Lessons about Motor Learning: How Is Motor Learning Taught in Physical Therapy Programmes Across Canada?

Educators' Perspectives on the Teaching and Learning of Type 2 Diabetes Content in Physiotherapy Programmes across Canada

Purpose

This qualitative descriptive study researched educators' perspectives of type 2 diabetes (T2D) Teaching and learning, in physiotherapy (PT) programmes across Canada.

Methods

Faculty members and clinical instructors from the 15 PT programmes in Canada were contacted. Online surveys collected data on the educators' professional background and perspectives on T2D in the PT curriculum. One-on-one telephone interviews were conducted and thematic analysis was used to generate themes and codes from the interview transcripts.

Results

Ten educators from 10 universities completed the survey. Seven of the 10 educators also participated in a telephone interview. Survey responses revealed that T2D content is taught predominantly through case studies and lectures. Of the 10 respondents, six reported that the curriculum does not devote adequate time to T2D content, and nine reported they "strongly agree" or "agree" that T2D is an essential component of the PT curriculum. The interviews revealed that T2D content varies across PT programmes. The educators agreed that T2D is a common condition seen in practice, there is a role for PT intervention, and T2D content is limited by classroom time.

Conclusions

Educators noted challenges integrating more T2D content in the curriculum and said that PT clinical contributions for people living with T2D are underutilized. Additional evidence-informed rationale is needed to explore optimal integration of T2D content in PT programmes.

The Path to Translating Focus of Attention Research Into Canadian Physiotherapy, Part 1: Physiotherapists’ Self-Reported Focus of Attention Use Via a Study-Specific Questionnaire

The focus of attention literature has shown robust findings for the benefits of providing statements that focus on the movement effect or outcome (external focus of attention [EFOA]) as opposed to focusing on the movement kinematics (internal focus of attention). Observational studies, however, have revealed that physiotherapists use fewer EFOA statements than internal focus of attention statements in their practice. Most evidence in this regard has been from non-Canadian physiotherapists working in stroke rehabilitation; consequently, we sought to examine whether Canadian physiotherapists working with various rehabilitation populations also use EFOA statements to a lesser extent than internal focus of attention statements. The “Therapists’ Perceptions of Motor Learning Principles Questionnaire (TPMLPQ)” was thus designed and data from 121 Canadian physiotherapists showed low relative frequencies of EFOA use (31.3% ± 14%) averaged across six hypothetical scenarios. A higher EFOA was reported, however, for two of the six scenarios: a functional reaching scenario (55.5% ± 37.0%) and pelvic floor task (65.6% ±32.9%). This data suggest that the findings of EFOA benefits have not been widely translated into Canadian physiotherapy settings; furthermore, the findings of the scenario-dependency warrant future investigation into factors, such as task characteristics, that may influence physiotherapists’ FOA use.

Is it only nice in theory? Implementation of motor learning principles in neurorehabilitation among Saudi physical therapists

BACKGROUND

Despite earlier recognition of the importance of motor learning principles in neurorehabilitation, research suggests that the motor learning principle is not being entirely utilized in neurorehabilitation. Implementation of motor learning principles has been associated with functional recovery and patient satisfaction.

OBJECTIVE

To examine implementation of motor learning principles in neurorehabilitation among Saudi physical therapists including self-efficacy, current practice, attitude and barriers.

METHODS

A cross-sectional survey of physical therapists managing patients with neurological conditions was conducted (n = 345). The survey questionnaire contained items to evaluate self-efficacy, current practice, attitude and barriers toward implementing motor learning principles in neurorehabilitation.

RESULTS

The data from the respondents indicated that they had moderate self-efficacy to implement motor learning in neurorehabilitation. Only 30.2% of respondents implement motor learning in their practice to a high degree and some respondents were unaware of the concepts of motor learning. The most reported perceived barriers to motor learning implementation in neurorehabilitation were at the level of the physical therapist (lack of knowledge) and the organization (lack of time).

CONCLUSION

Implementation of motor learning principles among Saudi physical therapists managing patients with neurological conditions was moderate. Self-efficacy, positive attitudes, academic training and organizational support are potential strategies to enhance implementation.

Virtual Reality Augments Movement During Physical Therapy: A Pragmatic Randomized Trial

OBJECTIVE

Virtual reality facilitates physical therapy via improved engagement. Although shown to benefit specific patient populations, such as stroke patients, it is less established in otherwise healthy adults and children receiving outpatient physical therapy. The primary objective was to compare total physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality.

DESIGN

This pragmatic, randomized, crossover study compared physical therapy-guided movement supplemented with virtual reality with physical therapy-guided movement alone without virtual reality in outpatients (ages 6-80 yrs). This community sample had variable physical therapy indications (injury, postoperative, chronic pain), and in pre-existing conditions, therefore, participants served as their own controls. Participants received 10 mins of both physical therapy-guided movement supplemented with virtual reality and physical therapy-guided movement alone without virtual reality separated by 5 mins. The primary outcome was differences in aggregate movement of physical therapy-guided exercises. Secondary outcomes explored OMNI rating of perceived exertion and participant and physical therapist satisfaction. Paired t tests, χ2 tests, and regression models were used to analyze differences.

RESULTS

The 41 participants (17 pediatric and 24 adult) moved significantly more during physical therapy-guided movement supplemented with virtual reality compared with physical therapy-guided movement alone without virtual reality (1120.88 vs. 672.65 m, P < 0.001), regardless of which intervention was completed first. Physical therapy-guided movement supplemented with virtual reality treatment was associated with more movement of the target limbs, lower body (P < 0.001), and upper body (P < 0.05). The OMNI rating of perceived exertion scores did not differ between those who started with physical therapy-guided movement supplemented with virtual reality or physical therapy-guided movement alone without virtual reality, and physical therapist and patient surveys endorsed physical therapy-guided movement supplemented with virtual reality.

CONCLUSIONS

Patients completed more physical therapy-guided movement during physical therapy-guided movement supplemented with virtual reality than physical therapy-guided movement alone without virtual reality, and therapists and patients supported its use. Future studies will examine finer tracking of movements.

A comparison of motorcycle instructor candidate selection practices in the United States

INTRODUCTION

An essential aspect of motorcycle rider education is how the instructor selection process impacts student learning, sometimes referred to as the human element, as it is a significant factor influencing curriculum success. Student and program achievements are partially contingent on instructors who understand the curriculum and facilitate student learning during instruction. Previous research on motorcycle rider education has emphasized a need for the examination of instructor selection and development, stating that quality education is reliant on instructors who are competent and qualified.

METHOD

By applying an exploratory study method, state and military Motorcycle Safety Education Program Managers and Instructor Trainers were examined and compared through telephonic interviews to develop a greater understanding of instructor candidate selection criteria and vetting processes.

RESULTS

The results suggest that changes in instructor candidate selection systems may improve decisions about a candidate's job and organizational fit.

CONCLUSIONS

Study conclusions indicate that use of multiple and thorough assessments to determine a candidate's motivation, social disposition, and emotional intelligence before preparation courses may better identify candidates and align potential job and organization fit within the discipline. Practical Application: Applications of the findings would include a standardized selection process with improved interviews and pre-course auditing, and candidate expectation management before the selection to attend preparation or certification courses. The efforts potentially decrease long-term costs and deficiencies when candidates have an inconsistent job or organizational fit, departing from organizations after short periods or by not providing consistent quality instruction to students. The study recommendations, when implemented, can improve most educational disciplines where instructors are selected for technical instructional positions where students risk injury or harm.

Study Paradigms and Principles Investigated in Motor Learning Research After Stroke: A Scoping Review

Objectives

To (1) characterize study paradigms used to investigate motor learning (ML) poststroke and (2) summarize the effects of different ML principles in promoting skill acquisition and retention. Our secondary objective is to evaluate the clinical utility of ML principles on stroke rehabilitation.

Data Sources

Medline, Excerpta Medica Database, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials were searched from inception on October 24, 2018 and repeated on June 23, 2020. Scopus was searched on January 24, 2019 and July 22, 2020 to identify additional studies.

Study Selection

Our search included keywords and concepts to represent stroke and "motor learning. An iterative process was used to generate study selection criteria. Three authors independently completed title, abstract, and full-text screening.

Data Extraction

Three reviewers independently completed data extraction.

Data Synthesis

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines for scoping reviews were used to guide our synthesis. Thirty-nine studies were included. Study designs were heterogeneous, including variability in tasks practiced, acquisition parameters, and retention intervals. ML principles investigated included practice complexity, feedback, motor imagery, mental practice, action observation, implicit and explicit information, aerobic exercise, and neurostimulation. An additional 2 patient-related factors that influence ML were included: stroke characteristics and sleep. Practice complexity, feedback, and mental practice/action observation most consistently promoted ML, while provision of explicit information and more severe strokes were detrimental to ML. Other factors (ie, sleep, practice structure, aerobic exercise, neurostimulation) had a less clear influence on learning.

Conclusions

Improved consistency of reporting in ML studies is needed to improve study comparability and facilitate meta-analyses to better understand the influence of ML principles on learning poststroke. Knowledge of ML principles and patient-related factors that influence ML, with clinical judgment can guide neurologic rehabilitation delivery to improve patient motor outcomes.

Testing a new active learning approach to advance motor learning knowledge and self-efficacy in physical therapy undergraduate education

BACKGROUND

Motor learning (ML) science is foundational for physical therapy. However, multiple sources of evidence have indicated a science-practice gap. Clinicians report low self-efficacy with ML concepts and indicate that the lack of access to systematic training is a barrier for practical implementation. The general goal of this preliminary study was to describe the effects of a new educational intervention on physical therapy student's ML self-efficacy and knowledge.

METHODS

Self-efficacy was assessed with the Physical Therapists' Perceptions of Motor Learning questionnaire. Data was acquired from third-semester students before their participation in the ML educational intervention. Reference self-efficacy data was also acquired from physical therapy professionals and first and last-semester students. The educational intervention for third-semester students was designed around an established framework to apply ML principles to rehabilitation. A direct experience, the "Learning by Doing" approach, in which students had to choose a motor skill to acquire over 10 weeks, provided the opportunity to apply ML theory to practice in a personally meaningful way. After the intervention self-efficacy was re-tested. ML knowledge was tested with an objective final exam. Content analysis of coursework material was used to determine how students comprehended ML theory and related it to their practical experience. The Kruskal-Wallis and Mann-Whitney U tests were used to compare self-efficacy scores between the four groups. Changes in self-efficacy after the educational intervention were analyzed with the Wilcoxon test. Spearman rank correlation analysis was used to test the association between self-efficacy and final exam grades.

RESULTS

By the end of the intervention, students' self-efficacy had significantly increased (p < 0.03), was higher than that of senior students (p < 0.00) and experienced professionals (p < 0.00) and correlated with performance on an objective knowledge test (p < 0.03). Content analysis revealed that students learned to apply the elements of ML-based interventions present in the scientific literature to a real-life, structured ML program tailored to personal objectives.

CONCLUSIONS

Positive improvements were observed after the intervention. These results need confirmation with a controlled study. Because self-efficacy mediates the clinical application of knowledge and skills, systematic, active training in ML may help reduce the science-practice gap.

Physical therapists' perspectives of the construct of motor learning, and their motor learning-based practice: a qualitative study

Introduction: The perceptions and beliefs of physical therapists play an important role in their clinical behavior. These clinician-related aspects may contribute to the knowledge-action gap in the field of motor learning (ML). Accordingly, this study explored how a sample of physical therapists perceive ML in their practice.Methods: A qualitative phenomenological study was conducted. Twelve physical therapists with a wide range of work experience were purposefully selected. Data were collected through semi-structured interviews and analyzed using content analysis methodology. Themes and categories were identified.Results: We identified five key themes: 1) 'ML within the scope of PT' showed that participants perceived ML as a fundamental part of the profession; 2) 'Understanding of ML' showed that participants had difficulty understanding the field comprehensively; 3) 'Self-efficacy toward the topic of ML' revealed that participants had low self-efficacy about their knowledge of the topic; 4) 'Features of ML implementation' showed that physical therapists tended to implement ML intuitively; and 5) 'Barriers to implementation and ways to facilitate it' showed that lack of knowledge was perceived as a main barrier to implementation.Conclusions: Physical therapists' perceptions of and experiences with ML showed the complexity of the field and the lack of clarity regarding its theoretical content and clinical applications. There is a need to reinforce knowledge of ML among physical therapists at different levels of professional development and to promote self-efficacy toward its use, possibly by increasing ML knowledge and education while emphasizing its clinical context.