Block vs Random Practice… Whats the best approach for your patient?
This is the age old question in skill acquisition research and also in clinical practice. The practice structure of your rehab class or rehab session is critical to the learning experience of your patient/s. Unfortunately, this is an area that most physiotherapists are relatively unfamilar with unless they have a background in neuro rehabilitation or sports coaching.
MSK physiotherapists in my experience tend to favour block practice when teaching movement skills. In block practice the patient is encouraged to learn a specific movement skill until they can almost do it perfectly! Then as the patients skill level increases they might move to a more random practice schedule but in my experience many will just pick another skill and again revert back to block practice.
Is this the right method?
Well like all things that are complicated and involve real patients it depends !
So, first lets explore why we would even need to consider the practice schedule. Well, in motor learning the rehearsal of a task is a fundamental factor in learning new skills . To take a practical example from sport , the reason why elite athletes such as football players , golf pros or tennis players make their sports look so easy is because they have spent many hours practicing their sport to a very high level.
"So the amount of time we spend on a skill will influence the end outcome , but also the quality of the time we spend practicing that skill will also influence the end out come".
Now from a clinical perspective our patients don’t have a endless amount of time in their day to practice movement skills. This is why we should be interested in how we structure their training and home exercise schedule to optimise the quality of each training session.
Block practice Vs Random practice
Block practice
Suppose you are rehabbing a patients gait and stair walking after a femoral osteotomy, and suppose they have been non- weight bearing for 6 weeks and this is there first session with you in the gym. A common senses approach for most of us would be to practice the discrete tasks of step ups on to a box and walking with crutches into blocks of practice time. So we would devote a fixed block of time for the patient to practice the first task before we moved on to the second task.
This is an approach to practice scheduling which is called block practice in which a substantial amount of time is spent on one task before moving on to the next task. This type of practice is often seen during the practice of agility drills, walking, throwing and stair climbing in which the patient is allowed a period of uninterrupted time to practice the same movement over and over again. This means they can concentrate on the performance of one task in isolation before moving on to the next task. This approach makes sense because it allows the patient to refine, ingrain and where necessary correct the skill before moving on to the next skill.
Random practice
Another method of structuring a rehab session is to use more variation of skill rehearsal within a single practice session . This is called random practice. In random practice the patient perform several skills in random order in the same practice session in no particular order. This means for example that the patient might practice step ups on a step, gait with a stick in a straight line , gait with a stick up an incline , and step ups on to a step holding a book in the opposite hand to the stick in no particular order. So in essence all the tasks are intermingled during the practice session with the therapist continually rotating the tasks .
What does the research suggest?
Well several studies have shown consistently that motor learning is often superior under random conditions when compared to blocked conditions. This has been shown in controlled labs studies and also in rehabilitation settings.
Indeed, it is well know that when patients practice a variety of skills in a random fashion their performance in the short term is very bad and less successful than blocked practice. However, when patients resume their performance some time later ( normally days later) those that practiced in a random fashion demonstrate superior performance when compared to their block practice counterparts.
The research points to a term called contextual interference as the theory underpinning this enhanced performance … this also challenges conventional wisdom that perfect practice is superior to practice conditions where mistakes are encouraged .
So the take home message is that blocked practice enhances immediate performance but random practice produces superior long term learning!
The reason why random practice is superior to block practice for long term learning is because of two possible reasons:
1. Random practice is proposed to increase the meaningfulness of movements when patient change from one to another during a random practice session. The randomness helps them to appreciate the distinctiveness of the different tasks making each one more meaningful in their long term memory. The more meaningful a memory is the more easily it can be retrieved for use later.
2. A second explanation for why random practice is superior to block practice is something called the : Forgetting hypothesis ! Yep … I said it "the forgetting hypothesis" !
According to the theory when you shift from one task to another randomly we forget what we did in the last task when we are trying to work out what to do in the new task.
So when its time to return to the first task the patient has to generate a new plan for that task all over again. This also means that because they are always being challenged to generate new plans for different movements their performance during their initial practice is very poor. This forces learners to practice the skill of retrieving the necessary performance information from their long term memory.
In contrast block practice learners can apply the same movement strategy over and over again and so become very skilled . This is very good for short term learning. But, their long term learning and ability to move beyond these basic skills is limited. This may be because block practice does not encourage them to generate different motor plans unlike a random practice schedule.
So whats the best appraoch ? Well, if you are teaching a patient a new skill and they are absolutely clueless then block practice initially is probably the way forwards. But if you want the patient to develop longer term movement expertise and to become independent learners then dont wait too long to randomise your practice schedule.
Further reading
Repetition and variation in motor practice: A review of neural correlates. (n.d.). Retrieved 19 October 2021, from https://www.researchgate.net/publication/281238061_Title_Repetition_and_variation_in_motor_practice_A_review_of_neural_correlates
Hanlon, R. E. (1996). Motor learning following unilateral stroke. Archives of Physical Medicine and Rehabilitation, 77(8), 811–815. https://doi.org/10.1016/s0003-9993(96)90262-2
Kumar, V. K., Kate, M., & Nayak, A. (2021). Effects of Practice Conditions in Improving Motor Performance in Neurorehabilitation: A Narrative Review. Critical Reviews™ in Physical and Rehabilitation Medicine, 33(2).
Moliterno, A. H., Bezerra, F. V., Pires, L. A., Roncolato, S. S., da Silva, T. D., Massetti, T., Fernani, D. C. G. L., Magalhães, F. H., de Mello Monteiro, C. B., & Dantas, M. T. A. P. (2020). Effect of Contextual Interference in the Practicing of a Computer Task in Individuals Poststroke. BioMed Research International, 2020, 2937285. https://doi.org/10.1155/2020/2937285
Renshaw, I., Chow, J. Y., Davids, K., & Hammond, J. (2010). A constraints-led perspective to understanding skill acquisition and game play: A basis for integration of motor learning theory and physical education praxis? Physical Education and Sport Pedagogy, 15(2), 117–137. https://doi.org/10.1080/17408980902791586
Sidaway, B., Gordon, R., Hopkins, M., Kershaw, M., Marean, C., & Wilkins, N. (2006). RANDOM AND BLOCKED PRACTICE SCHEDULE EFFECTS ON MOTOR SKILL LEARNING IN INDIVIDUALS WITH PARKINSON’S DISEASE. Journal of Neurologic Physical Therapy, 30(4), 204–205. https://doi.org/10.1097/01.NPT.0000281285.38882.40
Stevans, J., & Hall, K. G. (1998). Motor Skill Acquisition Strategies for Rehabilitation of Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy, 28(3), 165–167. https://doi.org/10.2519/jospt.1998.28.3.165
Williams, A. M., & Hodges, N. J. (2005). Practice, instruction and skill acquisition in soccer: Challenging tradition. Journal of Sports Sciences, 23(6), 637–650. https://doi.org/10.1080/02640410400021328
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