We are very good at developing the physical qualities that drive physiological adaptation E.g. (muscle strength, tendon mass, range of motion, balance or power output) for our patients. However, an important factor often missed in our clinical reasoning is how those adaptations will be applied in the context of the patient’s day to day life.
This is skill acquisition and motor learning.
Skill acquisition may be less relevant to the patient with a benign musculoskeletal problem such as rotator cuff tendinopathy, but it will be critically important to the patient after a major surgical procedure such as a femoral osteotomy, ACLR or total knee replacement relearning how to walk again.
The critical point, is our focus is often spent on the activities that we are already good at as a profession… such as improving our patient’s physical qualities. However, I think as a profession we spend less time understanding the skilful application of those qualities in the context of the patient’s environment. I.e. Skill Acquisition!
What is a skill
A logical starting place to develop this blog is to define what we mean by skill acquisition and motor learning:
“Skill is the ability to bring about an end result with maximum certainty and with the minimum amount of energy expenditure”.
Using this definition we can see that skill requires a very clearly defined goal….. and the acid test will be whether the patient can achieve the movement goal with consistency and efficiency.
So, skill is content specific and as such it needs a very clearly defined goal. So it is important that we consider the constraints of the activity the patient is returning to before deciding upon the best approach for skill development. This requires some thoughtful analysis as the devil will always be in the detail!
For example, walking on the side walk to catch a bus and walking on a woodland trail may on first impressions seem very similar, but both have subtle differences that affect the patient’s performance of these tasks. Although both tasks involve essentially the same muscle groups to achieve the goal of walking, the trail walk is self-paced and the walker is unrushed, whereas the patient walking to catch a bus is subject to time constraints. Additionally, the sidewalk provides a very different proprioceptive experience to that of the uneven softer trail. In this way these two activities on the face of it while seeming very similar are in actual fact poles apart, which will affect the optimal method by which these skills should be developed.
The process of deconstructing a motor task can seem very daunting for the practitioner without a clear and coherent framework. While motor skills can be classified in many ways. A very logical method is outlined in the infographic below.
Although, it may seem like an over complication classifying a motor skill, it is the starting point for your clinical reasoning and rehabilitation of movement. The deconstruction process provides you with a framework for selecting how you can improve your patient’s skill development ….. Which we will cover in subsequent blogs
Further reading
Larin, H. M. (1998). Motor learning: A practical framework for paediatric physiotherapy. Physiotherapy Theory and Practice, 14(1), 33–47. https://doi.org/10.3109/09593989809070042
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. https://doi.org/10.1016/j.jht.2012.12.007
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
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