Motor Learning Strategies Research Articles

Neural-Targeted Rehabilitation Strategies to Restore Typical Activation after Joint Injury.

In patients with musculoskeletal injury, changes have been observed within the central nervous system that contribute to altered movement planning. This maladaptive neuroplasticity potentially explains the clinical disconnect where residual neuromuscular dysfunction and high rates of reinjury that are often observed even after individuals clear return-to-activity functional testing. An improved understanding of these neural changes could therefore serve as a guide for facilitating a more complete recovery and minimizing risk of re-injury. Therefore, we propose a paradigm of neural-targeted rehabilitation to augment commonly used therapeutic techniques targeting sensorimotor function in order to better address maladaptive plasticity. While most treatments have the capability to modify neural function, optimizing these treatments and combining them with integrative therapies (e.g. implementation of motor learning strategies, transcranial direct current stimulation) may enhance neural efficiency and facilitate return-to activity in patients with musculoskeletal injury. To complete this model, consideration of affective aspects of movement and associated interventions must also be considered to improve the durability of these changes.

Assessment of the Teaching Strategies in Macro Motor Learning and Skill Display of the Primary Physical Education Curriculum

Instructional methods in physical education (PE) tend to be conceptualized in different approaches. This paper attempted to describe the level of academic achievement of third graders in the macro skills of motor learning and skill display and assumes significant differences in variables to propose some teaching strategies for improving motor learning and skill display skills. The results of the National Motor Learning and Skill Display Test revealed that 58.90% of students scored within the 81% to 90% range. The assessment of teaching strategies showed that overall, the strategies had a mean of 3.05 and a standard deviation of 0.83. The chi-square test for association between gross motor learning and teaching strategies was significant (Χ2 = 89.22, p = 0.00). The "Enhanced Motor Skills through Strategic Teaching (EMST) Program" is recommended to improve motor skills through effective teaching strategies.

Effects of a highly intensive balance therapy camp in children with developmental coordination disorder – An intervention protocol

BackgroundChildren with Developmental Coordination Disorder (DCD) often (<87 %) experience postural control problems, impacting all levels of the International Classification of Functioning, Disability and Health (ICF) including their daily participation, self-esteem and mental health. Due to the multisystemic nature of postural control, comprehensive therapy should target all systems which is currently not the case. Highly intensive therapy is effective and commonly used in pediatric populations, but has not been explored yet to train postural control in children with DCD. AimsTo investigate the effects of a highly intensive functional balance therapy camp at all ICF levels in children with DCD. Methods and proceduresThe effects on postural control, muscle activity, brain alterations, self-perceived competence, self-identified goals, gross motor activities and participation are evaluated. Participants are assessed pre- and post-intervention, including a 3 months follow-up. Forty-eight children with DCD, aged 6–12 years old, receive 40 h of comprehensive balance training. This intervention is fun, individually tailored, targets all postural control systems, implements different motor learning strategies and includes both individual and group activities. ConclusionNovel insights into the effects of a highly intensive comprehensive balance therapy camp designed for children with DCD will be gained at all levels of the ICF.

How do paediatric physical therapists teach motor skills to children with Developmental Coordination Disorder? An interview study.

When teaching motor skills, paediatric physical therapists (PPTs) use various motor learning strategies (MLSs), adapting these to suit the individual child and the task being practised. Knowledge about the clinical decision-making process of PPTs in choosing and adapting MLSs when treating children with Developmental Coordination Disorder (DCD) is currently lacking. Therefore, this qualitative study aimed to explore PPTs' use of MLSs when teaching motor skills to children with DCD. Semi-structured individual and group interviews were conducted with PPTs with a wide range of experience in treating children with DCD. A conventional content analysis approach was used where all transcripts were open-coded by two reviewers independently. Categories and themes were discussed within the research group. Data were collected until saturation was reached. Twenty-six PPTs (median age: 49 years; range: 26-66) participated in 12 individual interviews and two focus-group interviews. Six themes were identified: (1) PPTs treated children in a tailor-made way; (2) PPTs' teaching style was either more indirect or direct; (3) PPTs used various strategies to improve children's motivation; (4) PPTs had reached the optimal level of practice when children were challenged; (5) PPTs gave special attention to automatization and transfer during treatment; and (6) PPTs considered task complexity when choosing MLSs, which appeared determined by task constraints, environmental demands, child and therapist characteristics. PPTs' clinical decision-making processes in choosing MLSs appeared strongly influenced by therapist characteristics like knowledge and experience, resulting in large variation in the use of MLSs and teaching styles to enhance motivation, automatization, and transfer. This study indicates the importance of the level of education on using MLSs to teach children motor skills, and clinical decision-making. Future research should focus on implementing this knowledge into daily practice.

Development and content validation of the Upper Limb-Motor Learning Strategy Tool for cerebral palsy

Purpose To describe the development and content validation of the Upper Limb-Motor Learning Strategy Tool (UL-MLST) that aims to guide clinicians on how to implement and document the motor learning strategies used in the upper limb therapy approaches for children with cerebral palsy. Methods The study consists of two main stages (1) item generation and development and (2) content validation and refinement. The UL-MLST Online Training Program, Manual and Checklist were developed by the authorship group in stage one. In stage 2, two experts evaluated the UL-MLST regarding the Relevance, Coherence, and Significance of the individual strategies and whether the tool is Relevant, Comprehensive, and Clinically useful. Results Of sixty-two strategies included in the UL-MLST, 52 strategies were rated as being either “Moderately” or “Highly” Relevant, Coherent, and Significant. Ten strategies did not achieve mutual agreement; however, they did not meet the criteria for deletion and were revised according to expert feedback. Overall, the UL-MST was judged to be Relevant, Comprehensive, and Clinically useful. Conclusions The UL-MLST provides a valid tool to support clinicians in the implementation of the motor learning strategies for children with cerebral palsy. IMPLICATIONS FOR REHABILITATION The Upper Limb- Motor Learning Strategy Tool (UL-MLST) Online Training Program, Manual, and Checklist provide a comprehensive package of resources to support the application of motor learning strategies in upper limb therapy for children with cerebral palsy. The UL-MLST provides clinicians with a valid tool for self-appraising the implementation of motor learning-based therapies. The tool has the potential to improve fidelity, enhance the quality, and ensure consistency of evidence-based, task-focused approaches of therapy.

Using interactive computer play in physical therapy and occupational therapy clinical practice: an explanatory sequential mixed methods study.

This study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians' perceptions of their therapeutic role in the system's use as an intervention tool. In this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I-III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians' perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches. Bootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians' perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged. Bootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use.

Effectiveness of task-specific training for improving balance performance in children with cerebral palsy (CP): a narrative systematic review

IntroductionA body of research has focused on helping children with disabilities stay physically active. As poor balance has been found as a major limitation in physical activities, a systematic review exploring balance intervention programs is warranted.MethodsThe primary aim of this is to systematically evaluate evidence for the effect of task-specific training to improve balance outcomes in ambulant children with cerebral palsy. Seven databases were searched for studies involving ambulant children with cerebral palsy (4–15 years old); balance TST; and balance-related outcomes. The quality of the studies was appraised using the JBI Critical Appraisal Checklists for risk of bias, study design, and quality of evidence. Continuous data were transformed and summarised using standardised mean difference and 95%CI.ResultsSeven randomised controlled trials met the inclusion criteria. The risk of bias was deemed low in most of the studies. Due to heterogeneity of study design and outcome measures, a narrative synthesis was conducted. Positive between-group effects favouring TST were found across the six studies (BBS d = 1.528, 95% CI = 0.7747–2.2813) and follow-up (BBS d = –1.667, 95% CI = –2.459 ÷ –0.874). Despite poor reporting of motor learning strategies, repetitive practice, feedback, and task modulation strategies were used consistently in balance TST.ConclusionsTST could be recommended to be a part of an intervention programme to improve balance performance in children with CP. However, more studies with rigorous study design and adequately powered implementation of a more fun task-oriented training programme are needed.

Clinicians’ perspectives on motor learning strategy selection and application in occupational therapy and speech-language pathology interventions for children with acquired brain injury

Purpose Explore occupational therapists’ (OTs) and speech language pathologists’ (SLPs) process of selecting and applying motor learning strategies (MLS) in their interventions for children with acquired brain injury (ABI), and identify similarities and differences between OTs and SLPs in MLS selection and application. Methods This qualitative descriptive study involved individual semi-structured interviews with OTs and SLPs from the ABI program at Holland Bloorview Kids Rehabilitation Hospital (Toronto, Canada). Interviews were analyzed using thematic analysis. A modified constant comparison method permitted comparison within and between professions. Results Four OTs and three SLPs were interviewed. Four themes were developed: aligning MLS application with the child’s cognitive ability, using MLS to promote success within a single session, adjusting MLS across treatment sessions, and promoting generalization and transfer of motor skills beyond the therapy session. MLS application was predominately based on child-specific factors with task-specific considerations. OTs and SLPs used similar clinical reasoning processes for selecting and applying MLS. Conclusions This study provides a greater understanding of OTs’ and SLPs’ clinical reasoning process when applying MLS in pediatric ABI interventions. The similarities in MLS selection and application between disciplines suggest that an interprofessional approach to MLS is suitable for pediatric ABI rehabilitation.

Early Gains in Motor Learning Measured Through Two Coordination Tests: A Retrospective Analysis of Gender Differences

Motor skills can be improved through rapid on-the-job training or slower multi-session learning. The objective of this study was to determine the rapid learning differences between male and female university students during the execution of two motor coordination tests. Available data from 716 female and 331 male college students were retrospectively analyzed. The female participants had a mean age (±SD) of 19.6 (±1.55) years, while the male participants recorded a mean age of 19.8 (±1.87) years. Data were collected using two motor coordination tests, each performed in triplicate. The statistical method used in this analysis was mixed-model ANOVA. The interaction effect of gender and number of attempts was statistically significant for both motor coordination tests (F=12.446; p&lt;0.01; η2p=0.13 &amp; F=11.169; p&lt;0.01; η2p=0.01). Post-hoc testing showed that males performed better at the tasks in all three runs, and both genders improved their performance in subsequent trials. However, females showed a larger relative improvement from trial to trial than did males. The two coordination tests yield similar results. The observed differences in improvements in the coordination tests may be attributed to different motor learning strategies and cognitive processing between the sexes.

Implicit Motor Learning Strategies Benefit Dual-Task Performance in Patients with Stroke.

Background and Objectives: In stroke rehabilitation, the use of either implicit or explicit learning as a motor learning approach during dual tasks is common, but it is unclear which strategy is more beneficial. This study aims to determine the benefits of implicit versus explicit motor learning approaches in patients with stroke. Materials and Methods: Seventeen patients with stroke and 21 control participants were included. Motor learning was evaluated using the Serial Reaction Time Task (SRTT) in the context of dual-task conditions. The SRTT was conducted on two separate days: one day for implicit learning conditions and the other day for explicit learning conditions. Under the explicit learning conditions, a task rule was given to the participants before they started the task, but not under the implicit learning conditions. Learning scores were calculated for both implicit and explicit learning, and these scores were then compared within groups for patients with stroke and controls. We calculated the difference in learning scores between implicit and explicit learning and conducted a correlation analysis with the Trail Making Test (TMT) Parts A and B. Results: Learning scores on the SRTT were not different between implicit and explicit learning in controls but were significantly greater in patients with stroke for implicit learning than for explicit learning. The difference in learning scores between implicit and explicit learning in patients with stroke was correlated with TMT-A and showed a correlation trend with TMT-B. Conclusions: Implicit learning approaches may be effective in the acquisition of motor skills with dual-task demands in post-stroke patients with deficits in attention and working memory.

Can self-assessment and augmented feedback improve performance and learning retention in manual therapy: results from an experimental study

BackgroundThe purpose of this study was to investigate how feedback and self-assessment strategies affect performance and retention of manual skills in a group of chiropractic students.MethodsSeventy-five students participated in two spinal manipulation (SM) learning sessions using a force-sensing table. They were recruited between May and November 2022 during HVLA technical courses. Students were randomly assigned into three different groups: participants in group 1 received visual feedback, those in group 2 received visual feedback after self-assessment, and participants in group 3 (C) received no feedback. During the first session, participants started with one block of 3 familiarization trials, followed by two blocks of 6 SM HVLA (high velocity low amplitude) posterior-to-anterior thoracic SM trials, with 3 trials performed with a target force of 450 N and 3 others at 800 N. They received feedback according to their group during the first block, but no feedback was provided during the second block. All participants were invited to participate in a second session for the retention test and to perform a new set SM without any form of feedback.ResultsResults showed that visual feedback and visual feedback in addition to self-assessment did not improve short-term SM performance, nor did it improve performance at the one-week retention test. The group that received visual feedback and submitted to self-assessment increased the difference between the target force and the peak force applied, which can be considered a decrease in performance.ConclusionNo learning effects between the three groups of students exposed to different feedback and self-assessment learning strategies were highlighted in the present study. However, future research on innovative motor learning strategies could explore the role of external focus of attention, self-motivation and autonomy in SM performance training.

Understanding implementation of a complex intervention in a stroke rehabilitation research trial: A qualitative evaluation using Normalisation Process Theory.

The Implicit Learning in Stroke study was a pilot cluster randomised controlled trial, investigating the use of different motor learning strategies in acute stroke rehabilitation. Participating Stroke Units (n = 8) were from the South East/West regions of the UK, with the experimental intervention (implicit learning) being delivered by clinical teams. It required therapists to change how they gave instructions and feedback to patients during rehabilitation. This paper reports the processes underpinning implementation of the implicit learning intervention. The evaluation aimed to i) understand how therapists made sense of, engaged with and interpreted the effects of the intervention; ii) compare this to the experience reported by patients; iii) extrapolate learning of broader relevance to the design and conduct of research involving complex interventions in stroke rehabilitation. Qualitative evaluation, with data collected through focus groups with clinical staff (n = 20) and semi structured interviews with people with stroke (n = 19). Mixed inductive and theory driven analysis, underpinned by Normalisation Process Theory. How therapists made sense of and experienced the intervention impacted how it was implemented. The intervention was delivered by individual therapists, and was influenced by their individual values, beliefs and concerns. However, how teams worked together to build a shared (team) understanding, also played a key role. Teams with a more "flexible" interpretation, reported the view that the intervention could have benefits in a wide range of scenarios. Those with a more fixed, "rule based" interpretation, found it harder to implement, and perceived the benefits to be more limited. Therapists' concerns that the intervention may impair therapeutic relationships and patient learning were not reflected in how patients experienced it. Changing practice, whether in a research study or in the "real world", is complex. Understanding the process of implementation is crucial to effective research delivery. Implementation frameworks facilitate understanding, and subsequently the systematic and iterative development of strategies for this to be addressed. How teams (rather than individuals) work together is central to how complex interventions are understood and implemented. It is possible that new complex interventions work best in contexts where there are 'flexible' cultures. Researchers should consider, and potentially measure this, before they can effectively implement and evaluate an intervention. Clinical Trials - NCT03792126.

Experts' perspectives on how to promote implicit and explicit motor learning in children: A mixed-methods study.

Little is known about how motor learning strategies (MLSs) can promote implicit and explicit motor learning processes. This study aimed to explore experts' perspectives on therapists' use of MLSs to promote specific learning processes in children with and without developmental coordination disorder (DCD). In this mixed-methods study, two consecutive digital questionnaires were used to ascertain the opinions of international experts. Questionnaire 2 explored the findings of Questionnaire 1 in greater depth. In order to reach a certain level of agreement about the classification of MLSs as promoting either (more) implicit or (more) explicit motor learning, 5-point Likert scales were used in addition to open-ended questions. The open-ended questions were analysed with a conventional analysis approach. Open coding was performed by two reviewers independently. Categories and themes were discussed within the research team, taking both questionnaires as one dataset. Twenty-nine experts from nine different countries with different backgrounds in research, education and/or clinical care completed the questionnaires. The results of the Likert scales showed large variation. Two themes emerged from the qualitative analyses: (1) Experts found it difficult to classify MLSs as promoting either implicit or explicit motor learning, and (2) experts stressed the need for clinical decisionmaking when choosing MLSs. Insufficient insight was gained into how MLSs could promote (more) implicit or (more) explicit motor learning in children in general and in children with DCD specifically. But this study demonstrated the importance of clinical decisionmaking to model and adapt MLSs to child, task and environment, with therapists' knowledge of MLSs being an important prerequisite. Research is needed to better understand the various learning mechanisms of children and how MLSs can be used to manipulate these mechanisms.

운동학습의 운동처리과정과 운동학습 전략에 대한 이해

The human has the capacity to learn motor skill through practice and experience. The acquisition and long-term memory of motor skills play a fundamental role in our daily lives. Skills such as writing, riding a bicycle or playing tennis are all acquired through repetitive practice. Motor learning refers to the brain information process by which movements are executed more quickly and accurately with practice. In particular, the cerebral cortex plays an important role in motor skill learning. So, this article reviewed the basic principles underlying the neural basis of motor skill learning and a role of cerebral cortical in the motor learning process. In addition, the review focuses on factors that have been shown to enhance the learning of motor skills. Thus, this article contribute to the understanding of information process in cerebral cortex and motor learning strategy in motor skill and can be used guidelines for choosing effective motor learning method for individuals.

ACL Research Retreat IX March 17–19, 2022 High Point, NC

ACL Research Retreat IX March 17–19, 2022 High Point, NC

Nicotinic acetylcholine signaling is required for motor learning but not for rehabilitation from spinal cord injury.

Therapeutic intervention for spinal cord injury is limited, with many approaches relying on strengthening the remaining substrate and driving recovery through rehabilitative training. As compared with learning novel compensatory strategies, rehabilitation focuses on restoring movements lost to injury. Whether rehabilitation of previously learned movements after spinal cord injury requires the molecular mechanisms of motor learning, or if it engages previously trained motor circuits without requiring novel learning remains an open question. In this study, mice were randomly assigned to receive intraperitoneal injection with the pan-nicotinic, non-competitive antagonist mecamylamine and the nicotinic α7 subunit selective antagonist methyllycaconitine citrate salt or vehicle (normal saline) prior to motor learning assays, then randomly reassigned after motor learning for rehabilitation study post-injury. Cervical spinal cord dorsal column lesion was used as a model of incomplete injury. Results of this study showed that nicotinic acetylcholine signaling was required for motor learning of the single pellet-reaching task but it was dispensable for the rehabilitation of the same task after injury. Our findings indicate that critical differences exist between the molecular mechanisms supporting compensatory motor learning strategies and the restoration of behavior lost to spinal cord injury.

An Examination of Trunk and Right-Hand Coordination in Piano Performance: A Case Comparison of Three Pianists.

Playing the piano at expert levels typically involves significant levels of trial-and-error learning since the majority of practice occurs in isolation. To better optimize musical outcomes, pianists might be well served by emulating some of the practices found in sports, where motor learning strategies are grounded in biomechanics and ergonomics in order to improve performance and reduce risk of performance-related injuries. The purpose of the current study is to examine trunk-hand coordination and preparatory movement strategization in piano performance, while considering the influence of anthropometry, skill level of the performer, and musical context. Using a ten-camera motion capture system, movement of C7 and right-hand distal phalanges was tracked at three different playing speeds during performance of an excerpt from Beethoven’s “Appassionata” Sonata. There were three participants: two males and one female of differing anthropometric characteristics and skill levels. Motor strategization was examined. Expertise influenced starting trunk position: Initiation intervals and trunk range of motion (ROM) both suggested anthropometry to be a performance factor. For the shortest performer, trunk movement appeared to be used as an efficiency measure to compensate for a shorter arm reach. Skill level was revealed by examining right-hand velocity at the fastest tempo. The current study hypothesizes that an examination of proximal-to-distal preparatory strategies in terms of anthropometry and skill level can help to optimize motor learning for pianists. To realize piano performance as a whole-body skill and encourage healthy practice, pedagogy needs to educate learners regarding fundamental biomechanical and ergonomic principles, movement optimization, and movement strategization in the service of artful performance.

Effective Attentional Focus Strategies after Anterior Cruciate Ligament Reconstruction: A Commentary.

Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR.Level of Evidence5

Implicit motor learning strategies in people with Parkinson's: A scoping review of the literature

Purpose: Gait impairments in People with Parkinson's (PwP) are one of the most debilitating motor symptoms as they result in functional limitations of daily activities, and negatively impact the patient's quality of life. Emerging evidence suggests that implicit motor learning strategies may help to manage gait impairments. However, few attempts have been made to distinguish which commonly used strategies implicit strategies could be considered. Also, little effort has been made to evaluate the evidence for their efficacy.

Development of a vibrotactile cueing device that implicitly increases walking speed during gait training in stroke patients: an observational case series study

One of the main sequelae of stroke is difficulty walking, which is characterised by decreased walking speed and asymmetrical walking patterns. Physical therapists often rely on explicit motor learning strategies, i.e., providing mainly verbal instructions for how movements should be performed. However, the voluntary movement induced by explicit instruction may lead to associated unintended muscle contractions or higher cognitive demand, which could be detrimental. We introduce a vibrotactile cueing device that implicitly improves walking speed. The stroke patient walks while alternating vibrational cues are given to the left and right sides of their waist. At each specified step, cueing frequency increases in the cueing group without the patient’s awareness. The four patients in the cueing group did not notice the increase in walking speed during training; however, we observed an improvement in walking speed and cadence in patients using the proposed cueing system, which was maintained during the posttest phase. Additionally, patients using the cueing system were able to suppress excessive compensatory movements during training compared with patients who did not use the system. This case series study indicates that the proposed system for gait rehabilitation of stroke patients can enable an increase in walking speed without excessive effort.