lecture 4 chapter 2 Flashcards
1
Q
Motor Learning
A
- Defined as “the study of the acquisition [and reacquisition] and/or modification of skilled actions”
- “Set of processes associated with practice or experience leading to relatively permanent changes in the capability for producing skilled action”–Schmidt
- Compare to motor control – Understanding the control of movement already acquired
2
Q
Novel Learning
A
Acquisition of a new skill
3
Q
Recovery of Function
A
Reacquistion of a previous skill that was lost
4
Q
Four Concepts of Motor Learning
A
- Learning is a process of acquiring the capability for skilled action (intentional)
- Learning results from experience or practice
- Learning cannot be measured directly, instead it is inferred from behavior
- Learning produces relatively permanent changes in behavior, thus short-term alterations are not thought of as learning
5
Q
Performance
A
temporary changes
learn to kick better in one session
6
Q
Learning
A
permanent changes
retention across time transfer to other tasks and conditions
goals 6-8 week mark = learning
7
Q
You are teaching a patient to go up/down a high step with a walker for the first time. After practicing 10 times during the session the patient was able to accomplish the task with stand by assist. This is an example of learning.
true or false
A
false
8
Q
You see a patient in PALS. You indicate on your note how well the patient ambulated during the session. What are you most likely documenting?
perforance or learning
A
performance
9
Q
Instructive mechanism of motor learning
A
A change in motor behavior achieved through the use of an intentional movement strategy
Extrinsic feedback about movement error or performance to develop an intentional error-reducing movement strategy; Knowledge of
a. Performance
b. Error-reducing movement strategy can be explicitly described by the learner and reproduced
c. Explicit or strategy-based motor learning
d. High cognitive load
10
Q
Reinforcement mechanism of motor learning
A
Improvement in motor behavior that is driven by binary outcome-based feedback
a. Depends on extrinsic feedback about the outcome of the task goal; Knowledge of Results
c. Likely due to basal ganglia involvement; reward-based dopamine signaling
d. Moderate-high cognitive load
11
Q
Use-dependent
A
Change in motor behavior that is driven by repeated task-specific practice
a. Ex: Golf Swing
b. Experience-dependent neuroplasticity
c. Low-moderate cognitive load
12
Q
sensorimotor adaptation mechanisms of motor learning
A
A change in motor behavior that is driven by sensory prediction errors
a. Actual sensory consequence of a movement differs from the predicted sensory consequence of that movement
b. Unexpected task demands or changes in environment that require modifications to the executed motor program
c. Low cognitive load
13
Q
Learning and long-term memory
A
14
Q
Non-declarative (implicit) learning
Non-associative
A
Single stimulus, repeatedly offered
Leads to learning about characteristics of that stimulus
15
Q
Non-declarative (implicit) learning
Habituation
A
Decrease in responsiveness as a result of repeated exposure to a non-painful stimulus (e.g. vestibular rehab)
16
Q
Non-declarative (implicit) learning
Sensitization
A
Increased responsiveness following a threatening or noxious stimulus (e.g. falls)
Brain learns that things hurt us so then we don’t want to do that anymore
17
Q
Non-declarative (implicit) learning
associative
A
Learning to predict relationships between stimuli
Classical conditioning (Pavlov’s dog)
Operant conditioning (trial and error)
18
Q
Non-declarative (implicit) learning
Procedural
A
Learning automatic tasks, habits
19
Q
Classical conditioning
A
learn relation between one stimulus and another
20
Q
Classical Conditioning in Physical Therapy
A
Avoidance of movement due to pain
Manual therapy and relaxation (for someone stiff and rigid)
Balance training/habituation training
21
Q
operant conditioning
A
learning relation between stimulus and response
reward basal ganglia and dopamine
22
Q
Operant Conditioning in Physical Therapy
A
Positive cues
Rewards (goals and milestones)
Improved movement, less pain (negative reinforcement)
“Positive punishment” (correcting form)
Negative punishment (removing something aka privileges)
23
Q
Procedural Learning
A
Not dependent on awareness, attention, higher cortical processes
Develops slowly after many repetitions, varying circumstances
24
Q
Declarative (explicit) learning
A
- Can be consciously recalled & articulated
- Requires higher cortical processes awareness, motivation, attention, reflection, ability to relate new info to things they already know
- Can be enhanced by mental practice
- Constant repetition transforms declarative to procedural
25
Adam's Closed Loop Theory
Sensory feedback is necessary to learn skilled movement (learn how the skill should feel)
* Processing afferent information is central in human motor control
* “Internal reference of correctness” is stored with repetition of correct movement
* A motor program, here called a Memory Trace, is required
During performance, movement is adjusted by Perceptual Trace (refine the movement)
* Compares the movement in progress with a correct memory of the movement
Specificity should increase learning
Errors and variability will decrease learning
26
Adam's Loop level 2
Perceptual Trace controls/adjusts movement
Compares movement with the Memory Trace
Kinesthetic feedback (muscles)
Short feedback loop
Adjustment happens sub-consciously
Ex: Skier losing balance
27
Adam's Closed Loop Level 3
Longer Feedback Loop
Longer to adjust movement
Conscious thought and decision
Mismatch between Memory Trace and the Perceptual Trace – determines need to adjust
Ex: Hitting the tennis ball into the net, Driving a car
28
adams closed loop limitations
Does not explain accurate performance of novel movements
Does not explain improvements in movements without feedback
Indicates need for 1:1 brain mapping – Storage capacity would be overwhelmed ( we would need every task to be connected to a motor program pathway)
29
Schmidt's Schema Theory
Emphasized open-loop control processes and the generalized motor program (GMP) concept
Motor programs do not contain the specifics of movements, only generalized rules
Rules can be applied to a variety of contexts
Variability of practice should improve motor learning – Strengthens rules
Movement may be produced accurately even if novel if it is based on a previously created rule
30
# Schmidt's Schema Theory
After movement, 4 things are available for storage in short term memory:
1. Initial movement conditions (position of body, weight of cup, etc)
2. Parameters used in the generalized motor program (duration, force, muscle selection)
3.Outcome of the movement in terms of Knowledge of Results (KR) did I achieve the goal that I wanted achieve
4. Sensory consequences of the movement (how it felt, looked, and sounded)
Then abstracted into the 2 schema (how the absract) …
31
# Schmidt's Schema Theory
Recall schema
used to select a specific response
Based on previous experience, and current conditions are used to initiate the movement
Each time a movement is used for a certain goal, the previous schema is put into play
Input about accuracy; repeat and receive continued feedback
Nervous system creates a relationship between the size of the parameter and the movement outcome = Rule for movement
Initial conditions + desired goal = rule for movement to achieve goal; initial conditions (heavy vs. light object) may alter the rule (Recall)
32
# Schmidt's Schema Theory
Recognition Schema
used to evaluate the response
Based on feedback, adapts the program for new conditions
Uses sensory consequences and outcomes of previous similar movements, couples with current initial conditions
Creates a representation of the expected sensory consequences and compares the ongoing movement to evaluate the efficiency of the response
Previous outcomes + Initial conditions = expected sensory consequences; sensory feedback may alter (Recognition)
33
Clincial Implications of Schmidt's Schema Theory
More information is better
Errors and variability will increase learning
Variety is good for transfer of skills to other situations
Environment, weight of object, etc.
34
Limitation of Schmidt's Schema Theory
Variability isn’t always better. Depends on who is learning and what they are learning
Better for children
35
Newell's Ecological Theory
Borrowed from Systems and Ecological MC theories
Desired Outcome drives the initiation of movement.
Motor Planning is based on searching for optimal strategies to solve the task
Perception (Sensory input) used to understand task and as feedback during and after movement
Learn to match motor strategies to different conditions (task, environment and individual constraints)
36
Clinical Impications of Newell's Ecological Theory
Solve motor problems, instead of performing specific movement pattern
Variability and exploration are required
Altering conditions can alter motor performance
37
Limitations of Newell's Ecological Theory
Changing conditions may change strategy but does it lead to changes in neural control? We don’t know
38
Optimal Theory
OPTIMAL: Optimizing Performance through Intrinsic Motivation and Attention for Learning
Motivational and Attentional factors contribute to performance and learning by strengthening the coupling of goals to actions (goal-action coupling)
The learner’s needs must be met (or not jeopardized) in order to optimize learning
Essentially, goal-action coupling is a combination of the goal (i.e. what the learner wants to do) and how skilful movement can be used to achieve the goal
Builds on the various social, cognitive, affective and motor components of motor behaviour
Focuses primarily on learning “how” to achieve coordinated or skilful control of movement rather than focusing on skills that are more cognitive in nature
The aim is to:
Strengthen a patient’s goal-oriented actions
Bring about skilled quality of movement
39
# Optimal
Autonomy (A)
who controls when feedback is due or if it is desired? (depends on patient)
“Let me solve it on my own”
“Give me just a moment longer or another few repetitions”
Balanced with…. “Can I get some help here?”
With consideration for: preferences, communication, tolerance for error
40
Self Efficacy
Self efficacy: “I believe that I can do this”
Associated with: Autonomy, collaborative decision making, self-directed learning, autodidacticism, readiness for change, collaborative goal setting
Measured by: (how to measure it for PT)
General Self Efficacy Scale
Goal attainment scale
Patient Specific Functional Scale
41
Self Awareness
Can I learn while my therapist, instructor, coach is away?
Can they do it themselves
Can I learn from my own repetitions?
Am I learning because of KR or KP?
Knowledge of results vs knowledge of performance
Can I learn without KR?
Can I retain? information
42
Enhanced Expectancies (EE)
The belief that your next or future trials will be successful
“...perception of success is more important than actual success” (Palmer, Wulf, et al 2015)
In contrast with suppressed expectancies, expecting failure
Optimism v. Pessimism - close, not quite its true belief and what they learned or from sensitization
43
External Focus
Attention in movement directed at accomplishing a task or goal with a finite directive or end
Found to increase learning significantly when compared with internal
Contrasted with internal focus: Attention directed at movement specifics (my knee, back, elbow)
44
Areas of focus: Functional reach + pour
Pre-OPTIMAL
“Don’t lift your shoulder blade up so high”
“Try to turn your wrist and forearm over”
“You should be able to do this…”
45
Areas of focus: Functional reach + pour
Optimal - guided
“Are you able to focus on fully emptying the cup?” (EE)
“Excellent job! Would you like to try to move the cup farther away, or are you ready for more water in the cup?” (A/EE)
This adds autonomy
46
Fitts and Posner Three-Stage Model
46
Cognitive stage
Understand nature of task
Developing strategies to carry out the task (lots of errors and variability)
Determining how the task is evaluated
Lots of improvement as learn most effective strategy
Requires great deal of attention and conscious thought
47
Associative Stage
Less variability (refining one chosen strategy)
Improvements are made more slowly
Match motor output to task performance
Refine use of sensory input
May last days to weeks to months depending on performer and intensity of practice
Movements are refining
48
Autonomous Stage
Automaticity of skill
Low degree of attention required for performance
Can perform another activity simultaneously
Not achieved for every task
Performance of a well-learned task can be
improved when practiced with a secondary task
DUAL TASK TRAINING
Task becomes automatic
49
Clinical Applciation of stages of learning
Feedback and practice conditions should be adapted to match the cognitive load required for each stage
Provides explanation for reduction of errors with practice
Creates a roadmap for when to advance or add another task
50
Limitations of three-stage model
Applies more to explicit than implicit learning
Some tasks are learned better implicitly
Does not account for patients with cognitive challenges bc they can’t attend
51
Bernstein’s Three-Stage Approach
Emphasizes controlling degrees of freedom of body segments
Novice → Advanced → Expert
52
Novice
Simplified task
Reduced variability
Reduced efficiency
Building essential control (learning this)
“Freezes” degrees of freedom
53
Advanced
Movement is allowed at more joints
Increased variability
Increased adaptability
Gradually “frees” degrees of freedom
54
Expert
Efficient
Coordinated
Fluid movement,
Takes advantage of mechanics of system and conditions
Optimal efficiency
All degrees of freedom available
55
Clinical Implications of the Bernstein’s Three-Stage Approach
Explanation for presence of coactivation of muscles during early stages of acquiring motor skill
Justification for using developmental sequence during task retraining
Importance of providing external support during early phases of learning motor skill
Basis for targeted training: Method for training trunk postural control in children
56
Limitations of the Bernstein’s Three-Stage Approach
Principles that govern motor learning processes to lead to last stage of mastery largely unknown
Challenging to do research on the process to obtain Expert level due to time constraints
57
Gentile's Two Stage Model
First stage
First stage:
Learner develops understanding of task dynamics
Understand goal of the task
Develop movement strategies
Determine regulatory vs. non-regulatory features of environment
58
Gentile's Two Stage Model
Second Stage: Fixation/diversification stage
Learner refines movement
Develop adaptability to changing task and environmental demands
Perform consistently and efficiently
Fixation: Movement variability reduces with practice; useful for Closed Skills
Diversification: Movement diversification; useful for Open Skills (adaptation)
59
Instructions
Listen to or read facts about "best movement"
60
Observe
experts, peers, other novices
61
Practice
repetitions with observable outcomes
62
External feedback
Concurrent or summary information about movement and results provided by an authority or technology
External source
Augmented, supplements intrinsic feedback
Concurrent or terminal
63
Internal feedback
Adjustments made by the learner based on outcomes and understanding of best movements (automatic)
Internal source
Inherent
Provided by sensory systems when moving; what is felt by the learner
64
Practice Levels
Most important factor in retraining motor skills is the amount of practice
Rate of improvement during any part of practice is linearly related to the amount left to improve
Early learning = large changes
Later learning = small changes
Mental practice counts!
SMA
65
Implicit Feedback
Feedback that is acquired without conscious awareness, including sensory and environmental feedback
Assists with:
Error detection and correction (be careful with this?) (some patients may not understand what they are doing wrong)
Trial-and-error learning
Skill transfer
Ex: When a player acquires a skill when answers to problems are not provided directly and players find solutions for themselves. (ecological therory)
66
Explicit Feedback
Feedback that is directly provided to individuals about their performance in a motor task
Involves external feedback or instruction aimed at guiding and improving motor performance
Types of Explicit Feedback:
Instructional
Knowledge of Results (KR)
Knowledge of Performance (KP)
Error Correction
Goal Setting
Demonstration and Modeling
Self-Assessment
67
MORE ON FEEDBACK
Error recognition – Actual vs. intended
Error correction – Cues to improve
Reinforcement & increased motivation – Increases attention to & duration of practice
Guidance of ongoing movements – Only for very slow, especially novel movements
68
Augmented feedback
“Performance related information added to, or enhancing, task-intrinsic feedback”
It enriches naturally occurring intrinsic feedback, perhaps to aid the performance of motor skills
Extrinsic in nature
In addition to the intrinic feedback
Of greatest value when:
Intrinsic sensory mechanisms are impaired
Provides new or additional information
Provides specific information to guide subsequent attempts
Not too precise in young patients (they don’t do very well with this)
69
Knowledge of Results (KR):
Extrinsic feedback; Feedback regarding outcome of the movement
Important learning variable
Can include verbal, visual or auditory feedback; Provided by an external source (coach, clinician, stopwatch)
70
Knowledge of Performance (KP)
Feedback regarding quality of movement
Can include: Information about pattern of a movement, Kinematic feedback (e.g. speed, displacement), Kinetic feedback (e.g. force)
Often provided during the movement, though can be provided after (i.e. videotape)
71
Types of feedback
Continuous: Feedback with every trial
Faded: Higher frequency of feedback early in acquisition stage and less feedback in later stages of learning
Bandwidth: Feedback only given if errors > than threshold level
Summary: Feedback given for a group of trials (every 5, 10, 15 trials)
72
Frequency of feedback
Faded (50%) vs. Consistent vs. Summary
Fading feedback improved delayed retention scores
During times without feedback, pt uses other cognitive processes, i.e. error detection
Consistent, 100% feedback increases dependency
Summary (after blocks of 20 trials)
Initially least accurate, though most accurate on transfer tests (retention)
Immediate feedback is detrimental to learning
73
Recommended feedback
Simple movement timing tasks:
15 trials
Complex tasks:
5 trials
Adults - Precise Quantitative KR
Children - Can confuse them with too specific feedback
74
"Fade" the feedback
Stage 1 - Acquisition:
Continuous, immediate, prescriptive
Stage 2 - Refinement:
Delayed, summary/brief intervals, descriptive
Stage 3 - Retention
Delayed, summary/longer intervals, questions vs. answers
75
Massed
A session in which the amount of practice time is greater than the amount of rest between trials
May lead to fatigue
Better for continuous task retention/transfer task performance
76
Distributed
A session in which the amount of rest between trials is equal to or greater than the amount of time for a trial
Useful when someone is more likely to fatigue easily
77
Constant
Practice using same conditions every time; Closed environment
Useful when task requires minimal variation and will be performed in constant conditions
78
Variable
Practice with unpredictable variables (speed, environment, reaction time demands, etc); Open environment
Delays acquisition, though improved retention
Increases ability to adapt and generalize learning, perform better in novel variations of initial practiced task
Essential when task may be performed in variable conditions
79
Drill
practice one skill repeatedly
80
Blocked
Focused practice on one task for a block of trials, then moving on to the next task
Better performance during acquisition phase
81
Random
Performing tasks in a random order
Better performance with transfer task
Likely more affected by contextual interference
Useful when skills require different patterns of coordination/motor programs
**Inappropriate until learners understand the dynamics of the task
82
task analysis
Identifying components of a skill or movement and then ordering them into a sequence
83
Part
Practicing the components of a skill to increase mastery of that skill, “part-task training”
84
Whole
Practicing the task in its entirety
85
Error Augmentation
Error augmentation increases asymmetries and movement errors to which patients must then adapt
This method has potential to facilitate neuroplastic cortical change
86
Stage 1- Acquisition
Single task
Part task
Self-paced
Drill schedule
Constant Practice
Closed environment
87
Stage 2 - Refinement
Multiple tasks
External timing demands
Blocked schedule
Introduce variable practice
Open environment – limited
88
Stage 3 - Retention
Concurrent tasks
Random schedule
Highly variable
Open environment
89
Clinical Implications: Exam/Eval
Identify the stage of motor learning for each task to be learned
Novel task may be in acquisition phase during early learning
After a neurological injury, a common, previously known task may be in the acquisition phase when re-learning
Increase practice variation & decrease feedback as learner improves
90
Balance Training - Acquisition
Tasks: “Static” & Dynamic sitting activities
Schedule: 30 min. drill
Where: Patient room – bed, chair, toilet
Feedback: Immediate tactile & verbal cues, mirror for continuous visual cues.
91
Balance Training- Refinement
Tasks: Supine-Sit, Dynamic Sitting, Scooting Forward/Back; Right/Left
Schedule: Blocked - 10 min each
Where: PT dept. - wheelchair, mat, ball
Feedback: Hands off, mouth closed every other try, every two tries, etc. Question for error detection & self-correction.
92
Balance Training - Retention
Tasks: ADL’s in unsupported sitting, ball toss seated on ball, etc.
Schedule: Random - as soon as one task is complete, switch to alternate task
Where: Lobby, cafeteria, bus stop bench, etc.
Feedback: Questions vs. cues; after every five tries.
93
Exceptions to the Rules
Down’s Syndrome, Alzheimer’s Disease & Dementia
Declarative memory declines, but procedural memory does not
Motor learning is preserved!
But - variability in practice schedules & environments impedes learning
use drill & block schedules
closed, stable environments
Also true for patients post-TBI (esp early) and patients with moderate to severe mental retardation
94
As PT’s we should use the principles of motor learning to improve patient treatments and maximize the effectiveness of our treatments
Recognize the stage of learning for each task to be learned
Match the type of practice & feedback to the learner’s level for each task
Change practice and feedback methods as the learner improves
