. regulatory cues
2.Explore the optimal or most efficient
movements for the task
3.Incorporate the relevant perceptual
cues and optimal movement strategies
for a specific task

Ecological Theory
Clinical Implications
Patients learn to identify relevant
perceptual cues that are important
for developing appropriate motor
responses, e.g. identify relevant
perceptual cues for reaching and
lifting a heavy glass: weight, size,
or surface of the glass vs. its color?

Fitts and Posner Three Stage

Model: Cognitive stage
Learner activities
Learn what to do
Learn about the task and goals
Require high degree of attention
Select among alternative strategies
Performance may be more variable
Fast improvement in performance
Develop a motor program

Fitts and Posner Three Stage

Model: Associative Stage
Learner activities
Refine the skills
Refine a particular movement strategy
Performance is less variable and more
consistent
Cognitive monitoring decreases
Improve the organization of the motor
program

Fitts and Posner Three Stage

Model: Autonomous Stage
Learner activities
Become proficient, save energy
Attention demands are greatly
reduced
Movements and sensory analysis
begin to become automatic
Able to perform multiple tasks, scan
the environment
Ability to detect own errors improves

Implications for PT
Motor learning probably occurs in
stages
Activities of the patient are
different in the different stages
Activities of the therapist should
be different in the different
stages

Systems Three-Stage Model

Learners initially restrict degrees of
freedom (DOF) and gradually release
the DOF as the task is learned and the
skills improve
Novice Stage
Simplify movement by constraining
joints and DOF, e.g. muscles cocontraction
Less energy efficient

Systems Three-Stage Model

Advanced Stage
Gradual release of additional DOF
More adaptive to different contexts
Expert Stage
All DOF released
Efficient and coordinated movements
Exploit the mechanical and inertial
properties of the limbs and the
environment

Gentiles Two Stage Model

Early stage
Understand the task goals, develop
movement strategies, recognize
regulatory features of the environment
Late stage
Refine the movement, consistent and
efficient performance
Closed skills become fixation/consistent
Opened skills become diversification/
adaptive

Think-Pair-Share
A patient is learning to use a
walker. What would the patient
be able to do at each stage of
learning?
Cognitive stage (early)Association stage (late)Automatic stage (late)-

APPLICATION OF MOTOR
LEARNING THEORIES

How to Measure Learning?

To separate the relatively permanent
effects of learning from the transient effect
of practice, learning can be measured
using retention or transfer designs.
1.Test the subject after a retention interval,
typically >= 24 hr
2.Choose the same task (retention test) or a
variation of the task (transfer test)(e.g.
different speed or lighting conditions for
walking)

Practice Level: How Much?

PRACTICE, PRACTICE,
PRACTICE

Animal Studies
9,600 retrievals over 4 week period
(Nudo, 1996)
7,000 trials of food catching in 5
weeks (Pavlides, 1993)
Humans?
Dose-response log-linear relationship
Are patients getting enough practice?

Feedback (FB)
FB is all the sensory information that is
available as a results of a movement
Types by mode of delivery
Intrinsic (e.g. proprioception)
Extrinsic (e.g. instruction from PT)
Types of FB by information provided
Knowledge of results (KR)
Knowledge of performance (KP)

Knowledge of Performance
(KP)
Information about the movement
patterns
Usually intrinsic but can also be
extrinsic
Proprioception, Biofeedback, video
recording, verbal instruction (e.g.
Your elbow was too low.)

Knowledge of Results (KR)

Information about the result or
outcome of the movement in terms
of the goal
Verbal instruction (e.g. You were
off the target.), proprioception
(e.g. feeling loss of balance during
a fall)

Characteristics of Good
Feedback

Timing
Allow some time to reflect between
trials
Summary FB
Summary FB after a few trials works
better than after every trial
Give more frequent summary
feedback (e.g. after every 5 trials) for
complex tasks than for simple tasks

Characteristics of Good
Feedback

Accuracy
Positively reinforce correct performance
Augmented (extrinsic) Feedback
Video/visual of movement patterns
alone does not help; need to provide
error-correcting cues as well
AVOID VERBAL BOMBARDMENT
Can be given concurrently or afterwards

Characteristics of Good
Feedback
Frequency and Fading Schedule
More impaired patients may
require more frequent FB.
Avoid giving FB every trial.
Decrease the amount of FB given
across learning stages so the
patients wont become
dependent on FB.

Practice Conditions
Massed vs. Distributed Practice Schedule
Distributed in early stage (e.g. 20 min X
3 days) to avoid fatigue and massed in
later stage (e.g. 60 min in one day)
Constant vs. Variable Practice
Usually variable practice (walk at
different speeds) results in better
learning outcomes than constant practice
(walk at the same speed) in health adults

Practice Conditions
Random vs. Blocked Practice
Contextual Interference: practice that
makes the performance more difficulty
initially may result in more effective
learning in the long term
Random practice (practice multiple
tasks in 15 min) results in better
learning than blocked practice (practice
one task in 15 min) in healthy adults
but not necessarily patients

Practice Conditions
Whole- vs. Part-Task Practice
Task specificity says the best
practice is the task itself
If utilizing a part technique, the
part (e.g. hip and knee flexion,
extension) must be a naturally
occurring component of the
whole (e.g. walking)

Practice Conditions
Transfer
Amount of transfer is determined by
the similarity between the two tasks
or the two environments
The more closely the practice
environment resemble those in the
performance environment, the better
the transfer
Guided vs. Discovery Practice

Practice Conditions
Mental Practice
The same neural circuits producing
the movement are also active during
mental practice
Can produce large positive effects on
performance of the task (Rawlings
1972)
Physical + mental practice produces
the best learning outcome

Practice Conditions
Action Observation
Reorganization of the
primarily motor cortex
in patients with stroke
after observation of the
desired action + motor
training, but not
observation of irrelevant
movement + motor
training
Implications for patients
with poor motor ability

Mirror neuron
system: Inferior
parietal lobule
(IPL), Ventral
premotor cortex
(PMv), inferior
Garrison,
frontal
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