Aprendizaje Motor

From Cole, M. Applied theories in occupational therapy: a practical approach instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2008). Applied theories in occupational therapy: a practical approach. Thorofare, NJ: SLACK Incorporated.

MOTOR LEARNING THEORY

References: Cole & Tufano, Chapter 19

Reserve Article: Mathiowetz & Bass Haugen (1994) AJOT


Focus

• Replaces Motor Control (NDT, etc.) as a more evidence-based approach to all forms of movement disorders across the lifespan (CP, TBI, CVA, etc.)

• Backdrop for Task Oriented approach defined by Horak (1991), Shumway-Cook & Woolacott (2001) and Mathiowetz, Bass Haugen & Flinn (in Trombly & Radomsky, 2002).


Conceptos

• Control motor – la capacidad para regular o dirigir los mecanismos esenciales del movimiento (Shumway-Cook & Woolacott, 2001). teorias de re-adquisición del movimiento voluntario “neuromaduración” o “jerarquico” o “bottom up”

• Aprendizaje motor – conjunto de procesos asociados con la práctica o experiencia que conduce a cambios relativamente permanentes en la capacidad para producir acciones habilidosas. (Shumway-Cook & Woollacott, 2001). Combina neurociencias con teorías de sistemas y aprendizaje.


Principios • Se base en la plasticidad neuronal (la capacidad

del SN de modificar las conecciones neuronales para funcionar más eficientemente.

• Memoria corto plazo: Memoria de trabajo – aprender nuevos movimientos.

• Memoria largo plazo: guardar/recuperar –necearia para cambios más duraderos

• El aprendizaje motor ocurre naturalmente durante la ejecución de la tarea.


Teoría de sistemas

• El enfoque de sistemas considera:– Factores del cliente: condición de salud, disfunción o

daño, edad, género, etc. – Ocupación: significativas o tareas preferidas. – Entorno: contexto relevante

• Contextos: sensomotor, psicosocial, cognitivo y de desempeño. Mathiowetz & Bass Haugen, 1994).


Teorias del aprendizaje(modificación del comportamiento)

• Aprendizaje no-asociativo – Habituación: desensibilización que resulta de

la exposición repetida a estímulos no doloroso (e.g., ignorar estímulos que disparan respuestas no funcionales.)

– Sensibilización: incrementar la capacidad de respuesta (e.g., poner atención a los aspectos de seguridad, tales como agua en el piso, o a obstáculos durante el recorrido)


Learning, cont.

• Aprendizaje asociativo:– Clasico/condicionante: considera influencias

pasadas y actuales del entorno– Procedimental: realizadas sin atención conciente

(desarrolladas lentamente a través de muchas repeticiones llegando a ser habituales, almacenadas en el cerebro como “esquemas de movimiento”-caminar-)

– Declarativo: requiere de conciencia, atención y reflección (palabras)


Learning, cont.

• Variable practice, using motor/perceptual skills under varying conditions, works best for generalization of learning

• Contextual interference, using motor perceptual skills in random order, increases spontaneous use for new tasks

• Individual characteristics, such as level or experience & intellectual ability influences motor learning

• Transfer of learning occurs more easily when tasks are similar (Toglia – near transfers)


Learning, cont.

• Schmidt’s “schema theory” uses sets of general rules that apply in variety of contexts

• Schema: a generalized motor program that consists of 4 parts:– Initial situation– Parameters used– Outcome (knowledge of result)– Sensory consequence (how movement feels)

• Example: swinging a golf club or donning a coat


Learning, cont.

• Newell’s Ecological Theory clarifies the role of perceptions in motor learning.– Recognition of goal or task– Regulatory cues (sensitize to what is relevant

to the task)– Knowledge of Performance (KP): feedback

during performance, how movement felt– Knowledge of Result (KR): feedback on goal

achievement


FUNCTION & DYSFUNCTION

• Gentile (1992): early & late stages of learning

• Fitts & Posner (1967):– Cognitive stage of motor learning

(understanding of task, experimentation)– Associative stage: refined practice– Autonomous stage: skill relatively automatic– Example: child learning to climb stairs


Function cont.

• Degrees of freedom: refers to gradual increase in smoothness of performance of skilled movement. Example: using a hammer.

• Specific definitions for function & dysfunction have not been defined in occupational therapy (Kaplan & Bedell, 1999).

• Definition of dysfunction in OT must include all three components: person, environment, & occupation.


CHANGE & MOTIVATION

• Holistic approach: OT ALWAYS incorporates practice of perception and movement within the context of SPECIFIC TASKS.

• Client centered: Motivation comes naturally when clients and/or families set priorities for tasks to be accomplished & goals to be achieved.

• Systems approach begins with role performance, considering the best combination of remediation, adaptation, & compensation in order to promote client-identified level of functioning to fulfill desired roles.


Change, cont.

• Change occurs through learning process.

• Recovery may be:– Spontaneous, without benefit of intervention– Forced recovery, function gained through

therapeutic intervention, such as – example?– Adapted or functional recovery, attained

through altering methods or contexts within which client accomplishes a task


Postulates of Change, cont.

• Defined in Pediatrics by Kaplan & Bedell. Motor skills more likely to improve when:– Match between child’s ability, task, & context.– Child understands expectation & receives

clear guidance– Independent problem-solving encouraged– Just right challenge (zone of proximal

development).


Assessment

OT Assessment includes:

• Dynamic evaluation, watching client during occupational performance, including responses to cues.

• Collaboration with client to determine occupational problems and priorities.

• Evaluation of person, task, & context, to determine appropriate OT interventions.


Assessment• OT evaluations may incorporate manual muscle

tests, range of motion, strength & endurance tests, which directly relate to problems with specific task performance.

• Sensory & perceptual evaluations stem from client-identified problems with those aspects of task performance.

• Cognitive evaluations may further clarify difficulties with awareness, goal identification, motor planning, and generalization of learning.


INTERVENTION

• Client-centered role/task selection

• Discussion of OT assessment results

• Collaboration which includes therapeutic use of self in determining and/or raising level of client self-awareness

• Imparting information on current evidence with regard to a choice of approaches

• Practice of needed skills in natural settings


Motor Learning Interventions

• Prevention of injury/dysfunction through splinting, positioning, educating, & sensitization to relevant environmental cues.

• Promoting function through individualized task problem-solving & collaborative experimentation about the best way to accomplish the task.


Interventions, cont.

• Practicing whole tasks, not isolated parts.• Providing skill practice in varied contexts

during daily routines.• Providing randomized practice (changing

parameters or circumstances).• Providing intermittent feedback during task

performance or summarized at end.• Encouraging self-evaluation & error

detection (both KP & KR).


Interventions, cont.

• Modify task demand in order to achieve task goal (use e-mail instead of telephone to communicate with others; use alarm to remember next step).

• Modify contextual factors in order to achieve task goal (use bolsters to position for active movement in playing a game).


Intervention: Constraint-Induced Movement Therapy

• Contemporary variation of task-focused approach for stroke survivors (1 year post-stroke).

• Consists of “constraining” nonaffected arm, forcing use of affected limb for performing daily tasks.

• In 2-week experiment, “constrained” group showed significantly greater motor skills, carry over to life tasks, and maintenance of gains in 2-year follow-up.

• Original study replicated (Blanton & Wolf, 1999) shows that 20% to 25% of clients with chronic stroke symptoms may benefit from this approach.


The End

• Please make your own copy of reserve article. Focus on distinctions made between traditional & contemporary OT approaches.

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