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We return this week with our discussion of motor learning principles for school-based therapists. Whereas Motoropoly – Part 1 focused on the actions of the therapist (providing instructions, demonstrations and feedback), Parts 2 and 3 will discuss how to design the task to promote retention and transfers of skills.

Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) listed 3 factors that influence motor learning: the task, the person and the environment. Learning depends on the characteristics of each factor; as such, Gordon and Magill emphasize that there is no “one size fits all” approach.

3 Factors

Person includes intrinsic elements that may be structural (e.g., impairments) or functional (e.g., behavior, motivation). Environment includes the physical and the social environment.  Task involves the choice of the activity, the goal of the task, the rules, and the materials involved (Haywood and Getchell in Life Span Motor Development, 2009). These 3 factors interact with each other; hence, any change in one can affect the others, and the process of learning. This is good news! It means we have other tools that we can manipulate to influence learning, other than just focusing on the person.

For this article, we will discuss 3 task principles for designing practice of motor skills: specificity, difficulty and variability. They are very interesting to discuss together since they all seem contradictory at first glance; however, they are, in fact, complementary concepts that are best applied together.

Note that all motor learning principles are interconnected, so we will continue to bring back take-aways from Part 1, and pull knowledge from research that were cited in that article. Remember too that as we noted in the first article, when measuring “permanent changes,” it is important to focus on retention and transfer of skills, and not on the immediate rewards of improving performance during practice.

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Task Specificity

Despite being one of the oldest principles of motor learning, the importance of task specificity is still worth discussing. Teasell, et al (2008) defines task specificity as “practice of context-specific motor tasks” where the clients “receive some form of feedback.” Hubbard et al (2009) adds that in rehabilitation, this means “focusing on improvement in functional tasks through goal-directed practice and repetition.”

This highlights that just any kind of repetition won’t do. Kleim & Jones (2008) reviewed research on neuroplasticity resulting from motor learning, noting that positive effects such as increased neuronal activity, motor cortical territory and dendritic growth result from repetition of skilled movement, and much less from repetition of unskilled movement. They also add that such brain changes occurs in localized areas of the brain that corresponds to the motor learning activity (with only subtle, if any, effects in other areas), further supporting the principle of task specificity.

Provins (1997), studying the reason for handedness, stated that “motor skills tend to be specific to the particular neuromuscular resources that are habitually employed in their execution.” As such, performing the same task over and over, let’s say opening a specific door at home or utilizing a specific kitchen utensil with the left hand leads to more efficient functioning of the left hand for that specific task. [On a personal note, I am often right-handed. But I am more accurate using the mouse with my left hand because I trained myself to do so to avoid overuse of my right hand!]

Here are some of the many studies in the field of rehabilitation that show support for task-specific training:

  • Walking: Sullivan, et al (2007) found body-weight supported treadmill training was significantly more effective than leg cycling training in improving walking speed, and maintaining this gain 6 months post-intervention. Moreover, there was no added benefit to an exercise regimen that alternated daily between treadmill training and lower extremity strengthening.  
  • Upper Extremity Function: Arya et al (2012) reported meaningful task-specific training to be significantly better in improving clinically-relevant upper extremity function compared to neurodevelopmental technique (NDT). The task-specific training included such activities as: bringing a glass to the mouth, arranging curtains in standing, opening doors, applying soap to various body parts, etc. If you can get hold of this full article, you can review the detailed training protocol they utilized in the study.
  • In Children: Gordon, et al (2007) described the successful use of Hand–Arm Bimanual Intensive Therapy (HABIT) in children with hemiplegic cerebral palsy. HABIT uses a task-specific intervention approach.

Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) stated that specificity requires the “need for comparable conditions in both practice and future performance conditions.” School-based practice presents us with plenty of such conditions. We are not confined to the rectangular box of a therapy room. Neither are we limited to blocks, cones, weights, a 4-step staircase and other implements within a therapy room.

Here are some considerations for school-based practice:

  • Task: Choose real world specific tasks over rote “unskilled” movement exercises.
  • Environment: Encourage practice of specific tasks in the environment where they naturally occur. For example, reaching high and low for materials within the classroom, carrying a lunch tray in the lunchroom, playing in the playground, etc.
  • Materials: Utilize actual school materials, instead of therapy room materials.  
  • Challenges: Take advantage of real-life obstacles, such as other children, classroom furniture and heavy doors.
  • Routine: Collaborate with teachers and other school staff to maximize task-specific practice integrated throughout the student’s daily routine (e.g., placing coats on hooks, transitioning from the classroom to another area of the school, participating in physical education activities).

Who needs to discuss carryover when real-life tasks are already being done within natural environments and situations, and in collaboration with school staff?!

Take-away: Maximize use of real-life situations, environment and materials when designing motor learning tasks.

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Reducing Difficulty

After reading about task specificity, you may be thinking that in my attempt to emphasize real-life practice, I am being unrealistic. Some children may not be ready to perform certain tasks at levels expected in real-life situations. You are correct! The above discussion is a necessary starting point so we can move forward to discussing other principles in designing tasks.

Sometimes our intuition can lead us astray (e.g., thinking that focusing on our bodies – internal focus of attention – is the best way to improve performance). Other times, our intuition proves to be true, such as the idea of reducing difficulty of a novel task to promote learning, which is supported by multiple studies. For our purposes as school-based therapists, Capio, et al (2011, 2013) has shown that reducing errors in the school environment, and reducing errors for a group of children with intellectual disabilities resulted in better retention and transfer of skills.

[Seekfreaks, note that, in place of reducing difficulty, researchers use the terms “reducing errors” and “error-free environment” (a misleading term, since chance of errors is minimized, not removed).]  

Since this makes intuitive sense, perhaps, what is more interesting is a discussion of the possible explanation why reducing errors is necessary for our students with disabilities. Capio, et al (2012), described 2 different approaches to motor learning:

  • Explicit motor learning approach
    • It is based on the belief that motor learning starts explicitly via cognitive processes.
      • It requires knowledge of rules of execution.
      • It generates declarative knowledge, whereby the learner is able to verbalize performance of the task.
    • With practice, movement becomes automatic and rely less on declarative knowledge.
  • Implicit motor learning approach
    • It is based on the belief that motor learning is predominantly non-conscious.
    • It occurs “without early dependence on working memory.”
    • It does not require passing through the declarative stage of learning.
    • Hence, it does not depend on age or intelligence.

It can be deduced that an implicit approach would be best suited for children with disabilities who have delayed cognition and verbal abilities.

Capio, et al (2012) further pointed out that implicit learning seems to be the reason why reducing difficulty works. Picture a sample of each approach on a new task:

  • Explicit approach
    • Task: The child is asked to throw a beanbag towards a small target.  
    • Recall our discussion of the challenge point framework, whereby an individual would require more feedback when performing a difficult task. Perhaps, you have to instruct the child on the best posture, the best arm movement, etc.
    • The child will have to process such information cognitively.
    • How well do you think a child with cognitive delay can process these information?
  • Implicit approach
    • Task: The child is asked to throw a beanbag towards a larger target (an easier version of the same task).
    • This promotes more success with minimal instructions and feedback.
    • This decreased need for instructions and feedback means you do not have to tax the child’s cognitive processes.
    • Does this sound like a better alternative for a child whose cognition is compromised?

This easier version of the task is just a starting point for training. Going back to the principle of task specificity, it is important to advance the child from this easier environment to progressively harder ones until the child is able to perform the task with real-life expectations or level of difficulty.

Take-away: When learning a new task, start with an easier version to decrease the cognitive demand of the task.  

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Task Variability

We now come to the most controversial of the three principles we are discussing in this article. While the principle of task variability has mostly held true in studies of adults and adolescents with typical development, study results have so far been mixed for children, especially those with disabilities.

Let’s start with the definition of task variability. As the term implies, it refers to variations of the task during practice of a skill. This is done, for example, by asking the child to throw at 3 targets of different distances (close, medium, far), or by asking a child to catch a ball thrown square to, to the left of, or to the right of the child within the same practice session. On the other hand, constant practice means practice of the skill with the same parameters during a practice session.

Variability can be introduced in a:

  • Block format  – e.g., dividing the task into 3 blocks of 10 throws, 1 for throwing to a close target, 1 for far, and the other for a medium-distance target
  • Random format – e.g., throwing the ball towards 3 targets with different distances that are presented randomly

Although task variability may seem to contradict the principle of task specificity, the 2 are actually compatible principles. Think about it…the natural environment is often unpredictable. Observe a PE class and you will notice that kids throw towards different directions and with different intensities. Though the task of catching a medium-sized ball can be specific, the directions and speeds of the balls approaching the child are variable. Thus, training that is both specific and variable has been shown to be better at motor learning than constant practice.

Why is variability beneficial? Practice variability introduces contextual interference, which happens when one practices a task alongside other tasks (Raisebeck, et al, 2015). This contextual interference requires an individual to constantly reconstruct performance of the novel skill. This reconstruction means the individual is repeatedly learning how to generate a new, slightly-different solution to accomplish the task. This has the effect of enhancing the individual’s ability to generalize his/her motor skills to similar tasks in different situations.

How much practice variability can be beneficial for students with disabilities?

As I mentioned earlier, studies in children have been inconsistent, with some supporting constant over variable practice, and blocked training over a random training format. Zipp & Gentile (2010) posited that novice learners (children, or even adults) deals with high intrinsic variability as they sort out how to move their bodies to accomplish a new task successfully. Thus, introducing high extrinsic practice variability can increase the challenge and difficulty of the task beyond the abilities of the child (think challenge point framework again!).

In the same paper, Zipp & Gentile reported that children and adults learning a new task performed better on retention and transfer tests after a blocked training format, compared to training with a random format. In this case, the lower variability inherent in the blocked format (compared to the random format) was the more appropriate amount of variability to result in better learning.

Williams & Hodges (2005), in their recommendations on soccer training for adolescents, explained that, although constant practice may seem beneficial for skill acquisition, variable practice has been shown to be better in skill generalization or transfer (the ultimate goal of motor learning!). They pointed out that coaches often start with and stay too long in constant practice despite a preponderance of research supporting variable practice. They suggest, not just variable practice, but random variable practice from the start to promote retention and transfer of skills.

What do we make of these mixed messages? There is limited information on variable practice in children with disabilities. I can only make suggestions based on what we have read so far. I hope that future studies can provide better guidance.

Considering that children with disabilities take more time in acquiring skills, that reducing errors enhances learning, and that “just the right challenge” are motivating, it is reasonable to start with a blocked format. You should then monitor the child’s response, and move to random practice as soon as possible.

When do you progress to random variable practice? Since each child is different, I suggest monitoring responses to the task with a focus on the child’s motivation level as the gauge for advancing towards more variation.

  • Introduce random variations and see whether the student continues to be motivated
  • Or, if the child’s motivation is decreasing with the blocked format, it may be possible that task is getting too easy (challenge point framework!), and it is time for more variations

Recall that performance level during practice may not be a good gauge to use; as discussed multiple times, acquisition is the wrong focus for motor learning. Additionally, since random practice requires more problem-solving and adjustments in performance, therapists should expect that the child would require more time to practice the skill before seeing improvement in performance level.  

Is there a number of variations that is enough? Pinheiro, et al (2015) demonstrated that in an upper extremity task, 3 variations is just as good as 6 variations when it comes to promoting “flexibility for adaptation in the motor skill.”

Combining blocked format with other motor learning principles

To tell you the truth, providing the above suggestions to delay random variable practicing does not sit well with my logical thinking. It is good that we have other tools to promote learning, other than just random variability.

Raisebeck, et al (2015) tested 4 groups of children as follows:

  • Random format with an internal focus of attention
  • Random format with an external focus of attention
  • Blocked format with an internal focus of attention
  • Blocked format with an external focus of attention

They found the fastest performance during a retention test came from the blocked format with an external focus of attention group. This study demonstrated that a blocked format can be made more effective if our earlier suggestion of using an external focus of attention is used. This reminds us that variability is just one of many tools that we have; we can combine multiple principles to enhance learning.

Take-away: Practice variation may help improve retention and transfer of motor skills. However, their applicability to children, especially those with disabilities, is still inconclusive. Monitor the child’s response to the task closely.

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Applying the 3 Principles Together

There are many obvious variables that you can manipulate to reduce the difficulty and to add variability to a specific task, such as:

  • Use of different environment
  • Number of participants or peers taking part in the activity
  • Number and types of physical obstacles
  • Speed
  • Directionality
  • Distance or height of target
  • Size of the goal or target
  • Size, shape  and make of material or object

You can also use Gentile’s Taxonomy of Motor Skills to determine the action component and environmental context of the specific task that the child will be performing. Then using the taxonomy, determine the variables that you can modify to reduce task difficulty and to introduce task variability.

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Final Words

It is worth repeating my final cautionary words from my first article on motor learning principles. Most studies on the principles above were conducted on adolescents and  adults without disabilities. Application of the concepts of implicit motor learning and practice variability to children with various diagnoses such as autism spectrum disorder, developmental coordination disorder, cerebral palsy and others is not clear. Where no evidence applies directly to children with specific diagnoses, we recommend using the take-aways above as starting points. Monitor the student’s response, and re-design the task as appropriate.

In our next article on motor learning, read about salience, frequency, and part vs. whole practice.

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Seeking Your Views

What is your own experience in introducing variability? How did the student respond?

How have you combined the 6 principles we have covered so far?

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