What is motor learning

 It is an acquisition and modification of learned

movement pattern over time
 It involves practice and experience, which leads to
permanent changes in person’s ability to produce
movement sufficient to the demands of occupational
performance
 Brain plasticity known as “Cortical Map
Reorganization ” plays major role in regaining
functional use
 Dynamic systems theory
It is based on
heterarchical model that Client
views motor behavior as
dynamic interaction of
each component (client,
context, occupation) to Context occupation
enact the client’s role and
to engage in occupation.
 Dynamic system theory
components
1. Client factors: sensorymotor, cognitive, perceptual
and psychosocial
2. The Context (environment): Physical, social,
cultural, spiritual, temporal, personal and virtual
3. The occupation: the clients needs to perform or
wants to perform
 Task Oriented approaches (TOA)
Task oriented approach
emerges from a systems
model of motor behaviour
and is influenced by recent
developmental & motor
learning theories
 Goals of TOA
1. Discover the optimal movement pattern for task
performance
2. Achieve flexibility, efficiency and effectiveness in
task performance
3. Develop problem solving skills in clients so they can
identify their own solutions to occupational
performance problems in home & community
environment
Treatment Principles
 Client centered focus
 Occupation based focus
 Person and environment
 Adapt Client centered focus
 Art of TOA is the identification of the intervention for
unique needs of each client (Person, environment and
role)
 No “cook book” method for every person in every
environment
 Active participation
 Provide user friendly instruction for how to practice
task
 Creative therapeutic environment that are conductive
to active learning
 Teach principles of task analysis and to evaluate their
own performance
 Involve clients in recording their progress toward
functional goals
 Occupation based focus
 Use functional tasks as the focus in treatment
 The goal of treatment for motor behaviour problems is
to enable clients to do things they want to do now and in
the future
 Select task that are meaningful & important to client
roles
 Consider client’s occupation and meaning of those role
to the person
 Roles are defined by clients in terms of the tasks &
related activities that are interesting or important
 Analyze the characteristics of the task selected for
treatment Analysis is necessary to design appropriate
motor learning experiences and select practice and
feedback strategies that fit the nature of the task

Type of tasks

Tasks & required movements for task described as

 Discrete have definite beginning and end example hitting
and pitching used in sports with balls
 Continuous
 Serial discrete and continuous tasks are easily broken
into steps as serial tasks
 Taxonomy of task
Gentile (1987) proposed taxonomy of task
 Based on characteristics of the environment and a
person actions during task performance

Closed task Open task

• Stationary environment • Some features in

during performance does
not change from one trial to
another
• stable
• E.g. Singing name on desk
environment in motion or
changes from one
performance to another
• Complex and put more
demands on person
• Unstable
• E.g. Driving car
 Based on person’s actions

Body orientation Object manipulation

• Require stabilization or • Arms and hands used in

transport upper limb object manipulation
helps in balance & • E.g. Mop or sponge
postural support system
• E.g. Walking in wet
kitchen floor
 Describe the movement used for
task performance
 Preferred movement pattern are attractors are
ordinarily stable & optimal way to achieve a functional
goal
Determine whether movement pattern are stable or in
transition
 Potential transition period (Marble on smooth)
 Phase shift (marble on bumpy surface)

Remediation of motor behavior problems should begin

before the movement patterns fall into obligatory,
stereotype patterns (synergy)
 Analyze the movement patterns and functional outcome
of task performance
 An analysis movement patterns will help estimate stability
and flexibility, understand changes and prevent fixation of
movement pattern
 Strategy 1: to look at fluctuation in one or more quantitative
measures of movement patterns during the task (Collective
variables)
 Strategy 2: to determine what happens when the therapist tries to
disturb the movement patterns by changing some critical
personal or environmental factor (control parameters) (Critical
factors influencing behaviour)
 Person and Environment
 Identify personal and environmental factors that serve
as major influencer on occupational performance
 Qualitative & quantitative analysis (analysis of cretical
factors)

Person Environment

• Movement pattern • Older man who had

when lifting a tennis CVA were dependent
ball Vs beach ball in dressing
• Person’s strength,
hand size and size
and weight of objects
 Anticipate variables
 Personal and environmental variables influencing
occupational performance will change
 Based on clinical experience (neural factors- spasticity)
are important immediately after the onset of CNS
damage but have low effect on level of performance
later.
 The influence of non neuronal factors (eg soft tissue
contracture) is almost the reversible
 Anticipate variables
 What is effective for one client may not be effective for
another client with similar CNS dysfunction
 What is effective in early stage may not be effective in
later stage
 Therapist must identify the major influencer on motor
behavior at the specific time for a specific person and
anticipate changes in critical variables.
3. Address critical personal and environmental systems
to change occupational performance
 Therapist alter the personal or environmental
characteristics until a shift in motor behavior in motor
behaviour is observable
 Small changes in the system may produce large changes
in the movement patterns.
 E.g. Adult on treadmill with partial body weight support
 Forcing use of affected arm by constraining normal arm
4. Treat neural and non neural factors of the
sensorimotor system that interfere with optimal
occupational performance
 Degrees of freedom varies with different activities
 E.g. Lifting TV vs. Feather
5. Adapt the task or broader environment to promote
optimal occupational performance
 There are various ways to alter the physical context of
the task to promote optimal task performance
 E.g. Size, length and weight of equipment or tools may be
modified
6. Use natural objects and natural environments
 Rehabilitation unit should simulate the real life setting
as much as possible
 E.g. Home, Gift shop and cafeteria
 Practice and Feedback
1. Structure practice of task to promote motor learning
 Blocked practice: Many repetition of the same task in
the same way - Not effective
 Random practice: practice of the tasks vary randomly
asks the clients to try a variety of tasks in one session
(E.g. Dressing) – Very effective
 Client who practices the task in many contexts learn
many solutions and can vary performance.
 Principle stating that People need repetitions without
repetition
2. Design the practice sessions to fit the type of task and
learning strategies
 Whole learning – practice the task entirely – simple task
 Part learning – separate practice of the discrete
component of serial task
 Discovery stage- develop an understanding of the task
 Later stages: help the client refine the solutions
identified in the discovery stage
 Explicit (declarative) Learning: requires continuos
learning of rules of tasks
 Not very context dependent – not effective
 Implicit (Procedural) Learning: Learning to do the task
on an unconscious level - Effective
3. Provide feedback that facilitates motor learning &
encourages experimentation to find solution for
occupational performance problem
 Frequent, immediate and consistent feedback is
important

4. Optimize occupational performance given the

constraints on the person and environment
 The achievement of functional outcome is more
important to the client and family than therapist normal
movement pattern
 Limitations:
 It is not fully developed or refined
 Difficult to simulate natural environments
 Should ideally occur in clients home, school, leisure and
work settings
 Future directions
 TOA provides occupational therapists with new ideas
about the remediation of motor behavior problems
 Furthe basic and clinical research is needed
 Motor Relearning Program
(MRP)
 Carr and shepherd approach
 It is developed exclusively to improve motor control
 Practical Guidelines
 Assessment of motor function during task
performance
 Analysis of motor performance to determine key
limiting functions that are amenable to change
through therapeutic intervention
 Prevention or reduction of these key limiting factors
through direct intervention and client education
 Design of activities to be used as therapeutic
challenges that stimulate development of effective
movement strategies
 Adaptation of the physical environment to promote
maximum function by each individual
 Assistance for individuals in developing strategies for
approaching and mastering
 Motor challenges of new activities they wish to
perform in future
 Development of maladaptive
strategies
Attempt to move

Obstacles to efficient movement

(Negative control parameters)
•Diminished soft tissue extensibility
•Impaired balance
•Insufficient endurance
•Specific muscle weakness

Maladaptive movement strategies

(Insufficient deep well attractor state)
Cycle of immobility and soft tissue
shortening

Soft tissue
Immobility
stiffness
 Assessment
1. Evidence of mobility impairments at specific joints
2. Missing or limited components
3. Incorrect timing of component with in a movement
pattern
4. Evidence of weakness or paralysis of specific muscles
5. Compensatory motor behavior
Motor assessment scale (MAS)
1. Supine to side lying
2. Supine to sitting over side of bed
3. Balanced sitting
4. Sitting to standing
5. Walking
6. Upper arm function
7. Hand movement
8. Advanced hand activity
Berg balance scale used to check balance
 Categories of motor performance
1. Standing up and sitting down
2. Walking
3. Reach and manipulation
4. balance
 Planning
1. Stretching exercises – to enhance mobility
2. Environmental modification – to improve postural
alignment
3. Exercises and activity- to strengthen muscles
4. Verbal and kinesthetic instructions about key
foundational strategies to improve performance
5. Practive key fundamental strategies
6. Practice of observed task in varying conditions
 Constraint induced movement
therapy (CIMT)
 CIT or forced use is a technique designed to promote
increased use of weak or paralysed arm and has been
credited with speeding up the cortical map
reorganization process in human
 CIT is also based on dynamic systems theory and TOS
to motor control acquisition
 May foster learned non use of the stronger arm
 Learned non use is proposed to be a phenomenon in
which the individual effectively forgets to use the
affected or uninvolved extremity because of the
extreme difficulty coordinating movement after the
onset of stroke
Thank you