Retention & Transfer

Requirements of a "task-oriented" approach

-Functional movements -Similar to real environment -Manipulation of sensory feedback -Manipulation of physics -Fun & entertaining environment -High motivation

Examples of elements of a task

-Goals and shapes -Body kinematics and kinetics -Phase relationship -Type of movement (discrete vs continuous) -Similar mechanism of sensory corrections

- Announce max performance and discharge - Continue practicing and improving with justification for alternate techniques/approaches

List 2 options for clinical management of a ceiling effect:

True

T/F: A difference score reflects the amount of task related information that was lost during the retention interval.

True

T/F: A short term negative transfer or contextual interference can result in longer-term retention.

True

T/F: Absolute retention is directly related to the amount of original practice.

True

T/F: Dual task learning can be both detrimental and beneficial to a learner.

False - gross motor skills are retained better

T/F: Fine motor skills are retained better than gross motor skills.

True

T/F: If one task has elements that are completely different from the elements of another task, no transfer is expected.

True

T/F: If tasks have all their elements in common, transfer would be 100%.

True

T/F: Individuals with progressive disorders do not retain skills well and motor performance is declined.

True

T/F: Later in practice, the actual amount of improvement is reduced but the percentage will be the same.

False - this is greater at the beginning stages of learning

T/F: Performance variability is greater in the later stages of learning.

False - retention loss is decreased

T/F: Retention loss is increased if a patient pre-selected some spatial or temporal parameters by himself.

True

T/F: Retention rate is enhanced if repetitions are spaced apart rather than immediately completed.

True

T/F: Simulation can be used to keep similar task context and sequence while manipulating parameters the need to be retrained.

True

T/F: Spatial parameters are memorized better than temporal parameters.

True

T/F: Warm up decrement can be reduced/avoided at early stages of learning by keeping contextual setting the same.

Parameterization of skills

-Spatial: position, distance -Temporal: speed, sequence -Sensory qualities

Examples of contextual interference

1. Two tasks of different kinetics (timing) 2. Different sensory mechanisms 3. Different spatial setting 4. Different instructional setting

Severe cognitive impairments Visual deficits Perceptual deficits Vestibular deficits

Contraindications for Virtual Reality

Retention is good

If practice effect is greater than or equal to established MCID for scale and disease

Retention is poor

If practice effect is less than established MCID for scale and disease

- Performance has been perfected and maximum score reached - Limit of capacity has been met

List 2 reasons why a ceiling effect may occur:

1. Change performance measure to more sensitive changes 2. Continue working on movement pattern variability (dual tasking) 3. Use alternate measurement parameters

List 3 ways to justify necessity to continue treatment after ceiling effect has occurred

Should be valid, reliable, and sensitive -Movement time, precision, number of trials that are successful

List some key components of a performance curve measure

Nausea Dizziness Headache Neck pain if heavy helmet used

Potential side effects from using Virtual Reality

Alternative measurement techniques

Rather than measuring performance only, measurement of number of compensations is used - these are used when no further improvement is expected

False - poor performance early on (lower floor effect) can be compensated for by better learning and can result in the same overall final learning level

T/F: A better initial performance (higher floor effect) ensures a better final outcome.

False - 5-10% is representative of good level of retention loss

T/F: A poor retention score is when there is more than 5-10% loss of information.

True

T/F: A relative retention percentage score can be used to predict future performance.

True Ex. Practice for 2 weeks, retention interval should be a minimum of 1 week but could be 2 weeks

T/F: A retention interval should be at least 1/2 of the practice time.

False - it should be administered after a retention interval

T/F: A retention test should be administered before a retention interval.

False - positive transfer depends on similarity between tasks

T/F: Amount of similarity between task elements does not impact the amount of positive transfer.

False - discrete are more variable

T/F: Continuous tasks are more variable.

False - this statement is true of discrete tasks

T/F: Continuous tasks generally include smaller amounts of practice and may result in lower outcome.

True

T/F: Discrete tasks are performed more in the UEs as compared to the LEs.

True

T/F: Discrete tasks involve a greater cognition component with initiation and termination.

True

T/F: For pts with progressive disorders, it is expected that retention loss will be greater than 10%.

Relative retention - percentage score

measures the amount of skill lost during retention interval relative to the amount of improvement during the original learning session

Inter-task transfer

occurs on practice from one task to another task *this provides moderate skill transfer dependent on number of common elements

Minimal Clinically Important Differences

patient derived scores that reflect changes in a clinical intervention that are meaningful to the patient

Ceiling effect

performance has plateaued and no new improvements are seen

Retention

persistence of performance after a time interval

Forgetting

refers to a loss of capability for performance

Minimal Detectable Change

refers to the minimal amount of change outside of error that reflects true change by a patient between two time points

Bilateral transfer

regardless of movement type, both extremities are coupled to work as a single unit, causing characteristics of each to become similar

Learning curve

steep rise in curve during early trials followed by a gradual sloping as the trials progress - improvement during practice is lineraly related to the amount of left to be improved

Absolute retention score

the level of performance on the initial trial *represents the amount retained of what was originally learned

Intra-task transfer

transfer that occurs within the same task often between different levels of difficulty, different types of environment, or different practice conditions *this provides maximal skill transfer

-Computer generated image -Display in different forms -Computer interface -Devices to increase presence of reality

Virtual reality includes:

-type of skill to be retained -amount, duration, effect of practice -parameterization of skill -pre-selection or self-selection effect -spacing of repetitions -type of disease or disorder

What factors influence the retention of motor skills?

*specific motor neurons with intercollasal connections *in supplementary or premotor areas *corticospinal pathways (contra and ipsilateral) *reticular formation of brainstem *central pattern generators in SC

Which levels of the CNS provide bilateral coupling?

A: True B: False - receive more ipsilateral innervation (this controls medial structures more) C: False - less variable D: True E: False - more frequently used during ADLs

Which of the following are true about gross motor skills in comparison to fine motor skills? A: Involve greater amount of axial and postural muscles B: Receive less ipsilateral innervation C: Are more variable D: Require less coordination and involvement of higher cortical structures E: Are utilized less frequently with ADLs

- Time is needed to process feedback - Minimization of fatigue - Forgetting that occurs between repetitions can actually serve to stimulate memory

Why is spacing repetitions beneficial?

Warm up decrement

a decrease in the level of motor performance after a break *this is an unavoidable component of retention and is not related to loss of motor memory

Retention interval

a time interval in which the skill was not practiced

Scoring sensitivity

ability to detect small changes in score - this can be improved by having more increments on a scale

Successive interference

components of task A when performed successfully interfere with performance of task B *may result in long term negative transfer

Overlearning

continuing practice once the ceiling effect has been reached -more improvement is seen with those who continue practicing rather than stopping once they have reached ceiling effect

Relative retention - difference score

difference between the performance at the end of the original training session and the beginning of the retention test

Transfer of learning

gain or loss of proficiency in a skill as a result of practicing another skill

Simulation

imitation of real world environments and scenarios

Retention test

indicates persistence of acquired habit in the absence of practice

Floor Effect

initial level of performance

Contextual interference

when performance of successive trials is disrupted by performance of random movements that have the same goals but are practiced in different context

Negative transfer

when practice on task A has a detrimental effect on performance of task B

Positive transfer

when practice on task A improves the performance on task B