Motor Learning is required for motor recovery after an injury to the motor system. This slides discussed the forms of motor learning and the theories of motor learning.

1. MOTOR LEARNING
& RECOVERY OF
FUNCTION
PHT 613
Ekechukwu E.N.D (B.MR,PT; M.Sc; Ph.D.)

2. Motor Learning
• Learning is the process of acquiring
knowledge about the world
• ML is a set of processes associated
with practice or experience leading to relatively permanent
changes in the capability for producing skilled action
- capability of movt acquisition
- results 4m experience or practice
- cannot be assessed directly but inferred 4m behaviour
- produces relatively permanent changes in behaviour

3. Forms of Learning
1. Non-associative Learning
• Occurs when animals are given a
Single stimulus repeatedly that results
in the NS learning about the stimulus
eg Habituation and Sensitiation
• Habituation:
- Decrease in responsiveness that occurs due to
repeated exposure to a non-painful stimulus.
- It is used in many ways in the clinic eg habituation of
dizziness, tactile defensive children.

4. Non-associative Learning Cont’d
• Sensitization
- Increase in responsiveness following a threatening/
noxious stimulus eg tenderness
- It counteracts the effect of habituation
- Sometimes sensitization is important
eg balance training by Increasing awareness of fall

5. 2. Associative Learning
• Learning that involves the
association of ideas eg asking a pt
with walking problems to shift
of COG & swing
• It helps pts to learn how to predict r/ships
either of one stimulus to another (Classical
Condition) or one’s behaviour to a
consequence (operant conditioning)

6. Classical Conditioning
• A process of learning to pair stimulii
• The initially weak stimulus (cs) becomes higly
effective in producing a response (cr) when it
becomes associated with another stronger
stimulus (ucs)
• Eg giving a verbal cue in
conjunction with physical assistance
when making a movt
• We generally learn r/ships that
are relevant to our survival.

7. Operant/Instrumental Conditioning
• Basically trial and error learning
• We learn to associate a certain
response from among many that we
have made with consequence
eg rewards and punishment
• Law of effect “behaviours that are rewarded tend
to be repeated at the cost of other behaviours …
and vice versa”
• Implication: operant conditioning determines
behaviour of pt referred for PT eg falls

8. Procedural & Declarative Learning
• Associative learning classification
Based on the type of knowledge acquired &
ability to recall learned information
• Procedural learning
- Learning tasks that can be performed w/o attention or
conscious thought
- Devs slowly thru repetition of an act over many trials
- Repeating a movt under varying conditions leads to
procedural learning i.e automatically learning the rules
for movt eg transfer

9. P & D Learning
• Declarative Learning
- Results in knowledge that can be consciously
recalled and thus requires awareness,
attention & reflection
- DL can be expressed in declarative sentences
eg button the top button, then the next one.
- Constant repitition can transform DL to PL
- DL learning encourages mind rehearsal of
movt

10. Theories of Motor learning
• A group of abstract ideas about the nature and cause of the
acquisition/modification of movt
• Adam’s Closed Loop theory
- Sensory feedback used to organise skilled movt
- Proposes 2types of memory: memory & perceptual traces
- Memory trace used in the selection & initiation of movt
- Perceptual trace built up over a period of
practice & becomes internal reference of
correctness.
- After movt is initiated, the traces takes
over to carry out the movt & detect error.

11. Adam’s Closed Loop theory Cont’d
• Clinical Implication: The more the practice of a
particular movt, the stronger the perceptual trace
• Limitations
- Movts can be made w/o sensory feedback (open-
loop movt)
- Not possible to store a separate perceptual trace
for every movt ever performed
- Variation of movt practice may improve motor
performance

12. Schmidt’s Schema Theory
• Emphasised open-loop control processes and
generalized MP concept
• That MPs don’t contain the specifics of movt but
the rules for specific class of movt
• Central concept of schema: abstract rep stored in
memory following multiple presentations of a
class of info eg seeing many dogs
• Two types of schema: Recall and recognition
schema
• Variability strengthens the generalized schema

13. Schmidt’s Schema Theory Cont’d
• Clinical implication: Optimal learning occurs if
task is practiced under many varying
conditions
• Limitations
- Lacks specificity
- Inability to account for immediate acquisition
of new types of coordination eg quadruped
gait in centipedes.

14. Ecological Theory
• Karl Newell proposed that ML is a process that improves
the coordination btwn perception and action consistent
with task & environment
• Search for appropriate perceptual cue is as important as
search for motor response
• It emphasised on the dynamic exploratory activity of the
perceptual-motor workspace to create optimal strategies
for performing a task.
• Clinical Implication: Teaching pts to distinguish relevant
perceptual cues eg size, texture, vol, wt etc
• Limitation: No RCT

15. Stages of Learning
• Fits & Posner 3-stage Model
- Cognitive stage: understanding the nature of
task, dev strategies, how task can be performed
- Associative stage: refining of the best selected
strategy
- Autonomous stage: the automaticity of skills
with low degree of attention. Attention focused
on other aspect of the skill

16. Stages of Learning Cont’d
• System 3-stage model (Verejken et al, 1992): DF are
constrained when a novice learns skill eg use of
hammer.
- Novice stage: simplifies movt, freezes DF
- Advanced stage: muscle synergy used to create well
coordinated movt
- Expert stage: all DF released, learns to take adv of the
mechanics of the MSK system & the environment
- Explains coactivation, rationale for devt stage rehab
(biomechanical not neural perspective), providing
external support during early neurorehab

17. Stages of Learning Cont’d
• Gentiles 2-stage model: based on the goal of
the learner
- To dev understanding of task dynamics eg
learning to distinguish regulatory features
- Fixation/diversification stage: goal for refining
the movt

18. Practical Application of ML
• Feedback: all sensory info due to a movt
(response-produced feedback) – Intrinsic &
Extrinsic (concurrent/terminal)
• Practice
- Massed vs Distributed practice
- Constant vs variable practice
- Random vs Blocked practice
- Whole vs part training
- Transfer/ carryover effects
- Mental practice (SMA)

19. Recovery of function
• ML- the acquistion or modification of movt in
normal suject while recovery of fxn relates to re-
acquisition of movt skills lost thru injury
• Recovery – achieving fxnal goal in same way it
was performed pre-injury
• Compensation – behavioural substitution i.e
alternative behavioural strategies adopted to
complete a task
• Sparing fxn – when a fxn is not lost despite injury
• Spontaneous vs Forced recovery

20. Factors Contributing to Functional
Recovery
• Effect of age
• Characteristics of the lesion: size, onset
• Effect of experience: enrichment (pre-op &
post-op)
• Effect of pharmacology: trophic factors, NT,
anti-toxic, circulation , anti-oxidant etc
• Effects of training

21. Conclusion
• Knowledge of ML is inevitable to neurorehab
• Functional return may be due to recovery &
compensatory process
• My 3stage model of stroke rehab