So I see you’re back for more. Round two is all about doing it again and again, in other words practice. Now that we have learned how we learn (here), let’s talk about the process of “going through the motions” or practicing.

Clearly, if you have ever tried to learn a motor skill with proficiency, it takes more than just performing a bunch of repetitions. This is obvious if you ever watch me shoot a basketball. I have done this a million times (maybe more) in my life, and yet I still have awful form and only shoot in the high 30 percents. Practice need to be organized, or purposely disorganized, for someone to learn.

The basic breakdown of practice is Explicit vs. Implicit.

• Implicit practice – This is done in an incidental manner. The best example I can think of is practicing how to ride a bike. You just have to “do it” to learn it, and once you can do it, you then know how. This type of practice is done by doing.
• Explicit practice – This is a little tougher. It is more than just doing, it is understanding. This is the knowing the rules of basketball or the steps of shooting a basketball, versus being able to shoot a basketball [1]. This type of practice is usually done by breaking down the steps of a skill or by answering questions.

* Rehab Implications – We try to focus a lot on explicit practice, when sometimes we should just see if the patient can do whatever task we are asking of them. It has been suggested that explicit practice may not be as effective as we think [2]

*S&C Implications –  I believe that explicit practice must be performed when learning new lifts, as I think all trainers will agree. The forces used in S&C are usually much higher than in rehab, so being able to break down a motion so the athlete/client knows how to perform the lift correctly is a must (example: snatches). It’s called safety.

How is the practice scheduled? Is the same skill practiced all at once, or are many skills practiced together? This is blocked versus random practice.

• Blocked – This type of practice allows the patient/client to focus on one skill over and over and over. This type of practice is great for initial skill acquisition, decision making, and sequencing, but it is not the best for cross over into open environments (see Part 1). Patients who are impulsive, such as those who have suffered a stroke, respond best with this type of learning initially. Blocked practice sessions can still take place within different types of environments, and can involve differing types of feedback.
• Random – Random practice is considered better for retention of motor skills, but is not always appropriate as discussed above. When learning a new skill and the patient or client is appropriate, random practice will lead to improved skill retention for later use.

* Rehab Implications – Clearly the cognitive abilities of patients differ much more than in the S&C setting. This can lead to both types of practice scheduling to be utilized. Patients usually practicing a skill (such as descending stairs) for the first time are better off with blocked practice, while later on progressing to random practice, such as descending the stairs and then walking to a chair and then sitting down. Practicing exercises such as straight leg raises and short arc quads lend themselves to blocked practice, or doing all of the repetitions of the exercise at once. After initially performing these types of exercises, and they are retained by the patient, learning does not need to occur, and therefore the patient is not learning, but exercising. Until a new exercise or progression is added this is the case.

S&C Implications – I would suggest low weight and low reps of blocked practice at first, progressing to random practice once the client has exhibited proper technique. The athlete will have better skill retention if you can progress them to random practice. An example of this would be practicing squats for a period of time until proper form is observed. During the next workout, randomly having squats in the routine (if it fits the program design) will force the client to practice the squats once again, but randomly.

Once practice has begun, as the “teacher”we must provide feedback; however, the subject’s body will also provide feedback. Our feedback is known as extrinsic feedback, while sensory feedback is known as intrinsic feedback.

• Extrinsic (augmented) – Initially, when patients do not know how a skill should feel or look, they rely primarily on extrinsic feedback, or feedback from an external source. An example of this would be, “Nice, job, but next time try to slow down”. At first, patients usually require much extrinsic feedback, but gradually this feedback is tapered off to allow the patient to transition into the automatic phase of learning.
• Intrinsic – This feedback is reliant on the sensory systems. How does a movement/skill look and feel to a patient. Combined with the extrinsic feedback initially, the patient is able to formulate what is correct and what is incorrect. Gradually as this feedback system improves, patient will be able to correct their motions during the performance of the task. Performing exercises in front of the mirror to see when compensations are occurring is a great feedback tool.

Rehab and S&C Implications – These are pretty similar. Once again, the big difference here will be the patients’ cognitive abilities. Your everyday outpatient/ortho clinic and gym will typically have the same cognitive level people in it. This means that they will need more extrinsic feedback at first, with a tapering off as fewer errors are performed, and the client/patient gets a better understanding of their own intrinsic feedback systems.

There are many other aspects of learning such as the persons motivation to perform a task. If the person is not motivated to learn a skill they are less likely to learn the skill. This is where a practitioner’s abilities are tested. In what way can you motivate the patient, or client, to perform what you deem as a necessary skill.

Mental imagery/rehearsal/visualization has also shown to improve skill performance. I know it sounds crazy, but mentally practicing a skill has been shown to improve actual performance of the skill [3]. So even when our clients and patients are not able to physically practice, if they are cognitively able, they can mentally practice.

Knowing the individual is also a large help, due to some people responding well to negative feedback, and others positive. You must get to know your patients or clients, and usually the best way to find this out is to ask. There is no sense in always being nice if the person does not respond well to it. Sometimes you have to go outside your comfort levels and be a jerk to people.

I hope that when treating your patients, training your clients and forming programs, or learning a new skill on your own, you remember these different factors that go into the practice aspect of learning. Learning is way more than just doing something a bunch of times. There are clearly ways to make the most efficient use of your time, and get the bet outcomes. I will leave you with this quote from Vince Lombardi.

“Practice does not make perfect. Only perfect practice makes perfect.”

Resources:

1. http://www.ballstickbird.com/articles/a5_implc.html

2.http://www.inrs2009.com/fileadmin/user/PDF/INRS/Burridge_MotorLearning_INRS2009.pdf

3.http://www.vanderbilt.edu/ans/psychology/health_psychology/mentalimagery.html