Goal Setting for Skill Acquisition Pt 1

Goal setting is a concept we learn at University and can all probably speak at length as to why its important! But in reality we are all probably very poor at its implementation because of time constraints and other factors . Many of us and me included dont do a good job when it comes to goal setting for patients.

However, a prerequisite for effective skill development and motor learning in rehabilitation is a clear understanding of your patients intended goal.

The best rehab therapists have a goal setting mindset and philosophical framework that allows them to reverse engineer the patients target activity that is meaningful to them. But before you can reverse engineer the activity you need a method for deconstructing the patients goals into manageable components.

Setting goals acts as a reference point for assessing your parents progress. It allows the identification of specific behaviours and skills that need to be mastered to achieve the movement goal. It is well accepted that when patients engage in a goal setting process they are more committed to achieving their goals and often have a better understanding of the purpose of the learning process.

There are three type of goals that we should understand and apply to the management of our patents movement problems :

1. Outcome goals

2. Performance goals

3. Process goals

1. Outcome goals are often what all patients and therapists focus on , indeed it is often the primary reason the patient has sought the help of a physiotherapist. This type of goal while clearly important, is highly unstable and often a cause of failure! This is because it involves many factors which the patient has little or no control over.

For example a injured football player recovering from a knee injury may set an outcome goal of being selected for the first team after finishing their rehabilitation. This type of goal involves beating other players to team selection. The injured player could be in the best shape of their lives after rehabilitation and acheive personal bests in their 10 metre sprint times, 1RM leg press and change of direction speed tests, but still not make the coaches starting line up! Or to provide another example which many MSK therapists will resonate with, it is the patient with significant OA that has a pain free outcome goal when it is clearly unrealistic. We know that we can improve their functional preformance or preformance goal but the patients outcome goal is incongruent with their lifestyle and degenerative pathology.

2. Performance goals are very important and critical to skill acquisition because they focus on the patients ability to self-improve in a target activity. Performance goals are composed of activities that are relevant to the patients performance. So in the example above the injured football players goal might be made up of the following preformance goal:

1. To be able to dribble with a ball 5 metres and then to do a 45 degree change of direction cut and shoot at a target, hitting the target in 50-70% of attempts.

This is a measurable and very specific goal !

3. Process goals are goals that emphases particular aspects of a skilful task. It is a single cue or aspect of a movement skill that the patient and therapist needs to focus on that will improve the skill. These process goals can change as the patient gains mastery of the movement pattern and other process goals become important. In the example above, the injured football player may have difficulty executing a safe 45 degree turn. This may be because they dont lower their centre of mass enough to plant their outside foot to make the directional change. The process goal may be a simple cue reminding the them to stay low as they enter the change of direction drill.

So goal seting is not rocket science, in fact its quite easy when you have a simple framework to work with. The outcome goal is important but it can sometimes be counter productive when the outcome is beyond the patients control. Our role as rehab professionals is to guide and facilitate the patients process and performance goals so that their movement skills and motor learning is optimised.

Further reading:

Barnett, M. L. (1977). Effects of Two Methods of Goal Setting on Learning a Gross Motor Task. Research Quarterly. American Alliance for Health, Physical Education and Recreation, 48(1), 19–23. https://doi.org/10.1080/10671315.1977.10762144

Gauggel, S., & Fischer, S. (2001). The effect of goal setting on motor performance and motor learning in brain-damaged patients. Neuropsychological Rehabilitation, 11(1), 33–44. https://doi.org/10.1080/09602010042000150

Locke, E. A., & Latham, G. P. (1985). The Application of Goal Setting to Sports. Journal of Sport and Exercise Psychology, 7(3), 205–222. https://doi.org/10.1123/jsp.7.3.205

Principles of Motor Learning to Support Neuroplasticity After ACL Injury: Implications for Optimizing Performance and Reducing Risk of Second ACL Injury | SpringerLink. (n.d.). Retrieved 11 October 2021, from https://link.springer.com/article/10.1007/s40279-019-01058-0

Shifting Focus: A Clinician’s Guide to Understanding Neuropl... : Current Sports Medicine Reports. (n.d.). Retrieved 11 October 2021, from https://journals.lww.com/acsm-csmr/fulltext/2020/02000/Shifting_Focus__A_Clinician_s_Guide_to.8.aspx

The Power of Language: Using the OPTIMAL Theory to Coach Your Patients to Recovery - ProQuest. (n.d.). Retrieved 11 October 2021, from https://www.proquest.com/openview/9f71c99d0cefab84ede9596ba5ca4ad4/1?pq-origsite=gscholar&cbl=52166

Wulf, G., Shea, C., & Lewthwaite, R. (2010). Motor skill learning and performance: A review of influential factors. Medical Education, 44(1), 75–84. https://doi.org/10.1111/j.1365-2923.2009.03421.x