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!
And check out our shop for evidence-based speech therapy handouts and worksheets.
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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
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 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
References
- Bislick, L. (n.d.). Principles of Motor Learning and Motor Speech Disorders [Online course]. Medbridge. Retrieved 2021, from https://www.medbridge.com/course-catalog/details/principles-of-motor-learning-and-motor-speech-disorders-lauren-bislick-slp/
- 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. https://doi.org/10.1080/02687038.2012.676888
- Knock, T. R., Ballard, K. J., Robin, D. A., & Schmidt, R. A. (2000). Influence of order of stimulus presentation on speech motor learning: A principled approach to treatment for apraxia of speech. Aphasiology, 14(5–6), 653–668. https://doi.org/10.1080/026870300401379
- Maas, E., Robin, D. A., Austermann Hula, S. N., Freedman, S. E., 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. https://doi.org/10580360001700030277
- Maas, E., Barlow, J., Robin, D., & Shapiro, L. (2002). Treatment of sound errors in aphasia and apraxia of speech: Effects of phonological complexity. Aphasiology, 16(4-6), 609. https://doi.org/10.1080/02687030244000266
- Park, S., Theodoros, D., Finch, E., & Cardell, E. (2016). Be Clear: A New Intensive Speech Treatment for Adults With Nonprogressive Dysarthria. American Journal of Speech-Language Pathology. https://doi.org/10580360002500010097
- Wambaugh, J. L., Nessler, C., Wright, S., & Mauszycki, S. C. (2014). Sound production treatment: effects of blocked and random practice. American journal of speech-language pathology, 23(2), S225–S245. https://doi.org/10.1044/2014_AJSLP-13-0072
- Wambaugh, J. L., Nessler, C., Cameron, R., & Mauszycki, S. C. (2013). Treatment for Acquired Apraxia of Speech: Examination of Treatment Intensity and Practice Schedule. American Journal of Speech-Language Pathology. https://doi.org/10580360002200010084