About motor learning, procedures and more


Selected Publications

Background: People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual’s abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. Methods: A “construct map” approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. Results: Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait “balance exercises in PwMS” comprised three subdimensions (“stable BOS”, “sway” and “step and walk”). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. Conclusion: A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.
In Archives of Physiotherapy., 2021

Background: Acquisition of procedures is an important element in health professions education. Traditionally procedures are taught using a “see one - do one” approach. That is a teacher demonstrates and describes a procedure and afterwards the students practice the procedure. A more recent teaching approach for the acquisition of procedural skills was presented by Walker and Peyton. Peyton’s teaching approach is a stepwise teaching approach and consists of the following four steps: demonstration, deconstruction, comprehension and performance. The aims of this study were (i) to systematically evaluate the effectiveness of Peyton’s 4–step teaching approach on the acquisition of procedural skills in health professions education and (ii) to evaluate whether studies with fewer students per teacher showed a larger between group difference than studies with more students per teacher. Methods: We searched in Medline, PsycInfo, Embase and ERIC for eligible studies. Records were screened by two independent reviewers. A random effects meta-analysis was performed to evaluate skill acquisition and time needed to perform the procedures at post-acquisition and retention tests. A meta-regression was used to explore the effect of the number of students per teacher on the estimated effect of the educational interventions. Results: An effect size of 0.45 SMD (95% CI [0.15; 0.75]) at post-acquisition and 0.7 SMD (95% CI [−0.09; 1.49]) at retention testing were in favour of Peyton’s teaching approach for skill acquisition. The groups using Peyton’s teaching approach needed considerably less time to perform the procedure at post-acquisition (SMD: −0.8; 95% [CI −2.13 to 1.62]) and retention (SMD: −2.65; 95% CI [−7.77 to 2.47]) testing. The effectiveness of Peyton’s teaching approach was less clear in subgroup analyses using peer teachers. Meta-regression showed that the number of students per teacher was an important moderator variable.Conclusion: Peyton’s teaching approach is an effective teaching approach for skill acquisition of procedural skills in health professions education. When peer students or student tutors are used as teachers the effectiveness of Peyton’s teaching approach is less clear. Peyton’s teaching approach is more effective when small groups with few students per teacher are used.
In PeerJ., 2020

Recent Publications

More Publications

. Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis. In Archives of Physiotherapy., 2021.


. The assessment of procedural skills in physiotherapy education: a measurement study using the Rasch model. In Archives of Physiotherapy., 2020.


. Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review. In BMJ Open Sport & Exercise Medicine., 2020.


. A systematic review of assessments for procedural skills in physiotherapy education. In International Journal of Health Professions., 2017.

PDF Project

. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. In British Journal of Sports Medicine (BJSM)., 2017.


. A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education. In BMC Medical Education., 2016.


Recent Posts

The shiny app was designed as additional information regarding our paper on robot assisted gait training in people with MS.

Within the app users can interact with the published data. For example, it is possible to exlcude studies from the analysis based on the risk of bias during allocation concealment. In addition, the study size is a possible selection criteria.



This talk was presented at the World Confederation for Physical Therapy Congress 2019 in Geneva.

Please have a look at the handouts or a video recording of the talk


“ELEJ” (Easy Life and Experience joy) was developed based on a systematic review of studies reporting about home programmes for people with Parkinson. Effectiveness and structural parameters of the exsiting programmes were appraised and based on this findings “ELEJ” was proposed. More information is available on www.ELEJ.ch. This programme was developed by Jessica Loosli and Elena Steiner.



Assessment of movement control impairments of the neck

Neck pain is a complex frequently recurring problem with various underlying factors that could play a role in maintaining pain (e.g. catastrophizing, unfavourable work conditions, sensorimotor impairments)

Assessments of procedures in physiotherapy education

Within this project an assessment tool for procedural skills in physiotherapy education was designed and evaluated.

LEArN trial

The World Confederation for Physical Therapy (2011) state in their educational policy, that learning and mastering of procedural skill is an essential part in the education of future physiotherapists. Procedural skills are defined as “a motor skill involving a series of discrete responses each of which must be performed at the appropriate time in the appropriate sequence” (Kent 2007, p. 437). Some researcher (e.g. Wulf et al. (2010)) suggested to apply a specific set of training principles, so called “motor learning principles”, derived from the learning of movement skills to the learning of procedural skills in health professions education. Within the LEArN study we explored the application of mental practice and different attentional foci on the acquisition of complex skills in physiotherpay education. The LEArN trial is one of my doctoral research projects at QMU


I am a teaching instructor for the following courses at the HES-SO Valais-Wallis:

  • PHY_1006: An introduction to neurological rehabilitation
  • PHY_1008: Active seniors
  • PHY_2002: Neurological rehabilitation
  • PHY_2005: Evidence based practice
  • PHY_3001: Complex cases in neurological rehabilitation
  • PHY_3008: Tutoring bachelor theses