The OPTIMAL Theory
There is increasing evidence that motor learning principles can help to enhance skill acquisition and motor learning. When utilising motor learning principles in clinical practice, interventions are designed to promote long-term improvements in performance that result in learning. Physiotherapists create practice situations (e.g. variable vs constant, random vs blocked etc) and provide appropriate feedback (e.g. concurrent, summary, faded, bandwidth etc) in order to enhance the degree and the type of learning that occurs. To find out more about practice schedules and feedback types, please click here.
As Wulf and Lewthwaite state, these factors are significant, but current approaches to motor learning do not consider the importance of motivation and attention. They, therefore, developed the OPTIMAL Theory of motor learning, which can be used to harness patient motivation. OPTIMAL is an acronym, which stands for Optimizing Performance Through Intrinsic Motivation and Attention for Learning.
The OPTIMAL Theory
The OPTIMAL Theory builds on the various social, cognitive, affective and motor components of motor behaviour. It focuses primarily on learning “how” to achieve coordinated or skilful control of movement rather than focusing on skills that are more cognitive in nature.
- Strengthen a patient’s goal-oriented actions
- Bring about skilled quality of movement
Wulf and Lewthwaite refer to the combination of these two areas as goal-action coupling. Essentially, goal-action coupling is a combination of the goal (i.e. what the learner wants to do) and how skilful movement can be used to achieve the goal.
Understanding self-efficacy is key to understanding the OPTIMAL Theory. Perceived self-efficacy is an individual’s belief in his or her ability to “mobilize the motivation, cognitive resources, and courses of action needed to exercise control over environmental effects". In essence, it signifies how confident a person is that she or he can perform a task, action or skill.
Past experience (whether it was successful or not) has been identified as a significant determinant of self-efficacy. Confidence is a predictor of performance, as is self-efficacy generated by successful experiences.
Using Feedback to Enhance Self-Efficacy
It is possible for physiotherapists to influence a patient’s self-efficacy. By understanding what a patient’s previous experience has been, therapists can provide learning experiences from which the patient can build future self-efficacy. Similarly, the use of positive feedback and the learner’s own impressions can enhance self-efficacy.
In 2019, Ghorbani explored the hypothesis that feedback could have an impact on self-efficacy in a study using modified dart throwing as the motor task. Subjects were divided into three groups. The first group was provided with feedback after their three best throws. The second group received feedback about their three worst throws and the control group received no feedback. Retention and transfer tests demonstrated that the positive feedback group’s learning was more effective than the group which received feedback on their poorest results.
Ghorbani and Bund then conducted a similar study, but this time 60 participants were assigned to four different groups:
- Good performance knowledge of results (KR) and high self-efficacy
- Poor performance KR and high self-efficacy
- Good performance KR and low self-efficacy
- Poor performance KR and low self-efficacy
This study used throwing bean bags as the motor task. During the skill acquisition phase, the good performance groups received KR about their three most accurate throws while the poor performance groups received KR from their three worst throws. Ghorbani and Bund found that when compared to KR from poor throws, KR from good throws resulted in better accuracy scores. These results were independent of the participants’ initial self-efficacy, which reiterates findings from the other Ghorbani study.
Furthermore, participants who initially had high self-efficacy, but who received poor performance feedback had decreased self-efficacy in the follow up tests. However, those who started with low self-efficacy and received poor feedback had a slight increase in their self-efficacy.
Thus, it seems that positive feedback for participants, especially those with low self-efficacy, resulted in enhanced motivation and higher accuracy compared to the other groups. These studies indicate that it is possible to bolster a learner’s motivation, which in turn will help to enhance their learning.
There are a number of ways to measure self-efficacy, but because it is affected by the type of task and environment / situation, it is not possible to create an all-purpose measure of self-efficacy.
One simple way to measure self-efficacy is to ask patients to rate their confidence that they will be able to perform a task based on a 0-100 scale. This score can be repeated to re-assess self-efficacy after a learning intervention.
Main Components of the OPTIMAL Theory
There are three main aspects of the OPTIMAL Theory.
- Enhanced expectancies
- Autonomy support
- External focus of attention
In the OPTIMAL Theory, the term "enhanced expectancies" refers to “a range of forward-directed anticipatory or predictive cognitions or beliefs about what is to occur.” Enhanced expectancies develop based on previous experience and are not independent of motivation.
When learners have a positive outcome or a good experience, they will have a specific "psychological recognition in the form of positive cognitions [...] and associated positive affective responses”. It may also trigger a dopamine response. Dopaminergic systems support types of brain activity that are important in motor and motivational functions, as well as cognition. These systems include the mesocortical, mesolimbic (associated with reward or motivation) and nigrostriatal dopaminergic systems (associated with working memory and motor system functions).
The dopamine response is believed to aid learning and alter the learner’s perception of the task’s difficulty. Ultimately, this can help to facilitate better motor learning over time.
Various strategies can be used to alter a patient’s expectations to encourage learning in clinical settings. These include:
- Providing test results - providing feedback about performance, especially positive feedback, can enhance a learner’s expectations that she or he will perform well on a similar task in the future
- Providing normative feedback, which suggests the patient’s performance is better than average
- Observing other learners performing - this may enhance the patient’s expectation that they can also do well
- Using rewards
- Commenting on peer group performance such as “other people with similar injuries tend to do well when they work at this skill” - this can help to increase the patient's expectation that they will also do well
- Setting easier goals - while goals should be challenging, they should not overwhelm the patient
- Using wider bandwidths when providing feedback
Physiotherapists can also structure interventions and provide appropriate feedback and guidance to help the learner have positive experiences that inform their future expectations. As discussed above, feedback tends to work better when it focuses on good performance.
It has been found that allowing individuals to exert some control over their environment may not only be important psychologically, but may also be of fundamental biological importance. Various studies have found that both animals and humans have a preference for situations where they are able to make a choice, even if their chosen option results in greater effort or higher workload.
In the OPTIMAL Theory, Wulf and Lewthwaite use the term autonomy support to refer to situations where learners are provided with the opportunity to make choices. Choices can be very simple such as:
- Asking patients which tasks they want to do first
- Asking patients which side of the body they want to do an exercise on first
- Asking patients to choose when they receive feedback
- Inquiring whether or not a patient wants to use a walking aid
While the choices may appear to be small or incidental and may not even be related to the actual task, autonomy support has been found to be highly beneficial. It can help to:
- reduce stress
- promote task focus
- enhance self-efficacy
It may also result in fewer errors, with deeper processing and increase the likelihood that the learner will choose to do more practice.
This concept has been explored widely in the research. One recent study by Iwatsuki and colleagues investigated whether providing individuals with certain choices would increase movement efficiency. In this study, 32 participants were asked to run on a treadmill for 20 minutes. Participants in the choice group were able to choose five photos to appear on a screen during their run. They were also able to choose the order in which the images would be displayed. The control group were shown the same photos in the same order as chosen by participants in the choice group. During the submaximal treadmill run, the choice group had significantly lower oxygen consumption and heart rate than the control group. This suggests that providing autonomy support improved running efficiency and that it can enhance goal-action coupling.
Conversely, an environment that is too controlled can:
- increase stress for the learner
- trigger a cortisol response
- impair overall performance and learning
It is important to note that in self-controlled environments, it is still necessary for the learner to experience good performance as this helps to optimise self-efficacy and learning.
External Focus of Attention
Attention can refer to the monitoring of a task and environment, the scope / breadth of various cues associated with carrying out a task, the ability to concentrate despite other inputs or distraction, and being able to focus on information related to specific movement cues.
The item that an individual focuses on while learning a task has an impact on movement control. Individuals can, for instance, focus on controlling the object that is being moved or altered (e.g. focusing on a tennis racquet while swinging) or they can focus on their limbs to achieve accurate movement (e.g. focusing on the wrist or elbow while swinging a tennis racquet).
Focusing on an object is referred to as an external focus of attention (i.e. the individual concentrates on the effect of the action) whereas focusing on the body part is referred to as an internal focus of attention (i.e. the individual concentrates on body movements). An external focus of attention is more goal-oriented and promotes more implicit learning over time.
Studies on various populations, including younger adults, community dwelling older adults, and patients with strokes, have found that an external focus of attention leads to more effective motor learning and greater automaticity than an internal focus.
Thus, there is a wealth of evidence to support the use of external focus in clinical practice. It is, however, useful to consider how physiotherapists can use cues to achieve this focus and enhance learning. For example, if a patient is dragging his or her toe when mobilising, a therapist who wants to encourage an external focus might ask the patient to make sure that the bottom of his or her shoe does not scuff on the floor. Or the therapist might ask the patient to make sure that the heel of the shoe touches the floor. An internal focus cue would be to encourage the patient to pick up his or her toes. While the difference may be subtle, encouraging an external focus could result in greater skill retention and better learning.
It is believed that this external focus of attention may be effective due to enhanced dopamine availability (see discussion above about dopamine). As dopamine availability increases, memories are better consolidated and neural pathways are developed.
- Fast, unconscious movements
- More degrees of freedom
- Greater functional variability
- Reduced reaction times
The OPTIMAL Theory consists of three main areas:
- Enhancing expectations for future success
- Creating autonomy through choice
- Using instructions or feedback to encourage external focus of attention
When combined, these factors can help learners to achieve positive outcomes by strengthening the relationship between goals and movement actions.
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