Reduced Feedback: Motor Learning Strategy in Persons with Alzheimer's Disease

This study investigated various frequencies of feedback known as knowledge of results (KR) in learning a motor skill. Participants included 21 persons with Alzheimer's disease (AD) and 19 age-matched and education level-matched well elderly individuals who were randomly assigned to two groups; a 100% KR or 33% KR group. The task involved turning a knob that controlled the height of a column on a computer screen to match the height of a target column. Participants with AD who experienced the 33% KR condition performed significantly better in the retention and transfer tasks than those who experienced the 100% KR condition. This suggests that reduced frequency of KR may facilitate the retention and generalization of simple motor skills in persons with mid to moderate levels of AD. Replicating this study using a larger sample size will provide stronger evidence to help guide effective treatment protocols that facilitate motor skill performance.     

Neuropsychology and the relearning of motor skills following stroke

Regaining independent mobility is one of the most important goals in physical therapy with patients suffering from the consequences of stroke. Both physical therapy and occupational therapy are learning processes in which the patient has to remaster old skills or has to learn novel skills. It is argued that the (re-)learning of motor control is a process in which motor aspects continuously interact with sensory and cognitive processes. It is therefore necessary that neuropsychological knowledge should be integrated in the therapy in order to create the most optimal situation for learning. In this article the most prominent neuropsychological consequences are described and suggestions are given as to how a therapist may use this knowledge to improve the therapy.     

Occupational therapists' perceptions of psychosocial strategies for clients with Parkinson's disease

Psychological strategies are a promising adjunct to pharmacological treatment for symptoms, including depression and anxiety associated with Parkinson's disease. In this study, we investigated perceptions and reported behaviors of occupational therapists regarding the use of psychosocial strategies during their practice with clients with Parkinson's disease. The results of a cross‐sectional online survey (n = 115 occupational therapists) demonstrated that the majority of participants (83%) reported using psychosocial strategies with their clients living with Parkinson's disease, with goal setting the most frequent. Almost all occupational therapists (99.1%) reported that it was moderately to extremely important to have knowledge about psychosocial strategies for practice with clients living with Parkinson's disease, and 96.5% rated it important to be able to offer these strategies in practice with their clients living with Parkinson's disease. The majority (91.3%) felt incorporating psychosocial strategies into their practice was moderately to extremely beneficial, and 93.9% reported that psychosocial strategies have a moderate‐to‐extremely positive effect on Parkinson's disease management outcomes. These findings have important implications for the education and training of occupational therapists working with clients living with Parkinson's disease to help ensure the best possible outcomes for people with Parkinson's disease.     

Can a targeted home-based exercise programme improve turning characteristics in individuals with Parkinson's disease?

BackgroundTurns are often cited as a difficult task for individuals with Parkinson's disease and often lead to falls, however targeted exercise interventions may help to reduce this problem. This study examined the effects of a 10-week home-based exercise program focusing on turns which may be an exercise approach for improving mobility and reducing falls in individuals with Parkinson's disease.MethodsTurning and stepping characteristics were recorded using Inertial Measurement Units while participants performed a 180° standing turn. Eye movements were measured using a BlueGain electrooculography system. Clinical outcomes were assessed using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Functional axial rotation-physical score and the Falls Efficacy Scale International.FindingsTwenty individuals with Parkinson's disease were matched by severity using the Modified Hoehn and Yahr scale and were randomly allocated to an exercise (n = 10) or control group (n = 10). Significant improvements were seen after 10 weeks in the exercise group only for; onset latency of body segments, step size, number of fast phase eye movements, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale in motor and rigidity scores, Functional axial rotation-physical score and the Falls Efficacy Scale International.InterpretationThese results indicate that the home-based exercise programme targeting turning characteristics had positive effects on turning performance and clinical outcomes associated with falls in individuals with Parkinson's disease. These preliminary results support the notion that targeted home-based exercises may provide an effective intervention in this population.     

Elderly Drivers' Perceptions of Their Driving Abilities Compared to Their Functional Motor Skills and Their Actual Driving Performance

Occupational therapy is based on helping individuals to develop and function indpendently within their environment. The ability to drive allows a person to remain independent by providing the mobility and freedom to accomplish other activities of daily living. This study examined the elderly drivers' perceptions of their driving abilities, compared to their clinically tested functional skills in the area of motor abilities, and their actual in-car driving performance. The specific motor abilities include: range of motion, muscle strength, grip strength, head and trunk control, reaction time, proprioception, and light touch and localization. A population sample of 115 individuals 65 years and older was chosen from the Veteran's Administration Hospital. The results, although nonsignificant, indicated that the elderly individuals are indeed aware of their abilities for range of motion, muscle strength, head and trunk control, grip strength, reaction time, proprioception, and light touch and localization. The study also indicated that clinically tested motor skills and actual in-care driver performance can be predictive based on reaction time. Limitations of this study and ideas for future research are provided.     

电脑游戏配合作业疗法对痉挛型脑瘫精细运动功能的临床研究

目的研究电脑游戏配合作业疗法改善痉挛型四肢瘫脑瘫患儿精细运动功能的临床效果。方法 22例痉挛型四肢瘫脑瘫患儿随机分为对照组(n=11)和电脑游戏组(n=11)。对照组应用常规作业疗法,电脑游戏组应用常规作业疗法配合电脑游戏进行治疗。每天1次,每周5 d,治疗3个月。结果两组治疗后,精细运动功能显著提高(P<0.001),且电脑游戏组优于对照组(P<0.05)。结论电脑游戏配合作业疗法可以有效改善精细运动功能,优于单纯作业疗法。     

Implicit and explicit learning: applications from basic research to sports for individuals with impaired movement dynamics

Purpose.?Motor skills can be learned in an explicit or an implicit manner. Explicit learning places high demands on working memory capacity, but engagement of working memory is largely circumvented when skills are learned implicitly. We propose that individuals with impaired movement dynamics may benefit from implicit learning methods when acquiring sports-related motor skills.

Method.?We discuss converging evidence that individuals with cerebral palsy and children born prematurely have compromised working memory capacity. This may in part explain the difficulties they encounter when learning motor and other skills. We also review tentative evidence that older people, whose movement dynamics deteriorate, can implicitly learn sports-related motor skills and that this results in more durable performance gains than explicit learning.

Results.?Individuals with altered movement dynamics and compromised working memory can benefit from implicit motor learning.

Conclusion.?We conclude with an appeal for more extensive evaluation of the merits of implicit motor learning in individuals with impaired movement dynamics.     

Integration of Occupation for Individuals Affected by Parkinson's Disease

The purpose of this study was to describe the essence of occupation for community living adults aged 50 to 80 years old affected with Parkinson's disease. Through the development of seven themes, the phenomenon of activity integration for a person with Parkinson's disease was described. The themes transmit a message to occupational therapists regarding the idiosyncratic nature of occupations and the individual nature of adaptive strategies used by individuals with the disease to retain a meaningful occupational lifestyle. This is best accomplished when the therapist is able to retain a person-centered stance.     

脑损伤后的运动再学习与运动控制(二)

4运动技能重新学习各阶段的训练原则[3,5,11,12]4．1认知阶段的训练4．1．1训练目的认知阶段的训练目的是促进病人对运动的理解并能组织早期练习,重点是明确与功能有关的动作目的,所学习的任务对病人来说应是重要的、需要的和现实的。治疗师应按照正常情况先示范训练的运动,提出基本要求（如平稳、安全、正常速度）,这些将有助于帮助病人形成一个内在的认知联系或正确的参考点。病人的注意力应该放在所学习运动的关键部分,明确对个人能力发展至关重要的环境特征。治疗师则要指明该次练习与其它学习过的运动的相似之处,以便与其它运动…     

Motor variability in occupational health and performance

Several recent reviews have reported that ‘repetitive movements’ constitute a risk factor for occupational musculoskeletal disorders in the neck, shoulder and arm regions. More variation in biomechanical exposure is often suggested as an effective intervention in such settings. Since increasing variation using extrinsic methods like job rotation may not always be possible in an industrial context, the intrinsic variability of the motor system may offer an alternative opportunity to increase variation. Motor variability refers to the natural variation in postures, movements and muscle activity observed to different extents in all tasks. The current review discusses research appearing in motor control, sports sciences and occupational biomechanics literature to answer whether motor variability is important to consider in an occupational context, and if yes, whether it can be manipulated by training the worker or changing the working conditions so as to increase biomechanical variation without jeopardizing production. The review concludes that motor variability is, indeed, a relevant issue in occupational health and performance and suggests a number of key issues for further research.     

Brief Overview of Motor Learning and It's Application to Rehabilitation: Part Ⅰ: Motor Learning Theory

1 DEFINITION OF MOTOR LEARNING Motor learning is the study of how we acquire and modify movements.1 The acquisition of motor skills is the process of learning how to do a particular movement (performance), but the real key to therapeutic intervention is being able to affect permanent changes in motor skills via the process of motor learning. Therefore, motor learning is defined as the ability to retain the ability to perform a motor task at a later time. In rehabilitation, it is important to be cognizant of the concepts of acquisition and retention. We can facilitate acquisition,but do little to assist in the retention of the task (learning). Conversely, we can arrange practice such that acquisition is slowed, but we can actually be assisting learning the task. It is important to have a clear goal in mind and work towards the eventual learning of the task to allow full functional use of that skill.     

Motor learning of a dynamic balancing task after stroke: implicit implications for stroke rehabilitation

BACKGROUND AND PURPOSE: After a stroke, people often attempt to consciously control their motor actions, which, paradoxically, disrupts optimal performance. A learning strategy that minimizes the accrual of explicit knowledge may circumvent attempts to consciously control motor actions, thereby resulting in better performance. The purpose of this study was to examine the implicit learning of a dynamic balancing task after stroke by use of 1 of 2 motor learning strategies: learning without errors and discovery learning. PARTICIPANTS AND METHODS: Ten adults with stroke and 12 older adults practiced a dynamic balancing task on a stabilometer under single-task (balance only) and concurrent-task conditions. Root-mean-square error (in degrees) from horizontal was used to measure balance performance. RESULTS: The balance performance of the discovery (explicit) learners after stroke was impaired by the imposition of a concurrent cognitive task load. In contrast, the performance of the errorless (implicit) learners (stroke and control groups) and the discovery learning control group was not impaired. DISCUSSION AND CONCLUSION: The provision of explicit information during rehabilitation may be detrimental to the learning/relearning and execution of motor skills in some people with stroke. The application of implicit motor learning techniques in the rehabilitation setting may be beneficial.     

Sprint exercise for subjects with mild-to-moderate Parkinson's disease: Feasibility and biomechanical outputs

BackgroundHigh-intensity training, a still unexplored exercise for individuals with Parkinson's disease, is positively related with increased functionality and aerobic profile in healthy individuals. The aim of this work was to evaluate the feasibility, safety, and acceptance of sprint running in individuals with mild-to-moderate Parkinson's. Additionally, we compared sprint biomechanical outputs of force, velocity and power between individuals with Parkinson's disease and healthy.MethodsPhysically trained subjects with Parkinson's, men, (n = 16, 64:9.01 years, stage between 1 and 3 in the Hoehn and Yahr, 16.8:7.1 at Unified Parkinson's disease Rating Scales, and control group (n = 21, 65:9.27 years) performed 20 m sprint sessions. We analyzed the self-reported satisfaction and acceptance using a self-administered questionnaire, and the sprint biomechanics and performance based on high-speed video recordings.FindingsAll participants completed the tests with high feasibility, acceptability and satisfaction scores. The sprint maximal force and maximal power outputs were higher in Parkinson's disease. Conversely, control group showed higher mechanical effectiveness values. Interestingly, no difference in velocity capabilities and overall 20-m sprint performance was observed between groups, possibly explained by different mechanical strategies in both groups over the sprint accelerations. Linear regression analyses showed that physical qualities are predictors of mechanical effectiveness, and mechanical variables are important determinants of sprint performance on Parkinson's disease.InterpretationSprint is a feasible exercise for people with mild-to-moderate Parkinson's disease. Even though differences in physical qualities and mechanical effectiveness exist between subjects with Parkinson's disease and healthy, there is no overall substantial impact on sprint running performance.     

Application of motor learning principles in occupational therapy

The processes underlying skill acquisition depend on the nature of the task and the stage of the learner. In addition, feedback and practice are two potent learning variables when used appropriately in the instruction of motor tasks. Occupational therapists involved in the training and retraining of motor skills can benefit from knowledge of instructional methods used by coaches and physical educators. This paper reviews commonly accepted principles of motor learning and applies these principles to occupational therapy treatment. The stage of the learner, type of task, feedback, practice, and facilitation of skill acquisition are emphasized. Specific examples of how occupational therapists can use motor learning principles in treatment are given.     

Sit-to-walk performance in Parkinson's disease: A comparison between faller and non-faller patients

BackgroundFalls are one of the main concerns in people with Parkinson's disease, leading to poor quality of life and increased mortality. The sit-to-walk movement is the most frequent postural transition task during daily life and is highly demanding in terms of balance maintenance and muscular strength.MethodsWith the aim of identifying biomechanical variables of high risk of falling, we investigated the sit-to-walk task performed by 9 Parkinson's disease patients with at least one fall episode in the six months preceding this study, 15 Parkinson's disease patients without previous falls, and 20 healthy controls. Motor performance was evaluated with an optoelectronic system and two dynamometric force plates after overnight suspension of all dopaminergic drugs and one hour after consumption of a standard dose of levodopa/benserazide.FindingsPoor trunk movements critically influenced the execution of the sit-to-walk movement in patients with a history of falling. The peak velocity of the trunk in the anterior-posterior direction discriminated faller from non-faller patients, with high specificity and sensitivity in both the medication-off and -on state.InterpretationOur results confirm the difficulties in merging consecutive motor tasks in patients with Parkinson's disease. Trunk movements during the sit-to-walk can provide valuable measurements to monitor and possibly predict the risk of falling.     

Low Motor Assessment: A Comparative Pilot Study with Young Children With and Without Motor Impairment

Most of the developmental instruments that measure cognitive development in children rely heavily on fine motor skills, especially for young children whose language skills are not yet well developed. This is problematic when evaluating the cognitive development of young children with motor impairment. The purpose of this study is to assess the need for a Low Motor adapation of a standardized instrument when testing children with motor impairment. To accomplish this, we have adapted the procedures, item instructions and play material of a widely used and standardized instrument, the Bayley Scales of Infant Development-Second Edition (BSID-II, Bayley 1993). The Original and the Low Motor versions were administered to 20 children experiencing typical development and 19 children with motor impairment within a period of two weeks. Results showed that children with motor impairments scored significantly higher on the Low Motor version of the Bayley Mental Scale than on the Original version: a difference of between 5 and 10 points when the score is expressed in terms of a developmental index score. Results from children with typical development support the assumption that item content and difficulty remain unchanged in the Low Motor version.     

Purposeful activity in motor learning theory: an event approach to motor skill acquisition

This paper presents the event approach to motor skill acquisition as a theoretical treatment of the learning and relearning of motor skills; the emphasis is toward rehabilitation of physical dysfunction. Purposeful activity is viewed as a necessary prerequisite for the formation of coordinative structures, which are the bases for skilled movement. Traditional approaches to motor learning, which focus primarily on the actor, are seen as inadequate to accurately describe motor skill acquisition. The event approach treats the actor and the environment as inseparable in the acquisition of skills. Using this approach, I hope to establish a common ground and collaborative relationships between the disciplines of occupational therapy and motor learning.     

Motor control and the role of occupational therapy: past, present, and future

Human motor behavior continues to evolve and, therefore, may never be fully understood. Still, occupational therapy treatment approaches that are based on neurophysiological principles are fairly well accepted, and there is much potential for the development of treatments that will facilitate recovery of function. Occupational therapy must face and confront its roles in relation to the field of motor control; a health care profession involved with performance and motor control issues cannot afford to ignore the rapid advances in neuroscience information and the parallel developments in the field of motor control. Rood (1980) stated that many people want a "womb with a view," so that they remain protected and yet passively observe the outside world. However, if occupational therapy is to remain current with new developments in the field of motor control, it cannot afford to be passive.