The influence of errors during practice on motor learning in young individuals with cerebral palsy

The effects of errorless psychomotor training in the Y balance lower limb reaching task

This study investigated the training effect of errorless psychomotor training, a motor training method with perceptual, attentional, and psychological manipulation, in a balance-related, lower limb reaching task (Y balance reaching task) on dynamic balance by young adults. Thirty-nine participants (Mean age = 27.03 years, SD = 2.64 years) were trained with different psychomotor training methods in the Y balance reaching task. Results illustrate that errorless psychomotor training significantly improved the participants' dynamic balance and proprioceptive abilities. Additionally, gaze fixation duration on target during reaching decreased after errorless psychomotor training, suggesting that errorless psychomotor training could decrease visual information demand and be concurrently compensated by up-weighting on proprioception. This multisensory reweighting and cross-modal attention could contribute to the improvement of dynamic balance ability in sports.

Adaptation and Validation of a Serious Game for Motor Learning Training in Children with Cerebral Palsy

Objective: Children with cerebral palsy (CP) present motor learning disorders and somatosensory dysfunction. Although many protocols use videogames in children with CP, few apply or examine motor learning principles. This study aims at (1) implementing therapist-user-designer collaboration in adapting a videogame to the principles of motor learning and the characteristics of users with CP, and (2) piloting the effectiveness of these adaptations by analyzing the achievement of motor learning parameters (learning rate acquisition, retention, and transfer to motor and somatosensory function). Materials and Methods: Periodical interprofessional meetings conducted to the adaptation of a videogame, requiring the control of a joystick for traveling through a maze, to motor learning principles. In a pilot validation, effects in unilateral upper limb function, gross manual dexterity, and somatosensory thresholds were assessed before and after 10-week training in 13 children with CP. Results: After 10-week training with the adapted serious game, children showed learning rates above 90% and improvement in motor learning parameters along the sessions. Manual dexterity and pronation-supination of the dominant hand improved after training. No significant effects were found on somatosensory thresholds. Conclusion: Serious games are useful as motor learning tools for improving motor function in children with PC. Cooperative work among professionals and users is advisable for designing efficient videogames according to rehabilitation best practices.

A scoping review of the application of motor learning principles to optimize myoelectric prosthetic hand control

Although prosthetic hand rejection rates remain high, evidence suggests that effective training plays a major role in device acceptance. Receiving training early in the rehabilitation process also enhances functional prosthetic use, decreases the likelihood of developing an overreliance on the intact limb, and reduces amputation-related pain. Despite these obvious benefits, there is a current lack of evidence regarding the most effective training techniques to facilitate myoelectric prosthetic hand control, and it remains unknown whether training is effective in facilitating the acquisition and transfer of prosthetic skill. In this scoping review, we introduced and summarized key motor learning principles related to attentional focus, implicit motor learning, training eye-hand coordination, practice variability, motor imagery, and action observation, and virtual training and biofeedback. We then reviewed the existing literature that has applied these principles for training prosthetic hand control before outlining future avenues for further research. The importance of optimizing early and appropriate training cannot be overlooked. While the intuition and experience of clinicians holds enormous value, evidence-based guidelines based on well-established motor learning principles will also be crucial for training effective prosthetic hand control. While it is clear that more research is needed to form the basis of such guidelines, it is hoped that this review highlights the potential avenues for this work.

Use of Motor Learning Strategies in Occupational Therapy for Children and Youth with Acquired Brain Injury

Motor learning strategies (MLS) can be used to promote motor skills acquisition in children and youth with acquired brain injury (ABI). While occupational therapists (OTs) likely use MLS in clinical practice, research has not investigated the extent and variety of their application.Aims: This study explored MLS use by OTs in pediatric ABI and factors influencing their application.Method: Individual video-recorded occupational therapy sessions for a sample of eight children/youth (ages 4-16) with ABI were evaluated via mixed methods approach. The Motor Learning Strategies Rating Instrument (MLSRI-22) quantified the extent of MLS use in each video. Directed content analysis of the videos explored the factors influencing how and when MLS were applied.Results: The most frequently used MLS were promoting problem solving, encouragement, directing attention to the body, permitting errors as part of learning, repetitive practice, and whole practice. Three themes described how and when the OTs used MLS: 1) Getting buy-in, 2) Going with the flow, and 3) Movement and thinking go hand-in-hand.Conclusions: The OTs frequently used MLS with children with ABI, appearing to select MLS based on factors related to the child, task, and environment. These findings are fundamental to future exploration of OT decision-making and evaluation of MLS effectiveness.

Implicit motor learning in primary school children: A systematic review

The aim of this study was to assess the current state of evidence and methodological quality of studies on implicit and explicit motor learning in both typically developing children and children with developmental disorders. A systematic literature review was conducted on the experimental literature published up to April 2020. A total of 25 studies were included. Studies were evaluated on methodological quality, paradigm used, and level of evidence. The results showed that implicit paradigms are as effective as explicit paradigms in both groups of children. Studies are predominantly experimental in nature involving mostly upper limb aiming tasks. The few studies that were performed outside the lab (n = 5) suggest superior efficacy of the implicit paradigm. Methodological quality varied between studies and was not always of sufficient standard to allow conclusions. In particular, manipulation checks were only performed in 13 studies (52% of all studies), limiting conclusions. Further progress can be made by focussing on improving methodological quality through retention testing by the inclusion of a control group, by the inclusion of a manipulation check, and via assessment of relevant co-variables, such as working memory, age, and motor competence.

Early Intervention and Postural Adjustments During Reaching in Infants at Risk of Cerebral Palsy

PURPOSE

To investigate postural effects of the family-centered program, COPing with and CAring for infants with special needs (COPCA), applied at 3 to 6 months' corrected age in infants at high risk of cerebral palsy. Previously, we reported postural differences between the infants at risk of CP in the control group of the current study and a group of infants developing typically. Now we focus on differences between 2 intervention groups.

METHODS

We explored postural adjustments during reaching in seated infants at 4, 6, and 18 months using surface electromyography of arm, neck, and trunk muscles. Infants randomly received the family-centered program or another infant physical therapy. Using videotaped intervention sessions, we investigated correlations between time spent on specific physical therapeutic actions and direction specificity, recruitment order, and anticipatory activation at 18 months.

RESULTS

Postural adjustments in both groups were similar, but development of direction specificity and anticipatory activation in COPCA infants better mimicked typical development. These 2 parameters were associated with COPCA-type physical therapeutic actions.

CONCLUSIONS

Postural control was similar after both interventions. Positive outcomes were associated with fewer intervening actions of the therapist and greater allowance of spontaneous movements.

Rehabilitation Strategies Following Surgical Treatment of Upper Extremity Spasticity

Upper motor neuron injuries that occur in cases such as cerebral palsy, cerebrovascular accidents, and traumatic brain injury often have resulting upper extremity deformity and dysfunction. Multiple surgical options are available to improve upper extremity positioning, and, in some cases, motor control. Postoperative therapeutic management is imperative to assist the patient/caregiver in maximizing potential functional gains. This article provides an overview of postoperative guidelines for commonly performed surgeries to manage upper extremity dysfunction caused by spasticity and discusses acute management as well as therapeutic techniques for functional training and improved motor control.

Working Memory Capacity Limits Motor Learning When Implementing Multiple Instructions

Although it is generally accepted that certain practice conditions can place large demands on working memory (WM) when performing and learning a motor skill, the influence that WM capacity has on the acquisition of motor skills remains unsubstantiated. This study examined the role of WM capacity in a motor skill practice context that promoted WM involvement through the provision of explicit instructions. A cohort of 90 children aged 8 to 10 years were assessed on measures of WM capacity and attention. Children who scored in the lowest and highest thirds on the WM tasks were allocated to lower WM capacity (n = 24) and higher WM capacity (n = 24) groups, respectively. The remaining 42 participants did not participate in the motor task. The motor task required children to practice basketball shooting for 240 trials in blocks of 20 shots, with pre- and post-tests occurring before and after the intervention. A retention test was administered 1 week after the post-test. Prior to every practice block, children were provided with five explicit instructions that were specific to the technique of shooting a basketball. Results revealed that the higher WM capacity group displayed consistent improvements from pre- to post-test and through to the retention test, while the opposite effect occurred in the lower WM capacity group. This implies that the explicit instructions had a negative influence on learning by the lower WM capacity children. Results are discussed in relation to strategy selection for dealing with instructions and the role of attention control.

Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

Motor learning is a critical component of the rehabilitation process; however, it can be difficult to separate the fundamental causes of a learning deficit when physical impairment is a confounding factor. In this paper, a new technique is proposed to augment the residual ability of physically impaired patients with a robotic rehabilitation exoskeleton, such that motor learning can be studied independently of physical impairment. The proposed technique augments the velocity of an on-screen cursor relative to the restricted physical motion. Radial Basis Functions (RBFs) are used to both model velocity and derive a function to scale velocity as a function of workspace position. Two variations of the algorithm are presented for comparison. In a cross-over pilot study, healthy participants were recruited and subjected to a simulated impairment to constrain their motion, imposed by the cable-driven wrist exoskeleton. Participants then completed a sinusoidal tracking task, in which the algorithms were statistically shown to augment the cursor velocity in the constrained state such that it matched position-dependent velocities recorded in the healthy state. A kinematic task was then designed as a motor-learning case study where the algorithms were statistically shown to allow participants to achieve the same performance when their motion was constrained as when unconstrained. The results of the pilot study provide motivation for further research into the use of this technique, thus providing a tool with which motor-learning can be studied in neurologically impaired populations. This could be used to give physiotherapists greater insight into underlying causes of motor learning deficits, consequently facilitating and enhancing subject-specific therapy regimes.