ACQ Vol 12 no 1 2010

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Motor speech disorders
ACQ Volume 12, Number 1 2010 29
Anna McIlwaine
This article
has been
peer-
reviewed
Keywords
PRACTICE
PRINCIPLES
OF MOTOR
LEARNING
VOICE THERAPY
client is highly reliant on the clinician for cues and prompts
in the prepractice phase, in practice the client develops
independence and automaticity in production of the target
movement. In the case of voice therapy, prepractice might
involve demonstration, explicit instruction or initial attempts
at a given movement while practice may be drill-like
repetition of the new skill in an increasing hierarchy of tasks.
Motor learning research has predominantly focused on
structuring practice and on feedback during the practice
phase to ensure training leads to effective learning. This
research has involved increasing task demands during
practice to ensure that training leads to maintenance
and generalisation of motor skills, rather than temporary
improvements in performance during practice (Maas et al.,
2008). However, significantly less research has addressed
the initial phase of learning: the prepractice phase. This is
despite the client needing to be able to at least approximate
the target movement prior to beginning practice (Maas et al.,
2008). Examination of the prepractice phase could provide
clinicians with explicit guidelines for the initial stages of
intervention, where clinician behaviour is most salient.
Prepractice components
The aim of prepractice is to prepare the client for the
upcoming practice sequence, ensuring that the client has
knowledge of the movement goal (internal reference-of-
correctness) and can produce the movement under optimal
conditions (Maas et al., 2008). The focus is on which factors
allow a specified skill to be learned to a specified level of
performance in less time, with less effort and/or with less
cost (Wulf & Shea, 2002). This reduction is important for
ensuring treatment efficiency. By looking at the general
motor learning literature, it is possible to identify a number of
potential key variables in the prepractice phase. These ideas
are summarised in table 1.
Motivation
Acquiring a new motor skill requires effortful processing of
information. Ensuring that the client is motivated is essential
for maximising learning (Schmidt & Lee, 2005). Motivation
may be established by conveying the importance of the task
to the client (Maas et al., 2008) and by setting goals with the
client (McNeil, 2009). Specific, absolute goals of moderate
difficulty are beneficial to the performance and learning on
motor tasks compared with “try your best” goals or
compared with no goal (Kyllo & Landers, 1995; Weinberg,
Bruya, Garland, & Jackson, 1990). Finally, clients should be
actively involved in setting goals (McNeil, 2009). In voice
Study of the principles of motor learning is an
emerging area of scientific and clinical interest
to speech pathology. To date, limited research
has applied principles of motor learning to
voice therapy and no research has addressed
in detail the prepractice phase of voice
therapy. This paper reviews the available
literature on the prepractice phase of motor
skill learning, largely based on sports and
exercise science research. Five key
prepractice components are identified:
motivation, instruction, modelling, perceptual
training, and feedback. Suggestions are made
as to how these principles may be applied to
voice therapy prepractice, providing clinicians
with explicit guidelines for the initial stages of
voice therapy intervention.
D irect voice therapy, which changes vocal technique to
improve vocal function, has developed substantially
over recent years (Speyer, 2008). Direct voice
therapies aim to replace disordered vocal technique with
vocal behaviours which are sustainable, functional, and
efficient. Thus these therapies change the habitual motor
skills associated with voice production.
The principles of motor learning (PML) are a schema
to explain how performance and learning of motor skills
is affected by variables such as type and distribution of
practice and feedback (Wulf & Shea, 2002). Voice therapy
involves learning of a new motor pattern, relearning
previously efficient patterns, and eliminating mislearnt
patterns. As such, PML can and should be applied to voice
therapy. The aim of this paper is to review the PML literature
on the prepractice phase of therapy and to discuss how
these principles might apply to voice therapy.
In PML based therapies (and others based on learning
theory more generally), intervention can be divided into two
phases: prepractice and practice. Prepractice is the phase
where the client acquires a basic knowledge of what the task
is and how to perform it through conscious and focused
attention on the movement. Practice is the phase where
the client improves their proficiency, accuracy and speed
of performing the targeted skill such that the movement
is “learnt” (maintained and generalised) and produced
without conscious attention to its execution. While the
Voice therapy prepractice
and the principles of
motor learning
Anna McIlwaine, Catherine Madill, and Patricia McCabe