A Comparison of Manual Guidance and Knowledge of Results in the Learning of a Weight-bearing Skill

Ben Sidaway, PT, MA, PhD, Soyeon Ahn, PT, Pansy Boldeau, PT, Scott Griffin, PT,Bethany Noyes, PT, and Kristin Pelletier, PT

(JNPT 2008;32: 32–38)
DOI: 10.1097/NPT.0b013e318165948d

Background and Purpose:

Patients with certain neurological or
orthopedic conditions often present with asymmetrical weight-bearing
in stance. In the treatment of such patients, physical therapists
often use manual guidance to promote symmetrical weight-bearing.
Research investigating the efficacy of manual guidance to effect a
change in weight-bearing status however, is lacking. As a first step
in assessing the utility of such guidance, the present study compared
the effect of providing two frequencies of manual guidance and of
knowledge of results (KR) in the learning of a weight-bearing skill
in healthy subjects.
Subjects and Methods: Forty healthy subjects (20 males and 20
females) with a mean age of 21.8 years (SD 4.9 years) were
randomly assigned to one of four groups differentiated on the basis
of the type and frequency of information provided for learning.
Subjects were required to learn to distribute their weight on their feet
at a 70:30 ratio. Following a pretest, one group of subjects was
positioned by experimenter-provided manual guidance at the hips
until 70% of their weight was on one foot, as determined by a
bathroom scale. This guidance was provided on every trial for 10
blocks of 12 trials (GD100%). A second group was provided with
guidance on every third trial (GD33%), with the other two trials
being performed without any assistance. A third group was verbally
provided with KR regarding the percentage of body weight on the
test foot after every trial (KR100%) while the final group was given
KR after every third trial (KR33%). Following acquisition, retention
tests were performed 10 minutes, one day, and one week later during
which no feedback or guidance was given.
Results: No difference between groups was found at the pretest, but
an analysis of variance performed on the accuracy of achieving the
70% goal in retention revealed main effects for technique and
frequency. These effects were overshadowed by a significant interaction
of these variables with retention test. Analysis of this interaction
revealed that the most accurate performance was exhibited by
the KR33% group while the GD100% group consistently exhibited
the poorest learning. The GD33% and KR100% groups showed a
decrease in performance accuracy with time following practice.