The effects of knowledge of performance and cognitive strategies on motor skill learning in children with cerebral palsy

Physical therapists should facilitate skill acquisition, retention and transfer by acknowledging the contribution of cognition to these processes. Cueing children with cerebral palsy to use cognitive strategies to help organize augmented information provided during practice of motor tasks, should enhance the effects of the augmented information, resulting in improvements in learning. The purposes of this study were to determine if, (a) providing knowledge of performance (KP) during practice of a novel motor task, was more effective in improving performance of the task than providing no KP during practice and (b) providing a cognitive strategy (CS) to enhance cognitive operations on KP during practice of a novel motor task was more effective in improving performance of the task than providing KP alone during practice.;Thirteen children with a diagnosis of cerebral palsy (CP) between the ages of 6.0 and 12.7 years were assigned randomly to one of three experimental protocols. A single-subject, interactive, nonconcurrent multiple baseline design was utilized.;Each subject performed thirty-six, 10 second trials on three days within a five day period, attempting to mobilize in a backward direction on a Pedalo, a therapeutic exercise apparatus. Baselines were of varying lengths and subjects received KP and KP + CS according to designated intervention protocols. Procedural fidelity was established and remained consistently high throughout the study, with mean percent agreement ranging from 86.7--100% for all subjects. A block of four retention trials was performed on the third test day. Videotaped data of backward displacement of the Pedalo were collected for each trial.;Visual inspection of the data suggested variability in performance. Visual inspection of the data suggested that practice positively affected performance in all subjects. This was supported by mean scores over phases. Additional analysis of the data utilizing the C statistic and the celeration line, revealed that KP alone made a significant positive difference in performance for only one of the thirteen subjects. KP + CS made a significant positive difference over KP alone in four of the thirteen subjects. Receiving the KP + CS earlier in practice did not contribute to better retention overall.;This study suggests that practice does improve motor performance in children with CP. Some children with cerebral palsy can benefit from the use of cognitive strategies during practice of motor tasks. Future research should address learning styles of children with CP, the nature of the information contained in the cognitive strategies, and further analyze the effects of personal constraints on movement tasks in order to better develop efficacious strategies.