Aprendizaje de habilidades funcionales

Learning functional skills. Implications for rehabilitation after acquired brain injury


Over the past two decades, motor learning has been defined in many ways. While motor control focuses on understanding the control of movement already acquired, motor learning is comprised of a group of abstract ideas about how movement is acquired and/or modified, while offering a temporal perspective focused on the characteristics of the learning process. Notions related to the organization of treatments designed to maximize results, to improve transfer of learning and the design of essential activities of the rehabilitation process are, among others, issues to which motor learning attempts to offer a solution.

Similarly, it is important to distinguish between two aspects related to the performance of motor actions:

  • The process by which a motor action, task or function is carried out at a specific time and in a specific environment, known as “motor execution or performance.”
  • The notion of “motor learning.”

Complex interaction: perceptual, cognitive, and action systems

Shumway-Cook and Woolacott define motor learning as “a set of processes associated with practice or experience leading to relatively permanent changes in the capability for producing skilled action.” However, motor learning involves more than motor processes; the mechanisms for the development of new enabling strategies require the complex interaction of perceptual, cognitive, and action systems for the performance of activities of daily living.

Additionally, the development of a new skill emerges from the interaction of the individual with the activity being carried out and the environment in which this task takes place. Thus, the recovery of function or relearning requires the search for new solutions in relation to specific tasks and environments while also taking into account the limitations imposed by the person’s clinical characteristics. Therefore, one cannot study motor learning or recovery of function outside the context of how individuals are solving functional tasks in specific environments.

Learning complex skills

The learning of complex skills such as activities of daily living (basic and instrumental) involves the understanding of processes which are as yet unknown to us; thus, these activities are arranged in a hierarchic order ranging from “basic” to “complex” in relation those behavioral skills that must be learned.

Factors affecting motor learning

There are four factors that influence motor learning:

  • Stages of learning
  • Type of task to be learned
  • Feedback
  • Characteristics of practice

All these factors must be considered when carrying out an intervention program, however, the characteristics of practice and feedback seem to be the determining factors for learning to take place.

Maximize learning

Research related to motor learning strives to determine how to best plan clinical practice to maximize learning by considering aspects such as: intensity of practice, rest breaks, sequencing of movements and skills trained, conditions and design of tasks presented and/or the extent of the task being performed.

Teaching mechanisms

Teaching mechanisms are essential to maximize learning outcomes and must be adapted to individual needs considering the characteristics of the participant, of the task to be trained, and of the context in which training will take place. Thus, the type of verbal information and instruction, the use of modeling and molding techniques, and the previous experience of the individual are key factors to be taken into account.

Verbal instructions

They are one of the most frequent and relevant approaches in guiding the learning process whose greatest contribution is usually related to the development of a global idea or image of movement that can serve as a guide for the first attempt. Verbal instructions emphasize the ability to recognize errors, guide the process and provide the necessary data for setting goals, without forgetting that words given in an instruction cannot define the complexity of a movement. Verbal cues are brief, short phrases that serve to direct the individual’s attention to context regulatory conditions and serve as key points of movement skill components.

Metacognition

Knowledge about one’s own motor skills, as well as previous experience and awareness of certain relevant task components prior practicing the task influence motor learning.

Modeling

The demonstration of motor skills in which individuals can directly observe the component parts of an action confers greater effectiveness to the use of verbal instructions which may not be effective for motor learning when used alone. Information related to motor sequences and spatial and temporal motor components can be modeled, especially if the spatial attributes are presented in a static, discrete manner.

We now know that the observed (modeled) information contributes to learning the qualitative features of motor skill, which leads us to think that even very fine visual information can be learned through demonstration.

The benefit of observing a skilled demonstration is that the observer perceives the characteristics that remain constant in the movement pattern observed during skill execution. Perhaps the most successful strategy in the use of models is to intersperse the demonstrated information with physical practice performed by the observer. This has the advantage of engaging the individual more in the problem-solving process of learning than would be the case if all demonstrations were presented prior to physical practice.

Although demonstration principles can be limited, to intersperse modeling and physical practice results in better learning than a single block of observations prior to physical practice of the motor skill.

The influence of previous experiences

The influence of previous experiences on the performance of a skill in a new context or the learning of a new skill is the most accepted definition of transfer of learning. This influence can have:

  • A beneficial effect (positive transfer), which occurs when a prior experience facilitates the performance of a skill in a new context or the learning of a new skill.
  • A detrimental effect (negative transfer), which occurs when the subject, due to this previous experience, encounters more difficulties in the learning of a new skill or the performance of a skill in a new context.
  • No effect (neutral transfer) on motor skill. The notion of transfer is essential since it attempts to explain the mechanisms that underlie motor skill learning and control, as well as the effective context variables for this process to take place.

Practice conditions and teaching methods of motor skills clearly influence the transfer of learning. Distributed, variable, and random practice achieve better results in the maintenance of motor skills and are therefore recommended to promote the transfer of learning. Similarly, observational learning can improve transfer depending on the motor skill executed by the selected model, the novice (learning or unskilled) model or the expert (skilled) model.

The specificity of the effects presented appears to provide guidance for establishing the determining factors of practice effectiveness when considering the conditions under which execution and transfer will take place. However, attempting to anticipate these conditions and then classify the types of practice for these characteristics is very complex in real life.

Better practice conditions

The best practice conditions are those that require the subject to practice and learn the same underlying processes that will be used in everyday life. Each skill or task benefits from the previous skill/task and will also benefit from the future ones. These skills and activities are sequenced from basic to complex. Teaching motor skills includes practice opportunities in contexts and situations that are simulated or those in which individuals will use the skills in their activities of daily living.

Before designing a rehabilitation program, it is necessary to consider the previous experiences regarding the motor skills that the subject used to have. Thus, subjects benefit from these opportunities since they promote positive transfers and help them in negative experiences.

Motor learning should guide the clinical intervention process for the rehabilitation of motor control. Feedback, the number of practice trials, and the design of rehabilitation sessions are necessary factors in this process.

Objective of practice sessions

The objective of practice sessions should be to provide opportunities for subjects to develop the capability to execute activities that will require the use of the skills being trained and to acquire the action goals of those activities whenever they occur.

Practice conditions that encourage subjects to make mistakes (random conditions) are beneficial in helping them learn skills since they maximize their ability to execute them in a variety of contexts and situations.

If we teach a motor skill that requires the person to adapt to the conditions of their context or to situations they’ve never experienced, the design of practice conditions will require the person to execute the skills in as many different contexts, conditions and situations as are presented.

On the other hand, if we train a motor skill requiring execution in a context in which regulatory conditions do not change (i.e., are structured), then the design of practice conditions will require subjects to execute the skills in a specific context in which individuals will be required to perform the skill, but it is also necessary to provide experiences when non-regulatory conditions and situations are variable.

Rehabilitation sessions for the learning of multiple skills or multiple variations of a skill should provide opportunities for practicing them all and, whenever possible, under random practice conditions.

Bibliography

  • Shumway-Cook A, Woollacott MH. Motor control: Translating research into clinical Practice. Philadelphia: Lippincott Williams & Wilkins; 2012.
  • Magill RA. Motor learning and control. Concepts and Applications. Boston: Mcgraw-Hill; 2007.
  • Sánchez-Cabeza A, Arana-Echevarría JL. Aprendizaje motor: teorías y técnicas. En: Cano de la Cuerda R y Collado Vázquez S, eds. Neurorrehabilitación. Métodos específicos de valoración y tratamiento. Madrid: Médica Panamericana, 2012.
  • Sánchez-Cabeza A. Terapia ocupacional para la rehabilitación del control motor. Tratamientos basados en actividades para pacientes con daño cerebral adquirido. Saarbrücken (Alemania): Editorial Académica Española; 2011.

If you liked this post written by the occupational therapist Ángel Sánchez about the learning of functional skills, you might find some of his other posts interesting as well:

Ángel Sanchez

Diplomado en Terapia Ocupacional por la Universidad Complutense de Madrid. Máster en Patología Neurológica y doctorado en Patología Neurológica (terapia ocupacional, control motor y daño cerebral adquirido) en la Universidad Rey Juan Carlos. Su trayectoria profesional de más de 15 años se centra en el campo del daño cerebral adquirido, la neurorrehabilitacióny la terapia de mano. Además cuenta con varias publicaciones e investigaciones en el área de la disfunción neurológica y física, así como en el ámbito de las neurociencias.
Ángel Sanchez

Related Post


One thought on “Learning functional skills. Implications for rehabilitation after acquired brain injury

  1. Avatar
    fredy Thursday December 27th, 2018 at 04:22 AM

    excelente aporte es importantes este aporte a nuestro conocimiento profesional

Leave a Reply

Name *
Email *
Website