The role of order of practice in learning to handle an upper-limb prosthesis.

Abstract

To determine which order of presentation of practice tasks had the highest effect on using an upper-limb prosthetic simulator. A cohort analytic study. University laboratory. Healthy, able-bodied participants (N=72) randomly assigned to 1 of 8 groups, each composed of 9 men and 9 women. Participants (n=36) used a myoelectric simulator, and participants (n=36) used a body-powered simulator. On day 1, participants performed 3 tasks in the acquisition phase. On day 2, participants performed a retention test and a transfer test. For each simulator, there were 4 groups of participants: group 1 practiced random and was tested random, group 2 practiced random and was tested blocked, group 3 practiced blocked and was tested random, and group 4 practiced blocked and was tested blocked. Initiation time, the time from the starting signal until the beginning of the movement, and movement time, the time from the beginning until the end of the movement. Movement times got faster during acquisition (P<.001). The blocked group had faster movement times (P=.009), and learning in this group extended over the complete acquisition phase (P<.001). However, this advantage disappeared in the retention and transfer tests. Compared with a myoelectric simulator, movements with the body-powered simulator were faster in acquisition (P=.004) and transfer test (P=.034). Performance in daily life with a prosthesis is indifferent to the structure in which the training is set up. However, practicing in a blocked fashion leads to faster performance; in novice trainees, it might be suggested to practice part of the training tasks in blocks.