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Medical Case Study Analysis

Motor Learning in Children: Feedback Effects on Skill Learning

An executive summary: studies show that adults who practice motor learning skills with reduced feedback can often get better learning results than those who perform with constant feedback. There is an optimal challenge and this challenge can overload the learning capabilities of a child. This study probes into how children have different processing capabilities when compared to adults and how to approach their learning

Studies have shown that adults who practice motor learning skills with reduced feedback can often get better results, greater accuracy, and consistency than those adults who perform with feedback after every trial. It is thought that perhaps the use of frequent feedback may guide the learner but interfere with the mechanisms in the brain that come together to solve problems. Guadagnoli and Lee proposed a study framework called the Challenge Point Framework that demonstrates that motor learning depends on a certain level of challenge to engage the processes BUT there is an optimal challenge and there is a challenge that can overload the processing capabilities of the learner. It is this area of study that the paper looked into probing particularly how children have different processing capabilities when compared to adults and more specifically, whether reduced frequency feedback during practice benefits children in the same manner or different that it does to adults.

Methods

There were 20 adults and 20 kids tested in comparative tests and recruited from the Los Angeles area. The median age of adults was 25.6 years (12 male and 8 female). The age range for adults was 22 to 30 whereas the children had an age average of 10.7 but the age range for children was 8 to 14 — which is considerable in children (12 boys and 8 girls). The development of an 8-year-old is much different than a 14-year-old. The movement involved used a light level and a coordinated arm movement that utilized two elbow reversal movements to move the level. The level had a potentiometer attached that sent digital signals to a computer monitor. When a “go” signal was displayed, the subject was instructed to move the lever in the replication of the target trajectory. After a 2000 millisecond delay, a post response screen was displayed for 5000 milliseconds to display augmented feedback. For no-feedback trials, the screen would remain blank. An overall score and a graphic representation of the target was displayed post response.

The experiment lasted for two consecutive days. On the first day (Acquisition phase), 4- 50-trial sessions separated by 4-minute breaks. On day 2 (Retention phase), participants were under 2 conditions. A 10- trial, no feedback retention test determined the previous day’s retention and was followed by 20 trials of feedback to assess performance. At the end of both days, there was a retention test in which no feedback was given and which was then followed by a reacquisition phase when feedback was introduced to all. Both children and adults were divided into one of two categories:

• 100% feedback after every trial during the acquisition phase, or

• 62% faded feedback in which feedback faded progressively faded across the 4 trials: 100% in the first set of 50 trials, 75% in the second set of 50 trials, and so on.

Out of the 200 trials, participants in the reduced trials had feedback 126 times. The groups broke down to; young adults who received 100% feedback, a young adult who received faded feedback, children who receive 100% feedback and those that did not. They were instructed to make their movements as accurate as possible. Tests were given to all to test the level of difficulty of the movement. This showed there was not a visible difference in the level of difficulty even among the age groups. Tests were also showed that both groups had the same age-appropriate visual perception.

Results and Performance

The performances were assessed separately for acquisition and retention phases for accuracy and consistency and an ANOVA was used for variance analysis. To no surprise, the adults and children differed significantly from each other with adults showing better motor dexterity than the kids, and both groups benefitted from practice as test results would show. Adults and children started with a wide difference in accuracy but by the end of the acquisition phase, both had improved such that there was no sizable or significant difference. A child who received reduced feedback had significantly more errors and were much less accurate than those who had constant 100% feedback. When feedback was introduced, the children in the faded group performed as well as those who received 100% feedback.

Adults who received feedback that faded did better than those with constant feedback — the opposite of the child. By contrast, the kids who had practiced with 100% feedback did much better and those kids who practiced with faded feedback were not as consistent as the adults.

Outcomes

While not exactly groundbreaking, children who had consistent feedback did better than those who did not have consistent feedback, and practice was less effective. The results were consistent with the findings of the Challenge Point Framework in that if the challenge exceeds the optimal learning point, cognitive efforts may be overstretched and the tasks are beyond the learner’s capabilities. Practice with reduced feedback in adults however challenges them to become more cognitively engaged and more effort.

This engagement is thought to be more critical in promoting learning motor skills. Learning that can benefit from reduced feedback practice is best done if the person can process the cognitive demands without exceeding those capabilities of the learner. Children use different strategies for planning and execution. Evidence suggests that children rely more heavily on extrinsic feedback than adults. In children, cognitive efforts may be taxed too much and they may do better with extended practice as they do benefit from reduced feedback. The final synopsis of the paper was that children use information differently than adults. Adults seem to find that information overload about outcomes and movements is detrimental as too much information interferes with motor learning. Children may require more practice trials with feedback to accurately form a representation of a motor skill. This has some bearing when practitioners work with children who have brain damage from cerebral palsy when trying to teach motor skills.

Original study authors:
Katherine J. Sullivan — Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy at the School of Dentistry University of Southern California, Los Angeles, CA
Shailesh S. Kantak — PhD student in the Division of Biokinesiology and Physical Therapy at the School of Dentistry University of Southern California, Los Angeles, CA
Patricia A. Burtner — Associate Professor, Division of Occupational Therapy, Department of Pediatrics, University of New Mexico, Albuquerque, NM.
Cited works:
Sullivan, K.J., Kantak, S.S., Burtner, P.A, (2008). Motor Learning in Children: Feedback Effects on Skill Acquisition, Physical Therapy, Volume 88, Number 6 June 2008, 720-732
Guadagnoli M.A., Lee T.D., Challenge point: a framework for conceptualizing the effects of various practice conditions in motor learning. Journal of Motor Behavior. 2004; 36: 212–224.

Photo by Arthur Kriigsman from Pexels



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