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PTP
712 Neuroscience in Physical Therapy Winter 2018

Motor
learning and the recovery of function

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Emilia
Bartram
University
of Michigan – Flint

Activity
#1: Compare and contrast the explicit and implicit
learning processes.
Tom’s
inability to recall the sequence from day to day shows he has
difficulties with explicit
learning.
This may be because he has
medial temporal lobe lesions which do not allow the formation of
explicit memory.1
However, with
continued practice, the skill may
enter his implicit memory
even though he is unable to explicitly remember the stages of
movement. This can occur in patients with lesions of the temporal
lobe and the hippocampus, where new explicit information could not be
learned, but skill learning is
unaffected.2
Procedural
learning, a type of
implicit memory, creates a
movement schema that can then be applied to different contexts. If
procedural learning is not
possible despite repeated
practice, Tom will not be safe as he has not committed the movement
schema to memory. Thus,
he cannot then translate this to other conditions, so he will be
unsafe to walk with two canes in
new environments.

Activity
#2: Compare
and contrast various motor learning theories.
Fitts
and Posner’s 3 stage model assumes three stages of learning; the
cognitive, the associative, and the autonomous stage. Jean is likely
to manage the high cognitive
and attention demands of relearning a task. Based on the video, it
appears that Jean is still
in the cognitive stage of reaching for a glass. This is shown in her
inability to fully form a palmer grasp, showing she still needs to
develop a motor program for this skill, her
jerky movements, and her inability to isolate muscle movements (using
her trunk to abduct the shoulder).
Observing the video, she also appears to require a high level of
concentration to complete this task, and
relies heavily on her declarative memory as she manipulates the
information consciously.3
Therefore,
Jean requires external sources of information such as the Physical
Therapist to help produce a correct movement pattern.4
As her movement improves, she will require less external information
and begin to be able to adapt to the environment – different size
and weights of the object she is reaching for. It is therefore
important that the therapist initially provides feedback to help
develop the correct movement pattern, and then allows Jean to apply
this to different settings.3
During
the autonomous phase, feedback should be precise, and
Jean
should be allowed to make errors as this has shown improved
performance during novel tasks.5

However,
this model does assume that the movement will be able to be learned.
In Jean’s case, she has other limitations to movement such as
weakness, spasticity, and flexor synergy. These must be addressed
before she can achieve the associative and autonomous stage, as her
movements are likely to stay effortful if, for example, she has
spasticity limiting elbow extension. She may however gain
compensatory strategies, and therefore while a specific movement is
effortful and variable in performance, the functional task becomes
proficient. For example, she may learn to use her left hand to aid
her right in creating a palmer grip, and with practice, this could
become a proficient movement the requires little energy or attention
to complete.

Activity
#3: Compare and contrast various motor learning theories.
Freezing
the degrees of freedom involves constraining the joint movement using
co-contraction. The release of the degrees of freedom allows improved
efficiency of movement and greater ability to adapt the movement for
the environmental demands.

For
example, initially the degrees of freedom in the lower limb may be
constrained to flexion and extension of the hip and knee to re-learn
basic stepping after hemi-paresis, with little ankle movement. The
therapist may need a ‘hands-on’ approach to help constrain the
movement, for example to prevent circumduction. As this becomes
easier, you could introduce stepping around objects, that would
encourage the use of abduction and adduction in the hip, and
inversion/eversion of the ankle which would require the release of
more degrees of freedom to allow for adaptation to the environment.
This would allow synergies to develop, allowing more flexibility of
body movements.3 From
this, you could take your patient outdoors where there is uneven
flooring, obstacles, and busy pavements, to release more degrees of
freedom. This assist the development of adaptation to different
contexts, leading to efficient movements and the ability to exploit
the limb movements to navigate the changing environment.

References:

Shumway-Cook
A, Woollacott MH. Motor
Control: Translating Research into Clinical Practice. 5th
ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2017

Milner,
B. Amnesia following operation on temporal lobes, In: Whitty CWM,
Zangwill OL, eds. Amnesia. London, UK: Butterworths, 1966: 109-133

Edwards,
W.H., Motor Learning
and Control: From Theory to Practice. Belmont,
CA: Cengage
Learning, 2010

Fitts
PM, Posner MI. Human
Performance. Belmont,
Calif: Brooks/Cole Pub. Co; 1967. )

Poole
JL. Application of motor learning principles in occupational
therapy. The
American journal of occupational therapy. : official publication of
the American Occupational Therapy Association.
1991;45:531-537

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