Extensor Tendon Injury
An Occupational Therapy Perspective
Practice Schedule
Practice is the repetitive rehearsal of a behavior or activity until improvement or mastery are achieved (Reagan, 2014). This page will look at how we can enhance practice to be the most benefically to Felix and then look at what OPI's would beenfit from a practice schedule.
Practice Schedules and Motor Learning
One of the four factors that influence motor learning is practice (Maslovat, Lee & Franks, 2014). Therefore, motor learning theory has an impact in the creation of practice schedules for clients learning new tasks.
What is Motor Learning?
The achievement of motor skills involves a process of motor learning. Motor learning is the acquisition of new skills with practice and whose principles are created by an integration of information form psychology, neurology, physical education, and rehabilitation research (Schimidt, 1991; Muratori, Lamberg, Quinn & Duff, 2013). In motor learning, skills refer to things that are acquired and these skills are permanent changes learned through practice. Perspectives in motor control are based on evolving models of the nervous system that have shifted throughout history. Most of the modern theories of motor control have incorporated a systems view of distributed control of the nervous system. Systems model suggests movement takes place due to an interaction of multiple systems working together to solve a motor problem. These theories provide a foundation of intervention strategies based on task aimed at improving motor skills (Muratori et al., 2013).
Motor Learning in Occupational Therapy
Occupational Therapists are involved in the training and retraining of motor skills and motor tasks. The therapists role is to intervene in the learning process to assist patients in achieving independence in the performance of daily living skills (Poole, 1991). Principles of motor learning practice can assist the therapist in structuring functional activities to enable clients to learn and retain the desired skills. The therapist should strive for acquisition conditions that produce optimal retention and transfer of the learned skills (Jarus, 1994).
Motor Learning and Extensor Injuries
The challenge of achieving hand skills after injury can be accomplished through the integration of motor learning and control into treatment protocols (Muratori et al., 2013). Therefore, the OT must be able to effectively integrate these concepts into hand rehabilitation programs. Motor learning must therefore be better understood. Individuals with hand injuries may need to relearn previously acquired motor skills with an altered number and quality of resources available to them (Maslovat et al., 2014).
Motor learning researchers have devoted considerable effort to determining the best way to structure practice (Maslovat et al., 2014). There are many variables to consider when structuring practice to ensure long term learning by promoting retention and transfer of skills (Maslovat et al., 2014).
Principles of Motor Learning
Principle of Interest: The type of learning that takes place is dependent on the individuals attitude toward the learning of the skill (Muratori et al., 2013).
Principle of Amount of Practice: The more time given to the skill the more chance the individual has to improve their performance. (Muratori et al., 2013).
Principle of Whole-Part Learning: Whether it is more efficient to teach the whole skill (whole learning) or break the skill into component parts (part learning) is determined by the complexity of the skill and the learner’s ability (Muratori et al., 2013). In addition, should the time spent practicing the task be greater than the time resting (massed practiced) or should the time resting be greater than the time practicing the task (distributed practice).
Principle of Variable Practice: Block (constant) practice is performing one skill in the same way over and over again. Random (variable) practice is performing variations of a skill or different skills through treatment (Jarus & Gutman 2001).
Principle of Skill Specificity: Skill should be practiced in a situation most similar to real life, under the same conditions, and fit the abilities of the client (Muratori et al., 2013).
Principle of Mental Practice: Cognitive rehearsal and imagining of a motor action is performed but without the physical movement can improve motor learning (Muratori et al., 2013).
How Does Motor Learning Help Felix and His OPI's: A Practice Schedule
One of Felix's OPI's is to return to work (see Case Background). Felix is required to do a lot of keyboarding in his job. Since he still has a fully functional hand, one-handed keyboarding would allow Felix to return to work sooner before his injured hand is fully recovered. Below is a practice schedule for Felix to learn one handed keyboarding based on the principles of motor theory explained above.
Motor Learning Principle
Principle of Amount of Practice
Principle of Whole-Part Learning
Principle of Variable Practice
Principle of Skill Specificity
Principle of Mental Practice
One-handed Typing
(Jarus & Gutman 2001; Muratori et al., 2013)
Felix should practice this skill as many times a day as possible to improve his capabilities.
One handed keyboarding involves coupled movements and lends itself to be divided initial and then practiced as a whole.
One-handed typing can be practiced in small chunks with rests between.
Blocked practiced used initial as it is a new and complex task
Random practice once all movements can be performed and task is not as new and complex
Felix does most of his typing in the work environment.
Felix should visualize himself going through all the movements required to type on a keyboard.
Example Practice Schedule
Start week 1 as affected hand is not used.
- 3 hours a day
Week 1: typing single letters at a time and small words one at a time
Week 2: typing larger words one at a time
Week 3: typing sentences one at a time
Week 4: typing multiple sentences sets
3 hours a day can be split into 3 times a day for 1 hour at a time.
Week 1-3: During each one-hour session every 10 trials of words/sentences should be broken up with 5 minutes of rest between trials.
Week 4: 5 min rest between each set of sentences
Week 1: Block practice of 10 trials of one word, rest, 10 trials of a different word, rest, 10 trials of a different word etc.
Week 2-3: random practice of 10 trials of 2 words/sentences randomly sequenced, rest, 10 trials of 2 words/sentences randomly sequenced, rest etc.
Week 4: Random practice 2 sets of sentences randomly sequenced.
The skill should be performed within an environment that mimics the the clients work environment as closely as possible (keyboard and mouse type and desk set up).
Once a day if found benefical.
References
Thomson, G. (2012, July 19). Motor learning & practice. Retrieved March 21, 2016, from Rifton website: http://www.rifton.com/adaptive-mobility-blog/blog-posts/2012/june/motor-skills-learning-practice
Ragan, T. (2014, October 29). Motor learning: Block vs random practice [Video file]. Retrieved from https://www.youtube.com/watch?v=m_5nWKyRzKM
Jarus, T., & Gutman, T. (2001). Effects of cognitive processes and task complexity on acquisition, retention, and transfer of motor skills. Canadian Journal of Occupational Therapy, 68(5), 280-289. Retrieved from: https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com/docview/212999949?accountid=15115
Schmidt, R. A. (1991). Motor learning principles for physical therapy. In In: Foundations for Physical Therapy. Contemporary Management of Motor Control Problems, (pp. 49-63).
Maslovat, D., Lee, T. D., & Franks, I. M. (2014). Contextual interference: Single task vs multi-task
learning. Motor Control, 8(2), 213-233.
Poole, J, L. (1991). Application of Motor Learning Principles in Occupational Therapy. American Journal of Occupational Therapy, 45(6), 531-537. doi: 10.5014/ajot.45.6.531.
Jarus, T. (1994). Motor learning and occupational therapy: The organization of practice. American Journal of Occupational Therapy, 48(9), 810-816. doi: 10.5014/ajot.48.9.810.
Muratori, L. M., Lamberg, E. M., Quinn, L., & Duff, S. V. (2013). Applying principles of motor learning and control to upper extremity rehabilitation. Journal of Hand Therapy : Official Journal of the American Society of Hand Therapists, 26(2), 94–103. doi:10.1016/j.jht.2012.12.007
Schmidt, R, A., Lee, T, D. (199). Motor Control and Learning: A Behavioral Emphasis. 3rd ed. Champaign, IL: Human Kinetics.
Chester, D. L., Beale, S., Beveridge, L., Nancarrow, J. D., & Titley, O. G. (2002). A prospective, controlled, randomized trial comparing early active extension with passive extension using a dynamic splint in the rehabilitation of repaired extensor tendons. Journal of Hand Surgery, 27(3), 283-288. doi:10.1054/jhsb.2001.0745