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Motor Learning: A Very Brief Introduction

Motor learning is defined as “permanent changes in motor skills  achieved with practice or experience, that can be retained, transferred, and/or generalized to new learning situations” (Schmidt, 2005, cited in Levac, et al, 2013). Let’s break down this definition with respect to school-based practice.

That motor learning can be “achieved with practice and experience” highlights the role therapy services have in our schools. We can set up opportunities for our students with disabilities to practice a skill throughout the school week. Although this can be done via direct intervention, such opportunities can be multiplied if we educate the school staff and modify the school environment to allow the student to apply the skill during the school day. 

  • For example, if picking up objects is a desired outcome, some of the student’s art materials can be placed in lower bins, and the art teacher can be educated to provide the right cues for the student to complete the task of bending, reaching and retrieving.

The other important aspect of this definition, “permanent changes in motor skills,” means that the student performing well during therapy sessions is not enough. We should aim for our students to have the ability to perform the task in everyday situations.

There are many ways that we may observe learning:

  • Acquisition – during practice sessions, we can observe and record the level at which the student is able to acquire the skill
    • e.g., observing that the student is improving his speed and safety with repetition during practice ascending and descending the stairs in the same direction as other children
  • Retention test – conducted after a certain amount of time after practice, this tests whether the performance of the same task is retained or can be replicated
    • e.g., when tested a week later the student above showed improved speed and safety ascending and descending the stairs in the same direction as other children
  • Transfer test – conducted by asking the subject to perform a different task where skills learned during practice may be applied  
    • e.g., when tested a week later, the student above is able to ascend and descend the stairs safely and with appropriate speed while other children are headed in the opposite direction; or the student above is able to ascend and descend bus steps safely and with the appropriate speed

There are 2 interesting caveats to note. First, acquisition of a skill during practice does not constitute permanent changes. It is a temporary learning of the skill. Permanent change is demonstrated by testing retention and transfer of skills. Transfer of skill is superior to retention, since it indicates that the child is able to apply the skill, and the problem-solving that comes with the learning, into other situations.

Second, acquisition of a skill during practice does not guarantee retention and transfer of the skillWilliams & Hodges (2005) noted how focusing on acquisition of skill during practice can be tempting since one can readily observe improvement. However, as you will read in this series of SeekFreaks articles on motor learning, strategies for immediate acquisition of skills compared to strategies for retention and transfer of skills can be contradictory. Consequently, focusing on the immediate rewards of strategies to improve during a practice session can be detrimental to learning that results in permanent changes. [This can be an issue if you have problems with delayed gratification like some of the 4-year olds in the classic Marshmallow Experiment. Pause here, click on the link and watch the video if you need a good 3-minute laugh.]

What can this mean for therapists? Have patience – strategizing based on the child’s response during training can be misleading. Apply motor learning principles, and monitor the child’s responses via retention and, especially, transfer tests.   

A final note on permanent changes: Kleim & Jones (2008) stated that the permanent changes that motor learning brings is not limited to observable behavior. Neurological studies have shown changes in the brain itself. Motor learning stimulates growth, activity and interconnections within the brain. We will be referring to their article throughout this series of motor learning articles

Achieving Motor Learning

Certain principles have been shown to promote retention and transfer of skills, such as verbal instruction, demonstration, feedback, specificity, variability, reduction of difficulty, motor imagery practice, salience, and others. Although, most of these principles were gleaned from studies with adults, there is increasing research on motor learning in the field of pediatrics.

There are many nuances and components for each of these principles, so we will tackle them in four articles, each focusing on 2 or 3 principles at a time. The Motoropoly board SeekFreaks created will serve as our guide. By the end of the 4 articles, you will have a complete board that you can refer to for guidance. 

This is not an exhaustive list of motor  learning principles. I narrowed them down to the most studied and applicable to school-based practice. I will cite many references throughout that I hope you will find time to read. Since the motor learning literature is rich, I will surely miss many of them. I invite you to join the discussion by sharing them in the comment box below. Finally, this article is for practical guidance, so there are many motor learning topics that will not be covered. I refer you to the many motor learning books for more in depth discussions.

Let’s kick it off with a deep dive into verbal instructions, feedback and demonstrations. Remember, these are just 3 of many principles that interact with each other to promote motor learning.

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Verbal Instruction and Feedback

Let’s discuss verbal instruction and feedback together since they are very much related and, at times, overlapping. Feedback may include verbal instructions, and vice versa. As such, lessons learned from research often apply to both.

There are many elements to providing instructions and feedback that are essential for a school-based practitioner to know. Certain words, phrases or statements may hinder learning, while others promote it. We will look into research to answer questions such as: Is it beneficial to ask the child to focus on their body parts when they are performing a task? Is too much feedback detrimental to performance?

Painting a visual picture of the task

We all know that when providing instructions that we need to be cognizant of the child’s capacity to attend, understand and remember the whole instruction, especially a child with cognitive disabilities. One can easily be carried away with a long instruction to include all the details of the task (- I am reminded here of the instruction for the 6-minute push test that takes me at least 50 seconds to read). However, being concise might be more helpful.

Better yet, Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) suggests  providing verbal instructions that “describe a visual metaphoric image “ of the task and how it is performed. They gave the example of hopping “like a bunny”, instead of describing all the components of hopping. This certainly decreases the number of words needed. Woo, et al (2014) described it as reducing multiple task-relevant rules into one “analogical rule.” By using a familiar image, we can paint a visual picture that the child can use as a model for task performance.

Take-away: Do not be bogged down in details. Choose a familiar image that you can use to paint a visual picture of the task.

Sharing Knowledge

Niemeijer, et al (2003) observed physical therapists working with children with developmental coordination disorder (DCD) using neuromotor task training (NTT) to create the Motor Teaching Principles Taxonomy (MTPT). The study yielded a 3rd category of therapist verbalizations that did not fit neatly under either verbal instruction or feedback. They termed this 3rd category “sharing knowledge.”

In a follow-up article based on the same study, Niemeijer, et al (2006) found that 3 “sharing knowledge” principles correlated with improved motor performance:

  • explaining why it is better to execute a movement in a certain way,
  • providing rhythm or timing, and
  • asking whether the child understands the movement task

Though the MTPT focused only in the use of NTT for children with DCD, it’s a great read for reviewing verbal principles that you can utilize. As it relates to DCD, the 2nd study cited also explains which strategies are more effective for children with DCD.

Take-away: Conversations with the student to share knowledge can be helpful in improving motor learning.  

Focusing on one’s body movement or focusing on the goal?

The constrained action hypothesis  was put forth by Wulf, et al (2001) to explain their findings that the focus of attention does affect performance and learning in typically developing adolescents and adults.

  • Internal focus of attention
    • Asking the individual to focus on the movement of his/her own body when performing a task
      • For example: “Focus on your arm movement while throwing the ball” or “Focus on shifting your weight to your right foot”
      • It results in:
        • A conscious type of control
        • Constraining the motor system by interfering with automatic control processes
        • Poorer skill performance, retention and transfer
  • External focus of attention
    • Asking the individual to focus on the outcome, the movement effect, or anything external (i.e., other than the individual’s body parts) when performing a task
      • For example: “Focus on the ball as you throw it towards the target” or “Focus on pushing against the ground with your foot.”
    • It results in:
      • A more automatic mode of control
      • Better skill performance, retention and transfer

The same influences of foci of attention were eventually found in children with typical development. Chiviacowksy, et al (2013) then studied whether the same is true for children with intellectual disabilities. They divided 24 children into 2 groups. The practice task involved throwing beanbags overhand (with the dominant hand) at a bulls’ eye target 2 meters away from the child. The child scores 100 points if they hit the bulls’ eye; or 90, 80, 70,.., 10, or 0 points, respectively, if they hit within the outer concentric circles. Scores were then averaged for each group.

One group was asked to focus on the movement of their throwing hands (internal focus), while the other to focus on the movement of the beanbag while throwing (external focus). Performing 5 blocks of 8 throws each, both groups’ accuracies improved. The external focus group scored higher, but not significantly higher than the internal focus group.

The superiority of using external over internal focus became more pronounced 1 day later when the retention and transfer tests were conducted. The retention test showed significantly higher scores for the external focus group (average of 60.2) than the internal focus group (average of 50.2).

An even bigger difference was shown during the transfer test, where the children were asked to throw from farther away (3 meters). As expected with the increased distance, both groups’ accuracies decreased. But the external focus group’s score decreased down to 56.3, while the internal focus group’s score dropped precipitously to 38.4.

Perhaps an additional benefit of an external focus of attention is that it avoids the prescriptive nature of an “internal focus” instruction to move one’s body in a specific way. The external focus may allow students with disabilities to problem solve the task, and reach the outcome using the abilities their body affords them.

Take-away: Choose your words carefully. Ask the child to focus on the effect of the movement, not on the body movement itself.

When is it time to shut up?

Salmoni, et al (1984), critically appraising multiple studies in adults, found that providing external knowledge of results (KR) can be motivating and can provide guidance to enhance performance. However, they also found that KR given after every trial is detrimental to retention of skills; too much externally-provided KR causes a reliance on the feedback while discouraging the individual’s ability to detect error intrinsically.

However, different results were found in children. Feedback after every trial resulted in better learning, when compared to less feedback. Sulivan, et al (2008) explained the difference using the challenge point framework.  

This framework, in essence, points out the intuitive idea that an optimal level of challenge will result in learning. Too hard or too easy, and learning does not occur. There are many factors that affect the level of challenge: age, feedback and experience may be some of them. Adults may require less feedback to make an activity “just right” challenging; children may require more feedback to reach the “just right” level. Less feedback is also needed with experience as the challenge itself reaches the “just right” level. 

Let’s focus on age and feedback so we can discuss one of my favorite studies!

With the challenge point framework in mind, Sidaway, et al (2012) studied whether the difficulty of the task itself affects the amount of external KR children need to learn. The task involves throwing beanbags overhand over a barrier to an unseen target on the floor. As designed by the authors [yes, these italics are important and intentional], 48 children were assigned into 4 groups as follows:

  • S100: “Easy” task of throwing while standing, receiving feedback of accuracy after every trial (100% of the time)
  • S33: “Easy” task of throwing while standing, receiving feedback of accuracy after 1 of every 3 trials (33% of the time)
  • W100: “Hard” task of throwing while walking, receiving feedback of accuracy after every trial (100% of the time)
  • W33: “Hard” task of throwing while walking, receiving feedback of accuracy after 1 of every 3 trials (33% of the time)

Retention and transfer tests were conducted 1 week later. The transfer test required the children to throw underhand instead of overhand.

The results were surprising! Children in the walking groups scored generally better in all the tests compared to the standing groups. Children in the standing groups required higher feedback frequencies, whereas children in the walking groups required lower feedback frequencies. No typos here! What happened?

This is where this study became one of my favorites. The walking group had to walk and throw the beanbag as they pass a line on the floor that is 2 meters away from the barrier. To ensure similar time interval between trials, the researchers asked the standing group to walk towards the same line 2 meters away from the barrier, stop and throw the beanbag while standing. This begs the question, which of the 2 task is easier?

The authors explained that, in hindsight, the second is more cognitively taxing than the first, since it adds the task component of stopping at the line.

Lessons learned:

  1. Even the well-intentioned therapist can make a task harder when the objective is to make it easier. This reminds each of us to think about whether the modification we are injecting to the task actually makes it, not just physically, but cognitively easier or harder.
  2. The challenge point framework holds true for children. Easier task requires less feedback, harder tasks require more. [Sigh of relief…the world is all right after all, and we can all breathe easier now.]

Take-aways: Modify tasks thoughtfully to achieve the right amount of challenge. Grade your feedback to provide more for harder tasks, and less for easier tasks. Fade feedback with time.

Timing your feedback

Avila, et al (2012) summarized the benefits of providing feedback after relatively successful trials (instead of, after trials with large errors). They include:

  • ↑ perception of competence
  • ↑ self-efficacy or self-confidence
  • ↑ intrinsic motivation
  • ↑ movement automaticity
  • ↑ interest in the task
  • ↓ concern about one’s ability
  • ↓ nervousness
  • ↑ motor performance and learning

This is a reminder that feedback does not just provide information on the success of one’s performance, but it also provides motivation. Does this mean that we should not provide feedback about errors? Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) pointed out that feedback on errors provide information that can facilitate learning, while feedback on correct aspects of performance is more motivational.

How can a school-based therapist apply these seemingly incongruent information? First thing to note is timing. I would recommend providing more feedback when the student is relatively successful. When providing feedback, include feedback with positive information, and some constructive feedback on the errors of performance. This begs the question, how much of each should be provided?  

Consider the level of motivation, nervousness and self-competence of the student, and gauge the relative proportion of feedback on correct aspects and errors in performance that you will provide. A child who is very unmotivated, nervous and lacking self-competence can initially receive mostly, if not all, feedback on correct aspects of performance. Then, feedbacks on errors are introduced as the child is gaining motivation, self-competence and improved motor performance.  

Take-away: Feedback provides both information and motivation that affects learning. Feedback given during relatively successful performance promotes motor learning.

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Demonstration

Is demonstration better than verbal instructions?

Demonstration often serves as a solution when providing verbal instructions can be cumbersome, both for the instructor and the learner. While verbal instructions can “paint a picture” of the task, demonstration shows the actual task!

However, Williams & Hodges (2005) reported that, at times, demonstration is no better than verbal instructions. In fact, they cautioned that demonstration can also hinder learning. Showing the student the “ideal” manner of performing a task, may encourage the student to copy your exact movement and “adopt a movement pattern that may not be the most effective for him/her.” This is particularly poignant for our students with lifelong physical disabilities. Expecting them to copy your “ideal” body mechanics (intentionally or unintentionally) may constrain them from problem solving performance of the task within the context of their abilities.

One solution they offered is to demonstrate the outcome of the activity, instead of the performance of the activity (i.e., an external versus an internal focus of attention). For example, to demonstrate throwing a ball to a distant target, you can show the likely trajectory of the ball as it heads to the target.

In general, we should give much thought when determining the need for demonstrations. Use it only if it is absolutely needed.

Take-away: Demonstration can simplify instructions, but must be used with caution. Stick to simple verbal instructions when that will suffice.

Modeling by peers

Demonstrations can also come from the student’s peers, also termed as modeling or observational practice. This highlights the importance of interventions in the natural setting and in groups where the student can benefit from combining actual practice with observational practice (Wulf, et al2009).

Should you group or pair students with “experts” or “novice learners”? Lee, et al (1994) citing multiple studies suggested that each may be beneficial for different reasons. While the former provides information on the “ideal” movement, the latter engages the observer to problem solve performance of the task. Whether one is better than the other is still inconclusive. However, in line with the earlier discussion on the detriment of demonstrating “ideal” performance, Lee, et al (1994) and  Williams & Hodges (2005)  pointed to studies that showed better learning from observing novice learners than from experts. 

Take-away: Demonstration through observational practice can be provided via group intervention.

Video for demonstration and feedback

Now let’s bring the 21st century into this conversation. A majority of us now have smartphones that can take photos and videos. Why not use them? Here are some suggestions: 

  • Videos can be used to demonstrate the task. But recall the above discussions: is there a video that focuses on the outcome of the action (external focus), instead of on the ideal body movement (internal focus)?  
  • Videotape the student’s own performance, but don’t forget that showing novice learners relatively successful trials can potentially enhance both learning and motivation, more than showing trials with larger errors. 
  • Use videos to share knowledge, not just to provide instructions or feedback.
  • Regularly scheduled video recording can be used to show progress, which can motivate the student, family and other school personnel.
  • Videos can be used to demonstrate to family and school staff how to support the child (e.g., verbal cuing, manual assistance) during performance of specific tasks.

When using videos, take note of your school district’s policy. Most likely, you will need to secure written permission from parent/guardians to record the child, and from all school staff that will be on the video. When asking the family’s permission to record, don’t forget to discuss who are allowed to view the video.

Take-aways: Videos can be used to provide instructions and feedback. But don’t forget that the same principles that apply to face-to-face interaction may apply to videos.

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Final Words

Monitoring the student’s response is very important. Although the studies cited above gave suggestions, we do not know their efficacy for specific diagnoses (such as autism spectrum disorder, developmental coordination disorder, and others). Where no evidence applies directly to children with specific diagnoses, I recommend using the take-aways above as starting points. Monitor the student’s response, and adjust the type, amount and timing of your verbal instructions, demonstrations and feedback accordingly. Then don’t forget to fade the amount of instructions and feedback you provide with time.

In our next article on motor learning, we will discuss task specificity, difficulty and variability.

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Seeking your Views

How have you used the above principles?

Share other suggestions and/or studies on the above motor learning principles with your co-SeekFreaks.

Click here for Motoropoly 2: Specificity, Difficulty & Variability

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Readers of this article also read:

50 Alternatives to “Good Job!”

IEP 4.0 – Using Data and Collaboration to Develop a Clear PLEP

Article Review: A Service Delivery Model for Children with DCD

2 Tools to Promote Movement in the Classroom

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