Functional Exercise and Motor Learning




(1)
Neurorehabilitation Centre at CNA, Breda, Noord-Brabant, The Netherlands

 




Summary

Motor learning is the acquisition of a motor skill (Nijhuis-van der Sanden 2006) in a manner that is characteristic of the individual. In practice physiotherapists often have their own style of working and use that to teach the patient skills. However, it is more effective to adapt the method of working to the motor learning behavior of the patient. Consciously harmonizing with the specific learning style of the patient and his specific symptomatology results in more learning efficiency. In patients with CNS disorders, there are frequently information-processing problems with respect to, for example, auditive stimuli, perception problems, and sensation impairments. By testing, it is possible to discover which feedback system is still intact. Within the learning strategy, making use of the intact feedback systems, by way of compensation for the impaired feedback system, contributes to the effectiveness in relation to (re)learning a motor skill.


10.1 Introduction


Motor learning is the acquisition of a motor skill (Nijhuis-van der Sanden 2006) in a manner that is characteristic of the individual. In practice physiotherapists often have their own style of working and use that to teach the patient skills. However, it is more effective to adapt the method of working to the motor learning behavior of the patient. Consciously harmonizing with the specific learning style of the patient and his specific symptomatology results in greater learning efficiency.

In patients with CNS disorders, there are frequently information-processing problems with respect to, for example, auditive stimuli, perception problems, and sensation impairments. By testing, it is possible to discover which feedback system is still intact. Within the learning strategy, making use of the intact feedback systems, by way of compensation for the impaired feedback system, contributes to the effectiveness in relation to (re)learning a motor skill.

In doing so, you realize, however, that the impaired feedback system resulting from the CNS disorder has a residual capacity that can be used. Of course motivational and communicative aspects play a relevant role within motor learning as well.

In recent years there has been a tendency to practice functionally. As a result training functions has been pushed more and more to the background. In ► Chap. 7 it becomes clear, among other things, that training functions when treating patients with CNS disorders is worth considering, especially in the context of the studies that have been done into this and the positive effects of this.


Functional Exercise and Practicing Functions

Functional training is the training of components from the intrinsic system (see ◘ Fig. 10.1), in other words, everything that is within the human system, such as muscle strength, the cardiorespiratory system, attention, etc. Motor skills are also further determined by task and surroundings. If you want to do functional exercise, then task and surroundings should be involved. For example, walking on a treadmill is functional training, and walking in different surroundings targeting orientation is functional exercise. With the functional exercise of skills, insight in motor learning processes is essential. After all, it is about teaching someone a motor skill. We then talk of motor learning.

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Fig. 10.1
Motivation model


10.2 Motor Learning


Motor learning is the acquisition of a motor skill in a manner that is characteristic for the individual (Nijhuis-van der Sanden 2006). We use the term characteristic manner, because the learning strategy that someone uses is individually defined. One person learns to ski by making an analysis of the ski skills in a step-by-step manner before he ventures onto the piste. Someone else learns it by putting on a pair of skis and just heading down the hill. With the first way of learning, we can use the term explicit learning, also called knowledge of performance (KP).

In the second case, we can use the term implicit learning or gaining movement experience by means of trial and error. We can then use the term knowledge of results (KR).

In practice, physiotherapists each have their own style of working. They teach the patient skills and the choice of the learning strategy depends on the therapist’s method of working. However, it is more effective to teach the patient skills in a manner that is appropriate to him. This means that the physiotherapist must discover what is the patient’s learning strategy. If the therapist wants to put this into practice, then he has to have insights into various strategies of motor learning and be familiar with the processes that are responsible for attaining an effective learning efficiency.

Within motor learning three components are very important:



  • Motivation


  • Communication


  • Feedback


Box 10.1 Implicit and Explicit Learning


Implicit learning takes place on a daily basis. It is a question of acquiring movement experience and learning from the feedback that you get. In childhood we learned how to do transfers and how to walk, but no one has ever explained to us how it works. It was a question of twisting and turning and falling down and standing up or trial and error. This is a typical example of implicit learning.

This therefore happens every day, until the moment comes that we have to learn something that in our perception seems difficult or dangerous. We then analyze it and we would like someone to do it first perhaps.

For example, take abseiling. If you have never done it, you do not think: I will just get on and do it and see what happens. You want to do it step by step, you define the route, and you have someone explain to you what is handy to do. We call this explicit learning.


10.2.1 Motivation Models


Motivation is a condition for attaining achievements. Patients with a CNS disorder will have to learn to control skills that no longer occur routinely. They must achieve something to master that skill. To achieve a particular learning efficiency, the patient will have to be motivated. If he is not motivated, the therapist will often have to take it upon himself to motivate the patient. That means that in his care for patients with a CNS disorder he will regularly run into the situation where he is the motivator in order to obtain an optimal achievement. Insight in Atkinson’s motivation model shows which factors are determinative for the level of motivation. Insight into this offers the possibility of influencing the outcome of this (Geelen and Soons 1995) (◘ Fig. 10.1).


Example from Practice 10.1

Mr. B. would like to run in a marathon. It is something what he has always wanted to do, and the challenge appeals to him enormously (intrinsic motivation).

He has already run a number of half marathons for which he did not have to do much training. His body is obviously built in such a way that he can actually run a half marathon untrained in a respectable time, namely, 1 h and 38 min.

«Running the marathon – that’s a different matter –you have to really train for that,» according to Mr. B. (perception of the chance of success). You really have to run a lot of kilometers (costs of achieving success), if you want to set a bit of a reasonable time for the marathon (extrinsic motivator).

He thinks that through training he can finish the marathon and can do it in a decent time. Or:



  • Perception about the chance of success → high


  • Value of the success achieved → high

So far there is a favorable climate to assume that he will run the marathon, but we have not yet listed the costs. As indicated, Mr. B. feels that he needs to train intensively (costs) because he wants to run the marathon in a decent time (extrinsic motivation). However, he is a father with three young children. During the week, he has a full-time job, and on Friday evenings, he plays in a band. At the weekend, he regards his social life as important and he often attends parties. He also naturally wants to spend time with his family. As a result the costs of doing training are very high. Or:



  • Costs of achieving success → very high

Conclusion: in spite of the high score «above the line» (the chance of success and the value of that success), Mr. B. still has not run a marathon.

In Example from Practice 10.1, we see intrinsic and extrinsic motivation. Intrinsic motivation is something you get from within, but it can be influenced by extrinsic factors.

A link can therefore be made to another motivation model, namely, Maslow’s Needs Pyramid (1943) (see ◘ Fig. 10.2).

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Fig. 10.2
Maslow’s needs pyramid

Maslow’s needs pyramid is a hierarchically constructed pyramid where we can see that an overlap exists between intrinsic and extrinsic motivators. Thus «need for appreciation and recognition» is something that is within you, but it can be also influenced by external factors. Recognition by a person who is very important to you can perhaps motivate you more than you can do for yourself. It can therefore be important to investigate which people are able to motivate patients.


Example from Practice 10.2

Mrs. J. has suffered a brain hemorrhage. Up to and including the post-acute phase, she had a hemiplegic arm and leg; afterward she began to make a good recovery. Scar tissue has been reabsorbed as a result of which the space occupied by the process has reduced and there is a return of functions.

Mrs. J. feels that she is making good progress and this motivates her enormously. Unfortunately less than 5 months after the first hemorrhage, she had a TIA. Fortunately she experienced barely any consequences of it, but it has scared her.

Two months later she has an infarction, a hemorrhage, a TIA, and then an infarction. She is very discouraged. Her motivation has decreased, because each time she has suffered setbacks.

Until the moment that her son comes to tell her that she is going to be a grandmother (for the first time). Because of this, she is highly motivated and she goes to the extreme. She says that she herself was not able to enjoy her own children to the full because of her busy work. Her son, who now becoming a father, had talked to her about that a couple of years previously and expressed his dissatisfaction. She wants to show them that she can be a good grandmother. Recognition by her zoon is very important for Mrs. J., and she wants to be able to enjoy her grandchild to the full.

Thinking about these models and trying consciously to focus on why someone is or is not motivated is important in terms of deploying the right motivation techniques. In this way it is possible to generate more learning efficiency from the physiotherapy treatment.

For both Atkinson’s motivation model and Maslow’s needs pyramid, communication is an important component which has a substantial influence on the level of motivation.


10.2.2 Communication


Communication can influence motivation in other people, both positively and negatively. Realizing the importance of communication is a key aspect within the physiotherapy care of patients. What is important in terms of the communicative interaction during physiotherapy care can be illustrated in a practical manner on the basis of the four social learning styles according to Kolb (Hendriksen 2005). The four social styles of Kolb form only one of the ways to examine communication. The purpose of this brief description is to indicate the relevance of communication in terms of physiotherapy care for patients.


The Learning Styles According to Kolb

Jun 9, 2018 | Posted by in NEUROLOGY | Comments Off on Functional Exercise and Motor Learning

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