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      Updates in Motor Learning: Implications for Physical Therapist Practice and Education

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      , PT, DPT, PhD 1 , , PhD 2 , 3 , , PT, EdD, FAPTA 1 , , PT, PhD, FAPTA 4 , , PT, DPT, PhD 2
      Physical Therapy
      Oxford University Press
      Instructive, Motor Learning, Rehabilitation, Reinforcement, Sensorimotor Adaptation, Use-Dependent

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Over the past 3 decades, the volume of human motor learning research has grown enormously. As such, the understanding of motor learning (ie, sustained change in motor behavior) has evolved. It has been learned that there are multiple mechanisms through which motor learning occurs, each with distinctive features. These mechanisms include use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning. It is now understood that these different motor learning mechanisms contribute in parallel or in isolation to drive desired changes in movement, and each mechanism is thought to be governed by distinct neural substrates. This expanded understanding of motor learning mechanisms has important implications for physical therapy. It has the potential to facilitate the development of new, more precise treatment approaches that physical therapists can leverage to improve human movement. This Perspective describes scientific advancements related to human motor learning mechanisms and discusses the practical implications of this work for physical therapist practice and education.

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          Most cited references77

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          Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.

          This paper reviews 10 principles of experience-dependent neural plasticity and considerations in applying them to the damaged brain. Neuroscience research using a variety of models of learning, neurological disease, and trauma are reviewed from the perspective of basic neuroscientists but in a manner intended to be useful for the development of more effective clinical rehabilitation interventions. Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage. The qualities and constraints of experience-dependent neural plasticity are likely to be of major relevance to rehabilitation efforts in humans with brain damage. However, some research topics need much more attention in order to enhance the translation of this area of neuroscience to clinical research and practice. The growing understanding of the nature of brain plasticity raises optimism that this knowledge can be capitalized upon to improve rehabilitation efforts and to optimize functional outcome.
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            Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning.

            Effective motor performance is important for surviving and thriving, and skilled movement is critical in many activities. Much theorizing over the past few decades has focused on how certain practice conditions affect the processing of task-related information to affect learning. Yet, existing theoretical perspectives do not accommodate significant recent lines of evidence demonstrating motivational and attentional effects on performance and learning. These include research on (a) conditions that enhance expectancies for future performance, (b) variables that influence learners' autonomy, and (c) an external focus of attention on the intended movement effect. We propose the OPTIMAL (Optimizing Performance through Intrinsic Motivation and Attention for Learning) theory of motor learning. We suggest that motivational and attentional factors contribute to performance and learning by strengthening the coupling of goals to actions. We provide explanations for the performance and learning advantages of these variables on psychological and neuroscientific grounds. We describe a plausible mechanism for expectancy effects rooted in responses of dopamine to the anticipation of positive experience and temporally associated with skill practice. Learner autonomy acts perhaps largely through an enhanced expectancy pathway. Furthermore, we consider the influence of an external focus for the establishment of efficient functional connections across brain networks that subserve skilled movement. We speculate that enhanced expectancies and an external focus propel performers' cognitive and motor systems in productive "forward" directions and prevent "backsliding" into self- and non-task focused states. Expected success presumably breeds further success and helps consolidate memories. We discuss practical implications and future research directions.
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              Motor learning elicited by voluntary drive.

              Motor training consisting of voluntary movements leads to performance improvements and results in characteristic reorganizational changes in the motor cortex. It has been proposed that repetition of passively elicited movements could also lead to improvements in motor performance. In this study, we compared behavioural gains, changes in functional MRI (fMRI) activation in the contralateral primary motor cortex (cM1) and in motor cortex excitability measured with transcranial magnetic stimulation (TMS) after a 30 min training period of either voluntarily (active) or passively (passive) induced wrist movements, when alertness and kinematic aspects of training were controlled. During active training, subjects were instructed to perform voluntary wrist flexion-extension movements of a specified duration (target window 174-186 ms) in an articulated splint. Passive training consisted of wrist flexion- extension movements elicited by a torque motor, of the same amplitude and duration range as in the active task. fMRI activation and TMS parameters of motor cortex excitability were measured before and after each training type. Motor performance, measured as the number of movements that hit the target window duration, was significantly better after active than after passive training. Both active and passive movements performed during fMRI measurements activated cM1. Active training led to more prominent increases in (i) fMRI activation of cM1; (ii) recruitment curves (TMS); and (iii) intracortical facilitation (TMS) than passive training. Therefore, a short period of active motor training is more effective than passive motor training in eliciting performance improvements and cortical reorganization. This result is consistent with the concept of a pivotal role for voluntary drive in motor learning and neurorehabilitation.
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                Author and article information

                Journal
                Phys Ther
                Phys Ther
                ptj
                Physical Therapy
                Oxford University Press
                0031-9023
                1538-6724
                January 2022
                25 October 2021
                25 October 2021
                : 102
                : 1
                : pzab250
                Affiliations
                [1 ] Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, California, USA
                [2 ] Department of Physical Medicine and Rehabilitation, Johns Hopkins University , Baltimore, Maryland, USA
                [3 ] Center for Movement Studies, Kennedy Krieger Institute , Baltimore, Maryland, USA
                [4 ] Physical Therapy Department, University of Delaware , Newark, Delaware, USA
                Author notes
                Address all correspondence to Dr Leech at: kleech@ 123456pt.usc.edu
                Article
                pzab250
                10.1093/ptj/pzab250
                8793168
                34718787
                a87527b0-746e-4b26-b888-e666c2873169
                © The Author(s) 2022. Published by Oxford University Press on behalf of the American Physical Therapy Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 April 2021
                : 12 August 2021
                : 1 October 2021
                Page count
                Pages: 00
                Funding
                Funded by: funder-nameNational Institutes of Health, DOI 10.13039/100000002;
                Award ID: K12 HD055929–14
                Categories
                Perspective
                AcademicSubjects/MED00110

                instructive,motor learning,rehabilitation,reinforcement,sensorimotor adaptation,use-dependent

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