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We are now in the last few sections of our Motoropoly board. Whereas the first 3 articles focused on the therapist’s action and designing the task, this 4th article covers what children can do to enhance their own learning. In case you missed the first 3, go read them first by clicking here:

Motoropoly 4 looks into the research on motor imagery practice and self-controlled practice. We will follow this with a wrap up of our discussions by looking at a research article where therapists combined multiple motor learning principles to enhance learning.

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Motor Imagery Practice

Recall our discussion of implicit and explicit motor learning approaches in Motoropoly 2. Whereas the implicit motor learning approach hinges on the belief that motor learning is predominantly unconscious, the explicit approach uses the cognitive process for learning. Motor imagery practice falls within the explicit approach. It is defined as “the mental rehearsal of motor imagery contents with the goal of improving motor performance”, where motor imagery “involves the first-person mental simulation of action” “without any body movement” (Dickstein and Deutsch, 2007; Gabbard, 2009).  Motor imagery practice is also sometimes used interchangeably with mental practice.

Motor imagery practice on its own or in combination with physical practice has been shown to promote motor learning in adults with and without disabilities. The same benefit has been shown in children. Doussoulin & Rebhein (2011) tested 3 groups of 9-10 year olds on the task of running then throwing a ball towards a target. All groups were pre-tested on the activity. This was followed by:

  • Modeling only (watching a video of the task) for Group A
  • Physical practice only for Group B
  • Mental practice only for Group C

They found significant skill improvement in all 3 groups during post-tests.  

Researchers have posited that motor imagery ability develops with age, emerging around 5 years of age (Gabbard, 2009). At this age, Frick et al (2009) found that motor imagery performance is still very dependent on active motor control and feedback. It is not until age 7 that “mental representations become increasingly independent from motor activity.”

Dickstein and Deutsch (2007) also reported additional potential benefits of motor imagery practice: it enhances self-efficacy and motivation. These may be much needed side effects for our student who are poorly motivated and display a lack of confidence in their ability to succeed at a task.

However, it seems that motor imagery practice is not equally beneficial to all individuals. Since motor imagery is believed to be an individual’s internal representation of actions, it makes sense that the better an individual is in developing a vivid mental representation of the task, the more he/she can benefit from motor imagery practice (Avanzino, et al, 2015). Studies, for example, have shown that children with probable developmental coordination disorder seems to have poor internal action representation that may be causing inefficient motor imagery abilities (Fuelscher, et al, 2015). [If you are curious to know how Avanzino, et al (2015) measured vividness of mental representation, read the development of Movement Imagery Questionnaire (MIQ-R) by Roberts, et al (2008). You may also contact the first author to get a copy of the MIQ-R.]

How does this apply to therapeutic interventions? I recommend that you read the whole Dickstein and Deutsch (2007) article as it offers some suggestions as they relate to physical therapy interventions for adults with disabilities. Additionally, Holmes and Collins (2001) proposed the evidence-based PETTLEP approach to motor imagery, which describes the elements that need to be satisfied for motor imagery practice to be effective. When conducting motor imagery practice, the PETTLEP approach requires that the following elements should closely match the what, where, when and how of the actual physical performance of the task:

  • Physical or kinesthetic sensation of the task, including handling of materials or equipment
  • Environment where the tasksis performed
  • Task being practiced
  • Timing of the task or different components of the task
  • Learning stage of the individual
  • Emotion associated with performing the task
  • Perspective of the individual; i.e., the individual is imagining himself performing the task, not imagining himself watching the task being performed

Finally, Gordon and Magill in Physical Therapy for Children by Campbell, et al (2011) suggests combining mental practice with physical practice by asking the child to perform the whole task mentally prior to the physical performance of the task. This approach seems to be the easiest way to apply motor imagery practice in our schools. To maximize motor imagery practice, you should then educate families, teachers and other school staff to encourage its use prior to physical performance of a task.

Take-away: Motor imagery practice may be combined with physical practice to enhance motor learning.

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Self-Controlled Practice

As therapists, we often lead our clients during our intervention sessions. What would happen if they are given more autonomy via self-control of certain aspects of their training?

Wulf (2007) provided a great summary of implications of self-controlled  practice to physical therapy. I highly recommend you read this full article with a highlighter! She described 3 components that clients can control that have been shown to improve performance as measured by retention and/or transfer tests. These are:

  • Frequency and timing of feedback
    • Positive feedback is preferred: Interestingly enough, Chiacowsky and Wulf (2002) found that participants in their study (high school and undergraduate students) requested more feedback after “good” trials . This is consistent with our discussion in Motoropoly – Part 1 that feedback after relatively successful trials enhances motor learning.
    • Frequency still matters: Chiacowsky, et al (2008) noted that 10-year olds who requested feedback more often had better retention of skills compared to those who requested feedback less often. This again is consistent with our earlier discussion of the challenge point framework. According to this framework, children require more feedback so that the task offers just the right amount of challenge to result in learning. As such, the authors suggested encouraging children engaging in self-controlled practice to request more feedback, perhaps by asking the child to ask for feedback at least once for every n number of trials (but they still have control as to which of the n trials to receive feedback on).
  • Frequency and timing of demonstration
    • Learners of a basketball jump shot who self-selected frequency and timing of when to watch a video demonstration performed better at retention (Wulf, et al, 2005)
  • Use of assistive devices
    • Better search for optimal movement pattern: Subjects were able to engage “in different information-processing activities, such as a search for the optimal movement pattern” when they self-selected use of assistive device (Wulf, 2007).
    • Fading of use of assistive device: Wulf and Toole (1999) also noted a decreasing request in use of assistive device (ski poles) as they got better in the task (simulated skiing).
    • In adults with Parkinson’s disease: Chiacowsky et al (2012)  found self-selection of use of assistive device improved skill retention in adults with Parkinson’s disease

Additionally, motor learning was also enhanced by self-control of the amount of practice (Post et al, 2011), and order of practice (Sanli and Patterson, 2013). While most of these studies on self-controlled practice consisted of adults as subjects, the latter study also found that self-controlled practice benefited adults and children similarly.

Sanli, et al (2013) attributed the efficacy of self-controlled practice to the self-determination theory by Ryan and Deci (2007). Sanli, et al reviewed 26 research articles and concluded that self-controlled practice “can facilitate such factors as feelings of autonomy and competence of the learner…leading to long term changes to behavior.”

This reminds us of the importance of including the child in decision-making during school-based interventions as discussed in the discussion of salience in Motoropoly 3. Based on all of the studies cited above and the self-determination theory, they will most likely be better intrinsically motivated and engaged in the task being learned, which would lead to motor learning.

Take-away: Provide the student self-control on some aspects of practicing a skill.

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Combining Motor Learning Principles in Practice

Most of the research that we have discussed in our Motoropoly series focused on a single motor learning principle. This was necessary in research so that efficacy can be established on a specific principle. But in real life, motor learning principles should be applied together to optimize learning, retention and generalization of skills.

I have given you some ways of combining 2 or 3 motor learning principles in previous Motoropoly articles. Now it’s time to show you a research article where the authors combined multiple principles in their intervention and how motor learning performed compared to another intervention. 

Bar-Haim, et al (2010) divided 78 6- to 12-year-old children with cerebral palsy, GMFCS Levels II-III, into 2 groups. One group received motor learning coaching, while the other received neurodevelopmental treatment (NDT). Participants received the assigned intervention 3 times a week for 3 months. These children were tested within 1 week before intervention started (baseline), within 1 week after intervention stopped (immediate treatment effect), and within the 7th month after intervention stopped (retention).

The good news is that both groups showed statistically similar improvements in gross motor function between baseline and immediate treatment effect measurements. However, the retention test showed that the gross motor function of those who received NDT declined, while those who received motor learning coaching was maintained. This showed that “permanent changes in motor skills” occurred only in the motor learning coaching group (i.e., the definition of motor learning).

In case you are curious to know, here is a comparison of the treatment received between the 2 groups:

Neurodevelopmental Treatment (NDT) Group:

  1. Determination of the individual’s motor tasks & goals by the therapist
  2. Passive stretching of the legs at the beginning of each session
  3. Techniques to reduce spasticity and facilitate more normal movement patterns
  4. Functional motor activities, such as walking, standing up from sitting

Motor Learning Approach Group:

  1. Ask child to set gross motor goal
  2. Muscle stretching, applied randomly either before or after the session
  3. Identify the learner’s stage of ability to learn
  4. Provide verbal or non-verbal instructions
  5. Change environment at least once/week
  6. Follow Gentile’s taxonomy by manipulating biomechanical task features & environment
  7. Practice chosen motor task (goal) for 30 min.
  8. Perform and practice two cognitive tasks between the motor task practices at random times, e.g. arithmetic problem or jigsaw puzzle
  9. Provide realistic distractions while performing motor tasks, such as noise & people nearby
  10. Provide feedback at end of task practice
  11. Test to evaluate task performance at the end of the session

Motoropoly Pop Quiz

Which of the motor learning principles we covered are explicitly described in the above protocol?

Motor Learning Principles

Which of the motor learning principles we covered do you recognize in the above treatment outline?

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Unfortunately, I did not find an article that showed efficacy of combining motor learning principles in school–based practice. But, I feel like I have done my work in summarizing many of the principles here. And now it is your turn to let us know how you combine them by commenting below. And, if you are up for a challenge, why not start and write-up your own study – and we can share it with all SeekFreaks!

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Thank you for joining us through this journey of figuring out how we can apply motor learning principles in school-based practice. As I have mentioned ad nauseum there are other principles we have not covered. Moreover, there are always new articles that come out regarding motor learning. And there are articles that explore the application of motor learning principles on children with particular diagnoses. We plan to discuss those in the future.

In the meantime, I pass the baton over to you…print out your completed Motoropoly board and hang it up as a reminder. And think about how you plan to apply these principles in your everyday practice. Let us know!

Motoropoly 4 - Motor Learning Principles in School-Based Therapy

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