Exam 1 Flashcards
1) Motor behavior is the umbrella term for what 3 sub terms of motion:
2) ** SOS ** those 3 terms and their definitions will be on the exam. SO … what is the definition of each:
- Motor Control:
- Motor Learning:
- Motor Development:
2A) Roughly what age are most motor skills developed by?
3) KNOW THOSE 3 TERMS definitions above ** SOS **
- Is motor control the same thing as motor learning?
4) What is the APTA vision statement (related to motor control):
1)
- Motor Control (controlling movement)
- Motor Learning (learning new movement, that’s permanently learned)
- Motor Development (development of movement w/ age as a child develops)
2)
- Motor Control: The study of the neural, physical and behavioral aspects of movement. Ability to regulate or direct the mechanisms essential to movement.
- Motor Learning: Refers to the relatively PERMANENT GAINS in motor skill capability associated with PRACTICE or experience. It’s the RE-LEARNING motor skills with pt’s who experience stroke, TBI, SCI injuries. RE-train or relearn the brain through movement.
- *** The processes associated with practice or experience leading to relatively PERMANENT changes in ability to produce skilled movement.
- Motor Development: Refers to the continuous, AGE related process of change in movement. This is more about motor control and learning across the LIFESPAN (so more focussed on pediatrics who need motor control
or motor learning help). This is not to re-learn, but more learning for the 1st time.
2A) Age 5ish
3) ok
- NO
4) Transforming society by optimizing movement to improve the human experience.
1) Now, MOTOR CONTROL theories have developed over time. Theories are just that - theories. But what are the pros and cons of theories:
2) There are 7 major motor control theories (over time). What are they:
3) What is a motor control theory (define it):
4) What is the REFLEX THEORY:
- SO behavior is a result of the presence or absence of a ______
- This is the SR theory, meaning
- What does the reflex theory NOT account for:
5) So if you had a pt. come in with some UMN lesion, how would you test the pt. based on this theory
6) What is the Hiearchical theory
- What are the limitations of this theory:
7) What is the Neuromaturation Theory:
8) What is Motor Programming Theory:
- What does this theory NOT account for:
9) Who was the one that developed the Systems Theory?
- What is the Systems Theory:
- Major limitation of this theory is:
10) Who is the father of motion analysis:
11) Then it became the dynamic systems theory. What is this:
- Explain attractor state:
- What is the control parameter:
12) Explain stepping reflex:
13) ** SOS ** … Movement emerges from 3 things:
- So movement is not just reflexes and heiarchachal signals to create movement?
14) Lastly, what is the ecological theory for motor control:
- The emphasis for this theory is on what: (** SOS **)
- T or F: . “I need to move in order to perceive, and I need to perceive in order to move” … it goes both ways.
- T or F: This theory emphasizes the need/use of nervous system
15) With regards to the Ecological theory, what is “Affordance”
- Give an examples illustrating this point:
- Big picture of ecological theory:
1)
- Pros: Provides insight into how the brain controls movement, a framework for interpreting behavior, provide new ideas about movement, and a guide for clinical action.
- Cons: They are a hypothesis, always changing/developing, lacking info
2)
- Reflex Theory
- Hierarchical Theory
- Neuromatruation Theory
- Motor Programming Theories
- Systems Theories
- Dynamical Systems Theory
- Ecological Theory
3) An abstract idea(s) about how movement is controlled.
4) Stimulus applied to muscle results in a response, referred to as a reflex (peripherally based). He (Charles Sherrington) basically said EVERYTHING is a reflex, or all
movement is a result of reflexes based on a stimulus initiating the reflex. There needs to be a stimulus in order for there to be a response (reflex).
- Stimulus
- Stimulus-response theory
- Voluntary movements, movement without sensory input (stimulus), fast movements, or even sensory proprioceptive input.
5) Test their reflexes (based on giving the pt. a stimulus or some sensory input). You’d stimulate / practice their reflexes.
6) This is the top down approach. Everything regarding movement starts with brain and goes down to peripheral system, to muscles/joints, etc. Since body develops this way, then movement and reflexes work this way (according to this theory).
- Does NOT explain reflexes in healthy adults who step on a pin and have a movement response (this is a bottom up approach).
7) This theory is more prevalent for motor development. Combines reflex and heiarchacal theory together based on maturation of nervous system we see the emergence of different behaviors.
So as different parts of CNS mature, different motor development skills occur, which is true. *** CNS matures, and then these behaviors occur, or develop/progress. So, baby can’t walk since that part of CNS hasn’t developed yet. Head control before walking.
8) These are Central Pattern Generators (CPG): Central pattern generators are neuronal circuits that when activated can produce rhythmic motor patterns such as walking, breathing, flying, and swimming in the absence of sensory or descending inputs that carry specific timing information.
In other words … you can produce movement without the need of the brain providing input. So there is a system in spinal cord that programs movement and movement patterns (going up stairs) without always needing input from the brain.
It acknowledges movement in the absence of sensation/input/stimulus/enviornment implications
- SO it doesn’t account for gravity, slippery surface, object you have to walk over, etc. And how those outside environment factors impacts movement.
9) Developed by Nicolos Bernstien.
- He saw the body as a mechanical system (like an engineer looks at things). We have bones, muscles, nerves, etc. and combine all of them to work together to perform a movement. So he looked at body as a system. He was first one to look at motion analysis (electrodes over body to analyze movement). So it factors in gravity, surface, and environment.
- So limitation of this theory is it doesn’t account for or place as much importance on NERVOUS SYSTEM providing the input to move the system (or other outside enviornmental factors).
He was known for focus on mechanical system, not as much the nervous system.
10) Nicolos Bernstein
11) Same as systems, but it takes in task, individual, and environment. *** It has a control variable and attractor state
- Think of being on treadmill. Walking, your attractor state is stable, but as you turn speed up you are in this weird limbo state between walking and running where attractor state is not solid (not a deep well) and your control parameter (speed) is changing. Then when you get to running state, your new attractor state goes back to solid / deep well.
- A measure/parameter (like speed of treadmill) that you can change to move out of an attractor states (from one attractor state, walking, to another, running).
12) At birth, if you hold a baby up and make their feet touch ground, they automatically step (reflex). At 4-5 months they stop doing it. Why? NOT because the reflex is gone, but their legs get chubby, their nervous system develops and they get new/diff input and sensations. When placed in water, the stepping reflex reappears.
13) Individual, task, environment
- Movement is not solely the result of muscle – specific motor programs, or stereotyped reflexes, but results from a dynamic interplay between perceptual, cognitive, and action systems (neuromuscular and musculoskeletal system) while factoring in the task and environment.
14) Movement is a result of individual responding to and interacting with environment.
- PERCEPTION (** SOS **)
- True
- False
15) What can you afford to do based on the environment. THAT PERCEPTION DRIVES ACTION (and opposite)
- Stair height, pulling a door handle if vertical, pushing door handle if horizontal
- So we perceive and then move, and as we move we perceive.
1) What are the 3 things that are needed / factored into movement and analyzing movement:
2) What are the sub-factors within the “individual” aspect of movement:
3) What are the sub-factors within the “task” aspect of movement:
4) What are the sub-factors within the “environment” aspect of movement:
5) With regard to the task, a “task” can be classified as these below. Explain each:
- Discrete vs. Continuous:
- Open vs. Closed:
- Stability vs. Mobility:
- Manipulation vs. Nonmanipulation:
6) ** SOS ** will be a test question on concepts from the last point *** She will probably give examples and you identify what type of task it is:
- Single leg stance:
- Running:
- Shooting free throw:
- Playing soccer:
7) For environment, what are regulatory and non-regulatory factors (define and give examples of each):
8) What is the difference between an open and closed environment:
- Open:
- Closed:
- Is a small exam room an open or closed environment?
- Is exercise gym open or closed?
- Is sitting or standing on a non-moving surface an open or closed environment?
- What about walking on an uneven or moving surface
- Sitting or standing on a foam or uneven surface
9) Remember the 6 main stages of movement. What are the 6 steps of movement analysis: **
1) Individual, Task, Environment
2)
- Cognitive (focus, attention, planning, problem solving)
- Sensory/Perception (vision, touch, vestibular)
- Motor/Action (neuromuscular, MS, and biomechanical systems).
3) Mobility, Postural control, UE function
4) Regulatory, Non-regulatory
5)
- Discrete vs. Continuous: Discrete has a distinct beginning and ending (kick a ball, stand up, step over object). Continuous movements continue and don’t really end (walking, running, playing a sport). If it has a distinct start/end, it is a discrete task.
- Open vs. Closed: Open is like playing soccer requires changing tasks in open environment. Closed tasks are performed in fixed environments. Open is unpredictable, closed is predictable.
- Stability vs. Mobility: Stability has to do with BOS. If BOS is not moving, it is a stability task. A STS is a stability task since BOS is not changing. If BOS changes, it is a mobility
Task (TUG, walking, running, etc.) - Manipulation vs. Nonmanipulation: If you use your hands during the task or not. Nonmanipulation doesn’t require UE use.
6)
- Single Leg stance: discrete task, closed, stability (but could be mobility), nonmanipulation
- Running: Continuous, closed if by yourself and open if at a marathon, mobility, nonmanipulation
- Free throw: Discrete, closed, stability, manipulation
- Soccer: continuous, open, mobility, manipulation
7)
Regulatory factor: important factors in environment that really effect your movement and you have to conform your movement to them.
- Examples: BOS, surface, ball, people, obstacles, out
of bounds lines
Non-regulatory factors: features in environment that don’t really change your movement and you don’t have to conform to them.
- Examples: Lights, screaming fans, pictures being
taken, weather
8)
- Open environment: Lots of changes in environment. Like a basketball game.
- Closed environment: Nobody around, like shooting a free throw
- Closed
- Open
- Closed
- Open
- Open
9)
- Initial conditions
- Preparation
- Initiation
- Execution
- Termination
- Outcome
1) What is ICF model again … identify the parts
2) In ICF model, which of those are ‘functioning and disability factors’:
- Which are ‘contextual factors’:
3) Remember she focussed on the POSITIVE aspects within ICF model. Explain
- Give example:
4) Review these ICF definitions:
1)
- Health condition
- Body function / structure limitations or impairments
- Activity and participation limitations
- Enviornmental factors
- Personal factors
2) First 3
- Enviornment and personal factors
3) What are the POSITIVES on their current condition, function, structures, enviornment, and personal factors
- If pt. had right sided brain stroke, the positive is their RIGHT side still works fine (ROM, Strength, sensation).
4)
Body functions: are the physiological functions of body systems.
Body structures: are anatomical parts of the body.
Impairments: are problems in body function or structure such as a significant deviation or loss.
Activity: is the execution of a task or action.
Participation: is involvement in a life situation.
Activity limitations: are difficulties in executing activities.
Participation restrictions: are problems in involvement in life situations.
Environmental factors: make up the physical, social and attitudinal environment in which people live.
1) She put an ** SOS ** on this slide. So I guess I need to know it …
Task Oriented Approach to Evaluation:
Task Oriented Approach to Intervention:
Integrates with the ICF model to give a rounded view of the patient:
1) Evaluate functional activities and participation restrictions
2) Describe the strategies used to accomplish the tasks
3) Quantify underlying impairments
4) Acknowledge contextual factors = environmental and personal factors
1) Resolve, reduce or prevent impairments @ Body Structure/Function Level
2) Effective and Efficient Task-Specific Strategies
3) Change Task and Environmental Conditions to maximize participation and independence
- All steps occur simultaneously together at same time*
Let’s review all the theories:
1) How many major theories are there:
- What are they:
2) With reflex theory, explain it
Clinical implications of reflex theory:
Limitations of reflex theory:
3) With hierarchacal theory, explain it:
Clinical implications of this theory:
Limitations of this theory:
4) With Systems theory, explain it:
Clinical implications of this theory:
Limitations of this theory:
5) With Motor Programming theory, explain it:
Clinical implications of this theory:
Limitations of this theory:
6) With Dynamical Systems theory, explain it:
Clinical implications of this theory:
Limitations of this theory:
7) With Ecological theory, explain it:
Clinical implications of this theory:
Limitations of this theory:
1) 7
- Reflex Theory
- Hierarchical Theory
- Neuromatruation Theory
- Motor Programming Theories
- Systems Theories
- Dynamical Systems Theory
- Ecological Theory
2)
- Sherrington
- “Peripheralist”
- Reflexes are basis for all mvmt
- External stimulus leads to mvmt
- Nervous System – triggers, coordinates, and activates muscles
- Use sensory input to control motor output
- Stimulate good reflexes
- Inhibit undesirable (primitive) reflexes
- Relies heavily on feedback
- Reflex can’t be basic unit of behavior
- Doesn’t explain fast mvmts
- Doesn’t explain how single stimulus results in varying responses.
- Doesn’t explain voluntary mvmts.
3)
- JH Jackson
- “Centralist”
- “Top-Down” unidirectional flow
- Voluntary mvmts initiated by “will” (higher levels)
- Reflexive mvmts dominate only after CNS damage.
- Identify & prevent primitive reflexes
- Reduce hyperactive stretch
- Normalize tone
- Facilitate “normal” mvmt patterns
- DEVELOPMENTAL SEQUENCE
- Recapitulation
- Doesn’t explain dominance of reflexive behaviors in normal adults
- Everyone’s developmental pattern is diff.
- Hands-on approach pt may become very passive
4)
- Bernstein
- Goal-directed behavior (Task Oriented)
- Synergies to master redundant degrees of freedom
- Feedback (closed loop)
- Identifiable, functional tasks
- Practice under a variety of conditions
- Modify environmental contexts
- Very broad – many diff. systems
- Doesn’t focus as heavily on the interaction of the organism w/ the environment.
5)
- Central Motor Pattern – motor response w/o sensory stimulus/reflex
- Central pattern generators (CPGs) – spinal motor programs that can produce mvmt w/o cortical or sensory input
- Higher-level motor programs – store rules for generating mvmts.
- Abnormal mvmt – not just reflexive, also including abnormalities in central pattern generators or higher level motor programs.
- Help pts relearn the correct rules for action
- Retrain mvmts important to fxn’al task
- Do not just reeducate muscles in isolation
- Not intended to replace importance of sensory input in controlling mvmt
- Central motor program can’t be sole determinant of action
- Doesn’t explain nervous sys. dealing w/ both musculoskeletal & environment variables
6)
- New mvmt emerges 2o to change in control parameter.
- De-emphasize commands from CNS in controlling mvmt and emphasize physical explanations for mvmt
- Attractor state – preferred pattern (vice-versa)
- Deeper attractor well more stable pattern
- Stable patterns become more variable prior to transition to new mvmt pattern.
- Mvmt is an emergent property from the interaction of multiple elements.
- Understand the physical & dynamic properties of the body
- i.e.) Velocity- important for dynamics of mvmt. May be good to encourage faster mvmt in pts to produce momentum and therefore help weak pts move w/ greater ease.
- Mvmt is an emergent property from the interaction of multiple elements.
- Understand the physical & dynamic properties of the body
- i.e.) Velocity- important for dynamics of mvmt. May be good to encourage faster mvmt in pts to produce momentum and therefore help weak pts move w/ greater ease.
- Nervous sys. has unimportant role
- Presumption that the relationship b/w the physical sys. & environment determines behavior.
7)
- James Gibson
- Perception-action system
- Perception focuses on detecting information in the environment that will support the actions necessary to achieve the goal.
- Help pt explore multiple ways in achieving fxn’al task discovering best solution for pt, given the set of limitations
- Gives less emphasis on nervous sys.
Below are FC’s on the Motor Learning Definitions assignment. *** THIS IS IMPORTANT because we as PT’s help people ALL THE TIME to do new motor learning after an injury. So knowing how to educate them and help them learn, and which way is best for them to learn, these are important concepts.
Explain each:
- Nondeclarative (Implicit) Learning
- Nonassociative Learning
- Associative Learningo Classical Conditioningo Operant Conditioning
- Declarative (Explicit) Learning:
- How to remember:• Describe the 4 stages required for explicit learning to occur: - Types of Feedback
- Intrinsic Feedback
- Extrinsic Feedback
- Knowledge of Results
- Knowledge of Performance
** How to remember difference between results vs. performance?
- Practice Conditions:
- Massed Practice:
- Distributed Practice
- Constant Practice
- Variable Practice
- Random Practice
- Blocked Practice
- Whole Training
- Part Training
- Transfer Training
- Mental Practice
- Guided Practice
- Discovery Learning
- Nondeclarative (Implicit) Learning: Long-term memory, unconscious or automatic memory that becomes habit, long-term, part of you. Things you DO instinctively. You can remember past experiences and do things without even thinking about them.
• Nonassociative Learning: Is learning where someone’s response or behavior toward a stimulus will change based on whether the stimulus increases or decreases. So, the nervous system learns about a stimulus and responds based on amount of the stimulus.
- HABITUATION is a decreased response to a stimulus judged to be irrelevant (we TUNE IT OUT); and
- SENSITIZATION is an increased response to a stimulus (we FOCUS MORE).
• Associative Learning: When a response becomes associated with a specific stimulus. Best example is Pavlov’s dogs who salivated in response to a bell being rung (bell suggesting it was dinner time).
o Classical Conditioning: When a behavior/response is determined by what precedes it. A “reward” is given before the behavior. So you link the stimulus and reward together. A conditioned stimulus will produced a conditioned response (where before being learned no response came from stimulus … dogs and bell in Pavlov’s dogs example). I know that stimulus X will generate this X behavior response.
o Operant Conditioning: When a behavior/response is determined by what follows it. I know if I do X behavior, I’ll get X reward/punishment. A “reward” or punishment is given after the behavior. This is trial-and-error learning. We learn or associate a response based on what we experienced. Behaviors that are rewarded are repeated, and punished behaviors are not done any more (learn from experience).
• Procedural Learning: Learning tasks that can be performed automatically without even thinking about it. The motor task becomes a habit through repetitively performing the task over and over. You can do the task without being conscious about how to do it (i.e. riding a bike, walking, driving a car, tying a shoe, etc.).
- Declarative (Explicit) Learning: Things you know that you can tell others about. This is not about doing or performing skills without thinking (like in nondeclarative), this is about memorizing or knowing information and being able to express those things learned. It is about learning, knowing, and repeating factual knowledge.
- I have to DECLARE it (so speak it), thus it must EXit my mouth, so EXplicit
• Describe the 4 stages required for explicit learning to occur:
o Encoding: Getting information into our brains in a way to allow it to be stored.
o Consolidation: Process of making the info. stable for long-term memory storage.
o Storage: Long term retention and storing of info/memories.
o Retrieval: The recall of information from long-term storage sites in our brain.
- Types of Feedback
- Intrinsic Feedback: Feedback from yourself. You observe, recognize, or experience things you did (performance, movement, etc.) and make suggestions to yourself how to improve.
- Extrinsic Feedback: Feedback from others. People around you who give feedback (performance, movement, etc.) and ways to help you improve.
- Knowledge of Results: A form of EXTRINSIC feedback, about the outcome of the movement, in terms of the movements goals.
- Knowledge of Performance: A form of EXTRINSIC feedback, about the specific movement pattern/task used to achieve the goal.
*** You get results at the end, but the performance is now.
- Practice Conditions:
- Massed Practice: Rest break between sessions / attempts is less than the time it took to perform the task (short rest breaks).
- Distributed Practice: Rest break between sessions / attempts is equal to or greater than the time it took to perform the task. Equal rest / practice / rest / practice
- Constant Practice: Practice schedule where a task is practiced repeatedly over and over. (Shoot a free throw over and over again in same repeated manner).
- Variable Practice: Practice schedule where variations of the task are practiced over and over, but in different settings/contexts. (Throw different balls at different targets at different distances).
- Random Practice: Trials for a given task are mixed with other tasks in a random order.
- Blocked Practice: All trials of a given task are completed before moving on to the next task.
- Whole Training: Learning an entire task (movement sequence) as a whole. So with gait training, for example, practice the entire stance and swing phase and practice the whole stride and all smaller part steps in it together (practicing over and over).
- Part Training: This is learning and mastering one part of the whole movement before moving on to work on next part. So with gait training, work and practice knee extension on heel down phase and practice that part over and over before moving to the stance balancing step. Get parts down before practicing the whole.
- Transfer Training: How well learning something transfers to new environment. So what was learned in the clinic, how well will it transfer to home environment. So, the key as a therapist is to mimic as much as you can the home environment, so what is learned in the clinic can transfer.
- Mental Practice: Ability to mentally visualize and practice the motor/movement skill just learned. Being able to do this will help translate into doing and learning the motor skill in real life.
- Guided Practice: The learner is guided through the task by one who knows. So a patient, for example, is shown how to do an exercise and guided in the movement by the therapist to help the patient do exactly what is needed.
- Discovery Learning: The learner (patient) learns by trial and error, on their own through experience. Through discovery, and not being guided or shown/taught by someone (therapist), they learn themselves through discovery, which can solidify knowledge even more.
1) What is the “Learning Curve” graph? Explain it
- How does the graph look
- An example of this
2) Define motor learning:
- So is learning a new skill in the clinic “motor learning” **
3) So are short term “changes” thought of as “learning”
- T or F: Motor learning is developed by hearing and internalizing new lesson / skill
4) If a pt can do a skill or movement in the clinic, but then it doesn’t transfer to home, have they done motor learning
5) So what is the difference between motor learning and motor performance:
6) Explain the difference between a Retention test and a Transfer Test:
7) So if a new skill is learned and the PT waits and tests again 4 appts later, this is a ______ test.
- If PT tests a skill in a new environment, that is a _____ test:
1) It is that you increase your learning A LOT at the beginning of getting experience. But then over time, the less you learn from more experience.
- Experience on bottom, learning on side. As you get more experience, your learning shoots up. But over time with more and more experience, you don’t learn as much.
- I learned a TON from the first few weeks of the 1st clinical, but didn’t learn as much from the end (caused I’d experienced and learned those things).
2) The processes associated with practice or experience leading to relatively PERMANENT changes in ability to produce skilled movement.
- NO, not yet (it depends). When someone can learn something and then the next day they are back to normal or forget or it doesn’t translate to new environment, then they have not experienced motor learning yet. True motor learning is the PERMANENT changes that result from learning and/or practice, or experience. ***
3) No.
- False. Results from experience or practice, an action repeated over and over that becomes permanent.
4) No. Make sure skills learned in PT therapy can transfer, apply to home and work and normal daily ADL’s, and become permanent.
5)
- Motor performance: TEMPORARY change in motor behavior following practice.
- Motor learning: PERMANENT changes in motor behavior.
6)
- Retention: A test to see if the new motor skill learned/practiced was retained after a period of no practice.
- Transfer: A test to see if the new motor skill learned/practicied can transfer to new situation/setting/surface/enviornment.
7) Retention
- Transfer
1) Difference between implicit and explicit learning is:
2) Implicit forms of learning. What are the 2 types of implicit or nonassociative learning … and give example of each:
3) A form of implicit learning is Associative learning. This is:
- The 2 main types of associative learning are:
4) Classical learning is:
- Operant learning is:
- Which one is voluntary, which is involuntary:
- Which one is trial-and-error learning
- Which one is pairing two stimuli together
- Which one is positive reinforcement for good behavior (or punishment for bad behavior)
5) Great way to remember classical vs. operant related to pavlov’s dogs:
6) Can classical and operant conditioning be reversed (and people weened off learned condition/stimuli/response)?
1)
- Implicit: Acquiring skills or knowledge without thinking, just through experience. So nobody tells/teaches you, you just do it and learn without thinking about it (how to ride a bike, eat, pull hand away from stove, etc.)
- Explicit: A conscious and deliberate attempt to learn something. You think about it - conscious - and try to learn it (school work, learning a difficult concept, memorize something, have a coach tell you how/what to do).
2)
- Habituation: Decrease in responsiveness as result of repeated exposure to nonpainful stimulus. EXAMPLE: rat who hears gun shot going off gets scared/startled, but gun shot keeps going off and eventually rat is not phased by it. The rat tunes it out and becomes desensitized.
- Sensitization: Increased responsiveness following threatening or noxious stimulus. Touching hot stove hurts, so next time you do it you overreact to the touching of hot stove.
3) Associative learning: Prediction of the relationship between stimulus and responses.
- Classical and Operant
4) Classical: Behavior is determined by what proceeds it
- Operant: Behavior is determined by anticipation of what FOLLOWS it (reward or punishment)
- Classical is involuntary (operant is voluntary)
- Operant
- Classical
- Operant
5) Classical: There goes the bell, it’s time for food.
- Operant: I’m hungry, I should push the lever.
6) Yes
1) So what is explicit or declarative form of learning:
2) So what groups or patient populations can you give or will you need to give explicit learning to:
3) Will explicit knowledge work on infants?
- Will explicit knowledge work on normal healthy adults?
- Will explicit knowledge work on adults with cognitive impairments (or children)?
- For normal healthy adults, should you use implicit or explicit learning:
4) So if a pt. is learning to re-walk and the PT is telling the pt exactly what to do, and showing / forcing their leg into correct movement patterns, what type of learning is this:
- Is this good or bad
5) A PT who does SBA with a pt learning to walk again but gives no cues, feedback, or help, but let’s patient wobble, struggle, figure it out, etc. - this is what type of learning:
6) If the pt. has cognitive ability, is implicit or explicit learning better:
- T or F: If the patient can’t communicate or has low cognition, explicit learning is most effective
1) Knowledge that can be recalled, needs consciousness to learn it and recall it, ability to remember factual knowledge, spitting out info on an exam.
2) Children: They need to be told what to do / not to do
- Students: Teach them new concepts
- Athletes: Teach them a new skill or a play
- People who have little sensation
3) No
- Yes
- No
- Both. They’ll need explicit at first, but then the best way to learn is implicitly (just like my experience in PT school and becoming a PT - I need explicit at first, but best learning is through implicit learning through experience).
4) Explicit (declarative)
- Both. May need it at first (but eventually you want to get to trial-and-error and implicit learning where pt learns themselves through experience and through practice develops PERMANENT motor learning).
5) Implicit (non-declarative)
6) Use implicit if pt DOES have cognitive ability, or is an adult who understands, and you want them to learn themselves.
- False
We went over motor control theories, but now let’s discuss motor learning theories:
1) What is Schmidt’s Schema Theory:
- Motor schemes: recall schema vs. recognition schema
2) Clinical implication of schema theory (SOS)
- Example of this (how to put into clinical practice)
3) What are the limitations of the schema theory:
4) Now, what about Newell’s Ecological Theory. What is this:
- So practice =
Clinical implications for Newell’s Ecological Theory of Motor Learning (SOS):
1) Schmidt’s Schema Theory: A Schema = an abstract representation stored in memory following multiple presentations. So movement information is stored in short term memory following completion of movement (like I do with special tests).
- Recall: Organizing the movement, what movement do I need to do, and how to do it?
- Recognition: Did I do the movement right (evaluate)?
2) SOS Optimal learning occurs with VARIABLE practice conditions/settings/repititions. So Schema theory does affect the way patients learn … so optimal learning with pt’s occurs with variable practice conditions.
- So if a pt is having problems with going up stairs, then practice going up stairs of different heights, places, etc.
3) ** Limitation is you can’t learn something if you have had no schema (demonstration or experience/memory) of activity. How can I perform a special test if I’ve never seen or practiced it?
4) You have interaction between the individual, task, and environment – but you need to use PERCEPTION in order to perform and LEARN the task. So you have to be able to perceive the environment (constraints) in order to perform and learn a new task/skill/movement.
- Practice = improved coordination between patient perception and action that is consistent with the task and environment
- This is based on Systems and Ecological Motor CONTROL Theories
- Patient must learn to distinguish PERCEPTUAL cues important to organizing action, relative to the environment and task. (SOS)
1) What motor learning theory is this intervention below based on:
- A physical therapist is teaching a patient to safely perform sit to stand transfers. He instructs the patient to visually scan the environment and identify surfaces around that can be used as support.
2) What motor learning theory is this intervention below based on:
- A physical therapist is teaching a patient to safely perform sit to stand transfers. Based on schema theory what would be the optimal strategy for learning?
- Answer options are:
- Frequent breaks
- Practice with different heights of support surfaces
- Attention to verbal cues
3) What is the Fitt’s and Posner 3 Stage Model:
- What are the 3 stages:
4) So 3 stages are what (for Fitt’s and Posner):
- Is level of attention to skill higher in 1st stage (cognitive) or last stage (autonomous)
5) What is Bernsteins 3 stage model for acquiring a skill:
6) So where else do we hear Bernstein’s name?
- Why is this important to know?
1) Newell’s Ecological Theory (because pt is perceiving environment).
(This type of ? will be on the exam)
2)
- Practice with different heights of support surfaces
** Don’t focus on the details of the schema, but focus on how it impacts clinical practice and patients. (See ** SOS *** points above).
3) A motor learning model of skill acquisition. All skill acquisition follows 3 simple steps/stages:
- Stage 1: Cognitive Stage: Requires high degree of cognitive activity (attention) to learn.
Stage 2: Associative Stage: Less cognitive contributions as focus is on refining movement.
Stage 3: Autonomous Stage: Low degree of attention with skill becoming automatic. Less reliance on cognitive, more on repeating the skill over and over.
4) Cognitive, Associative, Autonomous
- First stage (cognitive)
5)
- Novice stage: learner constrains degrees of freedom in order to simplify task
- Advanced Stage: releasing degrees of freedom at additional joints
- Expert Stage: all joints are released to produce the most efficient and coordinated movement
6) He developed the Systems theory for motor CONTROL
- To separate motor control from motor learning. This 3 stage model is for motor learning / skill acquisition.
1) Now we want to structure therapy to implement motor learning for our patients.
- So, what are the 2 types of feedback we can give pt’s during an appointment:
1A) Recall the difference between INTRINSIC and IMPLICIT (and thus, extrinsic and explicit):
2) There are 4 types of Feedback. Explain:
2A) Learning is best by using what type of feedback(s) from above:
3) If someone had an impaired sensory system, what type of feedback would you give:
- T or F: Performance is better with constant feedback
4) Explain this concept: “# of trials to include in a summary of KR is based on complexity of the task.”
1)
- INTRINSIC feedback: is from yourself through proprioceptive feedback (of a movement). Or you see and get feedback from vision. FEEDBACK THROUGH PERSONAL SENSES and LEARNING DURING MOVEMENT.
- EXTRINSIC feedback: comes from an external source (family or you as PT give them verbal cues or feedback or tactile input). FEEDBACK FROM EXTERNAL SOURCE DURING MOVEMENT.
1A) Intrinsic and Extrinsic are forms of FEEDBACK
- Implicit and Explicit are forms of LEARNING
2)
- Knowledge of Results (KR): Give feedback about the outcome, or did they complete goal.
- Knowledge of Performance (KP): Give feedback about the actual performance or actual movement / task.
- Fading Schedule of Feedback: You gradually remove feedback. You start with lots of feedback, and then diminish the feedback you give. Move from extrinsic to intrinsic feedback
- Summary KR: You give feedback in a summary way after a block of trials.
2A) Learning is better with fading feedback and summary KR.
3) External / Extrinsic feedback (give them tactile input)
- TRUE ***
4) So simple tasks you may do 15 trials, then give summary KR. But more complex task, you’d give 5 trials and give summary KR. So let pt learn from intrinsic feedback, then give extrinsic feedback at the end.
1) As for practice conditions, explain these:
- Massed Practice:
- Distributed Practice:
- Constant Practice:
- Variable Practice:
2) Is variable or constant practice easier
- Which one (variable or constant) is better in the long run:
3) SOS What do you absolutely want to monitor and ensure when doing Massed Practice
4) For continuous tasks, ______ practice has shown better learning on transfer tests
5) Now what about these … explain these:
- Random practice:
- Blocked practice:
- Whole Training:
- Part Training:
- Transfer Training:
- Mental Practice:
- Guided Learning:
- Discovery Learning:
5A) So in a nutshell, good to practice part of task and repeat it till you get it down. But eventually you want to practice the whole task and repeat it till it is learned and can be recalled/repeated and transfer to new setting.
** ADD THESE BASIC PRINCIPLES TO “MY DOCS” … just one page of big Motor Control principles on how to ensure you help pt’s improve. ***
6) The key for rehab is preparing patient to be able to perform the task in ______________
7) T or F: It is vital to educate the patient on your reasoning behind your recommendations for training / interventions used?
- Blocked Practice = better performance during skill acquisition
- Random Practice = better performance on transfer task
- Contextual interference may be reason for initial poor performance with random practice
- Need to put the part training back into whole training to promote carry over
1)
- Massed Practice: Amount of practice time is greater than rest time (short rest breaks)
- Distributed Practice: Rest time is = to or greater than practice time (equal rest breaks)
- Constant Practice: Task practiced under constant conditions
- Variable Practice: Task practiced under variable conditions (surface, enviornment, WB)
2) Constant
- Variable (cause it transfers better)
3) Monitor fatigue (vitals)
4) Massed
5)
- Random practice: Tasks practiced in random order. Decompose task and perform in random order.
- Blocked practice: Practice 1 task in a block trial before moving on to the next
- Whole Training: Practice entire task at once
- Part Training: Practice part of task, then practice other part, etc.
- Transfer Training: Not a STS transfer, but transfer a skill
Learned to new enviornment
- Mental Practice: Practice task in your mind (imagine movement w/out practicing for real).
- Guided Learning: You guide and help (physically) pt go through a task
- Discovery Learning: Used a lot with babies – let them learn through trial and error to find solution. Let child fall so they learn implicitly their weakness and how to fix it.
5) Ok
6) Home and community environments (all about function, applicable, ADL’s)
7) True.
1) What is recovery vs. compensation when it comes to motor learning
1)
- Recovery = Achieved motion/goal and am back to normal state as pre-injury
- Compensation = I’m not back to normal but have learned to compensate to complete the task
