Use of Motor Learning Strategies in Occupational Therapy for Children and Youth with Acquired Brain Injury

Abstract

Motor learning strategies (MLS) can be used to promote motor skills acquisition in children and youth with acquired brain injury (ABI). While occupational therapists (OTs) likely use MLS in clinical practice, research has not investigated the extent and variety of their application.

Aims: This study explored MLS use by OTs in pediatric ABI and factors influencing their application.

Method: Individual video-recorded occupational therapy sessions for a sample of eight children/youth (ages 4-16) with ABI were evaluated via mixed methods approach. The Motor Learning Strategies Rating Instrument (MLSRI-22) quantified the extent of MLS use in each video. Directed content analysis of the videos explored the factors influencing how and when MLS were applied.

Results: The most frequently used MLS were promoting problem solving, encouragement, directing attention to the body, permitting errors as part of learning, repetitive practice, and whole practice. Three themes described how and when the OTs used MLS: 1) Getting buy-in, 2) Going with the flow, and 3) Movement and thinking go hand-in-hand.

Conclusions: The OTs frequently used MLS with children with ABI, appearing to select MLS based on factors related to the child, task, and environment. These findings are fundamental to future exploration of OT decision-making and evaluation of MLS effectiveness.

Keywords:

• Acquired brain injury
• brain injury
• children
• motor learning
• motor learning strategies
• occupational therapy
• youth

Acknowledgements

We would like to thank the children, youth, and OTs in the ABI program at Holland Bloorview Kids Rehabilitation Hospital who participated in this study, as well as research manager, Gloria Lee, for arranging access to study videos and associated documentation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The videos in this study were collected as part of an ongoing reliability study funded by CanChild. The research manager’s time was funded by the Holland Bloorview Children’s Foundation Chair in Pediatric Rehabilitation.

Notes on contributors

Kristi R. MacWilliam

Kristi MacWilliam, MSc, MScOT, OT Reg. (Ont.) is a registered pediatric Occupational Therapist at FIREFLY Physical, Emotional, Developmental, and Community Services and a recent MScOT graduate from the University of Toronto. She has a keen interest in bridging the gap between research and clinical practice. In her research, she seeks to inform evidence-based clinical decision making by exploring the complex and intersecting factors that impact therapy outcomes.

Julia R. Giancola

Julia R. Giancola, OT, MScOT, is a registered Occupational Therapist at CBI Health Group and a graduate from the MScOT program at the University of Toronto. Her research interests include motor learning approaches in Occupational Therapy and their application to clinical practice for children and adults with acquired brain injuries. She is also interested in the promotion of physical activity for the health of adult and older adult populations.

F. Virginia Wright

F Virginia Wright, PT, PhD, is a Senior Scientist at Bloorview Research Institute, Toronto, Canada and Professor in the Department of Physical Therapy, University of Toronto. Her measurement research includes the design and evaluation of advanced gross motor skills outcome measures. She has a strong interest in motor learning approaches and within this context also evaluates clinically integrated innovative interventions that promote functional mobility, physical activity, and participation in children and youth of diverse abilities.

Jennifer L. Ryan

Jennifer L. Ryan, PT, MSc, is a physiotherapist at Holland Bloorview Kids Rehabilitation Hospital and a PhD Candidate at the Rehabilitation Sciences Institute, University of Toronto. Her research interests include exploring how clinicians promote motor learning and evaluating innovative technologies as adjuncts to traditional motor skills-based rehabilitation. She is also passionate about promoting physical activity in children and youth with neuromotor disabilities.