Phases of Motor Learning II

In this month’s blog, we will continue to address motor control exercise and the last two phases of motor learning—the associative phase and the autonomous stage.

The first phase, the cognitive phase, was addressed in last month’s blog. This was described as the ‘ground floor’ stage of rehab-related postural or movement optimization. This phase is characterized by:

• • Exploration of options—recognizing the benefit of examining more than one choice in order to make an informed decision.

• • • Like the optometrist, we use a strategy of presenting a variety of possible solutions.
    • We want to provide a contrast between the ‘good’ movement we are proposing and the ‘bad’ movement they are doing.

• • Training attentional focus—acknowledging the need to proprioceptively distinguish the differences between choices.

• • • We use specific language as a strategy to direct internal attentional focus.
    • We use descriptive language to give specific instructions on ‘what to do’.
    • We use inquisitive language to give specific instructions on ‘what to pay attention to’.

• • Encouraging patient self-evaluation—accepting that they are the ones that need to make the choice or set the target.

• • • We bring them into the decision making process and give them a stake in the outcome.
    • We provide the actionable information, then they decide what action to take.
    • These are motor learning strategies called attention to task and autonomy.

Autonomous Phase

 

During the cognitive phase, we proposed solutions while our patient selected and established their provisional target.

• • This is how I want to align my foot over my knee.
  • This is the shape of my lower back that feels best.
  • I would rather anchor my arm to my back than to my neck.
  • My neck pain is reduced when I move it less and invite more thoracic participation.
  • I’ve got the basic idea—now it’s time to solidify it.

Conceptual vs Embodied Knowledge

As mentioned last month, coming to an intellectual awareness of ‘how to move better’ is not enough—our patients will need to move beyond that conceptual understanding to an embodied understanding of how to move.

An embodied understanding means:

• • I can now walk and chew gum at the same time.

• • • I don’t have to think about it so much.
    • I’ve experienced the sensations produced by the target movement, skeletal shape or muscle activation pattern enough that I can relegate sensory awareness to more of a background gestalt.

• • I have ‘unfired and unwired’ my old problematic muscle activation patterns and have made room for something else to grow.

• • • Previously habitualized, but suboptimal, movement or postural patterns have been recognized as the misery producers they are.
    • I have consigned old motor habits to the dust heap of personal history.

• • I have ‘fired and wired’, ‘linked and synced’, the more appropriate muscles.

• • • Newly acquired muscle activation patterns have now been practiced enough that synaptic transmission has been eased and neuronal sprouting has established new connections.
    • Neuroplasticity does its magic and an optimal new muscle synergist cooperation has been established.

• • I am able to take my shiny new movement pattern and use it in my daily life.

• • • I am now extrapolating what I learned during exercise into specific functional contexts, and am reaping the rewards of my diligence.
    • This ‘exercise to implementation’ phenomena is called transfer.

So this is what we are aspiring to—the autonomous stage. This is the ‘penthouse’ phase of motor learning—the ‘I’ve made it’ stage. I have established a new normal or created a new habit that is clearly superior than my old one.

I might still need to refresh my memory or fine tune some of the details with my custom-designed movement practice to prevent inertia from dragging me down again, but in essence ‘I’ve got this’.

But how do we get there? How do we move our patients from the early cognitive phase and a conceptual understanding to the autonomous stage and an embodied understanding?

Associative Phase

 

The associative phase constitutes a ‘bridge phase’ between the early learning of the cognitive phase and the movement mastery (more or less) of the autonomous phase. As in the cognitive phase, there are certain stratagems we can use that make it more likely that that our patient can transition from a conceptual to an embodied understanding—and from exploratory exercise to finished product:

 

Application of Constraints

Applying a constraint during movement training means setting up the conditions in which movement and effort is directed away from undesirable areas and funneled to more appropriate places.

• • This strategy provides a means by which we can fine tune a movement—to prevent hypermobile places from moving or to encourage hypotonic muscles to work.
  • We can make stiff places looser and weak muscles stronger, without risking stress on sensitive or over-worked tissues.

 

Practice Variability

Practice variability means taking a particular movement pattern and adding additional or complicating factors.

• • Positional Variations. Performing the same movement in a variety of positions or relationships to gravity (prone, supine, hands/knees, floor sit, chair sit, stand, etc.).

• • • This assists with patient pattern recognition and pattern reproducibility.
    • We want our patient to utilize our thoughtfully designed ‘corrective pattern’ throughout any possible position changes.

• • Variation of Intent. Performing the same movement but relating it to different functional intents (orientation, manipulation, locomotion, etc.).

• • • We want our patient to utilize the ‘corrective pattern’ throughout the whole gamut of human activity.

 

Practice Specificity

Practice specificity in movement training is designed to ensure ongoing accuracy.

• • The specificity principle urges us to make our exercise look like the motor behavior we are trying to influence.

• • • Make the exercise’s skeletal relationships, muscle activation patterns and cognitive processing similar to our target pattern.

• • ‘Aim small to miss small’ suggests that we do our best with each repetition—that quality is more important than quantity.

• • • Football coach Vince Lombardi famously stated “practice doesn’t make perfect, perfect practice makes perfect.” 

 

Link to Functional Context

This is related to practice variability, but is not exactly the same. The strategy of linking our exercise to specific functional contexts is a key aspect of the ‘transfer principle’. Examples:

• • Lengthen the hamstrings by practicing pattern-specific bending from split stance standing.
  • Strengthen the gluteals by simulating a push off movement in gait.
  • Mobilize the thorax in the context of looking along the horizon.

 

Intensity

This doesn’t just mean how hard you work, but how many other complicating factors are in play:

• • Objective progressions.

• • • Add more weight, more repetitions or done for longer periods.
    • This is classically what we think of as elements of intensity.

• • Speed and spontaneity.

• • • Make a movement faster.
    • Introduce an element of ‘flow’ or undulation.

• • Adding an external motor focus.

• • • Do the movement while talking or playing catch with a ball.

• • Adding an external sensory focus.

• • • Do the movement while reading something or while listening intently to the lyrics of a song.

 

Finito

Concluding this two part discussion of the three phases of motor learning, you might ask yourself a few questions:

 

• • Are the various motor training strategies presented here widely implemented throughout our beloved profession?
  • Are there any of these described elements of motor control exercise that you commonly use in your practice?
  • Would it really be that difficult to introduce some of these elements into the way we teach exercise?

• • • Can our profession truly claim to be doing doctorate level work when we still use exercise paradigms that were developed in the 1960’s?