9 Principles Of Motor Learning For Speech Therapy

What Is Motor Learning?

Motor learning is the process of learning movements by practicing those movements.

Motor learning is important to speech therapy because it’s a permanent change to how a patient moves and these movements generalize.

This means that your patients with apraxia of speech or dysarthria can get lasting improvements—even in skills you didn’t practice in therapy.

Let’s dive into how to use the principles of motor learning to improve your speech therapy sessions!

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Table Of Contents

What Is Motor Learning?
An Everyday Example of Motor Learning
What Are The Principles of Motor Learning?
1. Do Pre-Practice
2. Use a Large Number of Trials
3. Use Distributed Practice
4. Use Variable Practice
5. Use Random Practice
6. Use Complex or Simple Practice
7. Give Feedback
8. Give Reduced Feedback
9. Give Delayed Feedback
Speech Therapy Materials
References

An Everyday Example of Motor Learning

Let’s walk through the process of motor learning using the example of gaining a new skill: Capoeira, a challenging Brazilian martial art.

For the first 10 minutes of class, you copy the instructor as he models Ginga, the foundational movement of Capoeira.

After imitating him over and over again, you can do Ginga pretty smoothly. Great!

But when he asks you to do Ginga the next class…you can’t. Motor learning for this movement hasn’t happened yet.

You take Capoeira classes for a total of 4 weeks. By the end, you’ve had enough practice for motor learning to kick in and for some of the movements to stick.

Ten years later, you can still do the Ginga (permanent change). And when you try kickboxing, the different but similar kicks and punches come naturally (the Capoeira movements generalized).

What Are The Principles of Motor Learning?

There are 9 principles of motor learning.

Below, you’ll learn how to use them to maximize your motor speech treatment, based on speech therapy research.

1. Do Pre-Practice

Before starting a motor speech treatment, teach them how to do it.

This ‘pre-practice’ sets them up for success. They know what to expect and what a right (and wrong) response is.

During pre-practice, take the time to make sure that your patient is:

Stimulable for the treatment
Motivated
Understands the expectations (what a correct answer is and why)

Here’s an example of pre-practice from the ‘Be Clear’ protocol for dysarthria:

Before starting the treatment, patients watch a video of someone reading a passage using normal speech (incorrect) and then reading it using Clear Speech (correct).

Next, patients read the same passage using Clear Speech. The SLP gives them feedback until the patient knows how to do it correctly (Park, 2016).

2. Use a Large Number of Trials

Aim for at least 50 repetitions per target.

Not surprisingly, rehabilitation research shows that practicing a movement a lot leads to superior learning of that movement.

How you structure the practice also makes a difference in motor learning. We’ll go over these next.

3. Use Distributed Practice

Distribute vs Massed Practice

Distributed practice is a longer duration of therapy with fewer sessions per week.

Let’s say your patient has 20 sessions of therapy.

With distributed practice, you have 2 sessions per week for 10 weeks: The sessions are distributed over a longer time period.

An example of a massed practice schedule is 4 sessions per week for 5 weeks. Those 20 sessions are condensed into a shorter time period

Choose Distributed Practice

Rehab-therapy research suggests that distributed practice is best for motor learning (Maas, 2008). This is good news since many clinicians treat on a distributed schedule anyway!

That said, speech therapy-specific research shows that massed practice is also effective for some patients. LSVT LOUD® research, for example, shows that patients on both massed and distributed practice schedules have similar motor learning outcomes (Maas, 2008).

And a small study found that patients treated for apraxia of speech had similar outcomes, regardless of their treatment schedule (Wambaugh, 2013).

The takeaway is that motor therapy helps, even if you can’t offer an intensive schedule.

4. Use Variable Practice

Variable vs Constant Practice

Variable practice is practicing a movement in different ways. An example is practicing several different phonemes in different word positions.

Constant practice, on the other hand, is practicing the same movement over and over again. For example, practicing one phoneme in the same word position.

Choose Variable Practice—or a Combo

Variable practice may improve motor learning.

But there’s evidence that in the early stages of treatment or with a severe movement impairment, a patient may need to practice the same move a lot (constant practice).

An example of a constant-variable combo:

Your new patient practices 1 phoneme in word-initial position
Then she practices a 2nd phoneme in word-initial position
Once she’s reached a certain level of accuracy with those movements, she practices both phonemes in word-initial and final positions

5. Use Random Practice

Random vs Blocked Practice

Blocked practice is practicing one movement first, then moving on to practicing another movement. You ‘block’ out each movement.

For example, you practice /f/ for the first half of a session and then /z/ for the rest of the session.

Random practice is practicing these movements in random order throughout the session.

Using our example, the patient would practice both /f/ and /z/ in random order throughout an entire session.

Choose Random Practice—or a Combo

Random practice leads to better motor learning (Wambaugh, 2014; Knock, 2000; Maas, 2008). But some patients benefit from starting with blocked practice.

Patients early in treatment or with a severe impairment may need to practice each target individually (/f/ for the first half of the session, /z/ the final half) to get the hang of it.

Once they’ve reached a certain level of accuracy, they can move on to random practice of these phonemes.

6. Use Complex or Simple Practice

principles of motor learning speech therapy

Complex vs Simple Movements

Complex refers to the whole movement. The sum of all its parts.

For example, saying a multisyllabic word is a complex movement. Saying an individual phoneme in that word is a simple movement.

Practicing a complex movement improves motor learning of both the complex and simple movements. There’s some evidence that, for apraxia of speech, complex movement is better for motor learning (Maas, 2002).

But the research is mixed. And which is better may depend on the movement being learned.

For example, if the parts of a complex movement are easy to separate out, practicing those parts (simple movements) may be best.

7. Give Feedback

Knowledge of Results vs Knowledge of Performance

Give patients feedback about how they did on the movement.

Feedback can be a general cue about whether the patient did the movement right or wrong (“Not quite,” “That’s right.”) Or it can be about how to do the movement (“Bring your lips closer together for that sound.”)

Knowledge of performance: Feedback about how to do the movement

This kind of feedback is better when a movement is new or unclear to the patient
“Bring your lips closer together for that sound”
“Slow down”

Knowledge of results: Feedback about whether they did the movement right or wrong

This type of feedback is best when the patient already knows how to do the task
“Not quite”
“That was clear”

In speech therapy, this might look like giving feedback about how to do the movement during pre-practice or at the beginning of each session. Then giving feedback about how they did during treatment.

8. Give Reduced Feedback

Reduced vs Frequent Feedback

Reduced feedback is not giving feedback every time the patient tries a movement. Instead, you decrease feedback to every other movement. Or maybe every 5 movements (50% or 20% of trials).

Frequent feedback is giving feedback after every attempt at the movement.

Use Reduced Feedback—Or A Combo

Reduced feedback helps patients self-monitor.

Getting less feedback teaches them how to detect their mistakes—instead of depending on a clinician to point them out. This improves motor learning!

Patients with apraxia of speech or dysarthria who get reduced feedback have higher retention of motor learning than those given frequent feedback.

That said, frequent feedback can help patients with motor speech disorders to learn the movement faster (Bislick, 2012).

In your session, you might start with frequent feedback to teach the movement. Then give less feedback as they make progress, to help it stick.

9. Give Delayed Feedback

delayed feedback principles of motor learning

Delayed vs Immediate Feedback

Immediate feedback is when you give feedback right after the patient does the movement. While delayed feedback is when you pause before giving the feedback.

Choose Delayed Feedback

Wait 5 seconds after the trial before giving feedback. This gives your patient enough time to assess their own performance and maybe even self-correct, which improves motor learning.

But if a patient isn’t aware of how they’re doing—even with the extra time–they may need immediate feedback.

Speech Therapy Materials