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We return to complete 3 more squares on our Motoropoly board. So far, we have tackled 6 motor learning principles: verbal instructions, demonstrations, feedback, task specificity, reducing difficulty, and practice variability. If you missed them, do read them first as we are building principles on top of principles! If you are all caught up, then let’s continue designing the task this week by discussing task salience, frequency, and whole vs. part practice.

Just to remind us of some of concepts that guided our previous discussions:

  • Permanent changes is measured by retention and transfer of skills, not the immediate rewards of improving performance during practice
  • There are 3 main factors that influence motor learning: the person, the task, and the environment.
  • Motor learning principles, such as the 3 we are discussing today, interact with each other and should be applied concurrently, where applicable,  to enhance learning

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Saliency refers to the importance or meaningfulness of a task to the learner. Kleim & Jones (2008), reviewing studies related to neuroplasticity, reported that encoding of an experience is dependent on the importance of a given experience. Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) adds that the task “must also have salience to the performer to influence the person-task-environment triad.” As such, Bayona et al (2005) states that “rehabilitation may be more successful if the task and the stimuli are important to that person.” Schoemaker & Smits-Engelsman, for example, states that neuromotor task training emphasizes skills that a child and his/her parents would like to master, since they “increase the motivation of the child to practise [sic]” (in Children with Developmental Coordination Disorder by Sugden & Chamber, 2005).

As it relates to schooling, Thuen & Bru (2000) found that the student’s perception of meaningfulness of schoolwork is related to on-task orientation in the classroom. Unfortunately, I have not found any study on children that focused on the effect of salience (alone) to motor learning [SeekFreaks, if you found some, please share by commenting below]. However, there are various studies that seem to point us in the right direction, so let’s trudge on.   

There are at least 3 barriers in ensuring task saliency.

  • First, Ferguson & Twombly (1997) stated that researchers typically assume which task is meaningful to their subjects. Therapists have also fallen into the same trap. Hubbard et al (2009) explained that spending a lot of time and effort on a task that is of no value to the individual, no matter how meaningful to the trainer, is counterproductive.
  • Second, what is meaningful to one student may not be meaningful to another. By its very nature, saliency is personal.   
  • Finally, as adults who are ensuring that a child gets a well-rounded experience in school, we may want to encourage the student to participate in as many activities as possible, even if they are not motivated to do so.

Involving the child in goal setting can help address the above barriers. Blaine Kelly and Landers (1995) performed a meta analysis and found that goal setting improved learning in sports and exercise. They also found the following moderators “that seem to amplify the effectiveness of goal setting”:

  • Specifying goals in absolute terms
  • Setting short-term and long-term goals
  • Allowing individuals to participate in setting goals
  • Making the goals public 

Gauggel and Fischer (2001) also found that specific goals (i.e., objective, measurable goals) were better than “do your best goals” in improving performance and motivation in patients with brain injury.

How can you involve children in goal setting? The child needs to be involved in planning their interventions from the start. In school-based practice, this would mean that the child knows the contents of his/her own IEP and takes part in his/her IEP meeting. Danneker and Bottge (2008) did just that, and created a lesson plan so that students as young as 9 years old can lead their own IEP, as well as help create and present their own objective, measurable goals. That’s 4 checks for the moderators found by Blaine Kelly and Landers.    

You can also utilize the Perceived Efficacy and Goal Setting System (PEGS), a commonly used goal-setting tool for children in research (Dunford, 2011; Vroland-Nordstrand, et al,2015). You can then follow the suggestions of Blaine Kelly and Landers in making the goals specific and public. You can also include a short- and long-term goal, if appropriate.

What type of goals would children find most meaningful to themselves? Vroland-Nordstrand, et al (2015), comparing 2 goal-setting approaches (parent-goal and child-goal groups), found that parents tend to choose goals related to activities of daily living (i.e., toileting, dressing), while children additionally “identified several goals that could increase their opportunities to participate with peers.” This reminds us that the importance of the “participation” domain of the ICF is not just theoretical, but is actually experienced by the children we work with.

A second finding in the study by Vroland-Nordstrand, et al (2015) is that after 8-weeks of goal-directed intervention that included a home program, the children in the child-goal group achieved their goals to the same extent as those in the parent-goal group. The latter finding may also indicate that, in children, salience to the family is also consequential. After all, who ensures that the child practices the task and who provides the assistance to help the child learn the task, but the family! Which begs the question, are the goals we are working on salient to the student and the family?

Here are other suggestions to enhance saliency of the task:

  • Individualized: Use an individualized approach in determining and addressing the child’s needs/goals.
  • Specificity: Apply everything we learned about task specificity. Task-specific activities are more meaningful than rote unskilled exercises. They are also made even more meaningful if they are practiced in real-life environment with real-life materials and obstacles.
    • If a child’s goal is to be able to transition with his/her peers from the classroom to the lunchroom, going up and down the stairs is more meaningful than stepping up and down a box or performing lunges.
  • Purpose: Recall our discussion of sharing knowledge and provide the whys. Discuss the purpose of an activity to the child so he/she can understand its value toward reaching the goals he/she helped develop. Likewise, explain how the home program addresses the family’s goals and needs.
  • Self-monitoring: Provide the child a way to track his/her own progress.
    • e.g., use a pedometer, allow the child to graph his progress, use apps that keep track of performance
  • Home Program 2.0: Try home activity programs, instead of home exercise programs.
    • Instead of performing arm range of motion exercises, why not ask the child to play an active game on their home game console (e.g., Wii, Kinect), help pick up food items from shelves when out grocery shopping with the family, or push a sibling who is riding a swing at the park.

Take-away: Involve the child (and family) when selecting the task, to ensure that it is important and meaningful to him/herself.

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Frequency of Practice

The discussion of saliency is necessary so we can move on to the principle of frequency. It would be difficult to imagine how children will be motivated to repeatedly practice a task unless the task is important or meaningful to them. 

Practice, practice, and yes, more practice! A cliche that holds even more true for motor learning. Adolph, et al (2012) reported that toddlers aged 12-19 months travel a total distance of 46 football fields per day as they learn how to walk. Additionally, they fall over 100 times per day, get up and walk again. This begs the question, how much time do we give our children with disabilities to work on a skill such as walking? Typing on a keyboard? Communicating? Reaching for objects? Is it feasible to reach this much practice during PT, OT or speech sessions?

Another interesting finding from this research by Adolph, et al (2012) is that children chose to walk on various surfaces, including carpet, ramp, carpeted stairs, wooden stairs, slightly elevated “platform,” and others. The children also walked in random patterns back-and-forth over these different surfaces. [Go to the article link and see the overlapping lines a typical 13-month-old subject walked in their study.] How’s that for applying the principle of practice variability?

There has been many research in adults and adolescents to determine which is better: massed practice (greater practice duration with minimal to no rest periods) or distributed practice (shorter practice duration with longer rest periods). Results have so far been mixed. Though generally, distributed practice seems to be better for motor learning, other studies have shown the opposite or no differences between the two.

For example, Donovan & Rasodevich (1999) found that the benefit of distributed practice is stronger for relatively simple tasks than for complex tasks. Lee and Genovese (1989) found massed practice to be better for a discrete task (i.e., task that has a distinct beginning and end, such as picking up a glass to drink), while distributed practice is better for a continuous task (i.e., no distinct beginning and end, such as walking and driving). Contrary to the above studies, Moulton, et al (2006) found that distributed practice is generally better for tasks that are both complex and discrete.

Fortunately, we can skip this debate in school-based practice, where massed practice is impractical. Carving out long continuous durations for therapeutic interventions would be difficult considering that students need to attend to their lessons while in school.

Distributed practice, on the other hand, is feasible and ideal in our schools. It also adheres closer to the finding by Adolph, et al (2012) that novice learners walked in bouts. Here are some ideas to maximize opportunities for distributed practice during the school day:

  • Determine the motor skills that the student should learn based on his/her IEP goals. Don’t forget to make sure that the goals and skills are salient! 
  • Collaborate with teachers and other school staff to identify opportunities during the day for the student to practice the skills. In this way, you are distributing practice throughout the day and multiplying such practice opportunities beyond the amount of practice that can be achieved during a related service session alone.
    • When is a natural time to practice reaching? Walking with an assistive device? Dressing? Using a communication device?
    • Who will be responsible to ensure the practice occurs and who will assist during practice?
  • Design the classroom or school tasks and environment to encourage practice of motor skills.
    • Reaching can be practiced:
      • by assigning the child to hand out class materials (designing the task), and
      • by placing his/her bag, coat and books where reaching would be required (designing the environment).
  • Educate families, teachers and other school staff on providing instructions, feedback and support. They should also apply what we have learned about these principles in Motoropoly – Part 1.

Take-away: Motor learning requires lots of practice. Maximize practice opportunities by distributing it throughout the student’s school day.

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Whole vs. Part Practice

Another controversial question is whether to practice the whole task right away, or to practice parts of the task before practicing the whole.  Ma & Trombly (2001) reported that practicing the whole task “elicited a more efficient, more forceful and smoother movement” in older adults.

Chan et al (2015) came to the conclusion in their study that age/maturity impacts the efficacy between part and whole practice. In their study, 5th-graders had better retention and transfer of skills with whole practice, while the 1st- and 3rd-graders did better with part practice. However, I am critical of the design of the practice sessions in this study. The whole practice group juggled 3 beanbags for 6 days. The part practice group progressively juggled more beanbags: 1 beanbag for 2 days, 2 beanbags for 2 days, and 3 beanbags for the last 2 days. I question whether this is actually part practice, or an application of the principle of reducing task difficulty that we discussed in Motoropoly Part 2.

Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011), provide a great discussion on the topic of whole and part practice. To summarize:

  • Whole practice is better for highly organized tasks 
    • Highly organized tasks are those whose segments are very connected or dependent on each other
    • For example: reaching for a pen and grasping it; moving the leg back to kick a ball
  • Part practice is better for complex, unorganized tasks
    • Unorganized tasks are those whose segments are usually independent of each other
    • For example: putting books into a backpack, zipping it close and carrying the backpack; bouncing a ball and throwing it towards the hoop

Peck & Detweiler (2000) adds a 3rd option – which is really a variation of part practice. They showed that chaining different segments of a complex task resulted in similar improvements as whole practice. Additionally, these improvements were significantly better than improvements with part practice.

What is chaining? In chaining, an individual learns a segment of a task. As mastery is achieved, the next contiguous segment is added. This addition of segments is repeated until the individual is able to perform the whole task. Chaining is believed to work because it affords the individual more resources to learn the task by decreasing the task demands during practice.

Finally, all of the 3 concepts discussed today are related. Haphazardly segmenting a task into parts that are meaningless to the child (e.g., performing hip and knee flexion exercises when the child wants to learn to go up and down the stairs) can negatively impact saliency. The absence of salience will decrease the child’s motivation and commitment to practice, thereby reducing the frequency the child practices the skill. Such a chain of events ultimately leads to negative impacts on motor learning.

Take-away: Use whole-practice for highly organized tasks. Use chaining for complex, unorganized tasks.

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Final Words

It is worth repeating my final cautionary words from my first 2 articles on motor learning principles. Most studies on the principles above were conducted on adolescents and adults without disabilities. While frequency is a definitive principle and saliency makes sense, the efficacy of using either part versus whole practice in 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.

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Our Motoropoly board is almost complete! We’ll finish it next week with our discussion of motor imagery practice and self-controlled practice.

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Seeking Your Views

Which tasks have you found part- or whole-practice more effective for?

Do you have other techniques to ensure task salience?

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Readers of this article also read:

Article Review: Child-focused vs. Context-focused Intervention

Late Summer Reading List for Seasoned School-based OTs, PTs and SLPs

2 Tools to Promote Movement in the Classroom

Article Review: Can Online Modules Improve the Practice of Therapists?

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