What is Motor Learning? 9 Principles for Speech Therapy

What is Motor Learning?

When treating apraxia, dysarthria, and other motor speech disorders, a common goal for speech-language pathologists is to facilitate motor learning. You’re helping the patient learn new movements.

But motor learning has a couple of components that make it especially attractive for therapists:

First, it’s a permanent change to how the patient moves. And second, the movements generalize to other related (but untrained) movements.

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A Real-Life Example of Motor Learning

Let’s use the example of my first Capoeira class.

Capoeira is a Brazilian martial art/dance; it’s really cool but not easy to learn. For the first ten minutes of the class, I copied the instructor as he taught us a sequence of moves. By the end of those ten minutes, I could copy his movements pretty smoothly. Great!

But an hour later, when it was my turn to perform the sequence in the middle of a circle of expectant Capoeiristas, my mind was completely blank.

There I stood, motionless. Motor learning had not occurred for me.

I took the class for a few months, giving me enough practice for motor learning to kick in and for some of the movement to stick.

Ten years later, I can still bust out a pretty good Ginga (permanent change). And when I tried kickboxing, the different but still similar kicks and punches came naturally to me (the Capoeira movements generalized).

1. Pre-Practice

Before starting your motor treatment, do some pre-practice so that your patients are ready to learn; set them up for success.

Take the time to make sure that your patients are:

2. Use a Large Number of Trials

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

Aim for at least 50 repetitions per target.

How you structure the practice also makes a difference for 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.

For example, your patient has twenty sessions of therapy. With distributed practice, you schedule two sessions per week for ten weeks: The sessions are distributed over a longer period of time.

In contrast, an example of a massed practice schedule is four sessions per week for five weeks. Those twenty sessions are condensed into a shorter period of time.

Choose Distributed Practice

Rehab-therapy research suggests that distributed practice is best for motor learning. This is good news since many therapists treat on a distributed schedule anyway! And most don’t have the option to see a patient more than once or twice per week.

That said, SLP-specific research how shown that massed practice can also be effective for some patients. LSVT research, for example, shows that patients on both massed practice and distributed practice schedules have similar motor learning outcomes.

4. Use Variable Practice

Variable vs Constant Practice

Variable practice is practicing a movement in different ways. An example of variable practice 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 is shown to improve motor learning.

However, there is evidence that in the early stages of treatment or with a severe movement impairment, a patient may need to start with constant practice. This allows them to learn the movement well enough to practice it.

An example of a constant-variable combo: Your new patient practices one 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 moves on to practice 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 practice 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 throughout the session, in random order. 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 results in better motor learning—although certain patients may benefit from starting with blocked practice.

In the early stages of treatment or with a severe impairment, patients may need to practice each target individually (/f/ for the first half of the session, /z/ the final half). 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

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 while saying an individual phoneme in that word is a simple movement.

Practicing a complex movement can improve motor learning of both the complex and simple movements. There’s some evidence that for patients with apraxia of speech, complex movements better improve motor learning.

But the research is mixed on which is better for motor learning as a whole. It 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 beneficial.

7. Provide Feedback

Knowledge of Results vs Knowledge of Performance

Give patients feedback about how they performed.

Feedback can be a general assessment of whether the patient’s movement was done right or wrong (“Not quite”) or it can be specific and detailed (“Bring your lips closer together for that sound”).

Knowledge of results: Feedback about whether the movement was done right or wrong. This type of feedback is best when a task is already understood.

Knowledge of performance: Specific feedback (“Bring your lips closer together for that sound”). This kind of feedback is better when a movement is new or unclear.

8. Provide Reduced Feedback

Reduced vs Frequent Feedback

Reduced feedback is when you don’t give feedback every single time the patient tries a movement. Instead, you reduce your 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

Reduced feedback helps patients self-monitor. Having less input teaches them how to detect their own mistakes—instead of becoming dependent on their therapist to point mistakes out for them.

This improves motor learning.

Given reduced feedback, patients with apraxia of speech and dysarthria have higher retention of motor learning than those given frequent feedback. Their movement performance may be low during the session, but retention (or motor learning) is higher.

But in the early stages of treatment, patients may benefit from frequent feedback to acquire the new movement.

9. Provide Delayed Feedback

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 allows the patient enough time to evaluate their own performance first.

That said, studies done on apraxia of speech have shown that both delayed and immediate feedback resulted in similar gains in motor learning.

References

1. Principles of Motor Learning and Motor Speech Disorders presented by Lauren Bislick. Course on Medbridge.
2. Bislick L.P., Weir, P.C., Spencer, K., Kendall, D., & Yorkston, K.M. (2012). Do principles of motor learning enhance retention and transfer of speech skills? A systematic review. Aphasiology, 26(5), 709-728.
3. Maas, E., Robin, D.A., Hula, S.N.A., Wulf, G., Ballard, K.J., & Schmidt, R.A. (2008). Principles of Motor Learning in Treatment of Motor Speech Disorders. American Journal of Speech-Language Pathology, 17, 277-298.

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