A Process-Oriented Model of Human Motor Behavior:

Toward a Theory-Based Rehabilitation Approach

Theo Mulder
PHYS THER. 1991; 71:157-164.

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Movement Science Series

A Process-Oriented Model of Human Motor Behavior:

Toward a Theory-Based Rehabilitation Approach

The purpose of this article is to present a behavioral model of human motor acts
that ma-y have relevancefor therapeutic procedures aimed at the restoration of
motorfunction after neurological or orthopedic problems A key point of this
model is that motor behavior is the result of a n integrated and adaptive biological
system. Cognitive, perceptual, and motor mechanisms are not independent ele-
ments, but are viewed as inseparableparts of thisfunctional system, Implications
for therapy are discussed. [Mulder T. A process-oriented model of human motor
behavior: toward a theov-based rehabilitation approach. Phys Ther. 1991;71:157-
la.]
Key Words: Kinesiology/biomechanics,general; Motor activity; Motor skills;
Movement; Rehabilitation.

Each year hundreds of thousands of man motor behavior is often seen in in the hand somewhere between the
new cases of damage to the nervous obsolete terms, and, in general, treat- mouth and the table, and finally the
system are reported. A large number ment regimens are founded primarily cup is replaced on the table.
of people with neurological problems on empirical-clinical knowledge. In
are in urgent need of medical or neu- this article, a model on human motor On the one hand, you observed a
ropsychological treatment. A thera- behavior is presented that may be of normal daily life scene, but, on the
peutic approach aimed at rehabilita- importance for rehabilitation and that other hand, you observed a wonder-
tion of patients with neurological (or could play a role in the development ful biological machine designed for
orthopedic) problems should be of a theory-based rehabilitation adaptive and flexible functioning in
based on a sound theory regarding approach. an ever-changing context. You did not
how the brain regulates human motor see a movement, but an action with
behavior. Without such a theory, it is Human Motor Control and perceptual, cognitive, and motor as-
difficult to analyze the observed prob- Learning-A Model pects. Each movement is always the
lems, to select the most adequate result of such a subtle interplay
treatment procedure, and to predict If you observe someone drinking cof- among cognitive, perceptual, and
its outcome. The basic role of a the- fee while he o r she participates in a motor aspects.'-5
ory is to provide an underlying model lively conversation, you might see
that guides the fragmented practical him or her bending forward while Because the observable output of the
ideas into a coherent treatment extending an arm to reach for the nervous system is always in terms of
philosophy. cup, adapting finger position to the movements, in most discussions of
size of the cup. The person then lifts human motor behavior, the motor
Such a theoretical basis, in general, is the cup carefully, brings it to the aspect is not only highly overesti-
lacking or, when available, often does mouth, and sips the hot coffee. The mated but often seen as the only rele-
not fit with current knowledge on person stops talking, but continues vant factor. Perception and cognition
motor control. The regulation of hu- after a few seconds. The cup is held are seen as independent elements
studied and discussed separately from
motor aspects. It is remarkable that in
most physical therapy procedures, the
T Mulder. PhD, is Department Head, Department of Research and Development, St Maartensklin- emphasis is almost totally on the mo-
iek, PO Box 9011, 6500 GM Nijmegen, the Netherlands.

82 /I57 Physical Therapy /Volume 71, Number 2 /February 1991

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tor system and the perceptual and
cognitive aspects are ignored o r
treated separately."

In this article, I argue that such an

element-oriented standpoint cannot
be justified and that motor behavior
MEMORY
) INTENTION
( "GOAL" )
- ACTIVATION

should be studied (and treated) as the

output of an integrated and adaptive SENSORY INPUT
system. A model of human motor be-
havior is presented in which cogni-
tion, perception, and action are not SELECT ION
separate but form the components of
a flexible, functional system (Figure).
The model represents a way of think- n
rn
ing that may be of relevance to physi- rn
o
n
cal therapy. This way of thinking is 0
closely related to a cognitive view of STIMULUS RECOGNITION II
E
human behavior. Nothing is really (YEWNO) D
3
new in the model; each part of it re-
fers to the work of others. It is based - I 0

on Schmidt's1&13schema theory, but RESPONSE SELECTION

there are also strong influences from b (YEWNO)

the work performed in the Nether- - - - - - - - - - -_ _ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _

I

lands by Hulstijn and Van Galen14.15 I I

I

and Van Galen and ~ o l l e a g u e s . ~ ~ ~ 9 9 PLANNING P I

I I
Neurobiological ideas, as discussed by I
I
R I
I 0 w I
Cools," also play an important role. I
I

Activation

To perform an act, an optimal level of

activation is n e ~ e s s a r y .Extreme
~~,~~
exhaustion, coma, certain drugs, and
so on lower the arousal level to such
a degree that the organism is no INITICITION
longer able to react adequately to
stimuli.

Intention

Each movement a person makes has

intentional aspects; it is almost never Figure. Model of hrrman motor behaviolr showing hypothetical information-
transforming processes that take place in the interval between the stimulus and the ac-
an isolated movement or a displace- tual start of the movement.
ment of body segments in empty
space. Movements should be seen in (eg, visual, auditory, proprioceptive. has the same value and the same po-
terms of strategies for solving a prob- vestibular, tactile). Not all of this in- tential to trigger a reaction, the orga-
lem or for reaching a goal in the en- formation is relevant for the act under nism would quickly become over-
vironment (eg, picking up a cup of performance, and the organism has to whelmed by the input.2nThese
~offee).~3 An intention activates a select the most relevant information; selection processes serve to facilitate
stored repertoire of acquired abstract that is, the organism must be able to future behavioral responses and to
motor schemata.24The relationship pick up the essential information access memory.
between intention and action, how- from the en~ironment.26.2~ This is a
ever, is far from clear.*5 crucial requirement, because when Stimulus Recognition and
this input-selection (attentional) Memory Mechanisms
Sensory Input Selection mechanism is damaged, the environ-
ment loses its logical structure. In- The determination of the relevance of
The moving organism is continuously deed, when each bit of information stimuli is directly related to the identi-
bombarded by a multitude of input

Physical Therapy /Volume 71, Number 2 /February 1991 158/83

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fication of these stimuli. It is impossi- goal, and so on. As Granit33 argued, to copy its form while driving a car or
ble, therefore, to separate the recogni- without such intrinsic knowledge, the flying an airplane, or about how to
tion "stage" from the input-selection movement can be performed, but is pronounce it. It is a purely abstract
phase. In the example about drinking delayed and has lost its accuracy. representation, far away from the
coffee, the cup has to be recognized Much of this knowledge, however, is physical act of producing it.
as a graspable object and its func- tacit knowledge.
tional significance has to be known. The following perceptual example may
Its significance can only be known Response Selection further clarify this concept. When you
when there is contact with memory. see a dog (see article by Schmidtlo),
Memory contact, however, is not a Response selection refers to one of the you immediately know that it is a dog,
discrete phase; at each moment of the most fascinating aspects of human without the necessity of retrieving
unfolding motor act, contact with a motor behavior, its flexibility. In the from memory the images of all the
knowledge base is necessary. coffee-drinking example, there are dogs you ever saw. You know what a
thousands of ways to pick up the cup. dog is because, on the basis of a rich
The interplay between knowledge The possibilities depend on the con- experience with many different exem-
and motor processes is a crucial text and the momentary position of plars of this species, a prototypical rep-
characteristic of motor behavior. the body relative to the ~ u p . The 3~ resentation has been formed. Some-
The information picked up from an question is, How we are able to select thing very similar is suggested to
object has an important anticipatory the most adequate movement? The explain the control of movements: on
function. For example, the stretch classical explanation was the use of a the basis of numerous repetitions of a
and shape of the fingers at the start motor program, stored in memory certain class of movements, a prototyp-
of a reaching movement are deter- and containing detailed muscle- ical representation develops, which
mined by the functional character- specific information for each move- was termed a programming rule.
istics of the object (eg, different for m e n t . l l ~ 3 ~The
3 ~ logical consequence
a telephone and a cup).2983O Rosen- of such an explanation, however, Hence, what formerly was thought to
baum et a13l showed that, in reach- would be that there are as many mo- be an almost infinite set of detailed
ing, people occasionally adopt awk- tor programs as there are possibilities motor programs now becomes a lim-
ward starting postures to end up in to move. Each movement would re- ited set of acquired programming
comfortable ones. He gives the fol- quire its own motor program. The rules. Together, these rules form a
lowing example: A waiter is reach- performance of novel movements is "grammar of action," which functions
ing for a glass that has been placed difficult to explain by means of such a as the interface between cognition
upside down on a table. The waiter motor program. Therefore, the con- and action.
reached for the glass with an under- cept of a rigid motor program has
hand posture, that is, with his been rejected in favor of a much Programming
thumb pointing down. After picking more abstract concept, which I will
up the glass, he turned it over to fill term a "programming rule," that to a Programming is the construction of
it with water. In principle, the large degree is similar to a schema ad hoc motor programs on the basis
waiter could have reached for the rule as described by Schmidt1s13and of acquired rules and the actual infor-
glass with an overhand grip, but this others for motor control37-39 as well mation available in the environment.
would have put him in the awkward as for cognitive skill a~quisition.2.~0 It is argued here that programming
position of having to hold the glass consists of at least two processes:
with his thumb pointing down dur- I argue that, at the level of response planning and parameter specification.
ing the pouring operation. To avoid selection, a detailed response is not Planning is operationally defined as
ending in this awkward position, the selected from the "central nervous the temporal ordering of the se-
waiter initially grabbed the glass in warehouse." Instead, a programming quence of operations necessary to
a manner that was relatively rule, which should be seen as a very perform a required act effi~iently.~~
uncomfortable.3l(p~32~-323) abstract and prototypical representa- Everyone who works with brain-
tion of the task, is selected. The pro- damaged patients is familiar with
This example clearly indicates the gramming rule contains an amodal planning errors, that is, errors against
subtle interaction between knowledge representation of the task that is not the correct ordering of an act. In
and movement. Its importance is true specifically visual, acoustic, or hap- functional acts, such as preparing a
not only for complex acts, such as Consider, for example, a charac- cup of coffee or spreading butter and
dancing or musical performances, but ter such as the letter B. At the highest marmalade on a piece of bread, it is
also for very simple acts, such as level of control, this character is rep- the sequence in which the individual
pushing a button or moving a lever.32 resented as an amodal prototype, con- elements should be performed that is
These movements must be based on taining no information about its size, mixed up by the patient, whereas the
basic computations concerning the or about the muscles needed to write individual movements themselves are
length of the arm, the place where it on a sheet of paper o r to etch it in performed satisfactorily.4345
the arm actually is, the distance to the the sand with your foot, or about how

Physical Therapy /Volume 71, Number 2 /February 1991

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Parametric specij?cation refers to the rule). Fb4 informs the system about der at one or more of the above-
adding of context- and task-dependent the quality of the task performance in described processes. To understand
information (eg, force, direction) to relation to the determined goal. When the character of the pathology, how-
the motor program under construc- the desired goal has been obtained, ever, it is often not sufficient to study
tion.16 Patients with Parkinson's dis- the information is stored in memory the motor apparatus; a neuropsy-
ease shoa: among many other defi- to increase the existing knowledge chological analysis of the system as an
cits, the inability to specify the correct base. Fb5 plays a role in the regula- integrated (cognitive-perceptual-
force parameter.46 tion of posture. Although the number motor) network, uniquely linked to
of feedback loops is strictly arbitrary its environment, is required.
Postural Control and although the presented diagram
is a simplification, it is clear that in Motor acts are not regulated by
All movements are normally and most the model the total ensemble of means of muscle-specific, detailed
easily made against the background of response-produced information plays motor programs, but are constructed
postural stability. When a person ex- a crucial role in the regulation of on the basis of stored rules. How
tends an arm to reach for a cup, the movements. The continuous stream of these rules are reacquired is the topic
arm has to be controlled, but so must afferent information is needed for the of the next section.
other parts of the body (eg, the trunk). development and updating of the pro-
Before the arm can move, a large set gramming rules. Rehabllhtlon Therapy as
of muscles involved in postural control the Reacqulsltlon d Rules
must be activated. The work of Asa- Regulation entirely by feedback, how-
tryan and Fe11dman,47Belen'kii et alt8 ever, is often unsatisfactory,because A large part of therapy can be seen as
and Lee49 indicated that postural ad- the feedback operates only after faulty a learning process during which pa-
justments take place before movement output has already appeared, so it tients must master new skills (eg,
starts. The work of Lee and col- compensates for disturbances that walking with a prosthesis or ambulat-
leagues5wj2 showed that visual input may no longer be present.56 There- ing with a wheelchair) or must reac-
plays an important role in this anticipa- fore, the motor system also operates quire old skills (eg, walking or speak-
tory postural activity. Perceptual input with a feedforward control mode. ing). The therapist is, in essence, a
allows postural mechanisms to be Feedfonuard can be defined as the designer of learning situations. Al-
tuned to future disturbances.5+55 sending of some signal ahead of the though everyone uses the word
response in order to prepare the sys- "learning," learning is an abstract con-
lnltlatlon tem for inp~t.l3~37~3~This preparation cept that is difficult to define pre-
may take the form of the introduction cisely. Generally, learning is seen as a
The sequence of computational pro- of a specific bias or it may just be a set of processes associated with prac-
cesses ends with the actual initiation temporary increase in sensitivity.38 tice or experience and leading to a
of the movement. The postural system fully exploits this relatively stable change in behavior.13
sort of feedforward control.13.47-49 Hence, real learning effects should be
Feedback and Feedforward more o r less permanent and must be
There is a close resemblance between distinguished from performance ef-
A large set of afferent inputs inform the feedforward principle and older fects, which are temporary changes of
the higher levels of the system about concepts such as corollary discharge short duration attributable to in-
the state of the lower levels. Several or efference ~opy.57,5~ The basic idea creased motivation or arousal.59.60
types of feedback loops can be distin- behind these concepts is that efferent I have already argued that motor
guished (here arbitrarily defined as information destined for the effector learning is not the learning of muscle
Fbl-Fb5) that end at several levels. mechanisms is also sent to brain areas control o r movement control, but the
Fbl informs the lower levels of the that are primarily sensory in nature. acquisition of programming rules that
system about the selected parameter This information alerts these areas to enable the subject to behave flexibly
specifications, whereas Fb2 contains anticipate the arrival of the response- under different conditions.
information concerning the sequenc- produced feedback. A reference of
ing of the act. Note that planning and correctness is established against The process-oriented model, as pre-
parametric errors may occur without which the feedback of the actual sented in this article, implicates three
affecting response selection; that is, a movement will be compared. crucial requirements for the acquisi-
correctly selected programming rule tion of programming rules: (1) the
may result in a disordered execution Summary availability of adequate feedback and
because of a planning and/or para- knowledge of results (KR), (2) vari-
metric error. Hence, errors in re- Movements are the visible end result ability of practice, and (3) adequate
sponse (rule) selection should be of a complex series of serial and par- design of the learning situation (ac-
distinguished from programming er- allel processes in which information cording to the "law" of identical ele-
rors. Fb3 informs the system about is transformed. Motor pathology can ments) (see works by MuldelGl and
the selected response (the selected be studied as the reflection of a disor-

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Mulder and H ~ l s t i j n ~It~ is
) . important the first stages of therapy when the than the routinely used artificial (clini-
to note, however, that these require- task is new to the patient and when cal) task conditions.
ments are general requirements in the primary concern is to understand
that they are not necessarily of equal what has to be done and ~ O W . ~ & ~ ItO Variability of Practice
significance for every patient in all is during this phase that adequate and
situations. consistent feedback and KR,7O as well I have previously argued that a dog
as clear instructions13 and models for you never saw before can be immedi-
Feedback and Knowledge observational learning,71.72 are particu- ately recognized as a dog because a
of Results larly effective and should be used prototypical representation of a dog,
with great care by therapists. termed a rule, has been stored in
Feedback can be roughly classified memory. This rule can be "narrow"
into (1) information available prior to Many researchers have attempted to o r "broad." A narrow rule is not very
movement (eg, position of the limb, separate the motivational aspects of flexible; thus, only a limited number
relevant aspects of the environment), KR from the informational aspects. In of dog types can be recognized. The
(2) information available to guide an general, they have concluded that KR following, rather bizarre, example
ongoing response (knowledge of per- has an informational role, a conclu- may clarify this point. Suppose that
formance), and (3) information avail- sion based mainly on classical learn- your experience with dogs is very
able as a result of movement. The last ing studies such as that of Trowbridge limited and that during your entire
form of feedback has been termed and Cason,73 who showed in line- life you have seen only large dogs of
"response-produced feedback,"l3 o r drawing tasks that KR stated in quanti- a certain kind (eg, German shep-
"information feedback."63,64This form tative terms (eg, +2, -4) was more herds). It is plausible that this limited
of feedback can be further subdivided effective than KR stated in qualitative experience would lead to a rather
into two classes: (1) intrinsic feed- terms (eg, right, wrong). I argue, narrow (representation) rule. Some-
back, which refers to the wide variety however, that such a dichotomy is thing like this can be observed in
of information inherent to the pro- false; motivation and information can- small children.
duction of a movement (ie, muscle not be separated." Indeed, the sub-
spindle information; tendon informa- ject must be motivated to pick up the Although we do not know whether
tion; joint-receptor information; audi- presented information (which can something similar exists in motor
tory, tactile, and visual cues), and increase the motivation further). learning, the following analogy is in-
(2) extrinsic information, which is Against this background, the data pre- triguing. Suppose a trainee (or pa-
information provided about the task sented by Locke74Jj are interesting. tient) exercises by repeating a correct
in addition to those sources of feed- Locke showed, in a series of visual response in the same context. It is
back that are usually perceived when reaction-time tasks, that the amount of tempting to suggest that the learner
a response is made. Extrinsic informa- information o r specificity of KR did will acquire a task representation
tion (KR) can be presented verbally, not govern performance, but rather (rule) that is rather narrow and fully
mechanically, or electronically to the the goals that the subjects set for conditioned to the training context.
performer to indicate the outcome of themselves in relation to the informa- A similar argument was made by
the performance. This information tion they received (see works by Jen- Schmidt,lo who predicted that the rule
can be used to represent the error in sen et al,76S~hendel,~' Patrick and for a class of actions becomes
the performance as compared with M~tlusoy,~"nd Newe1179 for a general broader as the motor skills acquisi-
some defined goal. Annett and Kay65 discussion of KR and motor learning). tion or practice process becomes
have referred to KR as essential to more variable. Variability refers to
motor learning (also see Annett's There exists ample evidence for the practice in a range of task conditions
book entitled Feedback a n d Human statement that feedback and KR are of instead of repeating the same move-
Behavior), and Newellh7viewed KR as crucial importance for the learning or ments under essentially identical
the single most important variable therapy process and that therapists learning conditions.
governing the acquisition of skills. should be well aware of the impor-
tance of KR for learning. 10113359-70380.81 The practical implications for rehabili-
Most motor tasks performed in natu- Without adequate information, it is tation are clear. For example, gait
ral settings by healthy subjects pro- almost impossible to redevelop pro- training (after hemiplegia or a serious
vide the performer immediately and gramming rules. Furthermore, al- orthopedic problem) would normally
automatically with KR. Because the though less supported by data, I ar- take place in a physical therapy de-
patient with motor dysfunction often gue that the positive effects of partment under very predictable con-
also has sensory and perceptual prob- feedback and KR may be further in- ditions. The progress achieved under
lems, he or she is totally dependent creased by performing tasks that are these conditions, however, often does
on the therapist for information con- inherently motivating for the patients. not generalize to daily-life situations
cerning the outcomes of his or her In general, tasks performed under (see the works of Wilson82and Gou-
attempts to perform motor tasks. This everyday environmental conditions vier83 for similar arguments).
dependence is especially true during will fulfill this requirement better

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2015 71, Number 2 /February 1991
 To improve the generalization value learned in these two situations also sition of muscle control or movement
of the therapy result, the variability of will be different. If a therapy situation control, but as the acquisition of pro-
practice should be increased. The is characterized by a rather artificial gramming rules. The present model is
therapy should not take place solely and predictable learning environment of particular importance for under-
under relatively simple and predict- in which the patient has to repeat the standing how these rules are ac-
able conditions, but under a range of same movement patterns, I contend quired. It presents a view of motor
different conditions (eg, flat floor, that the patient will learn these pat- learning and a new look at the under-
sand o r gravel walking surfaces, with terns, but often not more than that. standing of motor disorders, namely,
and without obstacles, with and with- The therapist is doomed to fail. Even as the reflection of a disordered net-
out noise, combined with secondary though motor behaviors learned in the work instead of a disordered motor
tasks). For a real relearning of gait, it clinical setting can last even over rela- apparatus. The model is of less im-
is necessary to create a "learning tively long periods, there is no guaran- portance for the explanation of pre-
landscape" in which relevant aspects tee that the learned motor patterns can programmed o r "hard-wired" motor
of the environment can be simulated or will be applied in other situations. patterns (eg, walking) in healthy sub-
and implemented into the therapy. jects. These motor patterns, to a large
Furthermore, the development of The home situation, on the other degree, are regulated by fast "hard-
home training programs should be hand, is characterized by the continu- ware" mechanisms that function in
stimulated. ous availability of KR and by a large direct interaction with the environ-
degree of variability. It obeys the "law" mental input and d o not need the
Design of the Learning Situation of identical elements and therefore slow computational "software" as de-
provides better conditions for learning. scribed here.
1 have argued that separate movements Indeed, the cooperation and motiva-
play no role in the learning process tion of the brain-injured person will Final Remarks
and that detailed, muscle-specific com- be maximal if the tasks are inherently
binations are not learned, but rather interesting and ecologically relevant. In this article, a model has been de-
abstract programming rules are devel- scribed that may be of value for the
oped. The usefulness of these rules for Conclusions development of a theory-based physi-
daily-life activities depends to a high cal therapy approach. Because cogni-
degree on the structure of the therapy Movement should not be seen solely tion, perception, and action cannot be
approach. A therapy approach focused in terms of motor systems but as the separated, physical therapy cannot be
at the level of muscles and separate output of a complex integrated func- seen as a learning process directed
movements, that is, at the "repair" of tional system closely linked to the only at the reacquisition and reorgani-
distorted elements, will inevitably re- environment of the organism. Clearly, zation of movements. There is cur-
sult in the production of narrow rules no absolute separation can be made rently an urgent need for integrated
of limited. value, often only applicable between cognitive, perceptual, and theory-based therapeutical procedures
in a specific therapy situation. In the motor mechanisms. Sperry,85 in 1952, aimed at the restoration of motor be-
previous section, I have argued that criticized the arbitrary separation be- havior. Only a few attempts have been
the generalization value of the therapy tween mental and motor functions, made to develop such procedures
can be irnproved by increasing the and TrevarthenS6 wrote that visual (see the work of Carr et ale' for one
variability of practice. I believe variabil- perception and the plans for volun- of the exceptions). The present article
ity alone, however, is not enough. tary action are so intimately bound should be seen as a modest contribu-
The patient should be exercised in a together that they may be considered tion toward the development of such
setting resembling real-life conditions, products of one cerebral function. a theory-based treatment procedure.
or even in the real world itself In More recently, Turvey was even more
classical psychology (see article by clear when he stated,
Thorndikee*), it was proposed that References
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 A Process-Oriented Model of Human Motor Behavior:
Toward a Theory-Based Rehabilitation Approach
Theo Mulder
PHYS THER. 1991; 71:157-164.

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