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A Reflection on Motor Learning Theory in Pediatric Occupational Therapy Practice

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A Reflection on Motor Learning Theory in Pediatric Occupational Therapy Practice A reflection on motor learning theory in pediatric occupational therapy practice Jill G. Zwicker I Susan R. Harris Key words I Motor learning I Theory, Pediatric practice I Occupational therapy Mots clés I Apprentissage moteur I Théorie I Pratique pédiatrique I Ergothérapie Abstract Background . Theory provides a guide to clinical practice. To date, the most prevalent theories in pediatric occupational therapy practice are sensory integration and neurodevelopmental treatment. Purpose . The purpose of this paper is to present a brief overview and reflection on motor learning theories as well as a summary of motor learning principles that can be used in pediatric practice. Key Issues . Over the past two decades, motor learning theory has been applied in adult occupational therapy practice, but it has been slow to gain popularity in pediatrics. Implications . Although therapists may be tacitly applying motor learning principles in practice, conscious and deliberate application of these principles to a variety of pediatric populations is required to determine if motor learning theory provides a viable and effective contribution to evidence-based, occupational therapy pediatric practice. Further research comparing motor learning interventions to other dominant interventions in pediatric occupational therapy is warranted. Résumé Description . La théorie est un guide pour la pratique clinique. À ce jour, les théories les plus répandues concernant la pratique de l’ergothérapie en pédiatrie sont celles de l’intégration sensorielle et de l’approche du développement neurologique. But . Cet article présente un bref aperçu des théories de l’apprentissage moteur et propose une réflexion sur ces théories, tout en résumant les principes pouvant être appliqués en pratique pédiatrique. Questions clés . Depuis les vingt dernières années, les principes de la théorie de l’apprentissage moteur sont appliqués dans la pratique de l’ergothérapie auprès des adultes, alors que ces mêmes principes tardent à se répandre en pédiatrie. Conséquences . Bien qu’en pratique les ergothérapeutes appliquent tacitement les principes de l’apprentissage moteur, il serait nécessaire d’appliquer consciemment et délibérément ces principes auprès de différentes clientèles en pédiatrie, afin de déterminer si la théorie de l’apprentissage moteur contribue fondamentalement et efficacement à la pratique de l’ergothérapie en pédiatrie fondée sur les faits scientifiques. Il serait justifié de pousser plus loin les recherches en comparant des méthodes d’intervention basées sur les principes d’apprentissage moteur à d’autres méthodes fréquemment utilisées en ergothérapie dans le domaine de la pédiatrie. heory is the driving force behind occupational therapy multi-system rather than hierarchical (Shepard, 1991). This practice. Using the Canadian Practice Process shift in thinking about the CNS led to the development of TFramework (Townsend & Polatajko, 2007), therapists contemporary theories of motor learning. While motor select frames of reference to guide their practice. In pediatric learning theory has been widely used in adult occupational occupational therapy practice, the dominant theoretical therapy practice, it has been slow to gain popularity in approaches used in the United States, Canada, Australia, and pediatrics. the United Kingdom are sensory integration (SI) theory and The purpose of this paper is to review the key principles neurodevelopmental treatment (NDT) (Brown, Rodger, of motor learning theories and their application to pediatric Brown, & Roever, 2005; Howard, 2002; Storch & Eskow, occupational therapy practice. Chinn and Kramer’s (1995) 1996). These theoretical approaches were developed in the framework will be used to reflect on the clarity, simplicity, 1960s and 1940s respectively and are based on a hierarchical generality, accessibility, and importance of motor learning model of the central nervous system (CNS). Since the late theories as a foundation for pediatric practice. We will then 1980s, the CNS has been conceptualized as multilevel and provide an example of how motor learning theories can be © CAOT PUBLICATIONS ACE VOLUME 76 I NUMBER 1 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I FEBRUARY 2009 29 ZWICKER & H ARRIS applied to pediatric practice and will conclude with future and influence motor performance of new tasks. A recall directions for research and practice. schema initiates the GMP that closely resembles the desired Motor learning theories movement, and the recognition schema evaluates the occurring movement. The recall schema is then modified by Motor learning is defined as “a set of processes associated the movement experience. A major limitation of schema with practice or experience leading to relatively permanent theory is that it does not explain how GMP are initially changes in the capability for movement” (Schmidt & Lee, formed. Schmidt’s theory has evolved over time (Schmidt, 2005, p. 302). Motor learning has been a key concept in the 2003) and has provided important motor learning concepts fields of physical education and sport since the 1970s. Motor of knowledge of results and variability of practice , discussed learning theory entered the field of neurological rehabili - below. tation during the 1980s and has been applied primarily to adults with stroke (Carr & Shepherd, 1989; Gilmore & Dynamic systems theory Spaulding, 2001; Krakauer, 2006; Sabari, 1991). In recent Dynamic systems theory is considered a contemporary theory years, motor learning has formed the foundation for treating of motor learning despite its appearance prior to the previous children with developmental coordination disorder two motor learning theories (Bernstein, 1967). Bernstein’s (DCD)(Missiuna, Mandich, Polatajko, & Malloy-Miller, work resurfaced in the 1980s with the rejection of the hierar - 2001; Niemeijer, Smits-Engelman, & Schoemaker, 2007; chical view of the CNS. Dynamic systems theory places less Sugden & Henderson, 2007). No one theory of motor emphasis on the nervous system by viewing movement as learning has been able to explain motor skill acquisition in its emerging from the interaction of three general systems: the entirety, but each theory has offered an important contri - person, the task, and the environment (Kamm, Thelen, & bution to our understanding of how motor skills are learned. Jensen, 1990; Mathiowetz & Haughen, 1995; Newell, 1986). Three motor learning theories that have dominated the Each general system has several subsystems that interact with literature will be highlighted, and then the key principles of one another to either support or constrain movement. motor learning that have evolved from these theories will be Subsystems that have the potential to change are referred to summarized. as control parameters and may be the target of therapeutic intervention to improve motor learning. Practice and Closed-loop theory experience alter the formation of movement patterns through Adams (1971) was the first researcher to describe a theory of interaction with the environment and the demands of the motor learning. The primary aspect of his theory was the task. Attractor states are efficient patterns of movement that concept of a closed-loop process of acquiring skills. Briefly, develop with practice and experience for common tasks Adams posited that sensory feedback is required for learning (Kugler & Turvey, 1987; Mathiowetz & Haughen). motor skills. He proposed that movement was selected and Motor learning principles initiated by a memory trace , which was modified by a perceptual trace with repeated practice. This perceptual trace Several principles of motor learning have evolved from the is the internal reference within which to compare movement above theories and have been applied in normal and clinical and detect error. Adams’ theory assumes that motor learning populations. These principles include stages of learning, is enhanced by repeated practice of the same movement, with types of tasks, practice, and feedback. guidance if necessary, to minimize error. Adams’ (1971) theory has been refuted with two main Stages of learning lines of research. First, studies with animals (Fentress, 1973; Fitts and Posner (1967) described three stages of motor Taub, 1976) and humans (Rothwell et al., 1982) have learning: cognitive, associative, and autonomous. During the demonstrated that motor learning is possible without sensory cognitive stage , an individual may have a general idea of the feedback. Secondly, Adams’ contention that practice needs to movement required for a task but might not be sure how to be errorless has not been borne out by research; studies have execute that movement. Performance during this stage is indicated that variability in practice may be superior in likely to be highly variable with a large number of errors. promoting motor learning (Shea & Kohl, 1990, 1991). Improved performance is contingent upon the individual’s conscious effort to attend to the task requirements. Often this Schema theory is achieved through verbalization of movement strategies, To address the weakness inherent in Adams’ (1971) theory, which Adams (1971) referred to as the verbal motor stage in Schmidt (1975) proposed an open-loop process for motor his closed-loop theory of motor learning. learning known as schema theory. Briefly, Schmidt suggested The second, intermediate stage, of motor learning is the that generalized motor programs (GMP) are created from past associative stage . Skills become more refined with practice, movement patterns;
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