APTA CSM
A few weeks ago Sarah and Blair had an opportunity to travel to San Antonio, TX for their 2nd Combined Sections meeting where they learned about the latest research in our field and network with top Physical Therapists from across the country. Below each of them explain key points from one of their favorite lectures and how it applies to you!
Blair- I attended “Optimizing Motor Learning in Rehabilitation: Optimal Theory and Application,” where Rebecca Lewthwaite, PhD, Gabriele Wolf, PhD, and Mike Studer, PT, MHS, NCS, CEEAA, CWT, CSST presented their current research on a new perspective of motor learning. They discussed how optimal performance happens through intrinsic motivation and attention for learning. Intrinsic motivation coupled with attention for learning is what they deemed the “Optimal Theory” of motor learning and is centered on three specific conditions of practice: Enhanced Expectancies, Autonomous Support, and External Focus. Through their research they found that these three conditions paired with practice help facilitate efficient goal-action coupling for optimal performance and learning by aligning a person’s thoughts, attention, motivation, neuronal, and neuromuscular systems to the individual’s goals. “Shifting the circle for success” enhances an individual’s expectancies and leads to improved motor learning and retention by increasing dopaminergic activity in the brain. They also discussed how autonomy enhances self-efficacy expectations, promotes task focus, and reduces stress. The presenters found that individuals demonstrated fewer movement errors when they were able to pick the order of exercises. Lastly, the presenters found that external focus on the effect of movement ultimately enhances automaticity and movement efficiency compared to an internal focus on body movements.
So, what does this all mean? As clinicians and Pilates instructors, we want to set our patients and clients up for success with our interventions and exercises, provide autonomous support by giving our patients and clients incidental choices, and promote external focus by having our patients and clients focus on the effect of movement rather than the body part that is moving. External focus ultimately directs attention to the task goal and reduces a focus on the self and distractors.
Let's talk Pilates for example: Say you’re at the end of a private Pilates session with a client that has been practicing Pilates for a few months now. You have three “individual needs” exercises in mind that the client is familiar with from past sessions, however he or she struggles with Teaser. In order to optimize motor learning in this case, you would part teach the Teaser on the Tower in order to set the client up for success and leave the session feeling accomplished. You would also allow the client to pick the order of the three familiar exercises and provide cues that promote external focus. To promote external focus while performing a modified Teaser (legs stay in hook-lying position) on the Tower you would cue “peel up and press the bar high to the sky” rather than “articulate the spine up bone by bone and reach your arms long.” Tips to promote external focus: avoid any body related words, use of imagery is effective, and distal focus is better than proximal focus.
In conclusion, all three of these factors combined, enhanced expectancies, autonomous support, and external focus, help optimize motor performance and learning. This collaborative theory helps optimize interventions and patient/client outcomes through augmentation of the individual’s sense of progress by offering choices and setting them up for success!
Sarah- I attended a lecture by Kevin Ford, PhD, Carol Mack, PT, DPT, SCS, and Jilll Thein-Nissenbaum, PT, DSc, SCS, ATC on the specific visual and verbal cues that will enhance lower extremity movement. We have all been in a clinic, gym, pilates class, etc. where we have heard trainers and therapists use the infamous cue “knees over toes.” So you could imagine my shock when the presenters opened their session by saying this is actually not a good cue to use at all! The latest research shows that an external focus on the outcome of movement (implicit motor learning) produces greater accuracy and efficiency in the performer compared to an internal focus for movement outcomes (explicit motor learning) which activates unnecessary motor units and has less carry over long term (you can see this was a HOT topic this year). This has been supported with several EMG studies where lower muscle activation is seen with higher performance as an external focus forces the musculoskeletal system to simplify. Surprisingly, research also shows that the mirror neurons in the premotor and motor cortex areas fires the same whether the action is being performed with an external target or just observed. A study on various levels of basketball players showed that all participants increased number of mirror neurons in the brain through observation and experts experienced an increase hand muscle performance! If implementing action observed treatments, it is important to note the observer may benefit most from watching the same gender. For example, one study found that both men and women increased their jump height with an external target by improving knee moments. However, this was achieved by males through decreased stance time and by females increased stance time. For both genders to improve hip moments, another indicator of jump heights, they needed virtual targets instead of physical targets. Lastly, another study showed improved motor performance with carry over a month later in athletes who alternated playing with watching compared to those who only played.
Based on these advances we need to provide our clients in the Pilates studio and patients in the clinic with verbal and visual cues that bring focus to their surrounding environment instead of internal structure, as Blair detailedly explains above. Additionally, we should begin using photo and video feedback more frequently is more beneficial than practicing alone (the presenters suggested the coaches eye app). Lastly, if you are working with injured athletes most will use their practice to complete their rehabilitation exercises when unable to participate. However, it is now our job to educate them on the research and benefits of watching their teammates practice and encourage them to observe mindfully at that time to ensure the best results.
MARCH MATNESS
It is that time of year again! Make sure you follow @pilatespt on instagram and watch us participate in this worldwide Pilates Mat Challenge by Benjamin Degenhardt along with our peers! We will be posting exercises daily in the classical mat order with helpful tips and fun facts.
ASK PILATES PT
Having difficulty finding the right position during exercises? Don’t understand a recent medical diagnosis? Want to know how to target a problem area? You have questions, WE have answers! Don’t hesitate to email askpilatespt@gmail.com!
With love, scrubs, and sidekicks,
