You are on page 1of 12

Knowledge of Results and Motor Learning−− Implications for Physical Therapy Carolee J Winstein PHYS THER.

1991; 71:140-149.

The online version of this article, along with updated information and services, can be found online at: http://ptjournal.apta.org/content/71/2/140 Collections This article, along with others on similar topics, appears in the following collection(s): Motor Control and Motor Learning To submit an e-Letter on this article, click here or click on "Submit a response" in the right-hand menu under "Responses" in the online version of this article. Sign up here to receive free e-mail alerts

e-Letters

E-mail alerts

Downloaded from http://ptjournal.apta.org/ by guest on December 14, 2011

apta.org/ by guest on December 14. CSA 208. Department of Physical Therapy. A distinction between learning and pe@ormance is emphasized with respect to experimental d e s i e and the evaluation of laboratory and clinical intervention techniques. Specifically.' and contextual variety. bandwidth KR.2 transfer of training. CA 90033 (USA). It is suggested that it is uppropriate to use the principles obtained through laboratory experimentation as guidelines rather than as exact recommendations when applying basic research w i n g s to clinical practice.9J0 Certainly.8 Some of these research topics."ental practice. Learning. aside from practice itself.71:140-149. The ability of a person to acquire with practice or experience the proficiency to execute coordinated motor actions enables that person to have a wide range of human experiences. Los Angeles. termed "knowledge of results" (KR). the effects of a number of KR variations. and precision with which error information is delivered. Because of the importance of feedback."-14 One form of such feedback. and are often presented as topics within. Rehabilitation. Physical Therapy /Volume 71. data will be summarized from experiments examining the effects on motor skill learn140/65 C Winstein. PhD. Numerous variables considered important determinants of motor learning have been studied.5 part to whole task practice: variability in practice.1 Key Words: Feedback. <Movement. the domain of sport psychology. Number 2 /February 1991 Downloaded from http://ptjournal. one of the most critical of these learning variables. /Winstein CJ Knowledge of results and motor learning-implications for physical therapy. Theoretical and practical implicationsfrom this research are dkcussed. These experiences may range from grasping a cup after the disabling consequences of a cerebrovascular accident to flying an airplane through turbulence. This information serves as a basis for error correction on the next trial and thus can be used to achieve more effective performance as practice continues. 2250 Alcazar St. and engineering. Intrinsic and extrinsicfeedback are defned Basic principles of motor learning pertaining to the use of augmentedjeedback or knowledge of results (KR) are reviewed. is the augmented extrinsic information about task success provided to the performer. neurophysiology. University of Southern California. 2011 . lntroductlon The acquisition of motor skills is fundamental to human life. Part of this research has been directed toward understanding the principles governing the acquisition of motor skills. The search to understand the processes underly~ng control of motor bethe havior has motivated considerable research in various fields including psychology. PT. Among the research areas related to skill acquisition are the use of feedback. Motor skills. and KR delay) o n motor p e r f o m n c e and learning in healthy young adults.l modeling and demonstration. delay. is feedback to the performer. is Assistant Professor.Movement Science Series Knowledge of Results and Motor LearningImplications for Physical Therapy Relevant to this special series o n movement science. a brief overview of research in theJieId of motor learning is provided. overlap with.' This selected review is concerned with laboratory research pertaining to the effects on motor learning of three KR variations. kinesiology. such as mental practice and modeling and demonstration. Particular emphasis is placed o n recent research regarding the effects of selected KR variations (HZ relative frequency. Results are discussed i n terms of short-lasting temporary pet$ormance effects and relatively long-lasting learning effects. such as the frequency. P@s Ther 1991." prepractice instructions. have been studied.

2011 .apta. Finally. How often should the therapist provide feedback during a treatment session? What kind of feedback is best for motor learning? The knowledge base in motor learning can be used to provide at least partial answers to these and numerous other clinically relevant questions. Both Adams's and Schmidt's theoretical contributions stimulated substantial basic and applied research activity. to better familiarize the reader with the field of motor learning. Motor learning research has focused primarily on healthy individuals learning novel motor skills (see Mulder2" for an exception). further discussion of the informationprocessing view). Adams proposed the closed-loop theory of motor learning in which the motor response is seen primarily as driven by feedback from the moving limb.ing of KII relative frequency. and behavioral aspects of movement"13@l~ and motor learning as "an area of study focusing on the acquisition of skilled movements as a result of practice. research from the motor skills literature pertaining to the use of augmented feedback could be used to provide guidelines for physical therapy rehabilitation protocols. physical education community." in contrast to the task approach. The focus of this approach was more on the cognitive processes underlying skill acquisition than on outcomes. For example. poststroke gait training).20 With regard to future directions for motor learning research. Christina15 similarly advocates independent. Certainly. Research during that period used real-world motor tasks. and in KR. in particular. AdamslBintroduced the first theory of motor learning. During what has been referred to as the "task-approach" period. a considerable foundation has been established that may be useful to physical therapy once the proper boundary conditions are established. To better focus on the information-processing operations during motor skill acquisition. Second. endeavors at the basic and applied research levels. Invoking a cybernetics model. Clinical implications from this research for the practice of physical therapy will be addressed. patients participating in these various physical therapy programs are involved in some form of movement learning or relearning. To more fully appreciate the research paradigms and theoretical perspectives underlying research in motor learning. in general. and the emphasis was on performance outcomes. a brief overview is provided of recent and future directions of research within this domain. research in motor learning was motivated primarily by the dominant stimulus-response (S-R) formulation prevalent in behavioral psychology at that time. motor learning research has been dominated by the information-processing approach prevalent in cognitive psychology (see article by Light16 in this special series on movement science for Motor Learning and Physical Therapy The shift away from applied motor learning research during the "process-approach" period has recently been a source of debate in the Physical Therapy /Volume 71. In 1971. The interested reader should refer to the work of Schmidtlj and Christina15 for more detailed discussions. were generally used.~~ whereas others argue that motor learning research is not relevant to the needs and interests of motor skill teachers. but cooperative. Likewise. and KR delay. Number 2 / February 1991 Downloaded from http://ptjournal. simple motor tasks. was strongly advocated by psychologists such as Pew1' and AdamslHas a necessary step toward the development of a general theory of motor learning. If we assume that the principles of motor learning gleaned through research with healthy subjects may be similar to those of motor learning for our patients with orthopedic and neurologic disorders. prompted by the growing body of research in motor learning and the availability of a relatively large empirical database from linear positioning tasks. back education programs. many-if not most-of the practices of physical therapy involve some form of movement training o r reeducation (eg. SchmidtZ1 has advocated a return to the task approach and has emphasized both the theoretical and practical (eg. consideration is given to the potential relevance of motor learning research to physical therapy. Schmidt" proposed the schema theory of discrete motor learning. it could be argued that knowledge of these principles becomes highly relevant to the science and practice of physical therapy. one must consider the important influence of the parent discipline of psychology. Some argue that motor learning research is meaningful for physical education pra~titioners. bandwidth KR. applied) contributions of such an approach.org/ by guest on December 14. This "process approach."13@17) Space does not permit a detailed discussion of the history of motor learning research. Later. physical. Since the late 1960s. He suggests the need to extend research into the applied areas of health with an emphasis on gerontology and physical rehabilitation. Before reviewing the KR research. from about 1940 through the late 1950s. Several individuals recognized the relevance of motor learning research Research in Motor Learning Schmidt defines motor control as "an area of study dealing with the understanding of the neural. Although direct application of the principles of motor learning obtained through laboratory research may not be immediately possible. it is necessary to first make a distinction between motor learning and motor control. allowing for the principles of open-loop control in which the response is controlled primarily by a motor program. when viewed within the broader context of movement science.23 A similar argument could be raised with respect to the relevance of motor learning research to physical therapy. such as those involving the linear slide or positioning apparatus. nor would such an excursion be particularly germaine to the main focus of this article.

The evidence is R quite extensive.to physical therapy over 20 years ag0. has been the focus of a majority of the experimental and theoretical research on information feedback R and learning. In contrast to feedforward.org/ by guest on December 14. respectively. disassociated itself from related. motor control and thus must rely on the extrinsic feedback provided by the therapist. sound) as well as information related to the result of the action with respect to the environmental goal. It has provided a critical cornerstone for theory penaining to the learning process itself.3*~35 Currently. K might be R given in terms of the amount of time it took to complete the task (eg. coordinated actions found outside the lab0ratory. This research paradigm is based on the premise that KR functions with respect to these artificial laboratory tasks in the same way that intrinsic feedback functions in real-life movement situations. o r delayed in time with respect to the relevant action. 2011 . vestibular. Extrinsic feedback relating to the outcome of an action with respect to the Physical 'I'herapy /Volume 71. It can be verbal or nonverbal. One explanation may be that in an attempt to more clearly define its own domain. At the termination of the trial. an understanding of the principles governing how information feedback affects motor behavior has practical implications or at least could provide guidelines22 for teachers.23. and its effects on the learning process are examined. an experimental environment is created in which the usefulness of intrinsic feedback penaining to the movement outcome is minimized. is called "knowledge of performance" (KP) (see article by Gentile32 for further discussion). and it can be provided concurrently. therapists. the existing studies indicate that KP variables behave simiR larly to K variables with regard to motor learning. Number environmental goal is referred to as KR. and quantified in the experimental laboratory. 1. feedback can be provided to the performer in various ways."l3 These normal sources of intrinsic feedback may be absent or damaged in the patient with certain peripheral or central lesions. from the usually onedimensional motor tasks used in the paradigm to the multidimensional. cutaneous. sensory information associated with motor behavior can be divided into two major categories distinguished by their temporal relationship with the action.25 seconds). fields. the physical therapy profession turned inward and. The goal is to rise from a sitting position to a standing position in a given amount of time. The principles gleaned from the KR research paradigm may offer at best only minimal insight into the functioning of intrinsic feedback in multidimensional movements. In contrast to KR. Now.36~37 Thus. Feedback and Knowledge o Results f In general. immediately following. KP represents the kind of extrinsic feedback most often given to performers (and our patients) in natural (or clinical) settings.18J9 The Knowledge-of-Results Research Paradigm Researchers examining the relationship of feedback to motor skill learning must control the multiple sources of feedback that are available in natural settings. there is increasing evidence that the pendulum has begun its backswing. Feedback includes information related to the sensations associated with the movement itself (eg.33 This preference for K in empirical work has primarily been due to the ease with which it can be obtained. that K is an important determinant of behavioral change in these laboratory settings. Feedback is then systematically reintroduced (usually in the form of KR). visual. KP might be given by indicating the degree to which the patient leaned his or her trunk and head forward prior to rising from the chair. extrinsic feedback is information provided from an external source and is supplemental to the intrinsic sources mentioned above. In comparison. feel. and auditory signals collectively termed "responseproduced feedback." Scientists have typically found it useful to define learning as a set of internal processes associated with practice o r experience leading to a Downloaded from http://ptjournal.apta. little is known about the complex interactions of the multiple sources of feedback available through more natural actions. however. These principles may be quite different in real-life situations. These two sources of feedback have been referred to as intrinsic and extrinsic. but nonclinical.31 Intrinsic feedback is inherent to the action and includes kinesthetic. Knowledge of results. however. which provides information about the nature of the movement pattern underlying the goal outcome.feedback is sensory information that is available during o r after the action. Sensory information available prior to the action may be considered as feedfornard and includes information related to the environment and the performer with respect to the upcoming action. manipulated. such as error correction or the development of an internal reference of correctness. Extrinsic. Such an experimental design may closely mimic the conditions of a patient with sensory deficits who is unable to effectively use intrinsic feedback for Learning Versus Perfomlance Research in motor learning requires an operational definition of "learning. therefore. Consider the following clinical example. are thought to be similar to those processes facilitated by the use of intrinsic feedback sources in natural R settings in which K is unavailable or redundant. and performers. or augmented. In contrast to intrinsic feedback. Frequently. in so doing. Processes facilitated by the use of extrinsic feedback in the laboratory. R The K research paradigm has not escaped criticism by those who question the generalizability of research findings. Although more research using KP variables is needed. which in many everyday behaviors tends to be redundant with intrinsic feedback.~53O One might ask why this valuable integration was never more fully developed. extrinsic feedback. Using the same clinical example.

performance in the transfer phase can be said to reflect the learning p r o duced by the independent variable during the acquisition phase. frequency. no feedback). and 100%.42 This design typically involves two distinct phases: (1) an acquisition. during the practice phase in most tasks. the 100% group practiced the task for 10 trials and received KR after each trial.43. performance deteriorated on the sets of nine intervening no-KR trials. nearly any variation that increases the availability (eg. Of the numerous variables that influence behavioral change. which provides KR after trials for which performance is outside a given error tolerance range45. precision. using classical conditioning paradigrns. learning) changes in performance. absolute frequency was 10) and varying the number of interspersed noKR practice trials.3Although some researchers. These feedback variations that appear to enhance learning pertain to the scheduling of KR during practice and include (1) KR relative frequency. reflect learning. however. Thus. as expected. Operationally. In their experiment.47 involved a simple lever-pulling task. some (eg.'3 These processes are thought to be complex central nervous system phenomena whereby sensory and motor information is organized and integrated. This caveat becomes an important consideration for designing experiments in the laboratory as well as assessing the effects of a treatment intervention in the clinic. Not all behavioral changes. Blindfolded subjects pulled a vertically extended hand lever to a goal position. and (3) KR delay. KR is considered a practice variable that is capable of effecting both temporary and relatively permanent (ie. The motor learning literature and clinical practice protocols are surprisingly consistent in showing that. Comparison of the four groups on each of the trials immediately following each KR trial (ie. and still others (eg. number of channels) of information feedback benefits performance and increases the rate of improvement over trials. phase in which different groups receive treatments representing various levels of the independent variable (eg. behavioral researchers investigating humans must usually infer from a change in behavior that learning has occurred. Finally. which provides KR following some temporal delay after completion of a resp0nse. fatigue.41 have begun to isolate the neural substrates associated with learned behaviors in animals. 2011 . whereas absolutefrequency refers to the total number of trials for which KR is provided in a practice session. is usually interested in those variables thought to effect relatively permanent changes in behavior. For the 10% group. conducted over 30 years ago by Bilodeau and Bilodeau. This assumption was later shown to be invalid. practice) are considered to change behavior in more permanent ways.org/ by guest on December 14.relatively permanent change in the capability for responding. immediacy. the KR relative frequencies were lo%. vided. The motor learning researcher. however. has revealed that certain variations of KR that provide information feedback less ofen during practice prove to be more beneficial for long-term learning and retention than practice conditions with feedback provided more often. Number 2 /February 1991 Downloaded from http://ptjournal. followed by a general discussion with comments Relative frequency of knowledge of results. Four different relative-frequency practice conditions were produced by holding the number of KR trials constant (ie. The 25% group practiced the task for 40 trials and received KR after every fourth trial. This finding supported an assumption that the noKR trials interspersed among the KR presentations were not particularly useful. These KR frequency variables are relevant to structuring the learning environment and thus have received considerable attention. or practice. the 10% group practiced the task for 100 trials and received KR after every 10th trial. as well as the clinician. Results from each KR variation will be reviewed first. Knowledge of Results and Motor Learning In general.33 One of the earliest and most influential studies of KR relative frequency. The transfer phase is sufficiently separate in time from the acquisition phase such that the temporary effects from the independent variable have had adequate time to dissipate. 33%. regarding clinical implications for physical therapy. Bilodeau and Bilodeau con- + Physical Therapy /Volume 71. different schedules of extrinsic feedback) and (2) a tramfer phase in which all groups are transferred to a common level of the independent variable (eg.44 Because performance benefits from such conditions.~6 These potentially important KR variations have been examined exclusively with healthy subjects learning novel laboratory tasks. the relative frequency of KR is the proportion of practice trials for which KR is p n . Given this potentially ambiguous state. proper experimental techniques such as transfer designs must be used to determine which KR variations are important for learning (see article by Salmoni et all for further discussion).apta. Knowledge of results about the direction and amount of position error was presented in accord with the particular relativefrequency schedule. (2) bandwidth KR. KR) are thought to effect both tempo rary and relatively permanent changes. Because the number of practice trials was allowed to vary with relative frequency. others (eg. 25%. it is easy to assume that these conditions also benefit learning and retention. drugs) are thought to effect only temporary changes. Recent research. KR one trial) revealed no differences attributable to relative frequency. which is the proportion of trials receiving KR37. How are changes in behavior attributable to tempol-ary factors distinguished from changes attributable to more permanent effects? One way motor learning researchers experimentally distinguish the relatively permanent effects of various practice variables from the temporary effects is by using a transfer design. The 33% group practiced the task for 30 trials and received KR after every third trial.

GG Wicks. confounded the total number of trials and K relative R frequency.37) (25%). and not the relaf tive frequency o KR. long known to learning psychologists. may not be beneficial to learning in the form of retention performance when compared with conditions with less frequent KR.5OInstead. therefore. but not with regard to motor learning. Figure 1 shows the average error scores for the two relative-frequency groups across trial blocks during the 2-day acquisition phase and the immediate and delayed retention phases.48 could not be evaluated. Iater experiments by Ho and Shea49 and Johnson and colleagues (RW Johnson."47(p382)Because a transfer o r retention test was not conducted.37 Two groups o subjects pracf ticed a complex spatial-temporal movement pattern over a 2-day period under either high (100%) or moderate (50%) relative-frequency K R conditions. though detrimental to immediate performance during practice. the number of trials (196 per day) was held constant across groups. From a practical smdpoint. Apparently. the learning-performance distinction.8 4 6 10 12 14 16 Imm Del Retention Acquisition Figure 1 .0 versus 12. the 50%-KR group performed 35% better (10. The apparent beneficla1 effects from practice in low relativefrequency conditions could have amen simply from the amount of practice and not the relative K R frequency. These effects. making the results difficult to interpret. performance for both groups deteriorated (ie. Not surprisingly.19. In this experiment. 1981) extended the work of Bilodeau and Bilodeau47 by using no-KR retention tests and similarly simple motor tasks. These results were replicated in a second experiment37 in which a deR layed K retention test was used. 1-day delay retention test was administered in which K was provided after each trial. The faded 50% relativefrequency K schedule seemed to R f facilitate the development o a capa- Downloaded from http://ptjournal.apta. and. the subjects in the 50%-KR condition demonstrated larger error scores than did subjects in the 100%-KR condttion on corresponding acquisition trials. an attempt was made to optimize the beneficial learning effects attributed to practice in reduced KR relative-frequency conditions by manipulating the schedule of K and R no-KR trials within the practice session. In this experiment. however. conditions that provide KR more frequently may be appealing because o the temporary f effects on performance. the same K schedR ule was used as in the previous experiment during a 2-day practice period.cluded that "learning is related to the absolute frequency.l8. On the immediate neKR retention test. Number 100% 50% 8 L L ::\% 11 9 0 9 rn H b 7 . Recently. but the 100%-KR group showed greater deterioration than did the 50%-KR group. the 50%-KR group performed significantly better than the 100%-KR group even on this 100% K R retention test. and Bilodeau and Bilodeau's47 study. Each block is the average of 12 trials. These findings run counter to the conventional viewpoint that less frequent K should degrade learnR ing. error scores increased) between the end of acquisition and retention. unpublished data. were beneficial to learning as measured on a neKR retention test. such that on each day the proportion of K trials was relatively high early in R practice (100%) but was gradually reduced toward the end of practice Physical Therapy/Volume 71.5 versus 9. however. 2011 . a 5-minute (immediate) and a l d a y (delayed) no-KR retention test was administered to each group. a 12-trial. was reversed when performance scores for the groups were examined in the delayed neKR retention test. D Ben-Sira. A "faded" K schedR ule was used in the 50% condition.1) than the 100%-KR group. provides evidence with regard to motor performance. As illustrated in Figure 1. when performance was examined on trials for which K was R not provided. at least as measured on a neKR retention test. Instead of a no-KR retention test. a condition with R less frequent K was shown to enhance learning. These experiments.2) than the 100% group. thus allowing relative and absolute frequency to covary. Average error score for the 50%-KR and 1W/o-KRrelative-frequency groups during the 2-day acquisition phase (blocks 1-16) and the immediate (Imm) and I-day delayed (Del) no-KR retention phases.org/ by guest on December 14. the 50%-KR group performed with a slightly lower error score (8.37 This relationship. Bilcdeau and Bilodeau's experiment.V 2. on the delayed no-KR retention test. There were no overall group differences during the acquisition phase. however. Following 2 days of practice. (Adaptedfrom Winstein and Schmidt. conditions with less frequent KR. SurR prisingly. Results from these studies suggested that K relative R frequency was an important variable for learning.

however. Hence. During acquisition. Because skilled performances are characterized as being both accurate and stable. feedback is provided only if the performance response is outside a given range (ie. The 10% bandwidth KR group. In bandwidth KR. On the average.org/ by guest on December 14. These retention-test results with bandwidth KR are consistent with those for KR relative frequency. 2011 . The KR delay interval is the amount of time between the completion of the action and the presentation of the KR. the KR was not customized to the yoked subject's performance. Bandwidth knowledge of results. In the 5% bandwidth KR condition." They compared the performance of subjects in four KR conditions using a timing task with a 500-millisecond goal. the 10% group received KR if movement time error was greater than 20 milliseconds. The other two groups had conditions. nor was the absence of KR indicative of "good performance as it was in the bandwidth KR conditions. Similarly. During retention. the KR delay has been essentially eliminated). the subjects in the bandwidth KR conditions were less variable (withinsubject variable error) in their performance than those in the yoked relative-frequency KR conditions. Conversely.' however. in Shenvood's45 study. "Good. as suggested by Lee'ssl concept of transfer appropriateness. the authors suggested that there were some hints from the literature that shortened KR delays might degrade learning. whereas the 10% bandwidth KR group received KR at an average frequency of 31%. He used 5% and 10% bandwidth KR conditions and one control condition for which KR was provided on every trial. termed the 0% bandwidth. Another KR variation known as KR delay refers to the timing of KR. Because larger bandwidth KR conditions result in reduced KR relative frequencies compared with smaller bandwidth conditions. that were created by pairing each of the bandwidth subjects with a yoked counterpart who received the same KR schedule. Overall accuracy was highest for those subjects who practiced in conditions with less frequent KR trials. computer-assisted feedback devices recently available for various kinds of movement retraining are designed to provide instantaneous feedback to the performer (ie. designated the yoked-5% and yoked-10% conditions. shortening the KR delay interval as much as possible should benefit learning. indicated that. the bandwidth KR condition seemed to enhance accu- racy and stability over that achieved in the yoked relative-frequency KR conditions.") and (2) feedback that is informative with respect to errors for trials that fall outside the bandwidth. might even enhance learning.apta. recently Swinnen and colleag~es*~ compared skill acquisition for a group of subjects receiving 100% KR after a 71. Sherwood's results showed no differences between groups during acquisition and no differences in retention in terms of performance accuracy. in that the absence of KR actually informs the subject that the previous response was acceptable. it was unclear how much of the beneficial effects from larger bandwidths were due simply to the reduced relative frequency. Bandwidth KR. this interval has been thought to contribute to forgetting of the movement memory by allowing decay of the memory trace. feedback variations that enhance performance consistency are equally as important as those that promote accuracy.bility for responding that appeared immune to the particular superficial characteristics of the practice and retention conditions. Because the paired subject's KR schedule was being used. performed more consistently from trial to trial and with higher overall accuracy on the retention test than either the 5% bandwidth KR or control groups. It is interesting that hightechnology. The results of Lee and Camahan's52 experiment indicated that the beneficial effects of a bandwidth KR condition on learning were not simply due to a relative-frequency KR effect. however. Two of the groups had similar conditions to those used in Sherwood's study. subjects in the yoked conditions received KR about their own performance on precisely the same trials as the bandwidth KR subjects. provides two kinds of feedback: (1) feedback that is motivating for trials that fall inside the bandwidth (eg. in general. Knowledge of results delay.45 namely 5% and 10% bandwidth KR groups that received verbal KR about their timing errors according to the prescribed bandwidths. d o that again. Thus. subjects received movement-time KR if their absolute error was greater than 10 milliseconds. The beneficial learning effects of the bandwidth KR variation over a pure relative-frequency KR condition thus appear to be most pronounced with respect to movement consistency. in some cases. increasing the KR delay interval does not appear to degrade learning and. According to this view. it may be that a similarity in processing operations. Sherwood45 investigated the effects of bandwidth KR with a ballistic timing task in which a lever was to be moved through a target amplitude in exactly 200 milliseconds. Although a superficial similarity between low relativefrequency KR practice and retention test conditions cannot account for these findings. Number 2 /February 1991 Physical Therapy I'Volume Downloaded from http://ptjournal. in this same review. This procedure is quite different from the KR relative-frequency variation thus far considered. lengthening the interval between movement response and KR was thought to be detrimental to learning. window of acceptable performance).13 Theoretically. Lee and Carnahan52 attempted to unravel the contribution of KR relative frequency from the bandwidth KR variation by using an experimental procedure known as "yoking. the 5% bandwidth KR group received KR at an average frequency of 54% of the trials. The KR review by Salmoni et al. although there were no significant differences between groups with respect to accuracy. therefore. could account for these results.

those conditions in which KR was provided less frequently o r less immediately were more beneficial for motor learning than conditions in which KR was provided more frequently o r without delay. whereas the delayed KR group performed at a level between the other two groups. who advocate the provision of feedback immediately o r continuously. Theoretical and Practical implications In the relative-frequency. however. although the provision of instantaneous feedback may be beneficial for performance during practice. showed no pronounced differences in performance between the three groups during the acquisition phase.Delayed KR 2 V) L 8 120.55).- b ' 80. This method of providing KR is in direct contrast to that of some practitioners. bandwidth. and (3) an estimation condition in which the subject had an 8-second interval between the completion of the movement and the presentation of the KR during which he o r she was required to orally estimate his or her movement time. In a second experiment. By the end of the second day of practice. a complex coincident-timing task and two KR delay conditions were used.2 seconds after response completion. On the delayed (2-day) retention test. In addition. Swinnen and associates suggest that the use of frequent or instantaneous feedback can discourage the processing of other kinds of information. 2011 . or perhaps even shorter.org/ by guest on December 14. These results suggested that instantaneous KK may have degraded learning by blocking or interfering with important information-processing operations associated with the development of error-detection capabilities.46) the delayed KR group..46@22) From a practical standpoint. In the first experiment. this research suggests that an adequate KR delay interval be provided to allow for the processing of relevant response and task information. illustrated in Figure 2. the patient needs more immediate KR to "get the idea of the task. (2) a delayed KR condition in which the subject had an 8-second unfilled interval between the completion of the movement and the presentation of KR.short delay with another group receiving 100% KR instantaneously. This same relationship persisted through several retention tests (immediate and delayed). Average ewor score for the three kX delay groups during the acquisition phase (blocks 1-18) and the 10-minute and 2-day no-kX retention phases. demonstrating the detrimental effects of instantaneous KR on learning. it is apparent from this work that. Number 160. such as intrinsic response-produced feedback that would lead to the learning of the capability to detect errors in future perforrnances. Some researchers36~7~46~51 have suggested that these beneficial KR practice conditions invoke certain information-processing operations Downloaded from http://ptjournal. Each block is the average of3ve trials. the instantaneous KR group demonstrated a significantly worse performance than Physical Therapy/Volume 71. suggesting that evaluation of response errors during the KR interval was beneficial for learning.53.b 40" @ d q 2 : 4 : : 6 : 8 : : : : t 10 12 14 16 18 0 10 min C----C--I 2d Acquisition Retention Flgure 2. the instantaneous KR group showed marked deterioration in performance relative to the other two groups. and KR delay variations previously discussed and in the summary KR variation not addressed in this article (see articles by Schmidt and colleagues36. (Adaptedfi-om Swinnen et al. Persons with neurological deficits may require longer. The results of this first experiment. it can be detrimental for learning and retention. Three KR conditions were used: (1) an instantaneous KR condition in which the subject was presented with KR immediately after completion of the movement. The instantaneous KR group received 100% KR 210 milliseconds after response completion.54 It may be that early in the reacquisition phase. On the 10minute and 2-day retention tests. a timing task with two movement reversals was used. 9 Estlmstlon 4.Instantaneous KR 4. and the delayed KR group received 100% KR 3." but care should be taken to prevent overreliance on the extrinsic feedback at the expense of the development of an internal reference of correctness necessary for long-term retention and learning.46 The estimation group had significantly less error than the instantaneous KR group on the delayed retention test.apta. relevant to designing computer-assisted feedback devices. KR intervals than healthy age-matched controls. the estimation group performed significantly better than the instantaneous KR group.

frequent and continuous feedback.that are beneficial for learning. the informationprocessing operations suggested to occur during this period seem to be beneficial for learning. In contrast to a schedule with frequent KR. Perhaps a new set of treatment guidelines based on the KR literature would prove usefu1. This overdependence on KR may actually prevent the processing of important task-related information (eg. lead to hypothesis testing. intermittent. 2011 py Physical Thera] /Volume 71. The KR is said to act like a crutch that is not needed to the degree to which it is used. termed the "consistency hypothesis. and delayed KR conditions. tactual. bandwidth. especially with bandwidth KR). These frequent response "~~ modifications make performance inconsistent from trial to tria1. the original sources should be consulted. as opposed to specific do's and don't's. strong guidance (either manual. and provide for the development o thef ory as a basis for new o r revised therapeutic and educational practi~es.22 Direct application of the KR laboratory research to clinical intervention should be cautiously used until the proper clinical studies have been conducted. few entrylevel education programs have incorporated this knowledge base in their curricula (although there is evidence that this situation is changing)." is supported by a number of studies. and Future Dlrectlons Although it can be argued that the knowledge base o motor learningf particularly as related to the use of feedback (KR and KP)-is highly relevant to physical therapy.65>66 An understanding of the processes underlying these beneficial effects will be important for new developments in theory. during no-KR trials). In any attempt to bridge the gap between basic research and practice. Although this finding might seem counterintuitive. Although performance for trials not preceded by K appears by R immediate standards to be relatively poor (ie. termed the "guidance hypothesis. the subject begins to rely on its guiding properties. Early in our professional growth.apta.37852."36. and the training of physical therapists (as learners of new motor skills). practice.6~-6*.67 Motor Learning. and the foundations for our practices generally were based on what were thought to be fundamental clinical sciences.56holds that when KR is provided frequently. less accurate. A s we develop a broader Downloaded from http://ptjournal. This process of comparison may be beneficial for learning in that it gives the subject information about errors during performance that is not influenced by any extrinsic feedback. drift from the target pattern) that occur when KR is not directly influencing the response.61 nature and awareness The of errors may only become apparent to the subject following the next KR trial. This notion suggests that frequent KR induces frequent response modifications called "maladaptive short-term correct i o n ~ . it is important to understand that the principles gleaned through laboratory experimentation are best used as guidelines for practice.62263 Highly skilled and experienced therapists appear to intuitively use techniques analogous to the faded. One view. Educational curricula have developed. Physlcal Therapy. we drew heavily from the medical model. It is evident that performance errors are greater during no-KR trials than during KR tria1s. although their rationale may not be well developed o r understood from the perspective of motor learning principles. For a more detailed discussion with associated arguments. Finally. o r verbal). it has been suggested that a schedule with intermittent KR allows for a more obvious contrast between performance driven by KR and performance that is independent of KR (ie. In terms of clinical procedures. The KR research presented suggests a need to reexamine treatment approaches that advocate performance accuracy. Considering the learningperformance distinction with regard to these treatment practices may well account for the often-cited minimal "carry-over" and limited retention of newly acquired motor skills.64 It seems clear from these initial findings with healthy subjects that certain information-processing operations facilitated by conditions with less information feedback are better for learning than those with more frequent or more immediate feedback. these findings imply that the onceadvocated use of feedback in a manner consistent with the adage "more is better" no longer seems appropriate. Another view. although it may be more consistent. Applied research from which more specific recommendations can be made in the practical domain is needed. The following discussion briefly highlights some o the current hypotheses ref garding what these beneficial processes might be. an intermittent KR schedule provides an opportunity for the subject to obtain information about performance errors (eg. response-produced feedback) and thus block the development of errordetection capabilities needed at the time of retention and transfer. an understanding of the principles underlying the use and misuse of augmented information feedback could foster new insights.org/ by guest on December 14. For the growing knowledge base of physical therapy. Number 2 /February 1991 . in concert with the needs generated by professional practices rather than discipline-based knowledge.57-59 This induced response variability interferes with the establishment of a stable action plan necessary for later response production. and avoidance of errors o r "abnormal" movements. it appears that forcing the learner to actively develop problem-solving strategies independently of the guidance provided by feedback (and the therapist) is actually beneficial for motor learning. challenge present practices. The view advocated by motorlearning researchers and clinicians regarding the beneficial learning ef- fects of feedback variations that tend to increase the amount or frequency of KR should be challenged.60.

Science. application. Ill: Human Kinetics Publishers Inc.~ e c t i v e both entni-level and Acknowledgments Critical and insightful comments on an earlier version of this article were provided by my colleagues Beth Fisher. Percept Mot Skills. Patricia Pohl. The Learning of Motor Control Following Brain Damage: Experimental and Clinical Studies. In: Alkon DL. References 1 Salmoni AW.Journal of Motor Behavior. Toward a process-oriented theory of human skilled performance. Schmidt RA. ~ u b u q u c Iowa: k'm C Brown Group. Schmidt RA. Journal of Motor Behavior. Transfer of moveRA. 1952.'our entry-level curricula will also evolve in a similar manner. Pan-task training for tracking and manual control. 31 Winstein CJ. Palo Alto. 19%. 17 Pew RW. Psychol Rev. 49 Ho L.50:2633. Modeling considerations in motor skill acquisition and performance: an integrated approach. Hagman JD. Chichester. 2011 . The schema theory: recent evidence and developmental implications. 5 Locke FA. Transfer of Learning. 1981. ed. Motor learning is meaningful for physical educators. 45 Sherwood DE.2:231-242.Shaw KN.46:511-519.postgraduate education. Champaign. Hutton RS. 1988. 1979:475-513. New York. e r .46:487510. 1983.2:8-24. Am J P b ~ Med 1967. 1932. Clark JE.16:70G716. 27 Cross KD.2nd ed. A 1978:33-45. EEect of bandwidth knowledge of results on movement consistency. In: Safrit MJ. and the development of an unlikely theory. Scientrfic Bases for Neurophysiologic Approaches to Therapeutic Exercise: An Anthologv. Motor-skills learning. Primary Neural Substrates of Learning and Behauioral Change. In: Goodman D. Information feedback for skill acquisition: instantaneous knowledge of results degrades learning. An experimental study of Thorndike's theory of learning. Memory Traces in the Brain. Schmidt RA. J Eup Psychol. 44 Trowbridge MH. 1983. Publishers Inc. 1985.46:859466. eds. Lintern G. Transfer-appropriate processing a framework for conceptualizing practice eEects in motor learning. Variable frequency knowledge of results and the learning of a simple skill. Motor learning: future lines of research.82:225260.42:143-160. Quest. 42 Adams JA. A schema theory of discrete motor skill learning.15:352359. 41 Thompson RF. 1990. 2nd ed. 51 Lce TD. Swinnen S. Skill acquibition: an event approach with special reference to searching for the optimum of a function of several variables.J Exp P. Exercise and Sport Sciences Ret~iews. 19 Schmidt RA. Phys Ther. Reynolds B. 11 Bilodeau FA. 1967. and transfer of human motor skills. eds.25:20. 1954. 1975. Champaign.apta. Memory. Norman. 29 Hellenbrandt FA. EEect of shift in distribution of practice conditions following an interpolated rest. Information processing for motor performance in aging adults. A working model of skill acquisition with application to teaching. In: Meijer OG. 1958. Historical review and appraisal of research on the learning. Current Contents. Implications of research in motor learning for physical therapy. A review of the contextual interference eEect in motor skill acquisition. eds. 34 Fowler CA. Wilberg RB.101:41-74. Schmidt RA. 1984:71-100. 242:728-735. 1988.47:32-36. landers D.39:212-222. Relevance. 15 Christina RW. NY: Cambridge University Press. 40 Alkon DL. In: Brooks VB.17:3-23. L. Presented at the APTA-VRA Institute's Symposium on Learning Experiences in Physical Therapy Education. 37 Winstein CJ. 48 Guthrie ER. J Eup Pg~chol[Learn Mern Cognl. Human Skills. ed. Bilodeau IM. Rebecca Lewthwaite. hljormation Processing in Motor Control and Learning. 1984. EEects of relative frequency of knowledge of results on retention of a motor skill. Human Mouement Science. Dtffering Perspectives in Motor Learning. McNemar (2. Ill: Human Kinetics Publishers Inc. 33 Adams JA. Quest. 50 Thorndike EL. NY: Elsevier Science Publishing Co Inc. Corbin C. In: Skinner JS. 46 Swinnen SP.42:126-133. Ill: Human Kinetics Publishers Inc. The neural basis for learning of simple motor skills. 2 McCullagh P. 1990. The Psychologv of Learning. latham GP. New York. 28 Fischer E. 26 Michels E. 12 Newel1 KM. 1989. 10 Rejeski WJ.4:195228.4:235-244. Philadelphia. Factors aEecting motor learns ing.ychol. The Sport Psychologist.43:339-344.55:379383.66:535-542. April 18-22. Okla. This week's citation classic. IIum Factors. New York. J Gen Psychol. opment of Movement Control and Coordination. and Mary Ruth Velicki. New York. Md: Williams & Wilkins. I970. Coordination. Weiss MR. In: Stelmach GE.7:245260. Hirt S. 1972. In: Pandolf KB. Roth K. In press. 32 Gentile AM. Ross D. Human . Nicholson DE. NY: Cambridge University Press. Motor aspect of learning. 1990. 1990. Sensorimotor feedback. Psychol Bull. 1987:2641. eds. Turvey MT. 47 Bilodeau EA. Bilodeau 1M. Helen Hislop. 1981:1449-1480. 1987:47-79. Annual Rerlieru of Psl. Shea JB. . In: Payton OD. Future Directions in Exercise and Sport Science Research. Physical 'Therapy/Volume 71. Motor lcarning reconsidered: a study of change. ed. 35 Newel1 KM. NY: Academic Press Inc.Journal of Motor Behavior 1970.16:677-691. JExp Psycho1 [Learn Mern Cognl. In: Cormier SM. Baltimore. The effects of mental practice on motor skill learning and performance: a nieta-analysis. Champai~n. Berwyn. Erercise and Sport Sciences Ret:ieups Santa Barbara. eds. retention. Shapiro DC. landers DM. As programs in movement science begin to re~resent norm in the physical therapy.70:820426. Toward a better understanding of the acquisition of skill: theoretical and practical contributions of the task approach. In: Keogh J. 1978. 38 Arbib MA. eds. 1932. 24 Mulder T.Ill: Kinetics ~ublishgrs Inc. Orlando. 1978:1-40. Schmidt RA. 39 Lisberger SG. Quest. 1982:113-150. New York. Reduced frequency of knowledge of results enhances motor skill learning. Academic Press Inc. Am J Phys Med. 4 Feltz Dl. Fla. 30 McDaniel LV. Phys Ther. 14 Maaill RA. Psycho1 Bull. Champaign. Calif: Journal Publisher AEiliates. Psychol Bull. Saari LM. 16 Light ICE.chology. 1988. control and skill. Volume II: Motor Control Bethesda.J Sport PJychol. 1988. 1985. NY: John Wiley & Sons Inc. ed. Eckert k ~ .org/ by guest on December 14. Defining the boundaries of spon psychology. In: Kelso JAS.12:2455-280. McNemar 0. England: John Wiley & Sons Ltd. Knowledge of results and motor learning. 25 Forward E. New York. Associated movements and motor learning.5:25-57. Brawley LR.90:125-152. Calif: Annual Reviews Inc. Clark GA. Rev ed. 1976. 36 Schmidt RA. Percept Mot Skills 1988. Cason H. Phys Ther. Motor Learninp Conce~ts and ~pplica2on. and Control. 1961. The law of effect. 9 Gill DL. 1985295-317. 22 Magill RA. Am J Psychol. 6 Wrightman DC. 21 Schmidt RA. e d ~The Deuel. et al. our knowledge base must reflect that ment. Psychological Dynamics of Sport. Franks IM. Summary knowledge of results for skill acquisition: support for the guidance hypothesis. Barchas JD. The eds Cutting Edge in Pb)~sical Education and Ewercise Science Research. Newton RA. A closed-loop theory of motor learning.27:267-283. Knowledge of results and motor learning. IIandbook of Physiology. Md: American Physiological Society. 43 Newel1 KM. 23 HoEman SJ. Neuronal substrates of associative learning in the mammalian brain. University of Oklahoma. 1974. Pa: F Davis Co. 1990. 1966. 3 Schmid~: Young DE. Motor Control and Learning: A Behavioral Emphasis. 1987. 20 Schmidt RA. Knowledge of results and motor learning: a review and critical reappraisal. Role of practice in perceptualmotor learning. 1989. et al. Perceptual structures and distributed motor control. Pa: Swets Nonh America. Farley J.95:355-386.. Iri: Farmswonh R. 8 Magill RA. 1989:395-410. NY Harper & Row.eds. eds. Hall KG. I gratefully acknowledge their contributions. ment control in motor skill learning. 1963. Joan Walker. J Exp Psychol [Learn Mem Cognl. 18 Adams JA. 7 Shapiro DC. et al. Number 2 /February 1991 Downloaded from http://ptjournal. 13 Schmidt RA. Walter CB. 1989:17-47. ~ s for . In: Holding D. Oklahoma Center for Continuing Education. Young DE. Goal setting and task performance: 1969-1980.

Va: Foundation for Physical Therapy Inc. In press. 1970:l-23. with the experts exploring disorders in movement control. White MA. eds. ed. Am J Phys Med.. 1990. 1987. 1976. the Netherlands: Elsevier Science Publishers BV. Don't miss any part of this landmark series on human movement behavior. Md: Aspen Publishers Inc. Carnahan H. In: Lister M. Information feedback in positioning problems and progress. and developmental and pediatric concerns. 58 Lee TD. 1988:201-215.70:57%582. Journal of Motor Behavior. issues in motor learning. Theory: the guide to clinical practice and research. In press. 1983. In press.J Erp Psychol [Hum Percept]. Jones MB. 1975197-212. Research Quarterly. Ill: he ~thleiic ~nstitute.apta. Shepherd RA.ed. Designing practice for motor learning: clinical implications. On the role of knowledge of results in motor learning: exploring the guidance hypothesis. 1 Step Contemporaly Management of Motor 1 Control Problems. Trial-and-error versus errorless learning: training. Motor learning principles for physical therapy. J Erp Psychol [Learn Mem Cogn]. and stress. 65 Prather DC.9:334345. 64 Winstein CJ. Presentation. Carnahan H. 59 Rubin WM. E5ect of guided versus discovery learning strategies on learning. Motor learning considerations in stroke rehabilitation. 62 Mulder T. Shepard KF. Application of signal detection theory to error detection in ballistic motor skills. Phys Ther 1990.and test-trial effects on acquisition and retention of distance and location. In: Duncan PW. I1 Step Con- temporaly Management of Motor Control Problems. Neural Organization and Its Relevance to Prosthetics. 52 Lee TD.84:377-386. 2011 . Human Performunce. Relevant.. 66 Singer RN.org/ by guest on December 14. Amsterdam.. In: o Smith LE. For Release as a Monograph in Early Spring 74/149 Physical Therapy /Volume 71. Number 2 /February 1991 Downloaded from http://ptjournal. SCIENCE Diverse. Q J Erp Psychol [A]. 1971. Alexandria. 53 Carr JH. et al. ed. 56 Schmidt RA. 67 Tammivaara J . Rockville. 54 Herman R. 61 Hagman JD. 1984. Alexandria. 55 Schmidt RA. Young DE. Psycholo~y f Motor Learning Chicago. Pease D.22:191-208. 1978. Human Movement Science. Lange CA. 1987:109-134. Bandwidth knowledge of results and motor learning: more than just a relative frequency e5ect.4:311-320.47:78%796. 63 Winstein CJ. Stroke Rehabilitation: The Rec o v q of Motor Control.. When to provide knowledge of results during motor learning: scheduling e5ects. retention. NY: Intercontinental Medical Book Corp. 60 Lee TD.63:226244. transfer. Carnahan H. Mowment Science: Foundations for PLysical Therapy in Rehabilitation. and transfer of a serial motor task. Am J Psychol. 57 Bilodeau IM. Gordon J. Ill: Year Book Medical Publishers Inc. Sensory feedback therapy and theoretical knowledge of motor control and learning. Dynamic Physical TherapyS long-awaited series on movement science continues in this issue.Complex Movement Behavior: Tbe MotorAction Controversy. In: Field WS. New York. In press. Chicago. Optimizing summary knowledge of results for skill acquisition. eds. ed. Badke MB. Va: Foundation for Physical Therapy Inc. Augmented sensory feedback in the control of limb movement. In: Lister M. In press.

org/subscriptions/ Subscription Information Permissions and Reprints http://ptjournal.apta. Cited by This article has been cited by 18 HighWire-hosted articles: http://ptjournal. 1991.org/site/misc/terms.org/content/71/2/140#otherarticles http://ptjournal.Knowledge of Results and Motor Learning−− Implications for Physical Therapy Carolee J Winstein PHYS THER.xhtml Information for Authors http://ptjournal.xhtml Downloaded from http://ptjournal.apta. 71:140-149.apta.apta.apta. 2011 .org/ by guest on December 14.org/site/misc/ifora.