Thinking about muscles: the neuromuscular effects of attentional focus on accuracy and fatigue

An external focus promotes motor learning of an aiming task in individuals with hearing impairments

Research has shown that external relative to internal focus (IF) instructions may improve motor performance as well as cognitive function (e.g., attentional stability and task-focus). The aim of the study was to examine the influence of attentional focus instructions on skill acquisition and learning of an aiming task in individuals with hearing impairments. The participants (N = 39, Mage = 17.87 ± 1.88 years) performed a bowling task with their dominant hand to knock down as many pins as possible. On day 1, they were randomly divided into three attentional focus groups; IF (focus on your throwing hand), external focus (EF) (focus on the pins), and control (no-focus) instructions. Each participant performed 36 trials, divided into 3 blocks of 12 trials. Attentional focus instructions were given before each block, with a brief reminder provided after each 3 trials. On day 2, retention and transfer (further distance) tests were performed. Results showed that while there were no significant differences between groups in the pre-test, the EF group outperformed both IF and control groups in retention and transfer tests. No significant difference was found between the control and IF. The findings suggest that the advantages of the external relative to the IF and no-focus instructions may generalize to individuals with hearing impairments.

Modulation of reaching by spatial attention

Attention is needed to perform goal-directed vision-guided movements. We investigated whether the direction of covert attention modulates movement outcomes and dynamics. Right-handed and left-handed volunteers attended to a spatial location while planning a reach toward the same hemifield, the opposite one, or planned a reach without constraining attention. We measured behavioral variables as outcomes of ipsilateral and contralateral reaching and the tangling of behavioral trajectories obtained through principal component analysis as a measure of the dynamics of motor control. We found that the direction of covert attention had significant effects on the dynamics of motor control, specifically during contralateral reaching. Data suggest that motor control was more feedback-driven when attention was directed leftward than when attention was directed rightward or when it was not constrained, irrespectively of handedness. These results may help to better understand the neural bases of asymmetrical neurological diseases like hemispatial neglect.

Attentional focus differentially modulates the corticospinal and intracortical excitability during dynamic and static exercise

Although attentional focus affects motor performance, whether corticospinal excitability and intracortical modulations differ between focus strategies depending on the exercise patterns remains unclear. In the present study, using single- and paired-pulse transcranial magnetic stimulation and peripheral nerve stimulation, we demonstrated changes in the cortical and spinal excitability under external focus (EF) and internal focus (IF) conditions with dynamic or static exercise. Participants performed the ramp-and-hold contraction task of right index finger abduction against an object (sponge or wood) with both exercises. They were asked to concentrate on the pressure on the sponge/wood induced by finger abduction under the EF condition, and on the index finger itself under the IF condition. Motor-evoked potential (MEP) and F-wave in the premotor, phasic, or tonic phase, and short- and long-interval intracortical inhibition (SICI and LICI, respectively), and intracortical facilitation (ICF) in the premotor phase were examined by recording surface electromyographic activity in the right first dorsal interosseous muscle. Increments in the MEP amplitude were larger under the EF condition than under the IF condition in the dynamic, but not static, exercise. The F-wave, SICI, and LICI did not differ between focus conditions in both exercises. In the dynamic exercise, interestingly, ICF was greater under the EF condition than under the IF condition and positively correlated with the MEP amplitude. These results indicate that corticospinal excitability and intracortical modulations to attentional focus differ depending on exercise patterns, suggesting that attentional focus differentially affects the central nervous system responsible for diverse motor behaviors.NEW & NOTEWORTHY We investigated attentional focus-dependent corticospinal and intracortical modulations in dynamic or static exercise. The corticospinal excitability was modulated differentially depending on the focus of attention during dynamic, but not static exercise. Although the reduction of intracortical GABAergic inhibition was comparable between focus conditions in both exercises, intracortical facilitation was smaller when focusing on the internal environments in the dynamic exercise, resulting in lower activation of the corticospinal tract.

Effect of a Novel Training Program in Patients With Chronic Shoulder Pain Based on Implicit Motor Learning: Pilot and Feasibility Study

Background

Implicit motor learning has been shown to be effective for learning sports-related motor skills. It facilitates automaticity of movements and thereby improves performance in multitasking and high-pressure environments. Motor learning to develop motor skills and neuroplastic capacities is not sufficiently incorporated in musculoskeletal rehabilitation. Especially in patients with chronic pain conditions like shoulder pain this approach might benefit over traditional exercise programs.

Purpose/hypothesis

The aim of this study was to investigate the feasibility and clinical outcome of a new implicit motor learning exercise program in a group of patients with chronic shoulder pain.

Study design

Pilot and feasibility cohort study.

Methods

Twenty-six patients with chronic shoulder pain performed a 6-week home exercise program with weekly remote follow up by a physiotherapist. The program comprised five exercises designed to challenge overall body balance, simultaneously engaging the upper limbs in a range of reaching tasks. The tasks included reaching above the head, at and below waist level, in various directions. No instructions on correct performance were provided to foster external focus. Feasibility was assessed by (1) recruitment rate, (2) follow up rate, (3) subjective experience, (4) self-reported adverse events and (5) self-reported adherence of subjects. Clinical effects of the program were assessed with (1) the Shoulder Pain and Disability Index (SPADI), (2) the Auto-Constant score, (3) the numeric rating scale (NRS) at rest and at night, (4) the patient specific functional scale (PSFS), (5) the avoidance endurance questionnaire (AEQ), (6) patient acceptable symptom state (PASS) and (7) a global rating of change (GROC).

Results

The study protocol was feasible in terms of follow up rate (16w for 28 patients), exercise adherence (77.1%± 29.41), and adverse events (no serious, 5 light adverse events). Statistically significant improvements were observed for SPADI (p<0.001), NRS at rest (p=0.033), at night (p=0.29), PSFS (p<0.001) and PASS (p<0.001) after only six weeks training.

Conclusion

This study reveals promising results of another way of looking at exercise for patients with chronic shoulder pain. Both feasibility and clinical effects of the program on pain and function was acceptable. Future studies should incorporate a control group, provide longer follow up and include objective measurements.

Level of evidence

2b.

Golf skill learning: An external focus of attention enhances performance and motivation

An external focus of attention has been shown to enhance the performance and learning of motor skills, relative to an internal focus (see Chua, Jimenez-Diaz, Lewthwaite, Kim, & Wulf, 2021). In the present study, we examined possible motivational consequences of learners' experience of greater movement success with an external focus. Participants were asked to learn a golf pitch shot. In addition to measuring learning, we assessed self-efficacy, as well as positive and negative affect in groups that received external versus internal focus instructions. Furthermore, we examined the feasibility of providing several focus instructions in the same practice session as the learning of complex skills typically requires more than one instructional cue. The results showed that skill learning was enhanced by instructions that promoted external foci, as measured by golf shot accuracy on delayed retention and transfer tests. The external focus group also showed higher positive affect and reduced negative affect at the end of practice, and higher self-efficacy before retention testing, compared with the internal focus group. These findings provide support for several assumptions of the OPTIMAL theory (Wulf & Lewthwaite, 2016). From a practical perspective, they highlight the attentional and motivational benefits of an external focus.

[Combined influence of psychological and biomechanical factors in muscular loads in soccer : A new approach for the prevention of muscle injuries]

When mental stress and musculoskeletal loading interact, the risk for injury increases due to altered body kinematics and increased muscle tension. These changes can be detected with musculoskeletal models, and mental loading and stress must be analyzed at emotional, cognitive, and behavioral levels. To investigate these kinematic and loading changes under stress, competitive athletes were subjected to mental stress during highly dynamic movements, and musculoskeletal models were used to analyze the biomechanical loading. It was shown that under mental stress, independent of the subjective perception, a strong change in muscle forces can occur. Accordingly, competitive athletes should undergo screenings to assess individual movement patterns and promote general stress resilience.

Sleep-push movement performance in elite field hockey champions with and without training specialization

Objective

To investigate kinematic and muscle activity differences during the sleep-push movement in elite field hockey players. We hypothesized that players with specialized sleep-push movement training (specialists) would possess a lower center of mass (CoM) and enhanced reproducibility of muscle activations during the movement, compared to players without explicit movement training (non-specialists).

Methods

Ten field hockey players of the Belgian national field hockey team performed the sleep-push movement (5 specialists and 5 non-specialists). Muscle activity and kinematic data were recorded using EMG to evaluate the reproducibility of muscle activations by cross-correlation analysis and power spectral features across the movement, while a motion capture system was used to assess kinematics.

Results

Compared to non-specialists, specialists had significantly (p < 0.05) increased stick velocity (9.17 ± 1.28 m/s versus 6.98 ± 0.97 m/s) and lower CoM height (141 ± 52 mm versus 296 ± 64 mm), during the second part of the shot. Specialists also showed a significant (p < 0.05) lower power spectrum in the activity of the upper limb muscles before the shot. Superimposition of the auto crosscorrelation results demonstrated a high degree of reproducibility in specialists' muscle activations.

Conclusion

Sleep-push movements realized by elite players who are specialists in the sleep-push movement presented significant kinematics and muscular activation differences when compared to the sleep-push movements realized by elite players who were not specialists in such movement. Characterization of the specific movement and the related high-level performer's muscular strategies offers the possibility of translating sport science findings into functional training with concrete applications for coaches, players, and other key stakeholders for the continued development of the field.

That looks easy! Evidence against the benefits of an easier criterion of success for enhancing motor learning

OPTIMAL theory predicts providing learners with a relatively easier criterion of success during practice enhances motor learning through increased self-efficacy, perceptions of competence, and intrinsic motivation. However, mixed results in the literature suggest this enhancement effect may be moderated by the number of successes achieved by learners practicing with the difficult criterion. To investigate this possibility, we manipulated quantity of practice to affect the absolute number of successes achieved by learners practicing with different success criteria. Eighty participants were divided into four groups and performed 50 or 100 trials of a mini-shuffleboard task. Groups practiced with either a large or a small zone of success surrounding the target. Learning was assessed 24 h after acquisition with retention and transfer tests. In terms of endpoint accuracy and precision, there were no learning or practice performance benefits of practicing with an easier criterion of success, regardless of the number of trials. This absence of a criterion of success effect was despite the efficacy of our manipulation in increasing the number of trials stopping within the zone of success, self-efficacy, perceptions of competence, and, for participants with 100 trials, intrinsic motivation. An equivalence test indicated that the effect of criterion of success was small, if existent. Moreover, at the individual level, intrinsic motivation did not predict posttest or acquisition performance. There were no benefits of easing the criterion of success on pressure, effort, accrual of explicit knowledge, or conscious processing. These data challenge key tenets of OPTIMAL theory and question the efficacy of easing criterion of success for motor learning.

Cerebellar Excitability Regulates Physical Fatigue Perception

Fatigue is the subjective sensation of weariness, increased sense of effort, or exhaustion and is pervasive in neurologic illnesses. Despite its prevalence, we have a limited understanding of the neurophysiological mechanisms underlying fatigue. The cerebellum, known for its role in motor control and learning, is also involved in perceptual processes. However, the role of the cerebellum in fatigue remains largely unexplored. We performed two experiments to examine whether cerebellar excitability is affected after a fatiguing task and its association with fatigue. Using a crossover design, we assessed cerebellar inhibition (CBI) and perception of fatigue in humans before and after "fatigue" and "control" tasks. Thirty-three participants (16 males, 17 females) performed five isometric pinch trials with their thumb and index finger at 80% maximum voluntary capacity (MVC) until failure (force <40% MVC; fatigue) or at 5% MVC for 30 s (control). We found that reduced CBI after the fatigue task correlated with a milder perception of fatigue. In a follow-up experiment, we investigated the behavioral consequences of reduced CBI after fatigue. We measured CBI, perception of fatigue, and performance during a ballistic goal-directed task before and after the same fatigue and control tasks. We replicated the observation that reduced CBI after the fatigue task correlated with a milder perception of fatigue and found that greater endpoint variability after the fatigue task correlated with reduced CBI. The proportional relation between cerebellar excitability and fatigue indicates a role of the cerebellum in the perception of fatigue, which might come at the expense of motor control.SIGNIFICANCE STATEMENT Fatigue is one of the most common and debilitating symptoms in neurologic, neuropsychiatric, and chronic illnesses. Despite its epidemiological importance, there is a limited understanding of the neurophysiological mechanisms underlying fatigue. In a series of experiments, we demonstrate that decreased cerebellar excitability relates to lesser physical fatigue perception and worse motor control. These results showcase the role of the cerebellum in fatigue regulation and suggest that fatigue- and performance-related processes might compete for cerebellar resources.

External Focus Reduces Accuracy and Increases Antagonist Muscle Activation in Novice Adolescent Soccer Players

Instep kick is one of the most effective kicking techniques in soccer. Lower extremity muscles and joints play a crucial role during instep kick. However, external (EF) and internal focus and their effect on the muscles are still ambiguous. In this study, 13 male adolescent soccer players were included and aimed to hit the targets in internal and EF conditions. Lower extremity muscle activations were measured with surface electromyography, and kinematics were measured with a high-speed video camera. Muscle activations and movement latencies were analyzed in four different phases (backswing, leg cocking, acceleration, and follow-through) of kicking. While 10 out of 13 participants kicked accurately in internal focus, only five out of 13 in EF kicked accurately. Gastrocnemius muscle activations increased significantly in EF in all phases except acceleration. Movement latencies were found 0.07 ± 0.002 s for accurate and 0.05 ± 0.004 s for inaccurate kicks in EF. A correlation has been found between accuracy and movement latency in EF (R = .67). Our results suggest that novices cannot yet coordinate their muscles in EF, cocontraction ratio increases. Therefore, training strategies that aim to reduce the cocontraction ratio can help the athlete increase performance through better motor coordination. Moreover, better motor coordination may be beneficial in preventing injuries (joint stiffness, etc.) caused by increased cocontraction ratio.

Functional Outcomes of Motor Learning Interventions in Anterior Cruciate Ligament Injuries

Anterior cruciate ligament injury is one of the pathologies that affect the daily and professional life of the majority of athletes. When the treatment options are examined, there are two options surgical treatment and conservative treatment. Rehabilitation is essential in both cases, with or without surgery. Especially for returning to sports, long-term rehabilitation after surgery has become essential. While many different exercise methods have been tried in the prevention of anterior cruciate ligament injury and rehabilitation after reconstructive surgery, many have focused on strength training. The abnormal movement pattern that occurs with the somatosensory loss seen after anterior cruciate ligament injury results in a functional loss in the injured extremity and the contralateral extremity in the long term. Considering the incidence of injury, studies to establish the normal movement pattern and restore motor control are very important. For this reason, motor learning-based interventions that support neuroplasticity are of great interest today. This review aims to examine the functional results of current motor learning-based interventions in anterior cruciate ligament rehabilitation in line with the literature.

The Absence of Vision Impacts Attentional Focus Effects During a Balancing Task

Purpose: Recent work involving reaching and aiming tasks provides evidence that an internal focus results in less error than an external focus when visual information is removed. The purpose of this study was to extend these findings by determining how an internal and external focus impact motor performance during a balancing task for adults with and without visual occlusion. Method: Thirty-two undergraduate students were randomly assigned to perform the task with or without visual occlusion. Participants balanced on a stability platform during four familiarization trials, three internal focus trials, and three external focus trials. Results: A significant Focus x Vision interaction indicated the group without visual occlusion had significantly lower root mean square error (RMSE) with an external focus, whereas the group with visual occlusion had lower RMSE with an internal focus. Conclusions: These findings indicate that for tasks that rely on online sensory feedback, such as balancing, the optimal attentional focus may be dependent on the dominant type of sensory feedback that is available.

External and internal focus of attention differentially modulate corticospinal excitability in anticipatory postural adjustments

Whether attentional focus modulates the corticospinal excitability of the lower limb muscles in anticipatory postural adjustments (APAs) when performing a ballistic movement of the upper limb remains unclear. The present study used transcranial magnetic stimulation (TMS) to examine the corticospinal excitability of the lower limb muscles along with the kinematic profiles during dart throwing with different attentional foci, external focus (EF) and internal focus (IF). In 13 healthy participants, TMS was applied immediately before electromyographic onset of the tibialis anterior (TA) muscle, and the motor evoked potential (MEP) was recorded in the TA and soleus (SOL) muscles. The performance accuracy was significantly higher in the EF condition than in the IF condition. In both EF and IF conditions, MEP amplitude in the TA muscle, but not the SOL muscle, was significantly higher immediately before TA muscle onset (- 100, - 50, and 0 ms) compared to the control. In particular, the MEP increment in the TA muscle before TA muscle onset (- 50 and 0 ms) was significantly larger in the EF condition than in the IF condition. Our findings provide the first evidence for the modulation of corticospinal excitability in APA by changing attentional focus.

An external focus of attention enhances table tennis backhand stroke accuracy in low-skilled players

The aim of the study was to determine the impact of internal and external (proximal and distal) attentional focus on table tennis backhand stroke accuracy in low-skilled players. Fifty-one undergraduate physical education (PE) students were randomly assigned to 3 groups: Group G1 (IF) was instructed to focus on the hand holding the paddle, Group G2 (EFP) was instructed to focus on the ball, while Group G3 (EFD) was instructed to focus on targets marked on the tennis table. The experimental groups followed identical instructions except for the instruction about the focus of attention. Participants were asked to score as many points as possible by hitting the ball inside the three smallest targets marked on the tennis table. They were required to do so using a backhand stroke. The practice session consisted of 45 trials in three blocks of backhand (15 trials at each target). A special scoring system was used to determine the accuracy of the strokes. One of the most important findings from the current research was that groups with an external focus of attention revealed significant improvements in accuracy in the post-test, while the group with an internal focus of attention achieved low training effects. No significant difference was observed between G2 (EFP) and G3 (EFD) in the delayed retention test, which indicates that proximal and distal attentional focus had similar effects on table tennis backhand stroke accuracy in low-skilled players.

A Pilot Study on Attentional Focus in Prescribing Physical Exercise in Outpatients with Obesity

This pilot study compared the effects of two attentional focus strategies on fitness parameters and body composition in outpatients with obesity. This was a randomized, controlled study that enrolled 94 obese individuals and allocated them into an internal focus group (IF) or an external focus group (EF) while performing six weeks of a home-based training program. The home-based exercise program was the same for both groups except for the instructions that shifted the attention to an external or an internal condition. At the beginning and after the intervention period, participants were assessed for functional performance using the Functional Movement Screen (FMS), body balance using the Modified Balance Error Scoring System (M-BESS) and muscular strength with the Handgrip Strength Test (HST) and the Five-Repetition Sit-To-Stand (FRSTS) test. Concerning body composition and anthropometric parameters, the body mass index (BMI) and fat mass percentage (FM%) were calculated. Significant improvements, main interactions and effects of time and groups were highlighted in the EF group as compared to the IF group in FMS (35% vs. 21%), M-BESS (42% vs. 18%), HST (13% vs. 7%) and FRSTS (23% vs. 12%) measures, while FM% (5%) and BMI (6% vs. 5%) showed a similar improvement overtime (p < 0.001). In conclusion, our findings provide initial evidence that a 6-week training program performed following external focus instruction is able to promote significant enhancements in movement efficiency, balance and muscular strength as compared to an internal focus cue. Fitness coaches and therapists might consider integrating a specific attentional focus strategy when designing rehabilitation programs in subjects with obesity.

Steady, Aim, Fire! Optimized Instructions Enhance Performance and Reduce Intra-Trial Variability in a Shooting Task

The present study examined the influence of the individual and sequential combination of the key components of OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory (i.e., enhanced expectancies, autonomy support, and external focus), on the performance of a laser-pistol shooting task. In addition to shooting accuracy, intra-trial variability in the sway of forearm/pistol motion prior to movement execution (pulling the trigger) was the primary variable of interest. In a between-within-subject design, thirty-six participants (Mage = 21.27 ± 1.75 years) were randomized into either a control or an optimized group. Enhanced expectancies, autonomy support, and an external focus were implemented via sequential blocks of trials for participants in the optimized group. Participants in the control group performed all trials under “neutral” conditions. Our results showed that motor performance was enhanced for participants in the optimized group compared to those in the control group. Moreover, greater reductions in forearm sway leading up to the trigger pull were observed for the optimized group compared to the control group. These findings suggest higher movement effectiveness and efficiency, potentially through better attunement to task and environmental constraints, when implementing optimized instructions in a self-initiated fine motor task.

A scoping review of the application of motor learning principles to optimize myoelectric prosthetic hand control

Although prosthetic hand rejection rates remain high, evidence suggests that effective training plays a major role in device acceptance. Receiving training early in the rehabilitation process also enhances functional prosthetic use, decreases the likelihood of developing an overreliance on the intact limb, and reduces amputation-related pain. Despite these obvious benefits, there is a current lack of evidence regarding the most effective training techniques to facilitate myoelectric prosthetic hand control, and it remains unknown whether training is effective in facilitating the acquisition and transfer of prosthetic skill. In this scoping review, we introduced and summarized key motor learning principles related to attentional focus, implicit motor learning, training eye-hand coordination, practice variability, motor imagery, and action observation, and virtual training and biofeedback. We then reviewed the existing literature that has applied these principles for training prosthetic hand control before outlining future avenues for further research. The importance of optimizing early and appropriate training cannot be overlooked. While the intuition and experience of clinicians holds enormous value, evidence-based guidelines based on well-established motor learning principles will also be crucial for training effective prosthetic hand control. While it is clear that more research is needed to form the basis of such guidelines, it is hoped that this review highlights the potential avenues for this work.

The Recovery of Weight-Bearing Symmetry After Total Hip Arthroplasty Is Activity-Dependent

This study aimed to characterize ipsilateral loading and return to weight-bearing symmetry (WBS) in patients undergoing total hip arthroplasty (THA) during activities of daily living (ADLs) using instrumented insoles. A prospective study in 25 THA patients was performed, which included controlled pre- and postoperative follow-ups in a single rehabilitation center of an orthopedic department. Ipsilateral loading and WBS of ADLs were measured with insoles in THA patients and in a healthy control group of 25 participants. Measurements in the THA group were performed at 4 different visits: a week pre-THA, within a week post-THA, 3–6 weeks post-THA, and 6–12 weeks post-THA, whereas the healthy control group was measured once. ADLs included standing comfortably, standing evenly, walking, and sit-to-stand-to-sit (StS) transitions. All ADLs were analyzed using discrete methods, and walking included a time-scale analysis to provide temporal insights in the ipsilateral loading and WBS waveforms. THA patients only improved beyond their pre-surgery levels while standing comfortably (ipsilateral loading and WBS, p < 0.05) and during StS transitions (WBS, p < 0.05). Nevertheless, patients improved upon their ipsilateral loading and WBS deficits observed within a week post-surgery across all investigated ADLs. Ipsilateral loading and WBS of THA patients were comparable to healthy participants at 6–12 weeks post-THA, except for ipsilateral loading during walking (p < 0.05) at the initial and terminal double-leg support period of the stance phase. Taken together, insole measurements allow for the quantification of ipsilateral loading and WBS deficits during ADLs, identifying differences between pre- and postoperative periods, and differentiating THA patients from healthy participants. However, post-THA measurements that lack pre-surgery assessments may not be sensitive to identifying patient-specific improvements in ipsilateral loading and WBS. Moreover, StS transitions and earlier follow-up time points should be considered an important clinical metric of biomechanical recovery after THA.

Mental stress reduces performance and changes musculoskeletal loading in football-related movements

Purpose: Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Hence, this study investigated the musculoskeletal response of elite youth football players during highly dynamic movements under stress. The hypothesis is that mental stress reduces performance and changes the muscular forces exerted.Materials & methods: Twelve elite youth football players were subjected to mental stress while performing sports-specific change-of-direction movements. A modified version of the d2 attention test was used as stressor. The kinetics are computed using inverse dynamics. Running times and exerted forces of injury-prone muscles were analysed.Results: The stressor runs were rated more mentally demanding by the players (p = 0.006, r_s = 0.37) with unchanged physical demand (p = 0.777, r_s = 0.45). This resulted in 10% longer running times under stress (p < 0.001, d = -1.62). The musculoskeletal analysis revealed higher peak muscle forces under mental stress for some players but not for others.Discussion: The study shows that motion capture combined with musculoskeletal computation is suitable to analyse the effects of stress on athletes in highly dynamic movements. For the first time in football medicine, our data quantifies an association between mental stress with reduced football players' performance and changes in muscle force.

Neuromuscular training programs predominantly include instructions that promote an internal focus

Neuromuscular training programs that include movement pattern retraining and strengthening, plyometric, and balance exercises are recommended for anterior cruciate ligament injury prevention. Recent evidence suggests that the effectiveness of these programs may be enhanced when athletes train with an external focus; however, clinicians typically rely predominantly on instructions encouraging an internal focus. The aim of this study was to examine the types of instructions provided as part of popular neuromuscular training programs used for anterior cruciate ligament injury prevention. The technique-related instructions provided as part of the FIFA 11+, HarmoKnee, Knakontroll, and Prevent Injury and Enhance Performance programs were categorized as either promoting an internal focus or an external focus. Instructions provided during movement pattern retraining tasks and strengthening, plyometric, and balance training exercises were specifically examined. Next, the percentage of technique-related instructions that promoted an internal focus, versus the percentage that promoted an external focus, were compared for the various program components. Across all programs examined, the vast majority of technique-related instructions for the movement pattern re-training tasks (≥83.3%) and the strengthening, balance, and plyometric exercises (≥75.0%) appeared to promote an internal focus. Despite evidence suggesting that the effectiveness of neuromuscular training programs may be enhanced by encouraging an external focus, most technique-related instructions provided as part of popular neuromuscular training programs appear to promote an internal focus. Modifying neuromuscular training programs to promote a more external focus could help to improve the effectiveness of these programs for anterior cruciate ligament injury prevention.

Attentional Focus and Individuals’ Perceptions: A Systematic Review

Although multiple review studies have supported the superior effects of an external compared with internal focus, these reviews are based on performance outcomes. Currently, the literature lacks knowledge regarding the effects of external/internal foci on individuals’ perceptions, which may provide further explanations for how attentional focus affects performance. Therefore, the present study conducted a systematic review of survey/questionnaire data of participants’ thoughts and emotions from laboratory studies. The authors used ERIC, SPORTDiscus, PsycArticle, CINAHL Plus, Health Source Nursing Academic edition, and PubMed search engines. Literature specific to external/internal focus effects on motor learning or performance were reviewed (N = 37). The results showed that participants generally adhered to the assigned attentional focus instruction and there was a trend that preference may affect the attentional focus effects, but the results were inconsistent regarding if attentional focus cues affected the magnitude of adherence and mental demands. There were substantial differences in methodologies and theoretical issues of measuring these data. Future studies should adopt inferential statistics, choose theoretically relevant questions in a priori manner, or, at minimum, propose a hypothesis for the selected question.

Learning microvascular anastomosis: Analysis of practice patterns

BACKGROUND

Performing a successful microsurgical vascular anastomosis (MVA) is challenging and requires lots of practice. However, the most efficient practice protocol is yet to be found. We aimed to compare and analyze two major practice patterns for fine motor tasks as applied to learning MVA: distributed and mass practice protocols. Ten neurosurgeons with comparable experience in microsurgery (but no experience in vascular anastomosis) were randomized to practice MVA either using a distributed (1 session/day) or a mass practice (6 sessions/day) protocol. A total of 24 sessions of practice and 2 recall test sessions were given. Anastomosis score, time to complete a single stitch and the total time to complete an anastomosis were recorded. Mass practice protocol caused a clear fatigue effect observed toward the end of each mass practice trial block. Statistical comparison using one-way analysis of variance showed significantly higher anastomosis scores and shorter times to place a single stitch as well as to complete the anastomosis in distributed practice group for the last 3 acquisition practice trials, and the 2 recall tests (p < 0.05). The relative advantage of the distributed practice protocol could be attributed to forgetting/spacing effect. Although mass practice protocol resulted in worse performance, it still showed a gradual improvement trend in performance from beginning to the end. Therefore, certain adjustments to a mass practice protocol (such as increasing the number of practice blocks) could potentially lead to an eventual performance level comparable to a distributed protocol. This point is a subject of further investigation.

Looking beyond the binary: an extended paradigm for focus of attention in human motor performance

Focus of attention (FOA) has been shown to affect human motor performance. Research into FOA has mainly posited it as either external or internal to-the-body (EFOA and IFOA, respectively). However, this binary paradigm overlooks the dynamic interactions among the individual, the task, and the environment, which are core to many disciplines, including dance. This paper reviews the comparative effects of EFOA and IFOA on human motor performance. Next, it identifies challenges within this EFOA-IFOA binary paradigm at the conceptual, definitional, and functional levels, which could lead to misinterpretation of research findings thus impeding current understanding of FOA. Building on these challenges and in effort to expand the current paradigm into a non-binary one, it offers an additional FOA category-dynamic interactive FOA-which highlights the dynamic interactions existing between EFOA and IFOA. Mental imagery is then proposed as a suitable approach for separately studying the different FOA subtypes. Lastly, clinical and research applications of a dynamic interactive FOA perspective for a wide range of domains, from motor rehabilitation to sports and dance performance enhancement, are discussed.

Both a holistic and external focus of attention enhance the learning of a badminton short serve

Attentional focus research consistently demonstrates a benefit of an external focus relative to an internal focus. However, this dichotomous comparison may oversimplify the variety of attentional focus strategies a learner uses when acquiring a motor skill. Recent research suggests a holistic focus of attention provides a similar benefit over an internal focus in performing a standing long jump, but the generalizability of this effect is unknown. The purpose of this study was to determine how an internal (IF), external (EF), and holistic focus (HF) and control condition impact the learning of a badminton short serve. Novice participants (N = 60) were randomly assigned to IF, EF, HF, or control groups. They practiced the badminton short serve for 150 trials over 5 days and completed retention and transfer tests 48-h post-acquisition. Serve accuracy was analyzed in separate repeated-measures ANOVAs for acquisition and pretest/retention/transfer. All groups improved accuracy through acquisition with the HF group serving more accurately than the IF and control groups. In retention, the HF and EF group served more accurately than the control group, and in transfer, the HF group was more accurate than the IF and control groups. The present findings suggest a benefit of both a holistic and external focus in the learning of an accuracy-based task.

Attentional focus influences sample entropy in a balancing task

An external focus of attention has consistently been associated with improved balance (Wulf, 2013). Recent work has considered whether changes in postural control entropy, a measure of repeated movement patterns, could be a factor influencing this benefit. Rheaet al. (2019) reported that during quiet standing sample entropy when using an external focus was increased relative to baseline, whereas an internal focus did not differ from baseline. External and internal focus conditions did not differ from each other, but the authors speculated this difference may emerge with more complex balance tasks. The purpose of the present study was to determine if sample entropy and standard deviation of angular displacement differed when balancing on a stability platform while using an external, internal, or holistic focus. Young healthy adults (N = 36) completed three familiarization trials on the stability platform, followed by three trials each using an external focus (focus on keeping markers level), an internal focus (focus on keeping feet level), and a holistic focus (focus on feeling calm and stable). All trials lasted 20 s, and focus condition order was counterbalanced. Angular displacement of the platform was recorded at a frequency of 25 Hz, and sample entropy and standard deviation of angular displacement were calculated using a custom MATLAB code. Separate mixed ANOVAs for each dependent variable were used to assess differences due to focus and condition order, and Sidak post-hoc tests were used for pairwise comparisons. Results indicated an external focus led to higher sample entropy than a holistic focus (p = .001) and internal focus (p = .031). Standard deviation trended toward lower values with an external focus, but was influenced by a Focus x Order interaction. These results suggest that an external focus may promote more adaptive movement adjustments relative to a holistic focus and an internal focus.

Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

Context: The bodyweight squat exercise is a common component for treatment and prevention of patellofemoral pain; however, it can also place a high load on the patellofemoral joint. Restricting anterior motion of the knees relative to the toes during squatting appears to reduce patellofemoral loading. However, exercise professionals typically rely on verbal instructions to alter squat technique. Objective: To evaluate the influence of verbal instructions regarding squat technique on patellofemoral joint loading. Design: Cross-sectional study. Setting: Motion analysis laboratory. Participants: Eleven uninjured females. Intervention: Participants performed bodyweight squats before (baseline) and after receiving verbal instructions to limit anterior knee motion. Two different types of verbal instruction were used, one intended to promote an internal focus of attention and the other intended to promote an external focus of attention. Three-dimensional kinematics and kinetics were recorded using a multicamera system and force plate. Main Outcome Measures: Sagittal plane patellofemoral joint forces and stress were estimated using a musculoskeletal model. Results: Participants demonstrated a reduction in patellofemoral joint forces (35.4 vs 31.3 N/kg; P = .01) and stress (10.7 vs 9.2 mPa; P = .002) after receiving instructions promoting an internal focus of attention, compared with their baseline trials. Participants also demonstrated a reduction in patellofemoral joint forces (35.4 vs 32.3 N/kg; P = .03) and stress (10.7 vs 9.6 mPa; P = .04) after receiving instructions promoting an external focus of attention (vs baseline). However, there were no significant differences in patellofemoral forces (P = .84) or stress (P = .41) for trials performed with an internal versus external attentional focus. Conclusion: It appears that verbal instruction regarding knee position influences patellofemoral joint loading during squatting.

Exploring the Use of Meditation as a Valuable Tool to Counteract Sedentariness

Some forms of meditation have been recently proposed as effective tools to facilitate the handling of undesired thoughts and reappraisal of negative emotions that commonly arise during exercise-related situations. The effects of meditation-based interventions on psychological responses could also be used as a means by which to increase exercise adherence and counteract the detrimental consequences of sedentariness. In the present article, we briefly describe the effects of meditation on physical activity and related factors. We also propose a theoretical model as a means by which to further understanding of the effects of meditation on psychological, psychophysical, and psychophysiological responses during exercise. The results of very recent studies in the realms of cognitive and affective psychology are promising. The putative psychological mechanisms underlying the effects of meditation on exercise appear to be associated with the interpretation of interoceptive and exteroceptive sensory signals. This is primarily due to the fact that meditation influences the cerebral processing of physical sensations, emotions, and thoughts. In such instances, the bodily and perceptual responses that are commonly reported during exercise might be assuaged during the practice of meditation. It also appears that conscious presence and self-compassion function as an emotional backdrop against which more complex behaviors can be forged. In such instances, re-engagement to physical activity programs can be more effectively achieved through the implementation of holistic methods to treat the body and mind. The comments provided in the present paper might have very important implications for exercise adherence and the treatment of hypokinetic diseases.

Motor Program Transformation of Throwing Dart from the Third-Person Perspective

The perspective of perceiving one's action affects its speed and accuracy. In the present study, we investigated the change in accuracy and kinematics when subjects throw darts from the first-person perspective and the third-person perspective with varying angles of view. To model the third-person perspective, subjects were looking at themselves as well as the scene through the virtual reality head-mounted display (VR HMD). The scene was supplied by a video feed from the camera located to the up and 0, 20 and 40 degrees to the right behind the subjects. The 28 subjects wore a motion capture suit to register their right hand displacement, velocity and acceleration, as well as torso rotation during the dart throws. The results indicated that mean accuracy shifted in opposite direction with the changes of camera location in vertical axis and in congruent direction in horizontal axis. Kinematic data revealed a smaller angle of torso rotation to the left in all third-person perspective conditions before and during the throw. The amplitude, speed and acceleration in third-person condition were lower compared to the first-person view condition, before the peak velocity of the hand in the direction toward the target and after the peak velocity in lowering the hand. Moreover, the hand movement angle was smaller in the third-person perspective conditions with 20 and 40 angle of view, compared with the first-person perspective condition just preceding the time of peak velocity, and the difference between conditions predicted the changes in mean accuracy of the throws. Thus, the results of this study revealed that subject's localization contributed to the transformation of the motor program.

The Effects of Instruction Exercises on Performance and Kinetic Factors Associated With Lower-Extremity Injury in Landing After Volleyball Blocks

CONTEXT

Female volleyball players are more predisposed to anterior cruciate ligament injury in comparison with their male counterparts. Recent research on anterior cruciate ligament injury prevention strategies has shown the positive results of adopting the external focus (EF) of attention in sports.

OBJECTIVE

To determine the effect of 6-week EF instruction exercises on performance and kinetic factors associated with lower-extremity injury in landing after the volleyball blocks of female athletes.

DESIGN

Pretest and posttest control study.

SETTING

University research laboratory.

PARTICIPANTS

Thirty-two female volleyball players (18-24 y old) from the same team randomly divided into experimental (n = 16) and control (n = 16) groups.

INTERVENTION

The experimental group performed a 6-week exercise program with EF instructions. The control group continued its regular volleyball team schedule.

MAIN OUTCOME MEASURES

To assess function, single-leg triple hop test for distance was used. A force plate was used to evaluate kinetic variables including vertical ground reaction forces, the rate of loading, and dynamic postural stability index. All data were assessed at baseline and after the intervention.

RESULTS

There was a significant increase in single-leg triple hop test (P < .05) and in the first and second peak ground reaction force, rate of loadings, dynamic postural stability index (P < .05).

CONCLUSION

According to the results of this study, anterior cruciate ligament injury prevention programs should incorporate EF instruction exercises to enhance the kinetics and to increase athletes' functional performance.

Dart Throwing with the Open and Closed Eyes: Kinematic Analysis

Eye-hand coordination during dart throwing includes both the sensory and motor components, as well as cognitive variables, for example, the direction of the subject's attention to the target or to the hand kinematic. In the present study, subjects performed dart throws in the eyes-open and eyes-closed conditions with simultaneous recording of the kinematics of the throwing hand. The results showed that the position of the hand in its raising phase was closer to the torso when performing more accurate throws with the eyes-open condition compared to more peripheral throws and throws performed in the eyes-closed condition. Following the dart release, the position of the hand in the eyes-open condition was lower compared to the eyes-closed condition. Additionally, in the eyes-closed condition, raising the hand in its backward moving phase negatively predicts the throwing accuracy. Thus, the early phase of the movement is associated with attention, and the final phase is associated with the visual feedback about the throwing accuracy. Raising the hand in the eyes-closed condition reflects an increase in muscle tension, which leads to a decrease in the accuracy of movement. The results of the study can be applied in sports and in the treatment of hand-eye-coordination disorders.

More bang for the buck: autonomy support increases muscular efficiency

The purpose of this study was to examine whether conditions that provide performers with a sense of autonomy, by giving them choices, would increase movement efficiency. We evaluated neuromuscular activation as a function of choice, using surface electromyography (EMG), during isometric force production. Participants (N = 16) were asked to perform plantar flexions at each of three target torques (80%, 50%, 20% of maximum voluntary contractions) under both choice and control conditions. In the choice condition, they were able to choose the order of target torques, whereas the order was pre-determined in the control condition. Results demonstrated that while similar torques were produced under both conditions, EMG activity was lower in the choice relative to the control condition. Thus, providing performers with a choice led to reduced neuromuscular activity, or an increase in movement efficiency. This finding is in line with the notion that autonomy support readies the motor system for task execution by contributing to the coupling of goals and actions (Wulf and Lewthwaite, Psychon Bull Rev 23:1382-1414, 2016).

Influence of Attentional Focus Instructions on Motor Performance Among Adolescents With Severe Visual Impairment

Substantial research has demonstrated that an external (vs. internal) attentional focus enhances motor performance among various populations. Interest has recently grown in examining the effects of attentional focus among individuals with visual impairments (VI), and, to date, research results have been conflicting with some studies supporting a potential benefit to an external focus among adults with VI, while a study of children with severe VI was inconclusive regarding this benefit. The present investigation compared the effects of an internal versus an external attentional focus on a discrete throwing task among adolescents with severe VI. We recruited 13 participants with a visual acuity score of less than 6/60 and had them throw a Goalball (25 cm ball with bells often used in competitive sports designed for people with VI) as fast as possible for three familiarization trials, three internal focus trials, and three external focus trials. These participants threw the ball with significantly higher velocity when using an external focus than in other conditions, indicating a benefit from an external focus for this population when performing this discrete task.

A Systematic Review of Attentional Focus Strategies in Weightlifting

The way an athlete focuses their attention when lifting a weight has the potential to influence strength development during training and performance outcomes during competition. The effects of attentional focus strategies during weightlifting tasks was investigated through a systematic review. Major databases (SportDISCUS, PsycINFO, Scopus) were searched using key terms relevant to attentional focus and weightlifting and reference lists of identified articles were also searched. Following screening, 16 articles were retained for analysis. The review showed that researchers have recruited experienced and novice weightlifters of both genders in their studies, although male experienced weightlifters are the most commonly studied demographic. Weightlifting tasks have varied from bench press, biceps curls, squats, and leg extensions with some studies using measures of force production against a force plate. The predominant manipulations have been between internal-associative and external-associative foci. An external attentional focus has shown to be beneficial in terms of movement economy as reflected in a variety of outcome measures. The results are interpreted within the framework provided by the Constrained Action Hypothesis and more generally the advantages of an external attentional focus for motor skill learning. An external focus of attention promotes automatic control of actions, thus preventing the motor system being constrained by conscious cognitive control. Implications for informing training programs for athletes and for advising athletes to maximize performance during competition are discussed.

Target Size Manipulations Affect Error-Processing Duration and Success Perceptions but not Behavioural Indices of Learning

We evaluated if and how success perceptions, through target size manipulations, impact processes related to motor learning. This work was based on recent literature suggesting that expectations and self-efficacy exert a direct impact on learning. We measured arousal, kinematics, learner expectancies, motivation, and outcomes in a dart-throwing task. Novices (n = 29) were assigned to either a "Large-target" (horizontal target, 10-cm high) or "Small-target" (2-cm high) group for practice (t = 90), and both groups completed 24-h retention tests. The Small-target group took longer to plan and process feedback in the pre-throw and post-throw periods, respectively, and showed larger joint amplitudes early in practice compared to the Large-target group. As predicted, the Large-target group made more hits and had heightened outcome expectancies compared to the Small-target group. Surprisingly, only the Large-target group performed better than they expected. Despite the Large-target group having more target hits, enhanced expectancies, and more unexpected success, this group did not outperform the Small-target group on behavioural indices of performance and learning. This research questions assumptions and results related to success-related manipulations for task performance and mechanisms related to target size manipulations.

Revised Approach to the Role of Fatigue in Anterior Cruciate Ligament Injury Prevention: A Systematic Review with Meta-Analyses

BACKGROUND

Causes of anterior cruciate ligament (ACL) injuries are multifactorial. Anterior cruciate ligament injury prevention should thus be approached from a multifactorial perspective as well. Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury.

OBJECTIVES

The primary objective of this literature review was to summarize research findings relating to the kinematic and kinetic effects of fatigue on single-leg landing tasks through a systematic review and meta-analysis. Other objectives were to critically appraise current approaches to examine the effects of fatigue together with elucidating and proposing an optimized approach for measuring the role of fatigue in ACL injury prevention.

METHODS

A systematic literature search was conducted in the databases PubMed (1978-November 2017), CINAHL (1992-November 2017), and EMBASE (1973-November 2017). The inclusion criteria were: (1) full text, (2) published in English, German, or Dutch, (3) healthy subjects, (4) average age ≥ 18 years, (5) single-leg jump landing task, (6) evaluation of the kinematics and/or kinetics of the lower extremities before and after a fatigue protocol, and (7) presentation of numerical kinematic and/or kinetic data. Participants included healthy subjects who underwent a fatigue protocol and in whom the effects of pre- and post-fatigue on three-dimensional lower extremity kinematic and kinetics were compared. Methods of data collection, patient selection, blinding, prevention of verification bias, and study design were independently assessed.

RESULTS

Twenty studies were included, in which four types of single-leg tasks were examined: the single-leg drop vertical jump, the single-leg drop landing, the single-leg hop for distance, and sidestep cutting. Fatigue seemed to mostly affect initial contact (decreased angles post-fatigue) and peak (increased angles post-fatigue) hip and knee flexion. Sagittal plane variables at initial contact were mostly affected under the single-leg hop for distance and sidestep cutting conditions whilst peak angles were affected during the single-leg drop jump.

CONCLUSIONS

Training to resist fatigue is an underestimated aspect of prevention programs given that the presence of fatigue may play a crucial role in sustaining an ACL injury. Considering the small number of variables affected after fatigue, the question arises whether the same fatigue pathways are affected by the fatigue protocols used in the included laboratory studies as are experienced on the sports field.

The Influence of External Focus Instruction Characteristics on Children's Motor Performance

PURPOSE

Research has demonstrated that verbal instructions directing attention externally (i.e., toward the effect of the movement) significantly enhance motor skill performance, and this effect is enhanced when the distance of the external focus relative to the body is increased. However, few studies have investigated this distance-of-focus effect in children. The present study aimed to examine the effect of increasing the distance of an external focus on children's motor performance in 2 experiments.

METHOD

In Experiment 1, children performed standing long jumps under 3 instructional conditions (control, internal attentional focus, and external attentional focus). In Experiment 2, children performed standing long jumps under 4 instructional conditions (control, internal, proximal external attentional focus, and distal external attentional focus).

RESULTS

In Experiment 1, results revealed a statistically significant jump distance advantage for the external focus condition. In Experiment 2, a statistically significant jump distance advantage for the distal external focus condition was found. However, instructional and task characteristics beyond distance of focus may have been influential.

CONCLUSIONS

External focus instructions benefit children's jump performance, but specifically when they are supported by a concrete movement goal reflecting relevant performance criteria. These findings highlight the importance of examining the content of instructions and relevant task characteristics provided to children beyond attentional focus to consider their motivational characteristics.

Changing one's focus of attention alters the structure of movement variability

Substantial evidence supports the beneficial effect of an external (vs. internal) focus of attention on task performance during goal-directed movements. Counter-intuitively, an external focus has also been shown to increase joint-level movement variability.

OBJECTIVE

To determine whether shifting attentional focus can alter the structure of movement variability, thereby offering a probable mechanistic explanation for how adopting an external focus of attention might confer its benefits.

METHODS

Thirty-five healthy adults (age 23-55) performed unipedal hopping under three different attentional foci: natural (no directed focus), internal focus, and external focus. Uncontrolled manifold analysis was used to examine the structure of movement variability with respect to stabilization of leg orientation and vertical leg length during hopping. Takeoff/landing event bin and stance phase integrals of performance-irrelevant and performance-destabilizing variability were compared across focus conditions.

RESULTS

Accuracy of hopping in place improved with both external and internal foci compared to the natural condition (.004 ≤ p ≤ .035). External focus, to a greater degree than internal focus, destabilized leg orientation at takeoff and landing compared to the natural condition (.001 ≤ p ≤ .038). External focus increased - but internal focus decreased - leg length stabilization throughout stance compared to the natural condition (p < .001).

CONCLUSION

External focus was superior to internal and natural focus conditions in terms of increasing flexibility within the system to orient the leg differently at takeoff and landing to compensate for unintentional drift during hopping. An external focus increased leg length stabilization in stance by preferentially increasing the subset of variability that explores multiple successful performance options. These results provide an understanding of the mechanism underlying external focus benefits - improving movement variability/coordination.

Effects of audiovisual stimuli on psychological and psychophysiological responses during exercise in adults with obesity

The present experiment sought to further understanding of the effects of personalised audiovisual stimuli on psychological and psychophysiological responses during exercise in adults with obesity. Twenty-four participants (M_age = 28.3, SD = 5.5 years; M_BMI = 32.2, SD = 2.4) engaged in self-paced exercises on a recumbent cycle ergometer and three conditions (sensory stimulation [ST], sensory deprivation [DE], and control [CO]) were administered. Perceptual (attentional focus and perceived exertion), affective (affective state and perceived activation), and psychophysiological (heart rate variability) parameters were monitored throughout the exercise bouts. A one-way repeated measures analysis of variance was used to compare self-reported and psychophysiological variables (main and interaction effects [5 Timepoints × 3 Conditions]). The results indicate that ST increased the use of dissociative thoughts throughout the exercise session (η_p² = .19), ameliorated fatigue-related symptoms (η_p² = .15) and elicited more positive affective responses (η_p² = .12) than CO and DE. Accordingly, personally-compiled videos are highly effective in ameliorating exertional responses and enhancing affective valence during self-paced exercise in adults with obesity. Audiovisual stimuli could be used during the most critical periods of the exercise regimen (e.g., first training sessions) when individuals with obesity are more likely to focus on fatigue-related sensations.

The placebo effect in the motor domain is differently modulated by the external and internal focus of attention

Among the cognitive strategies that can facilitate motor performance in sport and physical practice, a prominent role is played by the direction of the focus of attention and the placebo effect. Consistent evidence converges in indicating that these two cognitive functions can influence the motor outcome, although no study up-to-now tried to study them together in the motor domain. In this explorative study, we combine for the first time these approaches, by applying a placebo procedure to increase force and by manipulating the focus of attention with explicit verbal instructions. Sixty healthy volunteers were asked to perform abduction movements with the index finger as strongly as possible against a piston and attention could be directed either toward the movements of the finger (internal focus, IF) or toward the movements of the piston (external focus, EF). Participants were randomized in 4 groups: two groups underwent a placebo procedure (Placebo-IF and Placebo-EF), in which an inert treatment was applied on the finger with verbal information on its positive effects on force; two groups underwent a control procedure (Control-IF and Control-EF), in which the same treatment was applied with overt information about its inefficacy. The placebo groups were conditioned about the effects of the treatment with a surreptitious amplification of a visual feedback signalling the level of force. During the whole procedure, we recorded actual force, subjective variables and electromyography from the hand muscles. The Placebo-IF group had higher force levels after the procedure than before, whereas the Placebo-EF group had a decrease of force. Electromyography showed that the Placebo-IF group increased the muscle units recruitment without changing the firing rate. These findings show for the first time that the placebo effect in motor performance can be influenced by the subject’s attentional focus, being enhanced with the internal focus of attention.

A novel approach to enhance ACL injury prevention programs

Efficacy studies have demonstrated decreased anterior cruciate ligament (ACL) injury rates for athletes participating in injury prevention programs. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. Unfortunately, improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills as needed in complex sports environments. In the motor learning domain, these types of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes' behavior.

Location versus task relevance: The impact of differing internal focus of attention instructions on motor performance

Impaired performance while executing a motor task is attributed to a disruption of normal automatic processes when an internal focus of attention is used. What remains unclear is whether the specificity of internally focused task instructions may impact task performance. The present study assessed the implications of changing the attentional focus of novice and skilled golfers by measuring behavioural, neurophysiological and kinematic changes during a golf putting task. Over six blocks of ten putting trials each, attention was directed either externally (towards the target) or internally in one of two ways: 1) proximal (keeping the elbows extended and the hands gripping the putter); or 2) distal (keeping the weight evenly distributed between both legs) to the critical elements of the task. Results provided evidence that when novice participants use an internal focus of attention more closely associated with task performance that their: 1) execution; 2) accuracy; 3) variability of surface electromyography (sEMG) activity; and 4) kinematics of the putter movement are all adversely affected. Skilled golfers are much more resilient to changes in attentional focus, while all participants interpret a distal internal focus of attention similar to an external focus. All participants produced decreased activity in the muscle (tibialis anterior) associated with the distal (less task relevant) focus of attention even when the "internal" focus was on the lower extremity. Our results provide evidence that the skill level of the participant and the distance of the internal focus of attention from the key elements of a motor skill directly impact the execution, muscle activity, and movement kinematics associated with skilled motor task performance.

Effects of auditory distraction on voluntary movements: exploring the underlying mechanisms associated with parallel processing

Highly demanding cognitive-motor tasks can be negatively influenced by the presence of auditory stimuli. The human brain attempts to partially suppress the processing of potential distractors in order that motor tasks can be completed successfully. The present study sought to further understand the attentional neural systems that activate in response to potential distractors during the execution of movements. Nineteen participants (9 women and 10 men) were administered isometric ankle-dorsiflexion tasks for 10 s at a light intensity. Electroencephalography was used to assess the electrical activity in the brain, and a music excerpt was used to distract participants. Three conditions were administered: auditory distraction during the execution of movement (auditory distraction; AD), movement execution in the absence of auditory distraction (control; CO), and auditory distraction in the absence of movement (stimulus-only; SO). AD was compared with SO to identify the mechanisms underlying the attentional processing associated with attentional shifts from internal association (task-related) to external (task-unrelated) sensory cues. The results of the present study indicated that the EMG amplitude was not compromised when the auditory stimulus was administered. Accordingly, EEG activity was upregulated at 0.368 s in AD when compared to SO. Source reconstruction analysis indicated that right and central parietal regions of the cortex activated at 0.368 s in order to reduce the processing of task-irrelevant stimuli during the execution of movements. The brain mechanisms that underlie the control of potential distractors during exercise were possibly associated with the activity of the frontoparietal network.

The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study

External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient's preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient's preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error (p < 0.01) compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated.

Cerebral mechanisms underlying the effects of music during a fatiguing isometric ankle-dorsiflexion task

The brain mechanisms by which music-related interventions ameliorate fatigue-related symptoms during the execution of fatiguing motor tasks are hitherto under-researched. The objective of the present study was to investigate the effects of music on brain electrical activity and psychophysiological measures during the execution of an isometric fatiguing ankle-dorsiflexion task performed until the point of volitional exhaustion. Nineteen healthy participants performed two fatigue tests at 40% of maximal voluntary contraction while listening to music or in silence. Electrical activity in the brain was assessed by use of a 64-channel EEG. The results indicated that music downregulated theta waves in the frontal, central, and parietal regions of the brain during exercise. Music also induced a partial attentional switching from associative thoughts to task-unrelated factors (dissociative thoughts) during exercise, which led to improvements in task performance. Moreover, participants experienced a more positive affective state while performing the isometric task under the influence of music.

An Internal Focus Leads to Longer Quiet Eye Durations in Novice Dart Players

While the benefits of both an external focus of attention (FOA) and of a longer quiet eye (QE) duration have been well researched in a wide range of sporting activities, little is known about the interaction of these two phenomena and how a potential interaction might influence performance. It was this study's aim to investigate the interaction and potential effect on performance by using typical FOA instructions in a dart throwing task and examining both the QE and performance outcome. The results replicate neither the benefit of an external FOA nor the benefit of a longer QE duration. However, an interaction was observed, as QE was prolonged by an earlier onset and later offset in the internal focus condition only. As the typical effect of a performance benefit due to an external focus could not be replicated, the interaction must be interpreted with caution. The results are discussed and interpreted in light of the inhibition hypothesis and possible avenues for future research are suggested.

Brain mechanisms that underlie the effects of motivational audiovisual stimuli on psychophysiological responses during exercise

Motivational audiovisual stimuli such as music and video have been widely used in the realm of exercise and sport as a means by which to increase situational motivation and enhance performance. The present study addressed the mechanisms that underlie the effects of motivational stimuli on psychophysiological responses and exercise performance. Twenty-two participants completed fatiguing isometric handgrip-squeezing tasks under two experimental conditions (motivational audiovisual condition and neutral audiovisual condition) and a control condition. Electrical activity in the brain and working muscles was analyzed by use of electroencephalography and electromyography, respectively. Participants were asked to squeeze the dynamometer maximally for 30s. A single-item motivation scale was administered after each squeeze. Results indicated that task performance and situational motivational were superior under the influence of motivational stimuli when compared to the other two conditions (~20% and ~25%, respectively). The motivational stimulus downregulated the predominance of low-frequency waves (theta) in the right frontal regions of the cortex (F8), and upregulated high-frequency waves (beta) in the central areas (C3 and C4). It is suggested that motivational sensory cues serve to readjust electrical activity in the brain; a mechanism by which the detrimental effects of fatigue on the efferent control of working muscles is ameliorated.

The acute effects of targeted abdominal muscle activation training on spine stability and neuromuscular control

Background

Targeted activation of the transversus abdominis (TrA) muscle through the abdominal drawing-in maneuver (ADIM) is a frequently prescribed exercise for the prevention and rehabilitation of low back pain. However, there is still debate over the role the ADIM plays in maintaining a stable spine during movement. Thus, a single cohort pre/post-intervention protocol was used to examine whether 5 min of ADIM training prior to a dynamic movement task alters dynamic spine stability and control.

Methods

Thirteen healthy participants performed a repetitive spine flexion task twice, once before and once after they received biofeedback training on how to correctly perform the ADIM in standing. Abdominal and back muscle activation (indwelling and surface electromyography, EMG) and 3D kinematic data were recorded during all trials. EMG activation (percent maximum) and local dynamic stability of spine movement [maximum finite-time Lyapunov exponent (λ_max)] were compared before and after the training using Friedman’s rank test and repeated-measures ANOVA, respectively. To assess the moderating effects of absolute changes in EMG (∆EMG) of each muscle after training on changes in stability, the ∆EMG (peak and mean) were added to the ANOVA as separate covariates (ANCOVA).

Results

Following ADIM training, there were greater peak and mean levels of activation in all tested abdominal muscles, including TrA, (p < 0.05), but not in the back muscles. The ANOVA showed no significant change in λ_max following training (p = 0.633). However, after considering the moderating effects of the ∆EMG seen in each muscle with training, it was found that only changes in TrA EMG significantly influenced stability. The ANCOVA revealed a significant main effect of training on stability as well as a significant interaction effect between training and ∆EMG recorded from TrA (p < 0.05); those with larger increases in TrA activation demonstrated larger improvements in stability.

Conclusion

As a group, 5 min of ADIM training did not change spine stability during dynamic movement. However, those who were most successful in improving TrA activation with a 5-min ADIM training session showed the greatest improvements in local dynamic spine stability after training. As such, dynamic spine stability in some individuals may benefit from ADIM training.

Electronic supplementary material

The online version of this article (doi:10.1186/s12984-016-0126-9) contains supplementary material, which is available to authorized users.