The OPTIMAL Theory

Introduction

As is discussed in more detail here, 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.

As Wulf and Lewthwaite state, these factors are significant, but current approaches to motor learning do not consider recent evidence that highlights the importance of motivation and attention on performance and learning. The factors that impact motor learning have been almost exclusively explored from a “motivationally neutral information-processing perspective.”

Based on this gap in the literature, Wulf and Lewthwaite 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 skillful control of movement rather than focusing on skills that have strong cognitive features.

A key tenant of the OPTIMAL Theory is that a learner’s motivational and attentional needs must be met, or not jeopardised, in order to optimise learning. Thus, the aim is to:

1. Strengthen a patient’s goal-oriented actions
2. 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 skillful movement can be used to achieve the goal.

Self-Efficacy

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. Please click here for a description of different types of augmented feedback.

In 2019, Ghorbani explored the hypothesis that feedback could have an impact on self-efficacy in a study using modified dart throwing as a 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:

1. Good performance knowledge of results (KR) and high self-efficacy
2. Poor performance KR and high self-efficacy
3. Good performance KR and low self-efficacy
4. 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 during acquisition and retention and transfer tests. 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.

Those participants who received feedback about good performances had, in general, better accuracy on their retention test, regardless of their initial 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.

Measuring Self-Efficacy

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 post learning intervention.

Main Components of the OPTIMAL Theory

There are three main aspects of the OPTIMAL Theory.

1. Enhanced expectancies
2. Autonomy support
3. External focus of attention

Enhanced Expectancies

In the OPTIMAL Theory, expectancies refer to “a range of forward-directed anticipatory or predictive cognitions or beliefs about what is to occur.”

Enhanced expectancies develop based on previous experience. They are not considered motivationally neutral.

When learners have a positive outcome or a good experience, they will have a specific “in the form of positive cognitions [...] and associated positive affective responses”. This can lead to positive affective responses. It may also trigger a dopamine response. Dopaminergic systems support types of brain activity that are important in motor, cognitive and motivational functioning. 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:

1. 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
2. Providing normative feedback, which suggests the patient’s performance is better than average
3. Observing other learners (not experts) performing well to enhance the patient’s expectation that she / he can also do well
4. Using rewards
5. Commenting on peer group performance such as “other people with similar injuries tend to do well when they practise this skill” can help to raise the expectation that this patient will also do well
6. Setting easier goals - while goals should be challenging, they should not overwhelm the patient
7. 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 be more beneficial when it focuses on good performance.