Essential Points:

• Motor Learning Requires Practice and Failure: Effective motor learning, essential for tasks like balance and falling, relies on repeated practice and the ability to fail and adapt, leading to permanent skill retention and brain changes.

• Understanding Task Complexity: Motor tasks can be broken into discrete, serial, and continuous types, each requiring different levels of complexity. Using this framework helps in progressing a patient’s motor skills from basic tasks to more complex ones.

• Stages of Learning: Cognitive to Autonomous: Motor learning progresses through three stages—cognitive, associative, and autonomous. Each stage builds on the previous one, guiding patients from understanding the task to performing it proficiently without external feedback.

When teaching a patient how to balance or fall correctly, it is important to understand what their learning process entails. As most of you know, pulling out a whiteboard and talking about balance and falling conceptually will not change a patient’s fall risk to any great degree. Patients need to physically learn, practice, and most importantly fail repeatedly to develop these skills. This process of growth is termed motor learning.

Motor learning is defined as a complex set of internal processes, that involve the obtainment and mostly permanent retention of a skilled movement or movement task. Motor learning occurs through repeated quality practice of a skilled movement. This repeated practice, and performance of a skill, changes the shape and cortical organization of the brain leading to long term retention, and thus learning of the motor pattern needed to perform a task.

Three Types of Motor Tasks

To understand proper teaching of motor tasks, we need to look at the three overarching types. These motor task types include discrete tasks, serial tasks, and continuous tasks. Because each of these tasks build into the next, we can use this framework to teach motor skills from the ground up starting with the discrete task and building into the serial or continuous tasks.

Discrete Tasks

Discrete tasks are actions or movements that have a defined beginning and ending. Such a task may be performing a squat, jumping, or sipping a cup of coffee. Essentially, all exercises fall into this category as each repetition is its own encapsulated discrete task.

Serial Tasks

A serial task is a series of discrete tasks done in sequence to perform a larger action. For example, drinking a cup of coffee requires first a gripping of the cup, then lifting of the cup to the mouth, then finally sipping. Most functional tasks in our daily lives require serial tasks to be completed. Some of these serial tasks are simple, and some require complex timing such as forming a piece of music with different chords in a specific rhythm.

Continuous Tasks

Continuous tasks involve repeated and seemingly unending movements with no defined beginning and ending. These include motor tasks such as walking, running, climbing stairs, biking.

Taxonomy of Motor Tasks – Gentile

When teaching motor tasks to a patient, it is imperative to understand the way a task can be progressed or regressed. The Taxonomy of Motor Tasks devised by Gentile (Gentile’s Taxonomy), is a system developed that allows analyzing of a task and the variables that can be used to change its complexity. This taxonomy consists of four task dimensions including: environment, inter-trial environmental variability, bodily movement, manipulation of an object.

Environment

Environmental factors simply come down to two scenarios which are an open environment, or a closed environment. An open environment means that the surrounding environment around a patient can be moving or ever changing. One example of an open environment would be a busy train station. In these open environments, the patient must anticipate the movements of surrounding environmental factors to

complete a task safely and efficiently. A closed environment means that the surrounding environment is static and unchanging. One example of a closed environment would be an empty physical therapy clinic with no movement. Due to the environment being static, no attention is lost to external factors, and thus all attention is given to the motor task.

Open environments make motor tasks harder to perform due to the added stimulus distracting us from the task at hand. Closed environments on the other hand, allow us to give full attention to the chosen motor task due to an absence of external stimulus. Consequently, when learning a new motor task, it is advised to start in a closed environment and build into more open environments as motor task proficiency is gained.

Inter-trial Environmental Variability

Inter-trial environmental variability occurs when the environment changes from one task trial to the next. When the environment changes from each trial the patient never gets a chance to learn and be accustom to the environment, and consequently always must adapt and divert attention from the task. When no inter-trial environmental variability exists, this means that the environment remains predictable from trial to trial. When an environment remains predictable from trial to trial, whether it be an open or closed environment, the patient slowly learns, and tunes out external stimuli. Thus, focus on the task increases, making it easier to perform.

Bodily Movement

Bodily movement can be broken down into either the body moving in space, or the body being stable. When the body moves in space, constant corrections in movement are needed to stay within the confines of the motor task. Consequently, bodily movement leads to more complexity of a given task. Keeping the body stable takes away these additional corrections and allows one to focus solely on the task.

Object Manipulation

When an object must be manipulated with the upper body it increases the complexity of the task versus when no object must be manipulated. Think of walking normally versus walking with a full cup of water. Walking with a full cup of water increases the complexity of the task greatly due to the desire not to spill the water with every step.

When following Gentile’s Taxonomy, we can clearly see that the simplest motor tasks involve a closed environment, no inter-trial environmental variability, keeping the body stable, and having no object manipulation. The most complex tasks comparatively involve open environments, with inter-trial environmental variability, bodily movement, and object manipulation. The complexity of the task should be dictated by the stage of learning that the patient is currently in as we will discuss next.

Stages of Motor Learning

Now that we understand the types of motor tasks a patient can perform and how to change their complexity, let us discuss the stages of motor learning. There are three general stages a patient will go through when learning a new motor task. These stages are the cognitive stage, the associative stage, and the autonomous stage. Each stage builds on the last and can guide us in a direction when applying Gentile Taxonomical concepts to optimize motor learning.

Cognitive Stage

The cognitive stage is the first stage of motor learning and entails a patient figuring out what to do. The patient is trying to learn what the end goal of a task is, and conceptually understand how to perform this task. Each component and sequence of the task must be thought about thoroughly to be completed successfully. Cognitive demand is high at this stage of learning and thus additional stimuli outside of the task parameters should be diminished as much as possible. Error rate is high, and the patient will most likely need a large amount of external feedback from the health professional for guidance. Near the end of the cognitive stage, the patient will begin to understand correct and incorrect performances and be able to give limited self-correcting feedback. The simplest forms of Gentile’s taxonomical categories should be utilized at this stage.

Associative Stage

The associative stage occurs when the patient understands the task and begins to fine-tune their performance while making infrequent errors. Often this stage is defined by increasing the efficiency and consistency of the given motor task. Inter-trial variability may be introduced to improve the adaptability of the motor skill in different situations. Self-correction of errors occurs naturally due to the patients full understanding of the basic motor task goal. Very little feedback is required by the therapist, and experience guides the patient’s actions. The intermediary forms of Gentile’s taxonomical categories should be utilized at this stage.

Autonomous Stage

The autonomous stage is characterized by a patient’s ability to perform a movement task proficiently and automatically without error. This is the final stage of learning. At this stage, dual motor tasks may be performed due to the mastery of single tasks on their own. For example, running and catching a football. Variability in task can be adapted to easily. No external instruction is needed at this stage. The highest levels of Gentile’s taxonomical categories should be utilized at this stage.

Conclusion

Although motor learning is a complex concept, by breaking it down into types of motor tasks, complexity of the task, and the stage of learning a patient is in, we are much better equip to create a valuable learning experience for the patient. In next week’s article we will build on these concepts and discuss a few variables to enhance this motor learning process.

Thank you for reading the article! If you want to learn a little bit more about motor learning check this article out on Medbridge. It takes a quick look at how motor learning changes in those with a damaged nervous system.

What sort of teaching method do you utilize? Have you found any sure fire ways to increase your patient’s learning ability? Do you use any of the above principles in your teaching practice? Comment below and let me know!

Happy Falling!

Special thanks to Siobhan McConnell, MS, OTR/L for editing this article.