Chapter 1

Current Theoretical Foundations

Core Concepts
Beginning with a brief discussion of the Neuro-Developmental Treatment (NDT)
approach, this chapter describes the critical elements of the NDT philosophy from early
beliefs of the Bobaths to those of clinicians who currently use the NDT approach in
their clinical practice with infants, children, and adults with neuropathology. Key
elements of an NDT approach to examination, evaluation, and treatment are
introduced, with more extensive discussion left for later chapters.

General assumptions that form the foundation of the NDT approach are presented. Ten
(10) assumptions that come from the original work of the Bobaths are delineated using
contemporary terminology. Additional assumptions expand the current therapeutic
model of NDT incorporating current knowledge from the motor sciences.

The theoretical model on which the clinical practice of NDT is currently based reflects
the assimilation and synthesis of information from a variety of models in the areas of
motor control, motor development, and motor learning. Although Dr. Bobath began
developing the theoretical model for NDT based on the reflex/hierarchical model of his
day, his characterization of NDT as a living concept suggested his recognition of
changes to come in our knowledge of the neurophysiological basis for the NDT
approach.

Theoretical models from motor control, motor development, and motor learning are
presented. Systems and Selectionist Theory perspectives of motor control are
described. These models recognize that in order to understand the neural control of
movement, it is essential to also understand the influences of other body systems, the
demands of the task, the environmental context, and the interactions of variables within
a single body system and between internal and external systems.

Ten premises are presented that discuss the theoretical framework from these
selectionist and systems perspective models that support the assumptions of NDT.
Each of the theoretical models used to understand the mechanisms of movement
execution (i.e., motor control, motor learning, and motor development) are discussed in
terms of their underlying theories, key concepts, guiding principles, and application to
or support for the assumptions and practice of NDT. Specific emphasis is placed on a
discussion of efficient movement execution as it relates to Systems Theory, Dynamic
Systems Theory (DST), Neuronal Group Selection Theory (NGST), and Generalized
Motor Program Theory (GMPT). Contributions of the sensory systems, especially in
terms of feedback and feed-forward systems of control and the environmental context,
are presented and discussed as they relate to motor control.

11
NDT has had a strong foundation in motor development as described in this chapter.
The Bobaths focused on the progressive development of postural control as a
foundation for skilled movement with significant attention to the contributions of
righting reactions and equilibrium responses to this development. Further expansion of
the developmental framework of NDT has been provided by works of neonatologist
Milani-Comparetti, who analyzed the development of movement patterns in infants by
their adaptive values; Mary Quinton, PT, who described the competition of motor
patterns observed in development; and Lois Bly, PT, who identified and described the
components of normal movement based upon contributions of the musculoskeletal
systems. As delineated in the text, NDT assumptions in motor development have been
expanded to reflect a framework consistent with the Systems and Selectionist Theories
of motor control. The reader is given two examples illustrating the relationship of the
NDT assumptions in motor development to the development of postural control as well
as the development of reach and grasp.

The chapter concludes with a review of motor learning principles/concepts and their
incorporation into assumptions that are part of the NDT framework. The motor
learning principles of preparation, instruction, practice, scheduling of practice, and
feedback are discussed with focus on their application to NDT training and theory.

Understanding the differences between motor learning and motor performance is

essential in intervention. In its early years, NDT focused on changes in motor
performance following treatment, rather than motor learning. Recognizing the need to
expand performance to life settings, modifications in NDT intervention strategies were
introduced by the Bobaths in the 1970s. NDT intervention strategies have continued to
be expanded through the years, creating a more direct link between treatment and the
performance of functional skills at home. This increased practice for improved skill
production reflects a key element of motor learning that is incorporated in NDT
intervention today.

Key Terminology
Therapeutic handling Feed-forward (open-loop system)
Systems theory Environmental contexts
Motor control Postural control
Dynamic Systems Theory (DST) Motor development
Self-organization Motor learning
Neuronal Group Selection Theory (NGST) Motor performance
Neuronal groups Practice
Neuronal maps Intrinsic feedback
Generalized Motor Programs (GMP) Extrinsic feedback
Feedback (closed-loop system)

12
 Learning Modules

Unit 1.1: NDT Assumptions

(pp. 1-15)

Objectives
At the conclusion of this unit, the reader will be able to:

1. Identify the current philosophy and core concepts of NDT

2. Distinguish between the assumptions that are the foundations of the NDT
approach and those originated by the Bobaths

3. Describe the current philosophy and core concepts of NDT with colleagues,
caregivers, physicians or non-NDT practitioners

13
Learning Activity 1.1.1 (pp. 1-2)

To develop a greater understanding of the NDT philosophy, fill in the blanks with
words or phrases.

NDT therapists hypothesize that:

1. Much of a clients disability in life skills relates directly or indirectly to

______________ and _______________ dysfunction.

2. Lesions in the CNS produce impairments in posture and movement combined

with atypical ___________ ____________ which contribute to ___________
___________.

3. ____________ _____________ change when specific ___________ are

targeted by intervention strategies.

4. Flexible treatment strategies with ____________ or _____________ carried out

in ______________ that are meaningful to the client are most effective.

5. ____________ _____________ is an intervention strategy that broadens a

clients options for selecting successful movement and is one of the hallmarks
of NDT.

6. _____________ ____________ with a hands-on approach will enhance the

individuals capacity to carry out functional skills.

7. A ________________ approach focusing on the ____________ and

____________ of the individual client rather than a prescribed treatment of
exercise is essential.
8. Goal-directed examination and intervention lead to the best functional
outcomes that minimize ___________________ and prevent ___________
___________.

9. _______________________ by the client during goal setting and treatment is

essential for meaningful outcomes.

10. NDT therapists must understand ___________ ___________ and how it

changes across the ______________ to make certain that intervention continues
to address the clients needs.

11. ____________________ must be flexible to fit the client and familys lifestyle.

14
Learning Activity 1.1.2 (pp. 4-8)

Some of the general assumptions have their basis in work done by the Bobaths, while
others have been added based on more contemporary studies of motor sciences. The ten
original assumptions of the Bobaths have been reworded using contemporary
terminology.

In the blank provided write a B for the reworded original Bobath assumptions and a
C for contemporary therapeutic model.

1. _____ Movement is organized around behavioral goals.

2. _____ Sensorimotor impairments affect the whole individual including the

persons function, place in the family and community, independence, and
overall quality of life.

3. _____ A working knowledge of typical adaptive motor development and how

it changes across a life span provides the framework for assessing functions and
planning intervention.

4. _____ A hallmark of efficient human motor function is the ability of the

individual to select and match various global neuronal maps with the potentially
infinite number of movement combinations that are attuned to the forces of
gravity, forces generated by contracting muscles, and constraints posed by a
variety of environmental conditions.

5. _____ On-going evaluation occurs throughout every treatment session.

6. _____ NDT accepts that human motor behavior/function emerge from

ongoing interactions among the multiple internal systems of the individual, the
characteristics of the task, and the specific environmental context, each
contributing different aspects of motor control.

7. _____ Impaired patterns of postural control and movement coordination are

the primary problems in clients with cerebral palsy or stroke.
8. _____ All individuals have competencies and strengths in various systems.

9. _____ Identifiable system impairments are changeable, and overall function

improves when the problems of motor coordination are treated by directly
addressing neuromotor and postural control abnormalities in a task-specific
context.

10. _____ NDT uses a model of enablement based on the International

Classification of Function developed by the World Health Organization (2001)
to categorize the individuals health and disability.

15
11. _____ NDT intervention utilizes movement analysis to identify missing or
atypical elements that link functional limitations to system impairments.

12. _____ The aim of NDT intervention is to optimize function.

13. _____ Clinicians can best design intervention by establishing functional

outcomes in partnership with clients and caregivers.

14. _____ Intervention programs are designed to serve clients throughout their
lifetime.

15. _____ Intervention strategies involve the individuals active initiation and
participation, often combined with the therapists manual guidance and direct
handling.

16. _____ Movement is linked to sensory processing in two distinct ways.

17. _____ Learning or relearning motor skills and improving performance

requires both practice and experience.

18. _____ Treatment is most effective during recovery or phase transitions.

19. _____ NDT clinicians focus on changing movement strategies as a means to

achieve the best energy efficient performance for the individual within the
context of age-appropriate tasks and in anticipation of future functional tasks.

20. _____ NDT clinicians assume the responsibility to provide clients with the
available evidence related to all intervention methods, outcomes, and service
delivery systems.

16
Learning Activity 1.1.3 (pp. 1-9)

Compose a paragraph describing key elements of the NDT approach in the following
scenarios:

1.1.3A You have received an email from a physician which states, I saw B in my
office for the first time. The mother (wife) said you were providing an NDT
approach for the therapy I recommended. I am not familiar with this specific
approach. Please briefly describe the essential elements of what you are doing.

OR

1.1.3B You have received an e-mail from a family that states, I have read something
about an NDT approach for cerebral palsy (or stroke) on the internet. Can you
briefly describe this approach to me so I can decide whether to pursue this for
my child (husband/wife)?

17
UNIT 1.2: MOTOR CONTROL
(pp. 15-40)

Objectives
At the conclusion of this unit, the reader will be able to:

1. Identify the three key principles of the Dynamic Systems Theory of motor
control

2. Identify the three basic tenets of the Neuronal Group Selection Theory of motor
control

3. Discuss how the Selectionist and Systems models of motor control support the
assumptions of NDT

4. Identify and describe the main difference between the Generalized Motor
Program, Systems, and Selectionist Theories of motor control

5. Discuss how the characteristics of the task and environment influence motor
control.

6. State how the Distributed Neural Model of motor control offers an explanation
for how movement is produced

7. Differentiate between the role of feedback and feed-forward sensory systems in

motor control

18
Learning Activity 1.2.1 (pp. 22-30)

The Bobaths, like clinicians and scientists of their time, explained the rationale for NDT treatment
from a hierarchical/reflex model. As our knowledge of motor control has expanded, this theory has
been replaced with the Systems and Selectionist Theories. Demonstrate your understanding of these
theories by providing a clinical example for each of the ten listed premises.

PREMISES NDT CLINICAL EXAMPLE

Brain and body systems are dynamically
organized.
Multiple intrinsic and extrinsic variables provide a
context for movement.
A childs creeping pattern will depend upon the
clothing being worn, the surface under the child,
and the body proportion. An adults walking will
vary based on the environment, shoes worn and
with whom the walking takes place.

Intrinsic and extrinsic variables change across the

life-span.

The motor system shows adaptability and

flexibility.

Any given system can limit any behavior at any

given time.

Motor performance has periods of stability and

instability. Instability may provide an opportunity
for reorganization.

Intrinsic and extrinsic variables are equally

important in task performance.

New behaviors can emerge based on the

interactions of different systems in two individuals
in the same environment.

A change in any system can lead to the

reorganization of the entire person and emergence
of new behaviors. (Success breeds success.)

Previous experience and system organization

influence current performance.

19
Learning Activity 1.2.2 (pp. 15-28)

Match each of the following theoretical constructs to the most appropriate motor control theory
using the key below.

A. Hierarchical/Reflex Model
B. Interactive Systems Model
C. Dynamic Pattern Theory
D. Neuronal Group Selection Theory
E. Generalized Motor Program Theory

______ Subsystems develop at their own rate which is influenced by physical and
environmental factors.

______ Cooperative systems and subsystems interact to produce controlled

movements.

______ The controller of movement is the CNS.

______ Motor behavior is composed of a series of states; shifts in phase allow new
motor behaviors to emerge.

______ The interaction or coupling of the body structures aids in the production of
efficient movements.

______ Recovery is aided when an individual engages in functionally appropriate

activities within an appropriate environmental context.

______ The nervous system is capable of executing movement without feedback.

______ Environmental control parameters, such as velocity of movement, can

spontaneously alter movement outcomes.

______ The CNS is organized into several levels; lower levels are responsible for
reflexive movements while higher levels are responsible for self-directed
movements.

______ Primary and secondary movement repertoires influence the efficiency of motor
behaviors.

______ Interacting systems can self-organize.

______ Multiple overlapping neuronal maps exist within the brain.

______ Motor programs exist.

______ The controller of movement is the motor behavior as it is produced.

______ Anticipatory postural control is part of a synergy that includes a self-directed

component as well as a component that meets the demands of posture within a
particular context.

20
Learning Activity 1.2.3 (pp. 33-40)

Using clues on the next page, complete the following crossword puzzle:

21
Across

3. Translation of body parts through space

5. The Systems Theory of ________ _________

7. Motor and _________ systems

9. Able to change

12. A type of response to a perturbation

15. Lets you know that you are hungry

16. Initials: The ______ Approach

18. The tactile and proprioceptive systems

19. The originators of the approach

20. A feedback based system of control

Down

1. Anticipatory control

2. The world we live in

4. Type of system used to respond to perturbations

6. A critical exteroceptor for focal information

8. Report on information from the environment

10. An acoustic form of feedback

11. Synonymous with open loop

13. Reference of __________

14 . A fundamental system for closed loop control

17. A mechanism of motor control

22
 Learning Activity 1.2.4 (pp. 33-37)

Word Find: In the puzzle below, find eighteen (18) key terms which relate to the
sensory systems and their contribution to motor control. The key terms used in this
word find are the answers to the Learning Activity 1.2.3 crossword puzzle (except for
#16 across and #19 across).

R S R O T P E C O R E T N I
E Y L O R T N O C R O T O M
A R E E E V I T P A D A L O
C O E N V I R O N M E N T O
T S N C O R R E C T N E S S
I E E O R M T N D P T Y R D
V O E N I M O T O R Y R A E
E S F P S A C O N T R O L E
S Y E P N O L S E N O S U D
R F E R E D R A R K T N B K
O Y D X E W A Y C D I E I C
T Z F S K C J I N G D S T A
P M O V E M E N T E U O S B
E L R P U Q P P V O A T E D
C S W T E U R I T U V A V E
O O A O L N S Y H O N M E E
R P R E G U L A R T R O N F
E R D O A F K O C A A S D E
T W A L R D C L O O S B T E
X R O T P E C I R P O R O D
E D P O S T U R A L O N E B

23
Learning Activity 1.2.5 (pp. 37-40)

Choose one of the following scenarios:

1.2.5A You are a therapist providing home care. Your patient, Tim, is four years of
age and age and has a medical diagnosis of cerebral palsy. He lives in a small,
two-story, three-bedroom home with his parents, three siblings, a grandmother
who is hard of hearing, two dogs, one cat, and five fish. His parents own their
own business, which is based out of their home. When you arrive at Tims
home to treat him, you find that all members of his family are home and that
his three cousins are visiting. His mother is in the middle of cooking dinner
and his grandmother is watching TV. You find Tim in the middle of a
computer game which he is playing with his brother and cousin.
OR

1.2.5B You are a home-care therapist. Your patient, Mrs. C, is 58 years of age. She is
six weeks post-stroke. She resides in her home with her husband, four teenage
children, two dogs, and a cat. Her mother-in-law also lives with her family.
Mrs.C. currently is independently mobile in her wheelchair, except that she
cannot get to the family room, which is located two steps down from the main
floor. She is looking forward to this treatment session, because she hopes that
she will be able to learn to walk independently on her own.

1. List five abstract aspects of the environment and explain how and why you
might address them in treatment.

2. Identify three physical aspects of the environment and explain how they will
influence your intervention.

3. How might you address interactive contextual factors in your intervention?

24
Unit 1.3: Motor Development
(pp. 41-52)

Objectives
At the conclusion of this unit, the reader will be able to:

1. Identify assumptions in typical and atypical motor development that reflect a

change in the NDT perspective on the developmental process

2. Describe how NDTs current concepts of motor development influence

examination, evaluation, and treatment

3. Identify the key components of postural control that contribute to the

development of distal function

25
Learning Activity 1.3.1 (pp. 41-46)

NDT has always had a strong foundation in motor development. However, many
changes have occurred in our understanding of motor development. Mark true (T) for
those statements that reflect current thinking in NDT. If the statement is false (F),
rewrite the statement so that it is true.

1. _____ The hallmark of typically developing movement is variability.

2. _____ Synergies are abnormal expressions of movement resulting from

combinations of flexion and extension that interfere with the
development of posture and mobility for function.

3. _____ Variability in motor synergies develops through individual experiences

and alterations in body subsystems.

4. _____ Motor milestones proceed in a linear sequence in which one milestone is

the foundation for the next.

5. _____ Understanding typical and atypical motor patterns underlying motor

function is useful in analyzing components of movement in adults or
children with CNS pathology.

6. _____ Following a developmental sequence in treatment allows the therapist to

emphasize what the person needs most to progress in his skills.

7. _____ Children practice combinations of movement patterns in different

positions eventually preferring some over others to solve motor tasks.

8. _____ It is often harmful to perfect one motor milestone before continuing to

another.

9. _____ Understanding the competition of motor patterns identifies infants at

risk for motor dysfunction.

10. _____ The development of components of the musculoskeletal system does not
alter the appearance of motor milestones.

11. _____ Motor milestones are the expression of age-appropriate behavior with an
identifiable onset.

26
Learning Activity 1.3.2 (pp. 45-46)

You have just completed your NDT certificate course and are returning to work. Your
place of employment has many therapists that took their course in the early 1970s and
still believe that treating in developmental positions is a critical concept in NDT.
Outline key points for discussion with your colleagues that describes how NDT
currently uses the concepts of motor development in assessment and treatment.

Learning Activity 1.3.3 (pp. 46-52)

Susans caregiver wants her to be able to reach and hold her spoon during feeding, but
Susan cannot sit without the support of her hands and falls to the side when she reaches
out with one hand. Briefly explain to the caregiver how the development of her
postural control is related to the development of her reach and grasp.

27
Unit 1.4: Motor Learning
(pp. 52-64)

Objectives
At the conclusion of this unit, the reader will be able to:

1. Provide examples of motor learning principles from the NDT framework of

examination, evaluation, and treatment

2. Define motor performance, motor learning, and skill acquisition

3. Distinguish among the clinical characteristics of motor performance, motor

learning, and skill acquisition

4. Describe how the principles of motor learning, including preparation,

instruction, practice, scheduling of practice, and feedback, influence the
delivery of NDT-based intervention services

5. Apply principles of motor learning to NDT intervention for the child or adult
with neuropathology

28
Learning Activity 1.4.1 (pp. 54-55)

The following assumptions, developed from motor learning concepts, are part of the
current NDT framework. In the space provided beside each assumption, give an
example that involves either an adult or child and demonstrates how each assumption is
used in NDT.

Note: There are actually two avenues of motor learning presented. (1) How the
therapist uses motor learning principles to plan and enhance the clients motor learning.
(2) How the client actually achieves motor learning.

Example of motor learning principle

Motor learning principle
Motor learning results as the individual gains
experience and practice in specific
environments in the pursuit of new or different
motor behaviors. It is important that the
environment and the task be conductive to the
clients learning capability (i.e., appropriately
motivating, stimulating, achievable, and
meaningful).
1 art supplies that are stored in a small
in NDT
Three year old B. receives therapy in
his preschool setting. He straddles a
roll with his feet on the floor while he
moves matchbox cars from one
cardboard garage on the floor on
one side of the roll, to the garage
on the other. His best friend is
playing with him in this activity. He
practices the same type of posture
and movement control while seated
on a small chair and reaching for his
box to his side and places the trash
in a can on the opposite side.

58 year old B. receives therapy in

her home. She stands next to her
washer and dryer and transfers the
clothes from the washer to the dryer.
(Example must mention appropriate
environment and choice of tasks that
are motivating and meaningful to the
client to allow for success.)
NDT interventions structure motor learning
experiences to elicit active participation from
the client.

29
 Goals and outcomes that the client selects, and
which are specific, meaningful, attainable, and
of moderate difficulty, have a greater effect on
motor learning than goals or outcomes that the
3 clinician sets.

During NDT intervention, the therapist allows

and assists the client to plan and develop
strategies for solving motor problems,
recognizing that each person works out his or
4 her own personal method of performing various
tasks.

NDT intervention uses specific instructional

strategies in a task-oriented approach that
recognizes functional tasks help motor
behavior. The selection of instructional
5 strategies reflects the state of learning of the
client.

Practice and repetition of activities that are

task-specific are critical components of motor
learning. Random practice in a variety of
settings facilitates learning.
6

Client treatment utilizes physical, cognitive,

verbal, and non-verbal guidance along with
verbal and nonverbal feedback.

30
 Hands-on guidance is a naturally occurring
motor-teaching strategy that influences motor
learning and may be particularly useful in
eliciting specific motor behavior in early stages
of motor learning or skill acquisition.
8

An optimal state of readiness, including

attentional, physical, emotional, cognitive, and
sensorimotor systems, prepares the individual
for the consequence of the motor action.
9

Experience, experimentation, memory, and

recall are additional elements involved in motor
learning.

10

NDT recognizes that improved performance

does not automatically equal motor learning.
Motor learning is reflected in the degree of
long-term retention of performance capability.
11

31
Learning Activity 1.4.2 (pp. 54-55)

Using the numbers (1-8) in the list of motor learning assumptions from Learning
Activity 1.4.1, identify the motor learning principles that the therapist is using with
these NDT assessment and intervention strategies. More than one principle may be
demonstrated during each strategy and each principle may be used more than once.

The therapist uses information gained during the examination to decide what
intervention activities should be incorporated into the plan.

The therapist demonstrates the movement to the client prior to asking the client
to perform the movement.

The therapist uses hands on the hip muscles to facilitate a more effective
alignment in mid-stance.

The therapist chooses activities for repetition during the session and in the
home program that are likely to be frequently repeated.

The therapist works on preparatory activities for ambulation (gait) that include
stepping in various directions, forward weight shift in stride standing, and stair
climbing.

The therapist includes the client in the analysis of the success and quality of the
performance.

The therapist and client choose activities for the session and the home program
that enhance the clients function and are meaningful to the client.

The therapist, while ensuring the clients safety, permits the client to make
performance mistakes.

The therapist chooses activities based on the clients goals and needs.

The therapist uses her own weight shift to give the client a feel for the direction
of movement.

The therapist selects activities that challenge but dont frustrate the client.

The therapist selects strategies that heighten the clients attention.

The therapist sets up practice in different environmental contexts.

The therapist evaluates the interventions as successful when the client can
spontaneously perform the tasks long after the intervention.

32
Learning Activity 1.4.3 (p. 54)

It is important to distinguish among motor learning, motor performance, and skill

acquisition.

Motor learning is a set of processes directly related to practice or experience

leading to relatively permanent changes in the capability for movement.

Motor performance is the temporary change in motor behavior that comes from a
variety of factors following practice.

Skill acquisition is the consistent attainment of an action goal with some economy
of effort. Acquisition of a skill assumes that learning has occurred.

Which of the following statements represents motor learning, motor performance, and
skill acquisition? Use L for motor learning, P for motor performance, or S for skill
acquisition in the space provided below.

The client walks with even step-lengths across the floor at the end of the
treatment session.

The clients walking speed is .2 km/hour faster three weeks after initiation of
treatment.

The client closes his lips with facilitation.

The client drools less during eating while on vacation.

The client walks efficiently on all surfaces all the time.

The client dresses himself for school or work everyday.

The client accesses greater gleno-humeral (GH) flexion when reaching for
ball during the session, after facilitation and practice activities.

The client transfers from all surface heights at home.

The client consistently drinks from a cup without spilling.

The client transfers with less help on the nursing unit.

The client required less help getting into his wheelchair at the end of the
session.

The client independently transfers in all directions and to/from all surfaces.

33
 The client walks without an assistive device as he leaves the clinic.

The client tolerates toothbrushing at the end of the treatment session.

The client plays golf regularly with peers in an appropriate time frame.

The client can produce five words/breath at the end of the session.

The client gave a speech at a wedding anniversary with clarity.

The client was able to release the hair brush during a morning ADL session
with therapist.

The client grooms her own hair on a daily basis.

Learning Activity 1.4.4 (pp. 55-56)

Preparation for a motor learning experience involves addressing the overall context that
is conducive to the individuals learning ability and style. Give examples for either
Case 1 (Pediatric) or Case 2 (Adult).

Case 1: T. is a seven year-old boy with spastic diplegia cerebral palsy. He

walks with a posture walker. He attends 2nd grade in his neighborhood school.
He is unable to participate independently in the cafeteria, library, or on the
playground. He would like to be more like his schoolmates.

Case 2: Mrs. B is a 67 year old woman, 6 months post-stroke living at home

with her husband. She is easily confused by complex directions or distractions
and becomes visibly upset. She would like to rely less on her husband during
daily routines.

1.4.4A

Select a context that is conducive to the Give an example:

clients ability and style.

34
When will you use the real context?
Why?

When will you select multi-contexts?

Why?

1.4.4B When planning a treatment session for Case 1 or 2, describe the following
aspects of your intervention.

Specific Task

Meaningful Goals

Practice in the Environment

- Context
- Critical features of environment

How can you increase the clients problem-

solving skills?

35
1.4.4C The following three factors are critical for motivated/intentional learning.
Consider one of the cases from Learning Activity 1.4.4 and give an example for each
factor.

Critical factors Examples

The learner must perceive the skill is
meaningful, useful, and has personal values
and implications.

The learner must experience satisfaction from

executing the movement.

The learner must find encouragement towards

higher, achievable goals after task execution.

Learning Activity 1.4.5 (pp. 56-57)

Physical or verbal guidance is an effective method for limiting movement errors during
the performance of a task.

1. Briefly describe the positive and negative aspects of physical guidance.

2. Is there a value to alternating between physical guidance and client independent

trial and error? Explain.

36
Learning Activity 1.4.6 (pp. 59-60)

Practice is the most important condition for motor learning. Blocked practice is slightly more
effective in the early stage of learning as it provides repetition of all trials without interruption.
Random practice has been shown to be more beneficial than blocked practice when measured
on retention tests. Using the letters B for Blocked, or R for Random, indicate which
situations represent blocked practice or random practice.

______ Joe practices sit-to-stand from the same chair five times before practicing
taking steps.

______ Jimmy takes the cookies out of the bag and puts them on the plate, one by one,
to practice the components of grasp and release.

______ Jayne repeats each of the vowel sounds, a, e, i, o, u, e, o, a, o ,

after the voice on the tape.

______ Bob plays a game of catch with his younger brother who is attending the
therapy session with him, while the therapist facilitates components of trunk
rotation.

______ Sue steps up and down off the bottom step with her right leg for two minutes
while standing on her more involved left leg.

______ Betty practices her wheelchair to bed transfers with a therapy assistant for 15
minutes each morning.

______ Bill retrieves his clothes (shirts, socks, and pants) from the dryer, folds them,
and puts them in the clothes basket. There are 15 items in the dryer.

Learning Activity 1.4.7 (pp. 61-62)

Scheduling practice trials is an aspect of motor learning that improves both performance and
learning.

1. Variability of practice is important for learning to occur. There are two main reasons for
including variability in practice. What are they?

2. Open skills contain unpredictable perturbating while closed skills contain conditions that
are unpredictable. Many life skills are made up of open and closed skill components. Give
an example of each for either an adult or a child.

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Learning Activity 1.4.8 (pp. 62-64)

Other than practice, feedback is the single most important variable for motor learning.
Using the information from the text, fill in the statements below.

1. Extrinsic feedback about the nature of the movement pattern is called

_________________of_________________(__).

2. There are two types of intrinsic feedback. The first provides information about the
components of the movement, sensing speed, direction, accuracy, joint angles,
muscle strength, and other factors. The second type of intrinsic feedback provides
information about _____________ and gives indications concerning the degree of
______________ _____________ through vision, hearing, or feeling success.

3. Two types of knowledge of performance (KP) feedback relevant to clients with

motor control problems are _____________ feedback and ______________
feedback.

4. ______________ feedback occurs as a natural consequence of motor behavior and

relates to the learners various sensory channels involved when practicing a task.

5. Verbal observations that refer to aspects of movement such as position, time,

velocity, acceleration, and patterns of coordination are examples of
______________ feedback.

6. ______________ feedback that provides information about the outcome of the

movement in the environment is called ______________of_____________(__).

7. Knowledge of _____________ is particularly useful when the goal is for the

individual to achieve the best possible __________ by taking into account his or
her unique physical attributes.

8. _______________ feedback is external information about the task that is

supplemental to __________________________ feedback.

9. Researchers have found that the frequency of __________ and the ___________
between task completion and knowledge of results (KR) were variables in
enhancing learning.

10. _____________ feedback gives information about the forces that produce the
variables, including the muscular forces that organize movement and their
durations.

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