Neuromotor Task Training (NTT) puts a particularly strong emphasis on the teaching principles used to guide practice, and the importance of providing feedback to enhance learning. Therapists become teachers who guide the child in the process of learning motor skills. Both the motivational and the informational functions of feedback are emphasized in NTT.
"During their training on NTT, physical therapists are encouraged to motivate children to learn and to provide specific instructions and feedback to the children. They can choose among different learning options, such as implicit, guided discovery or explicit learning. If explicit learning is chosen, they know that different stages of motor learning are involved: the cognitive phase, the associative phase, and the autonomous phase. Neuromotor task training emphasizes giving the child some sort of idea or image of the task to be learned, be it through verbal instructions or demonstrations. Schmidt and Lee (1999) reported that clear instructions about what task to perform, how to perform it, and what to attempt to achieve as a score are critical for motor learning. Less effective are instructions such as “go” or “OK.” Therefore, NTT therapists are trained to give instructions (clues) that provide useful and important information about the movement itself or to stress ways in which children can recognize their own errors. After a motor task is performed, providing feedback about what was done may be essential for skill learning. Physical therapists can talk about the outcome of a movement (results) or about the nature of the movement pattern (performance). In NTT, the provision of adequate feedback on performance is encouraged because it may enhance motor learning, especially in children with motor problems. Both the motivational and the informational functions of feedback are emphasized in NTT." (Niemeijer 2006)
Taxonomy of teaching principles
Physical therapists use a rage of teaching methods when training motor skills in children. A study by Niemeijer et al (2003) documented the different methods and used their observations to develop a taxonomy of teaching principles and an observation system, the Motor Teaching Principles Taxonomy (MTPT). The MTPT is a well-structured observation system developed to analyze videotaped recordings of NTT intervention sessions. The development of the MTPT was based on scientific motor learning information emphasized in NTT and on the observed (verbal) actions of therapists.
The therapists' overt actions can be clustered into 3 major categories, covering 20 different teaching principles (Tab. 2). These categories are mutually exclusive and exhaustive.
The teaching principles are based on a taxonomy of principles, with three categories covering the verbal actions of physiotherapists aimed at improving motor learning.
Giving information on what to do
- Giving commands
- Draw attention and demonstrate the movement
- Give clues on how to execute a movement
- Manually change the body in order to make a desired action possible Sharing knowledge Talking about movement tasks and execution (before or during execution)
- Talking about movement tasks and execution
- Explain why it is better to execute a movement in a certain way
- Revert to earlier trials
- Tell what the child is doing
- Provide rhythm or timing
- Explain the difficulty of a task
- Ask the child about the difficulty of a task
- Ask the child if he/she understands the task
- Ask the child if he/she thinks he/she can do the task (attainability)
- Ask the child questions about the movement execution of a task
Providing or asking for feedback
- Providing comments or asking for comments after the task is completed
- Ask/Tell the child what was done right during the execution
- Ask/Tell the child what was done wrong during the execution
- Ask/Tell about the results of performance neutrally
- Ask/Tell about the positive results of movement
- Ask/Tell about the negative results of movement
- Ask the child’s opinion about the movement execution
- Ask the child’s opinion about the results of the task
How do these methods relate to improved task performance?
A second study (Niemeijer et al 2007) using NTT as a training method investigated which of these different approaches were related the improved performance in the study children. Their findings indicated that motor patterns improve if children receive clues about how to perform a movement, however this does not necessarily translate into improvement in task related outcomes that measure accuracy. This finding is in line with numerous studies of adult learning that have shown that feedback with an emphasis on the body and body movements are not as effective as those that shift attention to cues outside of the body (Wulf 2016).
On the other hand three principles in the category of “sharing knowledge” were found to be statistically significant: explaining why it is better to execute a movement in a certain way, providing rhythm or timing, and asking whether the child understands the movement task.
"In another promising treatment approach, the cognitive orientation to daily occupational performance (CO-OP), emphasis is placed on teaching children to plan and evaluate their own movements (Mandich et al 2001) who performed in-depth videotape analyses of CO-OP, found that many children with DCD lacked an understanding of the motor requirements of a task. They interpreted the therapists' provision of this knowledge as a prerequisite for the use of the cognitive strategies of CO-OP. Their observations and the results of the present pilot study indicate that talking (sharing knowledge) about motor tasks or movement execution with a child with DCD enhances the child's motor performance."
Mandich AD, Polatajko HJ, Missiuna C, Miller LT. Cognitive strategies and motor performance in children with developmental coordination disorder. Phys Occup Ther Pediatr . 2001;20:125–143.
Niemeijer AS, Smits-Engelsman BC, Schoemaker MM.(2007) Neuromotor task training for children with developmental coordination disorder: a controlled trial. Dev Med Child Neurol. 2007 Jun;49(6):406-11.
Niemeijer AS, Schoemaker MM, Smits-Engelsman BC.(2006) Are teaching principles associated with improved motor performance in children with developmental coordination disorder? A pilot study. Phys Ther. 2006 Sep;86(9):1221-30.
Niemeijer AS, Smits-Engelsman BC, Reynders K, Schoemaker MM.(2003) Verbal actions of physiotherapists to enhance motor learning in children with DCD. Hum Mov Sci. 2003 Nov;22(4-5):567-81.
Schoemaker MM, Niemeijer AS, Reynders K, Smits-Engelsman BC. (2003) Effectiveness of neuromotor task training for children with developmental coordination disorder: a pilot study. Neural Plast. 2003;10(1-2):155-63.
Schmidt RA, Lee TD. (1999)Motor Control and Learning: a Behavioral Emphasis . Champaign, Ill: Human Kinetics; 1999.
Wulf G, Lewthwaite R. (2016) Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychon Bull Rev. 2016 Oct;23(5):1382-1414. PubMed PMID: 26833314.