A major focus of physiotherapy (PT) interventions for children with neurological impairments is the learning and/or relearning of functional motor skills. To this end, physiotherapists (PTs) need to consciously plan to use motor learning strategies (MLS) such as providing feedback, setting up the task environment and structuring practice conditions in a manner that promotes motor learning and achieves functional neuroplastic change (i.e., changes in motor activation patterns in the brain. However, practicing clinicians are challenged by the numerous ways in which MLS can be operationalized within a PT session. Pediatric PTs lack clear guidelines as to which strategies might be most effective to meet the needs of an individual child. Indeed, clinical trials evaluating motor learning approaches in pediatric and adult PT rarely indicate how the specific MLS used have been implemented (i.e., the fidelity of treatment) nor how they are adapted through the course of treatment.
A critical foundation for the application of MLS is for the clinician to also be able to document the extent and scope of MLS use within PT interventions. This is a key component of reflective practice. It was the lack of a measure to specify and document MLS use (i.e., unpack the MLS contents of the PT intervention ‘black box’) that motivated the creation of the Motor Learning Strategy Rating Instrument (MLSRI). The tool was first created for use within a research context to:
- Provide a means to describe the MLS used in interventions, thus supporting generalizability beyond the trial;
- Evaluate the fidelity of a MLS-based treatment session
The MLSRI is an observer rated instrument that measures the extent to which MLS are used within a videotaped PT intervention session. Initial validation and reliability work in a sample of therapists working with children with acquired brain injury (ABI) demonstrated strong psychometric promise but pointed to the need to create a shorter version and clarify certain items to facilitate use by clinicians. To this end, over the last year, I have worked with a pediatric PT research group in the Netherlands to simplify the MLSRI to a 20-item measure. A face validity assessment process involving international researchers was completed to inform these changes. Inter-rater reliability evaluation of the new MLSRI-20 in therapists working with children with cerebral palsy and ABI yielded an ICC of 0.79.
The Motor Learning Strategy Rating Instrument is currently being evaluated for use in practice and research to understand and measure the motor learning content of physical therapy interventions. A valid and reliable instrument will assist in understanding whether therapist use of motor learning strategies has an impact on client outcomes.
Please contact me for more information about the instrument’s use for teaching and research purposes.