Enhancing Occupational Performance Through Motor Learning

Editor's note: This text-based course is a transcript of the webinar, Enhancing Occupational Performance Through Motor Learning, presented by Nicole Quint, Dr.OT, OTR/L.

*Please also use the handout with this text course to supplement the material.

Learning Outcomes

• After this course, participants will be able to compare and contrast motor learning approaches in context with occupational analysis.
• After this course, participants will be able to distinguish the role of fundamental movements within motor learning of integrative functional motor skills within occupation.
• After this course, participants will be able to evaluate the concepts of generalization of motor skills to promote application within occupational therapy practice, including specific approaches for clients diagnosed with ADHD and ASD.

Introduction

I want to take a moment to thank everyone for joining me today. Our discussion will focus on enhancing occupational performance through motor learning. We will compare and contrast key concepts, distinguish between different approaches, and engage in thoughtful evaluation throughout the session.

Motor Skill Acquisition: Multiple Theories Resulting in Dynamic Systems Approach

I’d like to jump into motor skill acquisition, a topic many of you likely encounter regularly. Today, I want to focus on one particular theory— the dynamic systems approach. This unique approach integrates multiple theories, making it a more comprehensive and adaptable framework for understanding motor learning.

Definitions/Factors

I want to start by defining motor learning and motor control. Although these terms are sometimes used interchangeably, they have distinct definitions.

Motor learning refers to the process of acquiring a skill through practice. As we practice, we refine our movements, transitioning from clumsy or uncoordinated actions to more fluid and automatic ones. Coordination, in this context, involves automaticity, speed, and fluidity. Everyone has likely experienced learning something new—initially feeling awkward or unsteady, but with time and practice, becoming more proficient. This internal learning process involves neurological mechanisms that lead to permanent changes. Once a skill is acquired, it remains, even if it becomes slightly less refined without continued practice. The common saying, “Once you know how to ride a bike, you always know how to ride a bike,” illustrates this concept. While you might need a moment to adjust if you haven't ridden in a while, the motor memory remains intact.

Several factors contribute to motor learning, including verbal instructions, feedback, practice (remember, practice makes perfect), active participation, motivation, the possibility of errors, postural control, memory, and sensory feedback. Motor learning is not purely physical—it also involves cognitive, sensory, and neurological components.

On the other hand, motor control is more about the execution or output of movement. The body identifies a task, gathers sensory information from the environment, perceives and processes it, and then selects an appropriate movement plan to achieve a goal. For example, if I decide to take a drink, my body instantaneously coordinates the necessary motions to lift the cup. This process is closely linked to the central nervous system, which integrates sensory feedback, allowing for real-time adjustments and refinements. Sensory feedback plays a crucial role in learning, as it helps modify movement plans, acknowledge goals, and store information for future performance. As we refine our skills, we become increasingly proficient in executing movements with greater efficiency and control.

For those interested in a more detailed explanation, I’ve included a reference to Physiopedia, which provides a comprehensive overview of motor learning and control. The link is available in the course packet, and if you search for "motor control" on Physiopedia, you’ll find relevant resources. I know many of you, like myself, enjoy exploring different perspectives online, so I encourage you to check it out.

Theoretical Base

The theoretical foundation of motor control encompasses many models and perspectives. Various theories, including ecological systems theory, hierarchical theories emphasizing sequential development, and reflex theory, have all contributed to our understanding of motor control. When integrated with motor learning theories—such as closed-loop theory, schema theory, and ecological theory—it becomes clear that multiple frameworks inform how we approach motor skill acquisition.

As we piece these theories together, we arrive at the dynamic systems theory, which will be the focus of our discussion. Before diving into the specifics of dynamic systems theory, I want to emphasize that, despite its complexity, an underlying hierarchical structure is at play. This hierarchy is illustrated in Figure 1, which visually represents how these different concepts interact within the broader framework of motor learning and control.

Figure 1. Hierarchical structure of the dynamic systems theory.

This framework aligns closely with how we conceptualize movement and function within our respective disciplines. If you're a physical therapist, you might naturally think about functional movements. However, as occupational therapy practitioners, we focus on occupations—the meaningful activities that define and enrich daily life.

At the top of the pyramid, we find occupations such as dance, exercise, and play. Play could take many forms, from physically active games like hide and seek to more structured activities like playing cards. What defines these activities is their intrinsic meaning and purpose.

The next level includes activities of daily living (ADLs) and self-help motor skills. These tasks are essential but often have less intrinsic motivation than leisure or recreational occupations. For instance, brushing my teeth is not an activity I particularly look forward to, but it is necessary. ADLs tend to be more ingrained through repetition over time, making them less challenging for most individuals. However, for some populations—such as children or individuals with disabilities—these tasks can present significant difficulty.

Beneath ADLs, we find novel body configurations and movement forms, which involve learning new motor sequences or adapting movement patterns in unfamiliar ways.

The fundamental building blocks of motor performance—posture, locomotion, manipulation, and communication—are at the foundation of the pyramid. These elements serve as the underlying mechanisms that support all higher-level movements and activities.

Understanding this hierarchy helps us appreciate how foundational motor skills support functional tasks and meaningful occupations.

Dynamic Actions/Systems Theory

Dynamic systems theory suggests that new movement patterns emerge due to changes in one of the interacting systems. These systems include the task, the person, and the environment. To facilitate a change in movement, we must modify one of these components. Within this framework, there is always a regulatory variable that influences the behavior of the entire system.

For example, if I am walking and I increase my velocity, I may transition from walking to running. Consider how this applies to a horse—when its speed increases, it shifts from a walk to a trot, then to a gallop. This transition follows a hierarchical pattern, where a gradual change in a variable (such as velocity) leads to a qualitatively different movement. While this is just one example, it highlights the broader principle: movement is an emergent process that arises dynamically rather than being strictly pre-programmed.

Because dynamic systems theory is hierarchical and systems-based, we can intervene at various points within the system to influence movement outcomes. This approach forms the foundation of the task-oriented approach, which is considered the gold standard in motor skill acquisition. When we refer to something as a gold standard, we mean that it is the most research-supported approach available.

The task-oriented approach aligns directly with occupation-based practice, central to occupational therapy. This makes it a particularly effective framework for guiding interventions, allowing us to leverage meaningful, functional tasks to drive motor learning and skill acquisition—a true win-win for evidence-based practice and client-centered care.

Why is it important?

Most of us are here to better understand how to train or retrain motor skills in the children and adolescents we work with. Some of you may also work with adults. One of our key objectives is to reduce frustration during motor skill development.

If I were to take a poll, I imagine many of you would say that the children you work with often become frustrated when practicing motor tasks. Some may even be resistant to engaging in these activities. Fortunately, we can actively address this by optimizing occupational performance.

Rather than focusing solely on task practice, we must shift our perspective toward occupational performance. This means looking beyond the motor task and considering the broader activity and its meaningful outcome. By doing so, we help children and adolescents direct their attention toward the overall goal rather than getting stuck on the mechanics of movement. This approach facilitates alternating and divided attention, critical for functional skill development. Without this ability, skill acquisition remains limited.

This approach can be particularly beneficial for those stuck in a task-practice loop, where progress seems stagnant—whether in writing tasks or other fine or gross motor activities. Ultimately, our goal is to promote generalization, ensuring that the skills learned in therapy carry over into different contexts and environments.

Motor control is a key concern in most of the populations we treat as occupational therapy practitioners. Later, we will discuss ADHD and autism, examining how motor control challenges manifest in these populations and how we can apply a dynamic systems approach to support them effectively.

Dynamic Systems Theory: Motor Learning and Motor Control

When discussing motor learning and motor control within the dynamic systems theory, we focus on the interaction of three key systems:

1. The Task – The specific activity or movement being performed.
2. The Individual – The person’s unique abilities, limitations, and experiences that influence movement.
3. The Environment – The surrounding context, including physical space, objects, and social factors that impact performance.

The outcome of this interaction is motor control—the ability to regulate and direct movement to achieve a functional goal. These three systems constantly influence one another, shaping how movements are learned, refined, and executed in different situations.

Occupational Performance

This overlap can be seen in Figure 2 in the Venn diagram.

Figure 2. Venn diagram of occupational performance.

Think about the tasks you are proficient at and how the task, individual, and environment come together to support that proficiency. For example, many of us are skilled at driving a car—a complex motor task. Some may even multitask while driving, like conversing or eating a snack. This ability to divide attention comes from motor proficiency and automaticity in movement.

Now, consider something you are not as skilled at, such as juggling. If you’ve ever tried juggling and found it clunky and uncoordinated, it’s because those three systems—the task, individual, and environment—aren’t aligning in a way that supports fluid motor control.

Imagine these three elements as overlapping circles in a Venn diagram. When they align just right, optimal motor performance emerges. However, when they don’t align, difficulties arise.

• If the environment is overly distracting or unpredictable, it can interfere with coordination.
• If the task is too complex (such as juggling for a beginner), it may demand more than the person can handle.
• If the individual lacks the necessary foundational skills, their ability to complete the task is significantly reduced.

This is where occupational therapy practitioners (OTPs) make an impact. We have the ability to adapt the task, modify the environment, or build skills within the individual to bring these elements into better alignment.

When motor control and motor learning integrate successfully, we achieve optimal performance. While motor control can be seen as the output of motor learning, the two processes continuously influence each other, shaping skill development over time.

One of the greatest strengths of this model is that it allows us to make a meaningful difference at any level of ability—whether the person has advanced motor skills or significant challenges. This flexibility is what makes the dynamic systems approach so valuable in occupational therapy.

Tasks (Occupations)

I moved through that quickly, but I want to take a moment to break it down further. When we talk about tasks, we refer to occupations in an OT framework. However, I’m using the term “task” in alignment with Shumway-Cook’s model, which has been continuously refined over time. Shumway-Cook and colleagues, who come from fields like physical therapy and kinesiology, use this terminology to describe movement-based activities.

From the child’s perspective, some of these tasks may not feel particularly meaningful—at least not in the way that occupations are. However, our goal is always to embed them within meaningful occupational contexts. When we analyze a task, we must consider how movement occurs and whether it follows a discrete, serial, or continuous pattern.

A discrete task has a clear beginning and end. If I’m taking a free throw in basketball, I stabilize, shoot, and the task is complete. The movement is predictable, making it easier to execute. A serial task involves a series of discrete movements strung together, like a dance routine. Each movement has a defined start and end, but they are performed sequentially. Because it involves multiple motor actions, this type of task is generally more complex. A continuous task lacks a distinct beginning or end, and the movement is ongoing, like running or jumping rope repeatedly.

I don’t want you to get too caught up in categorizing every movement perfectly, but the key takeaway is that discrete tasks are typically the easiest to execute and learn, while serial and continuous tasks are more complex but vary in difficulty depending on the individual and context. For instance, a dance routine with many different movements might be harder than a continuous movement like running, where momentum helps sustain the motion. I recall working with a child with cerebral palsy who struggled with walking due to toe-walking, tone abnormalities, and spasticity. However, he could run with ease. In his case, velocity helped facilitate movement, making running easier than walking. However, a dance routine requiring different movement patterns, limb coordination, and directional changes would have been much more challenging for him.

Another key factor in task difficulty is stability versus mobility. The base of support matters. A wider base of support, like standing with feet shoulder-width apart, offers more stability, while a narrower base of support, such as when running or balancing on one foot, increases difficulty. In dance, the base of support constantly changes, adding another layer of complexity. A stable task, like a free throw in basketball, involves a fixed stance, making it easier to execute, whereas a mobile task, such as shooting while running down the court, requires greater coordination and control. The more movement involved, the more challenging the task. This applies across different activities—think of 80s-style dancing, which mostly involves upper body movements with a stable base, versus professional ballet, where dancers leap, spin, and balance on one foot.

The distinction between open and closed tasks is also a powerful tool in motor learning and intervention. A closed task takes place in a predictable environment. The setting is stable, and the movement can be planned in advance. Practicing free throws in an empty gym is an example of a closed task. These tasks often require precision and accuracy but are easier because of their predictability. On the other hand, an open task involves a dynamic environment where conditions are constantly changing, requiring real-time adaptations. Playing a basketball game with defenders moving unpredictably is an example of an open task. These tasks are more complex because the performer must adjust on the spot.

These task properties—discrete, serial, and continuous movements; stability versus mobility; open versus closed environments—are tools that we, as occupational therapy practitioners, can manipulate to support motor learning. By adjusting these elements, we can modify task demands, adapt environments, and develop targeted interventions to promote skill acquisition. These are all tools in your clinical toolbox, and we will explore how to use them effectively to facilitate motor skill development and optimize occupational performance.

Other Things to Consider

So what are some other things to consider?

One area I really want to highlight includes factors like strength, balance, reactions, muscle tone, and spasticity, even though spasticity isn’t explicitly listed here. Spasticity is important because it can significantly impact movement, especially in relation to velocity. Velocity and spasticity don’t always work well together, as increased movement speed can sometimes exacerbate tone-related challenges.

Dissociation is another key consideration. Thinking back to the little boy I mentioned earlier, he could run very well, but he struggled with dissociation of his lower extremities. This made movements requiring more independent control of each leg much more challenging.

Sensory processing plays a crucial role as well, and this applies to everyone, regardless of whether they have a sensory processing disorder. The way an individual processes sensory information influences their motor learning, motor control, and ultimately how they acquire skills. This also shapes how a therapist provides feedback to optimize occupational performance.

Another critical area to assess is protective equilibrium and righting reactions. It’s important to determine whether a child has effective righting reactions for the tasks they need to complete, as this directly affects their ability to move and maintain balance. Some children struggle with righting reactions, making it difficult for them to stand on one leg or shift their weight appropriately. They may instinctively shift their weight in the wrong direction due to weak or absent righting reactions. This is a foundational area to address before introducing more advanced motor training. If a child lacks effective righting, equilibrium, or protective reactions, that’s where intervention needs to begin.

For some children with more profound upper extremity involvement—such as those with cerebral palsy and persistent reflexive movements like the Moro reflex—righting reactions may not be the primary focus. However, for children with autism, sensory processing disorder, ADHD, Down syndrome, or other conditions where mobility is intact, assessing these reactions is essential. Weak protective reactions are a safety concern. If a child is at risk of falling and hitting their head, it becomes a high-priority goal to help them develop more effective protective responses.

I want to emphasize how important it is to understand where a child is in terms of these foundational reactions and address them as needed. Many of the motor learning strategies we’ll discuss involve activities where children could lose their balance or fall, so ensuring they have appropriate protective reactions is critical.

I won’t go into too much detail in the next slides, but I encourage you to use them as a resource. We’ll discuss them further, particularly Fleishman’s taxonomy in Figure 3, which categorizes different movement abilities.

Figure 3. Fleishman's Taxonomy of perceptual-motor and physical proficiency abilities (Click here to enlarge the image.).

Several people have adapted Fleishman’s taxonomy over time, and it highlights different types of coordination, such as multi-limb control and response orientation. I’m not going to go over each one in detail, but key elements include reaction time, speed of arm movement, and rate of control.

These are great terms to incorporate into your documentation when identifying specific areas for intervention. They provide a structured way to describe motor learning challenges and track progress. As you work with a child, these elements can guide your assessment process, helping you determine what’s holding them back. For example, if the primary challenge is the speed of arm movement, that insight can shape your intervention approach.

These are valuable tools for understanding motor learning, refining treatment strategies, and measuring outcomes effectively. Figure 4 shows more motor learning.

Figure 4. Fleishman's Taxonomy of perceptual-motor and physical proficiency abilities continued (Click here to enlarge the image.).

We then start getting into areas like manual dexterity, finger dexterity, arm-hand steadiness, and similar skills that are less about speed and more about precision and control. Wrist and finger speed, aiming, and similar fine motor components are also important considerations. These are things you’re already addressing in practice, but having them clearly listed can be helpful when planning interventions or writing documentation.

On the other hand, there are also gross motor considerations (Figure 5), which focus more on whole-body movement and coordination. These factors are key in assessing and developing motor skills, particularly in children who struggle with foundational movement patterns.

Figure 5. Individual Physical Proficiency Abilities (Click here to enlarge the image.).

I also included factors like static strength, dynamic strength, explosive strength, trunk strength, extent of flexibility, dynamic flexibility, gross body coordination, and equilibrium. In addition, I added stamina because I think it’s an important consideration. Stamina relates to cardiovascular exertion, and some children may struggle with this for various reasons, especially if movement and physical activity are not part of their typical routine. Remembering this when assessing their ability to sustain activity over time is helpful.

These elements round out the task components, providing a comprehensive resource for evaluating movement and understanding the specific demands of different tasks. With this framework, you now have a structured way to analyze movement challenges and tailor interventions based on the task's requirements.

Environment

Now, we're going to talk about the environment. The environment is an interesting component because it includes regulatory and non-regulatory elements. Before I got into motor learning, I didn’t always differentiate between the two, but understanding this distinction is important.

Regulatory elements are aspects of the environment integral to performing the task. For example, if a child is buttoning a shirt while seated on a bed, certain environmental factors will directly impact their ability to complete the task. The size of the buttons matters—larger buttons are typically easier to manipulate, while smaller buttons require more fine motor precision. The color of the buttons may also be relevant; if the buttons and shirt are both white, it may be harder for the child to discriminate between them visually. The shape of the buttons—whether circular or square—affects grasp and manipulation, as does their thickness. The size of the buttonholes can also influence difficulty, as tight buttonholes require greater dexterity to maneuver the button through.

Other regulatory elements include lighting. If a child is still in the cognitive stage of learning, they need to visually monitor their actions, which means adequate lighting is essential. The firmness of the bed also matters. Like an old-fashioned waterbed, a very soft or unstable surface would make it much harder to maintain stability while buttoning a shirt. In contrast, a firm surface would provide better support. Sitting on a chair instead of a bed would introduce a different postural challenge. The height of the bed is another factor—if the child's legs are dangling without support, it changes their stability and engagement in the task.

This ties back to equilibrium and righting reactions. A child with weak righting reactions may struggle to maintain an upright posture while seated on a soft surface. They will have better control over their posture if they have effective righting reactions. If they begin relying on equilibrium reactions, it may indicate that the postural challenge is too difficult and the task should be modified. Families often overlook these details, assuming that sitting on a bed is no big deal, without realizing that a soft, unstable surface could significantly affect performance.

Non-regulatory elements aren’t integral to the task but can impact attention, motivation, or frustration. Unlike button size, which directly affects task performance, non-regulatory elements don’t change the physical difficulty of buttoning a shirt. However, they can create distractions or interfere with focus.

For example, a noisy sibling in the hallway could make concentrating harder for the child. The smell of breakfast cooking might serve as a motivator but could also become a distraction if the child is eager to finish and get to the meal. A bright, patterned comforter on the bed might draw the child’s attention away from the task. These factors don’t make buttoning a shirt physically harder, but they can interfere with the child’s engagement, attention, and motivation.

We've all taken someone into a quiet room when working on a task. We are considering non-regulatory elements and how they might affect performance. Awareness of regulatory and non-regulatory elements allows us to strategically adjust the environment to set the child up for success.

Let's Break This Down

Okay, so let's break this all down. Figure 6 provides a great example, using a picture of a little girl fishing at the beach.

Figure 6. A girl fishing.

She’s standing on the sand with the water coming in. Since we’re in South Florida, I’m not sure if this is the East or West Coast, but based on how smooth the sand looks and the wave action, it seems more like the West Coast.

Looking at the task, we need to consider whether it’s discrete or continuous, if the base of support is stable or mobile, and whether it’s an open or closed task. Fishing involves holding the pole, lowering the line using the reel, waiting, and reeling in if a fish bites. There’s a mix of movement patterns—one arm is stable while the other is rotating the reel, making it a bimanual task. Referring to the earlier framework, this involves multi-limb coordination, with some parts of her body staying still while others move.

Her base of support matters, too. In this picture, she’s turned toward the camera, shifting her weight, which makes her stance more dynamic. However, while actively fishing, she’s likely standing with both feet braced for stability, especially with waves coming in. The fishing reel itself has moving parts, making it a mobile element, even though it’s not as fluid as something like a bouncing ball.

When considering open versus closed tasks, fishing itself is predictable in terms of the mechanics—lowering the line, reeling it in—but unpredictable in terms of whether a fish will bite. The movement pattern changes based on the fish’s actions, making parts of the task more dynamic. Fishing has both discrete and continuous elements. Lowering and reeling in the line are discrete, with clear beginnings and ends, whereas standing and holding the pole is more continuous.

Looking at the individual, she appears to have sufficient strength to hold the fishing pole, balance one leg, and rotate her body. Stamina is harder to determine from the picture, but since fishing requires patience and endurance, we can assume she has enough to stay engaged. Coordination also seems intact—she stabilizes the pole, maintains balance, and appears comfortable with the task.

When we analyze the environment, the regulatory elements directly impacting performance are critical. The length of the fishing pole creates a long lever arm, affecting control and requiring adequate grip strength and coordination. The spinning reel requires a precise pinch grip, which could be challenging depending on hand strength and dexterity. The handle also has grip material, influencing how securely she can hold it. The ocean waves add a dynamic element, affecting her stability and base of support as the sand shifts beneath her feet.

Non-regulatory elements include distractions that don’t physically alter the task but may impact attention or motivation. For example, the presence of family members, such as someone taking the picture, could shift her focus. The heat from the sun, potential wind, or even birds flying around could also be distractions. If this is a crowded beach, people running nearby or cars on a driveable beach like Daytona could add further complexity.

Finally, I didn’t go in-depth on cognitive components, but those would also fit under the individual aspect. Factors like attention span, ability to follow instructions, and sensory processing all affect how successfully she engages in the task.

Now that we’ve broken this down, it gives us a better appreciation for the complexity of everyday activities. Even something as enjoyable as fishing involves multiple layers of motor learning, coordination, environmental interaction, and cognitive engagement. If you’re still working through how this connects, don’t worry—we’ll have more opportunities to analyze similar situations and reinforce these concepts.

Clinical Reasoning

So let's get into the clinical reasoning part of this because this is where, as occupational therapy practitioners, we naturally want to start treating. We want to move from analysis to intervention, figuring out how to make tasks easier or more challenging based on the individual’s needs.

Returning to the fishing example, we need to consider adjusting the task to better support success or encourage skill development. This involves identifying what makes the task easier or harder and how we can modify elements to facilitate progress. By understanding the task demands, the individual's abilities, and the environmental factors, we can determine the best entry point for intervention and apply strategies that enhance motor learning and occupational performance.

Task

Figure 7 shows an example.

Figure 7. Less to more challenging motor learning (Click here to enlarge the image.).

A task with a discrete or serial beginning and end is typically less challenging. Stability also makes a task less challenging, as does having fewer objects to manipulate. In the fishing example, the fishing pole only has one primary manipulation—turning the reel—that remains consistent, making it less demanding. A task that requires a lower level of attention is also less challenging. It becomes even easier to manage if the task is closed and predictable. In this case, fishing has many elements that reduce difficulty, which is beneficial.

On the other hand, more challenging elements include continuous tasks where there is no clear beginning or end. However, as in the example of the little boy with cerebral palsy who found running easier than walking, this is not always the case. Serial tasks can also be more difficult, depending on the specific activity. Mobility adds complexity, as does manipulating multiple objects. Crocheting requires one tool, whereas knitting requires two, making knitting inherently more challenging due to the increased manipulation demands. A task that requires a higher level of attention, such as knitting or crocheting, is more difficult than something like free dancing, which requires less cognitive focus. Open tasks, which are less controlled and more unpredictable, are also more challenging.

This framework is a guideline for adapting tasks to be less or more challenging to promote skill development. When we move into intervention, these principles help us determine how to structure activities to optimize learning and participation.

The next step in clinical reasoning is to assess the individual’s level of learning concerning the motor task. Now that we understand the task, the environment, and the individual, we need to determine where they are in their learning process to tailor our approach accordingly.

Figure 8 is the Fitts and Posner 3-Stage Model.

Figure 8. Fitts and Posner 3-Stage Model (Click here to enlarge the image.).

Again, this is the gold standard for understanding motor learning, and most of us can relate to it when we consider what we are proficient at.

At the cognitive level, there is a high degree of cognitive activity. The person must pay close attention to every aspect of the movement. The movement itself is slow, inconsistent, and inefficient. There is frequent postural adjustment as they try to figure things out, and visual attention is critical—they must look at what they’re doing in a conscious, controlled manner. A hallmark of this stage is talking through the steps aloud, as the person verbally guides themselves through the process. This stage is often frustrating, highly error-prone, and lacks coordination. Visual attention, cognitive activity, and verbalization are high, and progress is slow and effortful.

As the person practices, they begin transitioning into the associative level. At this stage, they rely less on external guidance and internal feedback. They begin selecting the best movement strategies based on their experience rather than needing constant instruction. In contrast to the cognitive level, where feedback is primarily external (from an instructor or visual monitoring), the associative level shifts toward internal correction and refinement. Movements become more fluid and reliable, though mistakes still occur. However, these errors become less frequent and less disruptive, and the person no longer needs to adjust their posture constantly. As fluidity improves, efficiency follows, and cognitive and visual demands decrease as the task becomes more intuitive.

As refinement continues, the person eventually reaches the autonomous level. This is when the movement becomes automatic and fluent, requiring little conscious attention. The body instinctively knows what to do, and movements are accurate, consistent, and efficient. Errors are minimal and, if they occur, are easily corrected without disrupting the overall task. Most importantly, at this level, a person can divert attention from the motor task and focus on other aspects of the activity.

A great example of this is learning to drive. When first learning, you likely turned the radio off, had a parent or instructor help, and practiced in low-pressure environments like empty parking lots. You were focused on every detail—gripping the wheel tightly, overthinking turns, possibly braking too hard or accelerating too quickly. This was the cognitive level—high error rates, frustration, and concentration.

You could drive in neighborhoods and on roads with some traffic as you improved. You weren’t gripping the wheel as tightly, your turns were smoother, and you were better at anticipating stops. You weren’t making as many mistakes, though occasional errors still happened. This was the associative level—fluidity and efficiency increased, cognitive load decreased, and you relied more on internal feedback than constant external correction.

Eventually, you reach the autonomous level, where driving becomes second nature. You could carry on conversations, listen to music, and navigate without excessive focus on every little movement. You instinctively hit the brakes when needed, adjusted the wheel smoothly, and anticipated turns and stops without conscious effort. At this stage, you could redirect your attention to other driving elements, such as monitoring traffic, checking GPS directions, or reacting to unexpected hazards.

This also explains why novice drivers are at higher risk of distraction-related accidents—many are still in the associative phase, meaning they haven’t fully reached the autonomous level where they can safely divide their attention.

A key insight from this model is that even highly skilled individuals can temporarily revert to lower levels of learning. For instance, an experienced driver comfortable on highways might struggle with parallel parking because they don’t practice it often. When they attempt it, they may suddenly grip the wheel tighter, turn off the radio, and even talk themselves through the steps—all hallmarks of dropping back into the cognitive or lower associative level.

This ability to divert attention is critical for real-world occupational performance. If someone is stuck at the cognitive or lower associative level, they will struggle to apply their skills meaningfully. For example, if a child is still hyper-focused on handwriting mechanics, they won’t be able to use writing efficiently for note-taking in school because the motor task fully occupies their attention. Similarly, if a child struggles with buttoning, zipping, or tying shoes, the extra time and frustration in the morning can disrupt their entire routine.

In therapy, we often get stuck in skill-building mode, keeping individuals at the cognitive or early associative level without helping them transition to more functional performance. To promote true occupational success, we must help individuals reach the high associative or autonomous level, where they can perform tasks efficiently while attending to other aspects of their environment. This shift allows individuals to engage more fully in life—whether participating in school, playing with peers, or completing self-care tasks independently.

Analysis

What I want to do is look at a comparison of these two kids in Figure 9.

Figure 9. Comparison of two kids.

The young girl standing comfortably with her fishing pole. She appeared relaxed and confident, demonstrating good postural control and dissociation as she rotated to face the camera. She wasn’t overly concerned about the waves, and her ability to shift her attention suggests a higher level of motor learning—likely associative or beyond.

Now, let’s shift our focus to the young boy. He has a similar fishing pole with the same grippy material and turning mechanism on the same side. The environmental conditions are also similar, though he is standing deeper in the water, with the waves reaching higher on his legs. This adds an increased regulatory challenge, as the unstable footing and water movement make balance more difficult.

However, the most notable difference is in how he is holding the fishing pole. Instead of grasping it confidently, he has it tucked under his armpit or upper arm—a clear sign of fixing behavior. His posture is rigid and elevated, suggesting that he compensates for difficulty with control and coordination. Additionally, his lack of response to the parent taking the picture is another key observation. Unlike the girl, who turned and engaged, he does not acknowledge the interaction despite having no apparent issues with hearing.

Analyzing this within motor learning stages, he is displaying characteristics of the cognitive level. His high cognitive activity, inefficient movement, postural fixing, and intense visual focus suggest that he is still in the early stages of skill acquisition. His movements may also be slow, but without a video, this is harder to determine.

By contrast, the young girl demonstrates fluid, reliable movement and the ability to shift attention. While we don’t have enough information to determine whether she is fully autonomous, she is clearly beyond the cognitive stage, operating at least at the associative level or higher.

If this young boy remains in the cognitive stage, will he ever become proficient at fishing? Probably not. While he may still enjoy the activity, there is a risk of frustration—especially if he struggles to catch a fish while others around him succeed. If fishing is meant to be a social activity, but he can’t comfortably engage in conversation due to his high cognitive load, he may feel disconnected from the experience. Additionally, his compensatory posture and difficulty balancing could make it harder to reel in a fish, further increasing his frustration and decreased motivation to continue.

This comparison highlights how the dynamic systems theory (task, individual, environment) and Fitz and Posner’s motor learning model (cognitive, associative, autonomous) work together. Understanding where someone is in their learning process allows us to modify interventions to help them progress toward functional occupational performance—whether in fishing or any other meaningful activity.

Case Example

Javier

I want to talk to you about Javier, an eight-year-old who enjoys watching YouTube, caring for his guinea pigs, and playing video games. He sounds like a typical eight-year-old, right? He has a diagnosis of dyspraxia and struggles with motor planning, which many of us see frequently. He becomes easily frustrated and avoids motor challenges, often compensating by purposely falling or acting silly to get laughs.

Recently, he expressed a strong desire to start Taekwondo, which was a big step, but he struggles with jumping jacks and learning the movement sequences. He also wants to play basketball with his older brother but cannot dribble. Now that he has started occupational therapy in third grade, these goals—Taekwondo and basketball—are two key areas where we can support his motor development. While there may also be self-care goals to address, focusing on play and leisure activities that motivate him will likely lead to better engagement and outcomes.

Basketball, as we discussed earlier, is primarily composed of discrete and serial tasks. Dribbling, in particular, which Javier wants to learn, is a repeated discrete motion, making it serial. Many children struggle with dribbling at first, often smacking the ball rather than pushing it, not realizing that a controlled push keeps the ball closer to the hand and reduces the unpredictability of the movement. Regarding task analysis, dribbling is an open, serial movement with varying degrees of stability. Dribbling while standing still provides more stability, whereas dribbling during a game involves movement, making it significantly more complex.

Dribbling requires a grip or pushing motion, wrist flexion, elbow flexion, and limb dissociation. Environmental regulatory elements include the size and inflation level of the basketball and the type of surface he’s playing on. The task becomes even more complex when played in a game where defenders and other players introduce additional variables.

Similarly, learning a movement sequence in Taekwondo involves discrete tasks in a serial pattern. Whether it’s a sequence like punch-punch-kick or more advanced movements, each step has a clear beginning and end. However, stability and mobility vary depending on the movement—punching is a more stable motion while kicking introduces the complexity of single-leg stance and balance. Movements like roundhouse kicks require rotation and dynamic control, making them more challenging.

Environmental factors also play a role in Taekwondo. The uniform facilitates ease of movement, and the surface—whether a mat or a hard floor—affects stability. From a non-regulatory perspective, peers, the sensei, and mirrors in the dojo can provide useful feedback or serve as distractions.

From an individual perspective, Javier has intact equilibrium and fair balance but tends to use a larger base of support. He has normal muscle tone but struggles with frustration tolerance. Cognitively, he is typical for his age, though he has difficulty with working memory, which is common in dyspraxia. This means remembering movement sequences will be challenging, especially at the start. Interestingly, research supports serial activities like Taekwondo as beneficial for improving working memory, which makes it an excellent choice for him. However, knowing that working memory is a challenge, we need to introduce strategies or modifications to support him in learning these movement patterns.

Now that we’ve analyzed the tasks, the environment, and Javier as an individual, we can use this information to develop appropriate interventions based on his current level of motor learning. Dribbling a basketball is an open, serial task that can be adjusted to provide stability initially before progressing to a more mobile, game-like scenario. Taekwondo sequences are also serial but involve more dynamic movements. Understanding these distinctions allows us to modify the tasks appropriately while controlling for environmental and cognitive demands.

When teaching motor skills, we need to recognize the two types of learning involved. Procedural learning occurs when skills are performed automatically, without conscious attention, becoming habits over time. On the other hand, declarative learning requires active awareness, attention, and reflection. Javier engages in declarative learning if he verbalizes the steps as he practices. Over time, with enough exposure, these steps will shift into procedural memory, making the movements more automatic.

It’s important to note that procedural learning is typically well-developed by age 10, whereas declarative learning continues to mature into young adulthood. Children build procedural learning through increased exposure and repetition, reinforcing neural connections. Compared to declarative learning, the rapid maturation of procedural learning suggests that repeated motor practice helps children acquire and refine new skills more effectively.

Since Javier is currently at the cognitive stage of motor learning, our interventions should focus on making tasks more discrete, stationary, and closed to reduce unpredictability. We should also minimize environmental challenges and reduce non-regulatory distractions to optimize his learning. This means working in a quiet, low-stimulation space where he can focus on the task without excessive visual, auditory, or sensory distractions.

At the cognitive stage, skill-building should focus on both physical and cognitive abilities. Supporting his working memory through structured learning strategies or modifications will be key. As he progresses to the associative stage, we can start introducing serial tasks, some mobility, and open-environment conditions, gradually increasing the complexity of the task while reducing external support. The goal is to challenge him at the right level without overwhelming him.

At the autonomous stage, we should focus on more complex movements that involve continuous motor sequences, transitioning from closed to open environments. At this point, Javier should be able to perform skills under varying conditions and with minimal external feedback, relying instead on his internal cues.

So, how do we help Javier progress from the cognitive stage to the autonomous stage and generalize motor learning? The research points to practice as the key factor. Motor learning relies on structured practice and different types of practice influence skill retention and transfer.

Massed practice is effective for initial learning, where the practice time is greater than the rest period. However, if Javier has ADHD, this approach may need to be modified, as children with ADHD often require different pacing strategies. The practice structure should start with blocked practice, focusing on one task at a time before integrating multiple components. For example, if Javier is learning to dribble, we may first work on keeping the ball close to the hand before moving on to controlling direction and movement.

We shift to distributed practice for skill transfer, where rest periods equal or exceed the practice time. This helps reinforce learning while preventing frustration. Variable practice, where the task and environment are changed, helps increase generalization. Finally, randomized practice involves mixing up tasks rather than following a set sequence, which helps solidify learning.

Feedback is another critical factor in motor learning. Extrinsic feedback, such as therapist input, should be gradually reduced in favor of intrinsic feedback, where the child learns to self-monitor and correct errors. This shift is essential for transitioning into the autonomous stage.

There are different strategies for providing feedback. Faded feedback starts with frequent input and gradually reduces as proficiency increases. Bandwidth feedback sets predefined parameters for correction—only providing feedback when the child’s performance falls outside those parameters. Summary feedback involves giving feedback after several trials rather than after every attempt, encouraging self-assessment. Self-controlled feedback allows the learner to request feedback when needed, promoting autonomy.

Feedback should focus on the outcome rather than performance details in early learning stages to prevent overwhelming frustration. Summarized feedback is ideal to avoid cognitive overload. Feedback should be minimized in later stages, shifting the focus to self-reflection and internal awareness. Encouraging the learner to identify what went well and what needs adjustment helps develop independent problem-solving skills.

Finally, generalizing motor skills requires practicing in varied contexts and integrating skills into daily routines. Performing a task under natural conditions is key for functional carryover. This is why practicing self-care tasks in a real bathroom or dribbling a basketball in an actual game setting is more effective than isolated practice in a controlled environment.

For neurodiverse clients, specific adaptations should be considered. Children with ADHD tend to rely more on visual feedback and benefit from frequent feedback early on, with reduced feedback for generalization. Simple repetition of fine motor tasks does not improve performance in children with ADHD, so blocked practice must be quickly transitioned to more variable learning. Gross motor activities can improve overall motor control, self-regulation, and executive functioning. Research suggests that children with ADHD may learn better in the evening than in the morning, so scheduling therapy accordingly can optimize outcomes.

Motor impairment is highly prevalent in children with autism, often impacting social, functional, and repetitive behaviors. Participation in physical activities like sports and martial arts can significantly improve social communication and executive functioning. Children with autism benefit from visual and verbal feedback, though verbal feedback should focus on body parts and movements rather than external outcomes to enhance internal body awareness.

By applying these motor learning principles, we can ensure that children like Javier learn new skills and generalize them effectively into meaningful activities and daily life.

Fishing Example

Let’s go back to our fishing example. For feedback, if I’m working with a child with autism, I’ll use both verbal and visual feedback. If I’m working with a child with ADHD, I’ll focus more on visual feedback and provide it at a high frequency in the beginning. Summary feedback is probably not ideal for them, and I won’t rely on self-controlled feedback where they decide when to receive it—structured feedback will be more effective.

I’ll start with external feedback, but for children with autism, I’ll make sure the feedback is focused on the body and movement rather than external outcomes. I’ll also consider emotional tolerance, as research suggests that feedback can become ineffective or even counterproductive if the emotional load is too high.

I’ll use blocked practice to focus on individual parts of the skill. Since balance is a major factor in fishing, I’ll incorporate activities with long levers that require stabilizing while balancing. These might include dynamic balance and bimanual tasks that gradually increase in complexity. In a clinical setting, I can use sensory mats and other balance tools to create fun, engaging challenges while focusing on long-term stability.

For environmental modifications, I might start practicing the fishing motion without water or have the child step back out of the water to reduce instability. If necessary, I could add rain boots or other stabilizing footwear. I might consider having them seated instead of standing or increasing the size of the manipulated items to make the task more manageable. Shortening the fishing pole would also be helpful, though this may not always be practical given equipment limitations.

When thinking about physical activity and executive function, it's important to recognize that motor learning and executive function reinforce each other. As executive function improves, motor learning becomes more efficient, and vice versa.

To clarify visual feedback, examples include pointing to the activity, demonstrating the movement, or physically showing the expected outcome rather than using verbal instructions. If possible, video modeling or pictures can also be effective. One key strategy is to avoid giving verbal and visual feedback simultaneously, which can divide attention. Instead, I’ll be intentional and targeted with the type of feedback I provide.

The most efficient way to generalize skills is to move beyond discrete part-practice and transition to open, continuous, or closed sequential practice. Open continuous tasks involve unpredictable movements with no clear beginning or end, while closed sequential tasks involve predictable sequences with defined start and stop points. These two structures provide the best foundation for progressing to higher levels of motor skill acquisition.

When structuring practice, I might create an obstacle course incorporating long levers in different ways. For example, the child might use a fishing pole or a long reacher to retrieve items while moving. A magnet-based activity where they collect items with a long tool could also reinforce stability and motor planning. Another idea is a flag game, where they use a long flag pole in a movement-based activity, such as keep-away. The goal is to integrate long-lever activities into dynamic movement challenges to reinforce balance, control, and coordination.

Open sequential practice is ideal for long-term skill generalization. Tasks that are open (unpredictable) or sequential (structured steps) facilitate real-world skill transfer. Combining these elements into open sequential practice is the most effective way to help children become fully autonomous in their motor skills.

Back to Javier

This is the general pattern we want to follow when thinking about Javier and how to support his motor learning process.

Earlier, we identified that Javier has motor learning challenges, specifically dyspraxia. Now, let’s consider how our approach would shift if he also has ADHD while maintaining the same interests. Since we already understand the cognitive, associative, and autonomous stages, we can apply what we’ve learned to better support him.

If Javier has ADHD, we would start at the cognitive level by structuring tasks to be discrete, stationary, and closed to reduce unpredictability. The regulatory demands should be minimized, and non-regulatory distractions should be reduced as much as possible. We would also incorporate skill-building strategies to make the task less cognitively overwhelming.

As he progresses into the associative stage, we gradually introduce more complex elements such as mobility, sequencing, and a mix of closed and open tasks. By the time he reaches the autonomous stage, we aim to engage him in serial and continuous tasks with closed and open conditions—mirroring what the research supports as most effective. Open sequential practice becomes key for full generalization.

For feedback strategies with ADHD, the focus should be on visual feedback. This includes pointing, demonstrating, and using pictures or videos to illustrate the movements. For example, if he’s learning to dribble a basketball, a well-structured instructional video demonstrating proper technique would be helpful.

Since frequent arousal and attention are critical for children with ADHD, we need to incorporate strategies to maintain focus. This could involve white noise, full-body vibration, or movement breaks. Additionally, research shows that distributed practice is more effective than massed practice for children with ADHD, meaning breaks should equal or exceed practice time. This approach helps with sustained focus and frustration management as he moves from the associative to the autonomous stage. Once he reaches higher levels of learning, we continue using visual feedback, but less frequently, while monitoring arousal and attention levels.

Now, if Javier has autism instead, our approach changes slightly. In this case, we would use both visual and verbal feedback. Interestingly, studies have found that it doesn’t matter who provides the feedback—it could come from a person, a robot, or a video, and the results remain the same. This gives us flexibility in how we introduce feedback strategies.

For children with autism, the focus should be on internal attention, meaning feedback should highlight body parts and movement rather than external outcomes. This helps them develop a better sense of movement and motor awareness. As they transition from the associative to the autonomous stage, the feedback remains the same—visual and verbal cues emphasizing body awareness rather than environmental factors.

So, when considering how to support Javier, we tailor our motor learning strategies based on his unique needs, whether related to ADHD or autism. While both populations require structured feedback and practice, the key differences lie in how feedback is delivered, how practice is structured, and how attention and arousal are managed.

Takeaways

What are our key takeaways?

First, always focus on the task, the environment, and the individual. Adapt the task to create the just-right challenge and skill-build only when necessary, but always move toward the whole activity at the top of the pyramid. The ultimate goal is occupational performance, and in some cases, such as autism or dyspraxia, even just participation can be a meaningful objective. Many children with dyspraxia opt out of motor tasks altogether, so the first step may be engagement in the activity. But we must remember that the end goal isn’t just improving an isolated motor skill—achieving the bigger picture of functional performance within real occupations.

Second, remember the three phases of learning. The cognitive phase is highly visually attentive, with much external feedback, repetition, frustration, and errors. The associative phase is when learning becomes more internal, movements become more refined, and attention starts alternating between the motor task and other aspects of performance. The autonomous phase is when a person can divide their attention, make minimal errors, and integrate the skill into their full occupation without focusing solely on the movement.

Third, part-to-whole learning is essential. If we don’t move beyond part practice, the individual will remain stuck, and what they learn in therapy will never translate to real-life situations. They won’t be able to generalize skills to jobs, school, or daily routines.

A heartbreaking example comes to mind. I spoke with a post-secondary transition director about a young man with autism who had struggled to find a job placement. He had motor and executive function challenges but found his passion in a bakery. Unfortunately, he could not put on a hairnet or an apron, which was required for food safety, and eventually, the bakery stopped working with him. The OT services he received in school focused on stacking blocks and handwriting but never addressed dressing skills or occupationally relevant tasks. If those skills had been integrated into therapy—perhaps through painting smocks, dressing routines, or a motor learning approach that included apron-tying and hairnet application—he could have had the opportunity to succeed in a job he truly loved. Instead, he was placed in a different role he didn’t enjoy, and as a result, his behavioral issues increased. This kind of missed opportunity is something we can actively prevent by ensuring that therapy moves beyond isolated motor tasks and toward whole occupation-based performance.

Fourth, when writing goals, consider the phases of learning (cognitive, associative, autonomous) and how the task, environment, and individual factors interact. Goals should focus on skill-building and include modifications and feedback strategies. Consider what needs to be adapted—is it the task, the environment, or the individual’s approach? Instead of just writing goals that state “3 out of 5 times,” consider how many repetitions they can complete within a meaningful context.

Fifth, be intentional about modifications for ADHD and autism. Research has given us new insights—for example, children with autism respond to verbal feedback despite previous assumptions that they do not, while children with ADHD respond better to visual feedback than verbal.

For ADHD, keep in mind:

• They initially benefit from heavy feedback, but it should be gradually reduced.
• Distributed practice is more effective than massed practice, so longer rest periods help with focus and frustration.
• Later-day sessions may be more effective for motor learning.

For autism, remember:

• Both visual and verbal feedback work, and it doesn’t matter if the feedback comes from a person, video, or even a robot—the effectiveness remains the same.
• Feedback should focus on internal attention—body parts and movement—rather than external environmental factors to help with motor awareness.

Finally, always work toward varied environments. Motor learning and occupational performance are not just about mastering skills in one setting—they need to be applied across different contexts. By challenging individuals in different conditions, adjusting regulatory and non-regulatory factors, and emphasizing whole-task learning, we can help individuals achieve long-term success in their occupations and daily lives.

Evidence

These are tables with recent evidence.

Summary

Exam Poll

1)Which of the following is a key factor in motor learning that leads to a permanent change in movement?

A. External motivation only

B. Passive observation of movement

C. Verbal instructions, practice, and feedback   Correct Answer

D. Exclusive reliance on sensory input

2)According to the Dynamic Systems Theory, what regulates change in the behavior of the entire system?

A. Motor reflexes

B. Control parameters   Correct Answer

C. Centralized neural commands

D. Environmental constraints

3)What is a defining characteristic of procedural learning in motor skill acquisition?

A. It requires conscious thought and reflection.

B. It is dependent on verbal instruction.

C. It can be performed without conscious attention.   Correct Answer

D. It is only relevant in early childhood development.

4)According to the guidance hypothesis, how does excessive external feedback impact skill acquisition?

A. It enhances long-term retention of the skill

B. It prevents errors and ensures perfect execution

C. It can hinder skill acquisition by creating dependency   Correct Answer

D. It has no significant effect on learning outcomes

5)For children with ADHD, which motor learning approach is recommended to enhance skill acquisition?

A. Massed practice with minimal rest

B. Visual feedback with frequent reinforcement   Correct Answer

C. Exclusive reliance on verbal feedback

D. Focus only on fine motor skills

Questions and Answers

How can one differentiate whether a child’s movement patterns and postures are due to a lack of strength or tone versus a coordination issue? Is the child compensating for weakness?

That’s a great question. If you’ve completed your evaluation, you should have insight into the child's strength, tone, and other contributing factors. From a motor learning perspective, the key is determining whether the issue is coordination or compensation due to weakness. If strength is a major concern based on your evaluation, it likely affects the movement patterns.

It’s similar to equilibrium reactions—foundational elements that must be developed. You should work on both strength and coordination together. You won’t get the desired results if you only focus on one. Sometimes, you’ll emphasize skill-building, sometimes modifications, but ultimately, you’re working towards integrating strength and coordination into the whole occupation.

I have two ASD patients who cannot tolerate negative feedback. Their confidence is so low that any error feels like failure. Any techniques to overcome this?

This is a great question, and research highlights the emotional challenges related to feedback in children with ASD. My recommendation is to avoid negative feedback entirely when working on motor learning. Instead, focus on just-right challenges—providing feedback in a way that supports learning without reinforcing failure.

Rather than saying what not to do, use a Montessori-style approach and phrase feedback positively. For example:

• Instead of "Don’t slap the ball," say, "Push the ball so it makes a soft thump sound."

• Instead of "You're not dribbling straight," say, "If you push straight down, the ball will bounce straight back up."

If they struggle even with that, simplify it further: "Did your fingers touch the ball? Great job!" This ensures the focus stays on motor learning. If handling negative feedback is a separate goal, work on that separately—it shouldn’t be embedded in motor learning activities.

I’ve heard of using a 3x10 trials training method. How could this be reframed for writing?

I’m not entirely sure what 3x10 refers to in this context, but a useful approach for writing is using self-monitoring tools like scoreboards or visual analog scales. Some ideas:

• Have the child rate their writing performance using numbers or facial expressions.

• Use a scoreboard where they track their progress.

• Let them assign letter grades (e.g., "That one was a C. Can I try again?").

Finding a self-assessment system that resonates with the child helps maintain engagement and ownership of progress.

I have a patient with ASD who can write well but rushes her homework. When I ask her to redo it, she gets offended. How can I address this?

This sounds like a motivation and task preference issue rather than a motor learning problem. If she’s at a cognitive level where she can perform well but chooses not to, the focus should be engagement strategies. Instead of having her redo work as a punishment, try integrating preferred tasks into skill-building activities.

It’s also important to assess her motor learning stage:

• Cognitive stage: Needs guidance and structure.

• Associative stage: More independent but still refining.

• Autonomous stage: Can perform the skill fluently.

If she's resisting because it's a non-preferred task, find alternative ways to work on the underlying issue within a preferred context.

References

See additional handout.