Improving motor performance: Selected aspects of augmented feedback in exercise and health

Augmented-Feedback Training Improves Cognitive Motor Performance of Soccer Players

PURPOSE

In this study, we tested the hypothesis that augmented feedback (AF) training can improve both perceptual-cognitive and/or motor skills specific to soccer.

METHODS

Three groups of young elite players (U14-U15 categories) performed a test consisting in passing the ball as accurately and as quickly as possible toward a visual target moving briefly across a large screen located at 6 m from the player. The performed task required players to correctly perceive the target, anticipate its future location, and to adequately adjust the pass direction and power. The control group (CON) performed normal soccer training and was compared with two visuomotor training groups (AF and no-feedback [NF]) that followed the same training regime but integrated series of 32 passes three times per week over a 17-d period into their normal soccer training. Objective measurements of the passing performance were provided using a high-technology system (COGNIFOOT) before, during, and after training. During training, only players of the AF group received visuoauditory feedback immediately after each trial informing them about the accuracy of their passes.

RESULTS

The results show that only players of the AF group significantly improved passing accuracy, reactiveness, and global passing performance (+22%), whereas the NF group only improved passing accuracy. None of these parameters was improved in the CON group. The objectively measured changes in passing performance were compared with the more subjectively judged passing performance provided by coaches and players. Coaches' judgments were more reliable than players' judgments and exhibited a training group effect comparable to the ones objectively measured by COGNIFOOT.

CONCLUSIONS

This study provides evidence that the training of cognitive motor performance in soccer players highly benefits from the use of augmented feedback.

Effects of Vibrotactile Biofeedback Coding Schemes on Gait Symmetry Training of Individuals With Stroke

Variations in biofeedback coding schemes for postural control, in recent research, have shown significant differences in performance outcomes due to variations in coding schemes. However, the application of vibrotactile biofeedback coding schemes to gait symmetry training is not well explored. In this paper, we devised various vibrotactile biofeedback modes and identified their efficacy during gait symmetry training of individuals suffering from hemiparesis due to stroke. These modes are composed of variations in vibration type (on-time or intensity), and relation type (proportional or inversely-proportional) with the error in symmetry ratio. Eight individuals with stroke participated in walking trials. From dependent t-tests on the collected data, we found improved achievement of temporal gait symmetry while utilizing all the provided biofeedback modes compared to no biofeedback (P < 0.001). Furthermore, two-way repeated measures ANOVA revealed statistically significant difference in symmetry ratio for main effect of vibration type (P-value = 0.016, partial eta squared = 0.585). The participants performed better with modes of biofeedback with varying vibration on-times. Furthermore, participants showed better performance when the biofeedback varied proportionally with the error. These findings suggest that biofeedback coding schemes may have a significant effect on the performance of gait training.

Effects of Combined Versus Singular Verbal or Haptic Feedback on Acquisition, Retention, Difficulty, and Competence Perceptions in Motor Learning

While augmented feedback (AF) is widely acknowledged to affect motor learning, the effects of mode of feedback on motor learning acquisition, retention, and perceived competence has rarely been studied. The present investigation analyzes the effects of verbal, haptic, and combined (verbal and haptic) feedback when learning a novel gymnastic parallel bars task. Forty-eight physical education students and four expert gymnastics teachers participated in the study. We divided the students into three AF groups (verbal, haptic, and combined) and a no-feedback control group (CG). One gymnastics teacher led the learning sessions, while the others evaluated student performances following familiarization, acquisition, and retention learning phases. All sessions were video recoded, and the experts gave blind assessments according to an adapted gymnastic point code. We recorded task perceived difficulty (PD) and students' perceived self-competency throughout the sessions. A repeated measures analysis of variance revealed a significant effect of AF mode on acquisition and retention such that combined AF was best for learning stability and retention (19.1% improvement for combined vs. 9.9% for haptic and 6.9% for verbal). Similarly, participants in the combined AF group, relative to the verbal and haptic AF groups, also reported lower perceived difficulty and higher perceived self-competency after the retention phase. PE teachers are encouraged to combine verbal and haptic AF when teaching new motor skills.

Dual Mode Gait Sonification for Rehabilitation After Unilateral Hip Arthroplasty

The pattern of gait after hip arthroplasty strongly affects regeneration and quality of life. Acoustic feedback could be a supportive method for patients to improve their walking ability and to regain a symmetric and steady gait. In this study, a new gait sonification method with two different modes—real-time feedback (RTF) and instructive model sequences (IMS)—is presented. The impact of the method on gait symmetry and steadiness of 20 hip arthroplasty patients was investigated. Patients were either assigned to a sonification group (SG) (n = 10) or a control group (CG) (n = 10). All of them performed 10 gait training sessions (TS) lasting 20 min, in which kinematic data were measured using an inertial sensor system. Results demonstrate converging step lengths of the affected and unaffected leg over time in SG compared with a nearly parallel development of both legs in CG. Within the SG, a higher variability of stride length and stride time was found during the RTF training mode in comparison to the IMS mode. Therefore, the presented dual mode method provides the potential to support gait rehabilitation as well as home-based gait training of orthopedic patients with various restrictions.

The use of motor learning and neural plasticity in rehabilitation for ataxic hemiparesis: A case report

Background and Purpose: Although the principles of neural plasticity for stroke rehabilitation are well established, specific intervention plans for patients with ataxia following a lacunar infarct are not well described. The purpose of this case report is to describe the intervention program for a patient with ataxic hemiparesis based on principles of motor learning and neural plasticity. Case Description: An 83-year-old, socially active male presented to the emergency department with right-sided upper extremity weakness and ataxia. The patient's acute hospital course included 4 days in a stoke unit, followed by 13 days in inpatient rehabilitation. Intervention: A 3-phase graded mobility and coordination plan was used during inpatient rehabilitation. Interventions included function-based training with repeated ambulation, coordination activities for the upper and lower extremities, and strengthening to help the patient achieve his goal of walking "without gait deviations." The concepts of motor learning and neural plasticity were utilized for timing and feedback on patient errors when implementing this novel program. Outcomes: The patient's level of assistance for mobility and activities of daily living improved from minimal assistance to modified independence without use of an assistive device. The Dynamic Gait Index score improved from 16/24 to 20/24 suggesting a decreased fall risk. Discussion: This case report describes a novel intervention strategy for a patient with ataxia following a lacunar stroke. The application of the principles of neural plasticity and motor learning was the foundation for a function-based plan of care.

Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury - A qualitative study

Objectives

It is well known that physical activity levels for persons after stroke or acquired brain injuries do not reach existing recommendations. Walking training is highly important since the ability to walk is considered to be a meaningful occupation for most people, and is often reduced after a brain injury. This suggests a need to innovate stroke rehabilitation, so that forms of walking training that are user-friendly and enjoyable can be provided.

Method

An interview study was carried out with persons after stroke (n = 8), or acquired brain injury (n = 2) at a rehabilitation unit at Sahlgrenska University Hospital. We used a semi-structured interview guide to investigate experiences and thoughts about walking on a treadmill with non-immersive virtual reality feedback. The contents were analyzed through an inductive approach, using qualitative content analysis.

Results

The virtual reality experience was perceived as enjoyable, exciting, and challenging. Participants stressed that the visual and auditory feedback increased their motivation to walk on a treadmill. However, for some participants, the virtual reality experience was too challenging, and extreme tiredness or fatigue were reported after the walking session.

Conclusions

Participants’ thoughts and experiences indicated that the Virtual Reality walking system could serve as a complement to more traditional forms of walking training. Early after a brain injury, virtual reality could be a way to train the ability to handle individually adapted multisensory input while walking. Obvious benefits were that participants perceived it as engaging and exciting.

The role of sensory augmentation for people with vestibular deficits: Real-time balance aid and/or rehabilitation device?

This narrative review highlights findings from the sensory augmentation field for people with vestibular deficits and addresses the outstanding questions that are critical to the translation of this technology into clinical and/or personal use. Prior research has demonstrated that the real-time use of visual, vibrotactile, auditory, and multimodal sensory augmentation technologies can improve balance during static and dynamic stance tasks within a laboratory setting. However, its application in improving gait requires additional investigation, as does its efficacy as a rehabilitation device for people with vestibular deficits. In some locomotor studies involving sensory augmentation, gait velocity decreased and secondary task performance worsened, and subjects negatively altered their segmental control strategies when cues were provided following short training sessions. A further question is whether the retention and/or carry-over effects of training with a sensory augmentation technology exceed the retention and/or carry-over effects of training alone, thereby supporting its use as a rehabilitation device. Preliminary results suggest that there are short-term improvements in balance performance following a small number of training sessions with a sensory augmentation device. Long-term clinical and home-based controlled training studies are needed. It is hypothesized that sensory augmentation provides people with vestibular deficits with additional sensory input to promote central compensation during a specific exercise/activity; however, research is needed to substantiate this theory. Major obstacles standing in the way of its use for these critical applications include determining exercise/activity specific feedback parameters and dosage strategies. This paper summarizes the reported findings that support sensory augmentation as a balance aid and rehabilitation device, but does not critically examine efficacy or the quality of the research methods used in the reviewed studies.

Vibrotactile feedback as a tool to improve motor learning and sports performance: a systematic review

BACKGROUND

Evidence concerning the use of vibrotactile feedback for acquiring and learning new motor skills is limited. Although various concepts and applications for tactile feedback have been proposed, little is known about the suitability of this feedback mechanism in sports training.

AIM

The goal of this systematic review was to gather knowledge on the efficacy of the use of vibrotactile feedback in improving sports performance skills.

DESIGN

Systematic review.

METHODS

Comprehensively searched databases were: PubMed, Cochrane and Web of Science. Studies investigating the effects of using vibrotactile feedback in sports training in healthy subjects were included in this review.

RESULTS

No consensus was found regarding the positive effectiveness on performance using vibrotactile feedback in a sports context. No evidence was found that the addition of tactile feedback is effective for acquiring new motor skills. None of the studies show a significant learning effect.

The effects of video game therapy on balance and attention in chronic ambulatory traumatic brain injury: an exploratory study

Background

Patients with traumatic brain injury often have balance and attentive disorders. Video game therapy (VGT) has been proposed as a new intervention to improve mobility and attention through a reward-learning approach. In this pilot randomized, controlled trial, we tested the effects of VGT, compared with a balance platform therapy (BPT), on balance, mobility and selective attention in chronic traumatic brain injury patients.

Methods

We enrolled chronic traumatic brain injury patients (n = 21) that randomly received VGT or BPT for 3 sessions per week for 6 weeks. The clinical outcome measures included: i) the Community Balance & Mobility Scale (CB&M); ii) the Unified Balance Scale (UBS); iii) the Timed Up and Go test (TUG); iv) static balance and v) selective visual attention evaluation (Go/Nogo task).

Results

Both groups improved in CB&M scores, but only the VGT group increased on the UBS and TUG with a between-group significance (p < 0.05). Selective attention improved significantly in the VGT group (p < 0.01).

Conclusions

Video game therapy is an option for the management of chronic traumatic brain injury patients to ameliorate balance and attention deficits.

Trial registration

NCT01883830, April 5 2013.

The effects of a single bout of exercise on motor memory interference in the trained and untrained hemisphere

Increasing evidence suggests that cardiovascular exercise has positive effects on motor memory consolidation. In this study, we investigated whether a single session of high-intensity interval training (HIIT) mitigates the effects of practicing an interfering motor task. Furthermore, learning and interference effects were assessed in the actively trained and untrained limb as it is known that unilateral motor learning can cause bilateral adaptations. Subjects performed a ballistic training and then the HIIT either before (HIIT_before) or after (HIIT_after) practicing an interfering accuracy task (AT). The control group (No_HIIT) did not participate in the HIIT but rested instead. Performance in the ballistic task (BT) was tested before and after the ballistic training, after the exercise and practice of the AT and 24h later. After ballistic training, all groups showed comparable increases in performance in the trained and untrained limb. Despite the practice of the AT, HIIT_before maintained their BT performance after the high-intensity interval training whereas HIIT_after (trend) & No_HIIT showed prominent interference effects. After 24h, HIIT_before still did not show any interference effects but further improved ballistic motor performance. HIIT_after counteracted the interference resulting in a comparable BT performance after 24h than directly after the ballistic training while No_HIIT had a significantly lower BT performance in the retention test. The results were similar in the trained and untrained limb. The current results imply that a single session of cardiovascular exercise can prevent motor interference in the trained and untrained hemisphere. Overall learning was best, and interference least, when HIIT was performed before the interfering motor task.

Maximizing Performance: Augmented Feedback, Focus of Attention, and/or Reward?

Purpose

Different approaches like providing augmented feedback (aF), applying an external focus of attention (EF), or rewarding participants with money (RE) have been shown to instantly enhance motor performance. So far, these approaches have been tested either in separate studies or directly against each other. However, there is no study that combined aF, EF, and/or RE to test whether this provokes additional benefits. The aim of the present study was therefore to identify the most powerful combination.

Methods

Eighteen participants performed maximal countermovement jumps in six different conditions: neutral (NE), aF, RE, aF + EF, aF + RE, and aF + EF + RE.

Results

Participants demonstrated the highest jump heights with aF + EF, followed by aF + EF + RE, aF + RE, aF, RE, and finally, NE. Activity of the M. rectus femoris differed significantly between conditions resulting in lower muscular activity in aF + EF and aF + EF + RE compared with NE. All other parameters, such as ground reaction forces and joint angles, were comparable across conditions.

Conclusions

This is the first study showing superior performance when combining aF with EF. As reduced muscular activity was found only in conditions with EF, it is argued in line with the constrained action hypothesis that adopting an EF improves movement efficiency. In contrast, aF seems to rather enhance (intrinsic) motivation. However, monetary reward did not further amplify performance.

Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? - A Narrative Review of the Literature

In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.

Force and Position Control in Humans - The Role of Augmented Feedback

During motor behaviour, humans interact with the environment by for example manipulating objects and this is only possible because sensory feedback is constantly integrated into the central nervous system and these sensory inputs need to be weighted in order meet the task specific goals. Additional feedback presented as augmented feedback was shown to have an impact on motor control and motor learning. A number of studies investigated whether force or position feedback has an influence on motor control and neural activation. However, as in the previous studies the presentation of the force and position feedback was always identical, a recent study assessed whether not only the content but also the interpretation of the feedback has an influence on the time to fatigue of a sustained submaximal contraction and the (inhibitory) activity of the primary motor cortex using subthreshold transcranial magnetic stimulation. This paper describes one possible way to investigate the influence of the interpretation of feedback on motor behaviour by investigating the time to fatigue of submaximal sustained contractions together with the neuromuscular adaptations that can be investigated using surface EMG. Furthermore, the current protocol also describes how motor cortical (inhibitory) activity can be investigated using subthreshold TMS, a method known to act solely on the cortical level. The results show that when participants interpret the feedback as position feedback, they display a significantly shorter time to fatigue of a submaximal sustained contraction. Furthermore, subjects also displayed an increased inhibitory activity of the primary cortex when they believed to receive position feedback compared when they believed to receive force feedback. Accordingly, the results show that interpretation of feedback results in differences on a behavioural level (time to fatigue) that is also reflected in interpretation-specific differences in the amount of inhibitory M1 activity.

Effectiveness of knowledge of result and knowledge of performance in the learning of a skilled motor activity by healthy young adults

[Purpose] The acquisition of motor skills are fundamental to human life. There is a lack of research on whether knowledge of performance or knowledge of result as augmented feedback is more effective. The objective of this study was to compare the effectiveness of knowledge of result and knowledge of performance in the learning of a skilled motor activity by healthy young adults. [Subjects and Methods] A total of thirty healthy young adult males and females without any neurological or musculoskeletal impairment, between the age of 18-30 years were the subjects of the study. They were randomly allocated to 2 groups: group 1 was given knowledge of result as feedback, and knowledge of performance was given as feedback to group 2. Both the groups practiced the task of throwing a soft spongy ball for 6 days per week for 4 weeks, with 40 trials each day. The outcome measure used was the distance of the throw. [Results] The results were analyzed using the t-test. The mean distances thrown by both the groups showed highly significant improvements and throwing distance of group 2 showed better improvement than that of group 1. [Conclusion] Both types of augmented feedback were effective at improving skilled motor activity, but the knowledge of performance group showed better improvement than the knowledge of result group.

Multidisciplinary Views on Applying Explicit and Implicit Motor Learning in Practice: An International Survey

Background

A variety of options and techniques for causing implicit and explicit motor learning have been described in the literature. The aim of the current paper was to provide clearer guidance for practitioners on how to apply motor learning in practice by exploring experts’ opinions and experiences, using the distinction between implicit and explicit motor learning as a conceptual departure point.

Methods

A survey was designed to collect and aggregate informed opinions and experiences from 40 international respondents who had demonstrable expertise related to motor learning in practice and/or research. The survey was administered through an online survey tool and addressed potential options and learning strategies for applying implicit and explicit motor learning. Responses were analysed in terms of consensus (≥ 70%) and trends (≥ 50%). A summary figure was developed to illustrate a taxonomy of the different learning strategies and options indicated by the experts in the survey.

Results

Answers of experts were widely distributed. No consensus was found regarding the application of implicit and explicit motor learning. Some trends were identified: Explicit motor learning can be promoted by using instructions and various types of feedback, but when promoting implicit motor learning, instructions and feedback should be restricted. Further, for implicit motor learning, an external focus of attention should be considered, as well as practicing the entire skill. Experts agreed on three factors that influence motor learning choices: the learner’s abilities, the type of task, and the stage of motor learning (94.5%; n = 34/36). Most experts agreed with the summary figure (64.7%; n = 22/34).

Conclusion

The results provide an overview of possible ways to cause implicit or explicit motor learning, signposting examples from practice and factors that influence day-to-day motor learning decisions.

Measuring kinematic variables in front crawl swimming using accelerometers: a validation study

Objective data on swimming performance is needed to meet the demands of the swimming coach and athlete. The purpose of this study is to use a multiple inertial measurement units to calculate Lap Time, Velocity, Stroke Count, Stroke Duration, Stroke Rate and Phases of the Stroke (Entry, Pull, Push, Recovery) in front crawl swimming. Using multiple units on the body, an algorithm was developed to calculate the phases of the stroke based on the relative position of the body roll. Twelve swimmers, equipped with these devices on the body, performed fatiguing trials. The calculated factors were compared to the same data derived to video data showing strong positive results for all factors. Four swimmers required individual adaptation to the stroke phase calculation method. The developed algorithm was developed using a search window relative to the body roll (peak/trough). This customization requirement demonstrates that single based devices will not be able to determine these phases of the stroke with sufficient accuracy.

Enhanced jump performance when providing augmented feedback compared to an external or internal focus of attention

Factors such as an external focus of attention (EF) and augmented feedback (AF) have been shown to improve performance. However, the efficacy of providing AF to enhance motor performance has never been compared with the effects of an EF or an internal focus of attention (IF). Therefore, the aim of the present study was to identify which of the three conditions (AF, EF or IF) leads to the highest performance in a countermovement jump (CMJ). Nineteen volunteers performed 12 series of 8 maximum CMJs. Changes in jump height between conditions and within the series were analysed. Jump heights differed between conditions (P < 0.001), resulting in best performance with AF (32.04 ± 7.11 cm), followed by EF (31.21 ± 6.67 cm) and IF (30.77 ± 6.87 cm). Significantly different (P < 0.001) within-series effects of higher jump heights at the end of the series in AF (+1.60%) and lower jump heights at the end of the series in EF (-1.79%) and IF (-1.68%) were observed. Muscle activity did not differ between conditions. The differences between conditions and within the series provide evidence that AF leads to higher performance and better progression within one series than EF and IF. Consequently, AF seems to outperform EF and IF when maximising jump height.

Effects of acoustic feedback training in elite-standard Para-Rowing

Assessment and feedback devices have been regularly used in technique training in high-performance sports. Biomechanical analysis is mainly visually based and so can exclude athletes with visual impairments. The aim of this study was to examine the effects of auditory feedback on mean boat speed during on-water training of visually impaired athletes. The German National Para-Rowing team (six athletes, mean ± s, age 34.8 ± 10.6 years, body mass 76.5 ± 13.5 kg, stature 179.3 ± 8.6 cm) participated in the study. Kinematics included boat acceleration and distance travelled, collected with Sofirow at two intensities of training. The boat acceleration-time traces were converted online into acoustic feedback and presented via speakers during rowing (sections with and without alternately). Repeated-measures within-participant factorial ANOVA showed greater boat speed with acoustic feedback than baseline (0.08 ± 0.01 m·s(-1)). The time structure of rowing cycles was improved (extended time of positive acceleration). Questioning of athletes showed acoustic feedback to be a supportive training aid as it provided important functional information about the boat motion independent of vision. It gave access for visually impaired athletes to biomechanical analysis via auditory information. The concept for adaptive athletes has been successfully integrated into the preparation for the Para-Rowing World Championships and Paralympics.