Principles of Motor Learning: Part 1

Principles of Motor Learning: Part 1

Principles of Motor Learning: Part 1

 

Principles of Motor Learning: Part 1, Tali Kellerstein from The Speak Boutique wearing shirt with words consistent, results and performance circled

Principles of Motor Learning (PMLs) refers to patterns of learning that have emerged from research into human movement. The bulk of this research has evolved from disciplines outside of Speech-Language Pathology (e.g. exercise and sport), and the research within our field though growing, is still in its very early stages. Nevertheless, PMLs are increasingly being investigated as they apply to speech therapy in the hopes that a solid understanding of PMLs can help Speech-Language Pathologists optimize their work with patients/clients struggling with motor speech challenges, such as Childhood Apraxia of Speech. Dr. Edwin Maas has been at the forefront of synthesizing the applications of PML research to Speech-Language Pathology. He has an excellent video on the Apraxia Kids On-Demand Webinars library, and his team's tutorial on Principles of Motor Learning in the Treatment of Motor Speech Disorders is published in Volume 17 of the American Journal of Speech-Language Pathology. This blog post will summarize some of the key PMLs has outlined in those sources.

 

Principles of Motor Learning as they pertain to speech therapy apply to two broad categories of intervention: Practice Conditions and Feedback Conditions. Practice Conditions in a nutshell are what the patient/client does, Feedback Conditions are what the therapist/communication partner does. Practice conditions refer to aspects such as how much the individual practices, and how often, while feedback conditions refer to how and when the therapist/communication partner responds to what is being practiced.

 

This post is the first of a 4 part series on PMLs, and will highlight two (and a bonus) Practice Conditions and one Feedback Condition outlined by Dr. Maas. For additional PMLs and more in-depth discussion, please refer to the sources listed above.

 

An important concept to understand in the context of Principles of Motor Learning: Learning - as measured by the research above - is not what happens in the session, but what happens after. True learning within the motor speech literature refers to the retention of skills beyond the teaching activity. I.e. applied to S-LP therapy, success is measured not only by the way targets and the amount that targets are successfully produced within the session but also how those targets appear in real life. Having said that - and I cannot emphasize this enough - therapy takes time. Skills are learned incrementally, each skill builds on the next - and rarely in a linear fashion. I discuss the stages of speech therapy in this YouTube video. I've recently started thinking of the 3 stages as: Acquisition, Practice, and Transfer, or APT for short.

 

Highlighted Practice Conditions:

 

Pre-practice: Pre-practice aims to set the learner up for success. In pre-practice, the therapist strives to ensure that the learner is motivated, the goals are understood, and are appropriate/achievable.

 

Practice Amount: Small vs. Large

Is more practice better? Does repetition help? Generally - yes! Large practice amounts have been shown to be better for motor learning and retention. Though the research is from areas outside of speech, extrapolated to speech therapy, this suggests a large amount of repetition of speech targets is more beneficial. But there are caveats . . . how that large set of targets is mixed in with other tasks (aka variability) matters.

 

Practice Variability: Variable vs. Constant

Is it better to do the same this over and over or to mix it up? If we simply followed the previous principle - more is better, then the implication is that constant practice - doing the same task over and over - beats variable practice. Nevertheless, the research points to a more nuanced conclusion. A large amount of constant practice was found to be less effective for retention than a large amount of variable practice. So yes - repeat a LOT, but make sure to mix things up during the repetition. In terms of motor speech, if you have a child struggling with bilabial closure for /p/. this might mean considering whether your targets remain bilabial to low vowel, or mixed bilabial to high vowel. There is research to support the idea that constant practice followed by variable practice is optimal for learning and transfer. E.g. when establishing a new motor pattern, constant practice may be preferable, but when working on transfer, variable practice is likely a better bet.

 

The Speak Boutique Graphic showing knowledge of Performance (Precice and Place) and Knowledge of Results (Right and Wrong)

 

Highlighted Feedback Condition:

 

Knowledge of Performance vs. Knowledge of Results

Knowledge of Performance and Knowledge of Results are two feedback types that differ in context. Knowledge of Results (KR) is binary - think: wrong vs. right with nothing else in terms of direction. Responses such as "You got it!" or "That wasn't quite right" would fall in this category. Knowledge of Performance (KP) involves more specific directives: "Your tongue needs to move slightly forward, back etc." Knowledge of Performance feedback is more detailed, descriptive, and open-ended. I find associating the mnemonic of Results = Right/Wrong and Performance = Precise Placement, helps me remember which is which! Research into limb motor movement suggests KP is more beneficial in the early stages of therapy - when establishing a new movement, while KR is preferable as therapy progresses.

 

The Speak Boutique, Speech Language Pathology Product Line, Resources for Parents and Professionals, Party Animals, What's that Sound? Speech Sound Cards, What's the Story? Storytelling Cards

 

Principles of Motor Learning with Party Animals! inspiration:

 

Pre-practice:

In therapy sessions, pre-practice often takes the form of a warm-up. Say it! cards in the What's that Sound? Speech Sound Cards have a selection of words highlighting specific target sounds that can be applied to introduce the character who will highlight the session's targets, establish how attainable the targets is, and decide whether adjustments should be made. These cards can also be used for phonemic awareness tasks to help the child practice isolating and identifying speech sounds. Say It! cards have mouth shapes for all the consonants in the deck, and can be used as a teaching tool for placement, while Spell it cards pair images of mouth shapes with letters to foster the introduction of letter-sound association skills.

 

Practice:

The highly repetitive text in the Party Animals! poems grew from an appreciation of the importance of large practice amounts. For example, the poem Party Puppy could be used in therapy for a child who has trouble with getting their lips back together in a CVC (Consonant Vowel Consonant) word. In this case, the therapist can simplify the word Puppy to "Pup" and have the child finish each stanza while practicing the word "Pup". Some children may struggle with going from the vowel /ʌ/ ("uh") to the vowel /i/ ("ee"). (In PROMPT therapy this is referred to as difficulty integrating planes of movement, where the "uh" has the jaw open - the vertical plane of movement, while the "ee" has the lips stretch - the horizontal plane of movement). For this movement target, the word puppy can similarly be recited through cloze sentences in reciting the poem. See it! and Spell it! cards from the What's that Sound? Speech Sound Cards box can provide additional support through visual cues. The poem structure of having a different word that begins with /p/precedes the repeated word is one way to allow the therapist to shift between constant and variable practice as needed.

 

One of the challenges in the context of motor speech therapy is keeping large amounts of practice interesting and motivating. A therapist who faces the constraint of knowing that a child will most benefit from a small target set (sometimes just a single word like "puppy"!) can address that challenge by helping the child practice the word in a variety of activities. In the context of Party Puppy, a therapist can use the What's the Story? Story Telling Cards as a story retell activity with numerous opportunities to practice the word pup or puppy. The free puppy printable downloadable from The Speak Boutique store provides a craft activity for even more opportunities to practice the same target in a different context.

 

Principles of Motor Learning in Treatment of Motor Speech Disorders, Maas Edwin, Robin Donald A., Austermann Hula Shannon N., Freedman Skott E., Wulf Gabriele, Ballard Kirrie J., Schmidt Richard A. (2008) American Journal of Speech-Language Pathology

doi: 10.1044/1058-0360(2008/025)

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