Search

What value is there in effective practice regimes if these same regimes do not, in themselves, engage the learner to continue to practice? This question was discussed in the context of two practice schedules that have been shown to be effective in studies of motor learning. But recent evidence has found these practice schedules to be either inefficient in their use of practice time (distributed practice), or results in metacognitive judgments of incompetence (random practice). We discuss these conundrums, possible ramifications relative to the law of practice, and potential resolutions of these issues by recent research efforts. (Contains 4 figures and 1 table.)

Bimanual coordination was tested at two metronome speeds with simultaneous performance of an attention-demanding task by 12 younger (20-22) and 12 older (65-74) adults. At the lower frequency, coordination patterns seemed automatic and impervious to aging. At the higher frequency, older adults sacrificed movement frequency in order to maintain task performance. (Contains 34 references.) (SK)

Two experiments are reported that compared younger and older adults on their performance of two bimanual temporal coordination tasks at varying movement speeds. In many cases, older adults performed as well as younger adults at all speeds of an in-phase coordination pattern and at slow speeds of an anti-phase pattern for both coordination accuracy and stability. Age differences tended to emerge most prominently at high speeds for the anti-phase pattern. These findings are consistent with the aging literature regarding automatic and effortful processing distinctions, suggesting that relative age differences become magnified when effortful resources are required for motor performance.

Although there is evidence for age-related changes in both cognition and motor control, very little is known about the effect of age on learning of new motor skills. The present experiment addressed the interaction between aging and the role of knowledge of results (KR) on a motor learning task. Using a three-segment task on which each segment had specific timing goals, three different manipulations of relative frequency of information about performance were compared in younger and older adults. The three conditions were (a) 100% KR in which information about performance on each segment was provided after every trial, (b) 67% KR in which the performance information was faded over trials, and (c) 67% KR in which the performance information was faded over the segments within each trial. Following 90 acquisition trials, all subjects performed retention, transfer, and reacquisition tests. There were age-related differences for movement accuracy and consistency on acquisition and on the retention tests but not on the transfer test. However, none of these differences interacted with the frequency of KR manipulations. Surprisingly, there was no effect due to the fading schedules of KR. In general, these results indicated that younger and older adults use KR in a similar way to learn a motor skill.

Abstract Background Although task-oriented training has been shown to improve walking outcomes after stroke, it is not yet clear whether one task-oriented approach is superior to another. The purpose of this study is to compare the effectiveness of the Motor Learning Walking Program (MLWP), a varied overground walking task program consistent with key motor learning principles, to body-weight-supported treadmill training (BWSTT) in community-dwelling, ambulatory, adults within 1 year of stroke. Methods/Design A parallel, randomized controlled trial with stratification by baseline gait speed will be conducted. Allocation will be controlled by a central randomization service and participants will be allocated to the two active intervention groups (1:1) using a permuted block randomization process. Seventy participants will be assigned to one of two 15-session training programs. In MLWP, one physiotherapist will supervise practice of various overground walking tasks. Instructions, feedback, and guidance will be provided in a manner that facilitates self-evaluation and problem solving. In BWSTT, training will emphasize repetition of the normal gait cycle while supported over a treadmill, assisted by up to three physiotherapists. Outcomes will be assessed by a blinded assessor at baseline, post-intervention and at 2-month follow-up. The primary outcome will be post-intervention comfortable gait speed. Secondary outcomes include fast gait speed, walking endurance, balance self-efficacy, participation in community mobility, health-related quality of life, and goal attainment. Groups will be compared using analysis of covariance with baseline gait speed strata as the single covariate. Intention-to-treat analysis will be used. Discussion In order to direct clinicians, patients, and other health decision-makers, there is a need for a head-to-head comparison of different approaches to active, task-related walking training after stroke. We hypothesize that outcomes will be optimized through the application of a task-related training program that is consistent with key motor learning principles related to practice, guidance and feedback. Trial Registration ClinicalTrials.gov # NCT00561405

Purpose: To establish proof-of-concept of a novel rehabilitation self-management program that aims to optimize walking recovery after stroke through engaging patients in independent walking-related practice outside of supervised physiotherapy sessions. Materials and Methods: The Independent Mobility-related Physical ACTivity (IMPACT) Program is a coach-supported intervention that uses self-management strategies to empower patients to engage in additional autonomous walking-related activities after stroke during and after inpatient rehabilitation. The aim of this study was to assess whether implementation of this intervention would be associated with targeted patient behaviors; goal setting, negotiation and completion of a walking-related practice plan outside of formal therapy sessions. Using a pre-intervention/post-intervention design, the Independent Mobility-related Physical Activity program was implemented with a convenience sample of 10 adults (mean age 62.3; SD 11.7 years) within an inpatient stroke rehabilitation unit (mean stroke onset 25.3 [SD 10.5] days). Results: All participants were able to set a personal goal, negotiate an autonomous walking-related activity practice plan, and partially or completely adhere to that plan. Patients completed an average of 36 min/day of practice outside of supervised physiotherapy, practicing on weekdays and weekend days. All patients indicated that the Independent Mobility-related Physical Activity program helped them increase their activity, and indicated they would continue to practice walking-related activities beyond the coaching period. The IMPACT program is a feasible self-management strategy to facilitate walking-related practice outside of supervised therapy time during inpatient stroke rehabilitation. Patients were able to engage in goal-setting and practice plan development with support of a therapist-coach. Patients who are able to stand and walk with minimal assist were able to practice walking-related activities outside of formal therapy sessions. Therapists may benefit from specific training and support to adopt self-management strategies into practice. [ABSTRACT FROM AUTHOR]

What value is there in effective practice regimes if these same regimes do not, in themselves, engage the learner to continue to practice? This question was discussed in the context of two practice schedules that have been shown to be effective in studies of motor learning. But recent evidence has found these practice schedules to be either inefficient in their use of practice time (distributed practice), or results in metacognitive judgments of incompetence (random practice). We discuss these conundrums, possible ramifications relative to the law of practice, and potential resolutions of these issues by recent research efforts. [ABSTRACT FROM AUTHOR]

Background. Older adults who receive training for functional skills in contextually appropriate environments may show greater functional improvement than persons trained in a traditional environment. Functionally limited older adults receiving training in contextually appropriate environments (simulated home and community settings) may show greater improvement in activities of daily living (ADL) than persons trained in a traditional manner. Methods. Eighty-eight patients from a day hospital, aged 65 years or older, were randomized to either receive rehabilitation in a simulated environment (Easy Street) or in a gymnasium setting. Rehabilitation focused on retraining functional skills in a contextually appropriate environment (Easy Street) or in a traditional setting (gymnasium) using motor learning principles for a period of 16 weeks. Outcome measures included the Structured Assessment of Instrumental Living Skills (SAILS), a performance measure with criterion and timed components; a self-report health status questionnaire, the Short Form-36 (SF-36); and the patient-orientated goal-directed Canadian Occupational Performance Measure (COPM). Results. There were no group differences on any of the outcome measures: SAILS (p = .3); the SF-36 physical (p = .83) and mental (p = .51); and the COPM performance scale (p = .94) and satisfaction scale (p = .40). Conclusions. Although we have not excluded benefits of contextually appropriate rehabilitation environments with different intervention approaches, at different stages of rehabilitation or with patients at higher functional levels, our results suggest the appropriateness of a moratorium on these expensive interventions pending demonstration of clear positive effects determined from further study.

The purpose of this paper is to describe the opportunities and challenges in the development of a research group established to investigate and disseminate knowledge related to aging, mobility and participation. Various aspects of the research group are described, including the purpose, membership, structure, funding, communication, decision-making and a research model developed to inform research activities. Some current research and educational activities are outlined. Insights and recommendations are provided about strategies used to facilitate the development of this group, including commitment and perseverance; joint projects; designated physical space and funding for infrastructure; regular meetings, educational sessions and retreats; and an opportunity for peer support. [ABSTRACT FROM PUBLISHER]

Comments on the goal of optimizing function and quality of life for individuals with Parkinson's disease (PD). Highlights of the achievements from stroke rehabilitation research; Ability of learning and executing manual tasks by the patients with PD; Need of large randomized controlled trials for demonstrating the most effective form of physiotherapy in PD.