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 environment in motion or
not change from one trial to changes from one
another performance to another
• stable • Complex and put more
• E.g. Singing name on desk 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
