ACQ Vol 12 no 1 2010

Motor speech disorders

Voice therapy prepractice and the principles of

motor learning Anna McIlwaine, Catherine Madill, and Patricia McCabe

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 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 exercise science research. Five key prepractice components are identified:

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

Keywords PRACTICE

This article has been peer- reviewed PRINCIPLES OF MOTOR LEARNING VOICE THERAPY

Anna McIlwaine

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ACQ Volume 12, Number 1 2010

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