{"doi":"10.1093/ptj/pzac084","title":"Author Response to Macpherson et al","abstract":"We thank Macpherson et al1 for their interest in our manuscript and the editors for the opportunity to respond. We hope that the continued conversation about motor learning in physical therapy will lead to a comprehensive understanding of what is currently known about this important topic and, ultimately, produce improved patient outcomes. In this response, we aim to provide clarity about the different mechanisms of motor learning and how they can be used to guide physical therapist practice and education. First, we agree with Macpherson et al that these 4 motor learning mechanisms (use-dependent, instructive, reinforcement, and sensorimotor adaptation-based motor learning) likely co-occur to drive changes in movement, and the relative weight of each can change depending on the task constraints or stage of practice. However, current evidence suggests that these mechanisms are distinct from one another (for examples, see Roemmich et al2 and Diedrichsen et al3) and engage networks in different areas of the brain (for examples, see Therrien et al4 and Slachevsky et al5). Importantly, this means the amount each contributes to a sustained change in movement control can be manipulated and reweighted by altering the task structure. This multiplicity of mechanisms for motor learning might be a powerful tool for physical therapists across areas of practice, but we must first understand the rules governing how each of them operates. A key property of these motor learning mechanisms is that they are not necessarily yoked or dependent on one another. Although each mechanism requires that multiple movement trials or repetitions be completed, the neural process underlying the changes in movement during and after practice differ depending on the structure and the amount of task practice. More specifically, use-dependent learning and sensorimotor adaptation motor learning can operate simultaneously and one can be preferentially targeted without engaging the other.2 Similar evidence exists for the independence of instructive1,6,7 and reinforcement learning4 from sensorimotor adaptation and use-dependent learning. This is why we displayed the motor learning mechanisms to be parallel to one another in Figure 2 of the original manuscript. These distinct mechanisms operate in parallel (versus serially), which means that (1) each can be individually targeted and (2) if one is impaired (in the case of a neurologic injury or disease) the others are still available to enable motor learning. That said, further research is needed to better understand how these distinct, parallel learning mechanisms might interact during motor learning.8,9 Macpherson et al also point out that our paper does not directly cover the application of this knowledge to neurologic patient populations. The choice not to include this topic in the paper was intentional for the following reasons. First, we wanted to keep the topic broadly applicable to multiple practice areas of physical therapy practice (eg, orthopedics, neurologic, pelvic health, etc). As such, a nuanced discussion about the application of these concepts to different neurologic populations was beyond the scope of the original article. Second, there is not yet enough evidence to indicate how disorders of the nervous system might impact the translation of these principles into practice. Nevertheless, Macpherson et al highlight an important line of inquiry that deserves more attention—should a motor learning mechanism that relies on a part of the brain that is damaged be intentionally bypassed? Or, should that form of motor learning be incorporated to promote plasticity in that brain area? In the case of Parkinson disease (PD) that Macpherson et al discuss, reduced dopaminergic signaling likely results in less responsivity to rewards.10 Thus, patients with PD have an impaired or reduced capacity for reinforcement or reward-based motor learning, so targeting other motor learning mechanisms should be prioritized to pro","journal":"Physical Therapy","year":2022,"id":303626,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.963,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":324110,"name":"Ryan T. Roemmich","orcid":"0000-0003-0797-6455","position":1,"is_corresponding":false},{"id":628868,"name":"James Gordon","orcid":"0000-0001-9494-0586","position":2,"is_corresponding":false},{"id":408286,"name":"Darcy S. Reisman","orcid":null,"position":3,"is_corresponding":false},{"id":324108,"name":"Kendra M. Cherry‐Allen","orcid":"0000-0003-2692-4028","position":4,"is_corresponding":false},{"id":512258,"name":"Kristan A. Leech","orcid":"0000-0002-0443-5971","position":0,"is_corresponding":true}],"reference_count":20,"raw_metadata":null,"created_at":"2026-07-19T00:32:24.307938Z","pmid":"35713528","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}