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

Dimensionality of instructional quality in physical education. Obtaining students' perceptions using bifactor exploratory structural equation modeling and multilevel confirmatory factor analysis

Background

In research on instructional quality, the generic model of the three basic dimensions is an established framework, which postulates that the three dimensions of classroom management, student support and cognitive activation represent quality characteristics of instruction that can be generalized across subjects. However, there are hardly any studies that examine if the three basic dimensions model could represent a suitable approach to measure instructional quality in physical education. Based on an extended model of the basic dimensions, a measurement model of instructional quality for physical education is presented, which integrates different theoretical approaches from the fields of educational and psychological research as well as different subfields of sports science in order to test the factorial structure of the corresponding measurement model.

Methods

1,047 students from 72 seventh to ninth grade classes from different German-speaking Swiss cantons participated in the study. The conceptualization of the instrument is based on a hybrid approach that integrates generic and subject-specific characteristics. The simultaneous analysis at the individual and class level using MCFA was supplemented by more complex methodological techniques within the relatively new B-ESEM framework at the individual level.

Results

The postulated five-factor structure was initially tested using ICM-CFA and showed a good model fit (e.g., χ2/df = 2.32, RMSEA = 0.03, CFI = 0.97, TLI = 0.97, SRMR = 0.04). MCFA revealed a differential factorial structure at both levels of analysis with five factors at the individual level and four factors at the class level (e.g., χ2/df = 2.23, RMSEA = 0.03, CFI = 0.96, TLI = 0.96, SRMR within = 0.04, SRMR between = 0.10). ESEM and B-ESEM outperformed the ICM-CFA and showed an excellent model fit (B-ESEM: χ2/df = 1.19, RMSEA = 0.01, CFI = 1.00, TLI = 1.00, SRMR = 0.01). Inter-factor correlations and factor loadings are largely in line with expectations, indicating arguments for construct validity.

Discussion

The study represents a substantial contribution in linking physical education and the generic research on instructional quality. Overall, strong arguments for the factorial structure of the measurement model were demonstrated. The study can be interpreted as a first step in a multi-step procedure in terms of further validity arguments.

Real-time visual feedback can cue changes in grip force during electric hand tool operation

Objectives. Grip force applied during repetitive hand tool use varies amongst individuals and some apply more force than necessary. Augmented feedback may help modify grip force to reduce the risk of developing cumulative trauma disorders but has been scarcely investigated during electric hand tool operation. This study evaluated the feasibility of using real-time visual feedback to modify grip force and forearm electromyography (EMG) during electric hand tool operation. A secondary objective was to evaluate the effect of hand and tool orientation on any effects of visual feedback. Methods. Grip force and forearm muscle EMG were recorded as participants fastened bolts at three locations (low, high and overhead) using an electric pistol-grip nut-runner, without and with visual feedback. Results. Feedback decreased grip force (36.1% decrease; p < 0.001) and EMG of three wrist flexor muscles (22.8-33.0%; p < 0.008). Grip force and EMG also differed between fastening locations, but there were no interactions with condition (baseline and feedback; p > 0.266), suggesting that visual feedback can modify grip force across varying hand and tool orientations. Conclusion. Visual feedback can successfully modify grip force during hand tool operation. However, further investigation is needed to understand how to appropriately implement visual feedback during hand tool operation.

Augmented feedback can change body shape to improve glide efficiency in swimming

Curvatures of the body can disrupt fluid flow and affect hydrodynamic resistance. The purpose of this study was to evaluate the effect of a feedback intervention on glide performance and torso morphology. Eleven male and female national swimmers performed glides before and after augmented feedback. Feedback consisted of self-modelling visual feedback and verbal cuing, to manipulate body curvatures that affect hydrodynamic resistance. Two-dimensional landmark position data (knee, hip and shoulder) were used to enable computation of glide factor and glide coefficient as indicators of glide efficiency; posture (trunk incline and hip angle); and performance (horizontal velocity). Underwater images of the swimmers were manually traced to derive transverse and sagittal diameters, cross-sectional areas, and continuous form outlines (anterior and posterior) of the torso. Maximum rate of change in cross-sectional area and form gradient progressing caudally, were calculated for torso segments: shoulder-chest, chest-waist, waist-hip. Mean velocity, glide factor and glide coefficient values significantly (p< 0.001) improved due to the intervention, with large effect size (d) changes 0.880 (p= 0.015), 2.297 and 1.605, respectively. Significant changes to form gradients were related to reductions in lumbar lordosis and chest convexity. The study provides practical cuing phrases for coaches and swimmers to improve glide efficiency and performance.

Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction

The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.

Combination of narrow and wide bandwidth knowledge of performance in the acquisition of a complex sports motor skill

OBJECTIVES

This study tested the effects of combining two bandwidth knowledge of performance (KP) on a complex sports motor skill.

METHOD

Twenty-two elementary students were divided into combined wide and narrow bandwidth KP (WNG) and control group (CG). The task was the volleyball serve, whose goal was to hit the bull's eye center of a target lying on the floor on the opposite side of the court. The study was composed of a pre-test, acquisition phase and retention test, and had three measures (pre-test, intermediate test, and retention test) with 15 serves recorded each. The acquisition phase consisted of 252 trials. The WNG had a wide bandwidth KP in the first half of the acquisition phase and a narrow one in the second. The CG received KP in all trials. The effects of bandwidth KP were analyzed separately to infer parameters and skill structure learning.

RESULTS

Both groups improved the skill structure from the first to the intermediate test, but only WNG also improved on the retention test. The parameters accuracy improved only on retention compared to the pre-test and intermediate test but had no difference between groups.

CONCLUSION

Providing information using the bandwidth KP led to an initial engagement and prioritization of skill structure learning.

Immediate effects of visuomotor tracking with the head on cervical sensorimotor function and pain in chronic neck pain patients

BACKGROUND

Working in awkward and sustained postures is, besides psychosocial risk factors, the most reported physical risk factor for neck pain. Accurate proprioception is fundamental to correcting awkward head-to-trunk positions, but impaired proprioceptive performance has been found in patients with chronic neck pain.

OBJECTIVE

The aim was to compare the effectiveness of two different interventions in a workplace set-up on sensorimotor performance and pain sensitivity in people with chronic neck pain.

METHODS

A total of 25 patients with chronic neck pain participated in this double-blind study. Patients were randomly allocated to the visuomotor tracking task group or the video group (watching a massage video, imagining themselves being massaged). The primary outcomes were cervical joint position sense acuity and pressure pain threshold of the cervical spine, evaluated by a blinded assessor.

RESULTS

There were significant time by group interactions for cervical joint position sense acuity (F1;23: 4.38; p= 0.048) and pressure pain threshold (F1;23: 5.78; p= 0.025), with the tracking task group being more accurate in cervical joint position sense testing and less pain sensitive for pressure pain threshold.

CONCLUSIONS

The visuomotor tracking task improves cervical joint position sense acuity and reduces pressure pain threshold immediately after intervention in people with chronic neck pain.

Effect of Practice Structure and Feedback Frequency on Voice Motor Learning in Older Adults

OBJECTIVES

The long-term goal of this research is to advance the rehabilitation of voice disorders through the study and development of efficacious treatment regimes based upon motor learning principles. This study examined the effect of contextual interference (CI) of practice structure with knowledge of results (KR) feedback on motor learning of a novel voice task, "Twang," by hypophonic, novice, and expert older adults.

STUDY DESIGN

Prospective, randomized controlled mixed design.

METHODS

A total of 92 adults, age 55-80, recruited from the following motor skill levels: 1) Hypophonic voice; 2) Novice-untrained vocalists; 3) Expert-trained vocalists were randomly assigned to four different interventions and examined during acquisition, retention, and transfer phases of motor learning. Participants from each skill-level practiced the novel task, "Twang," according to the randomly assigned Practice Structure/KR combinations: 1) Blocked practice/100%KR; 2) Blocked practice/55% KR; 3) Random practice/100%KR; 4) Random practice/55% KR.

RESULTS

During the motor performance phase, our results mirrored those reported in the limb motor learning literature for CI: A Blocked practice structure enhanced short-term effects of motor acquisition for novice, expert, and hypophonic subjects. The only significant result for KR occurred when paired with Random Practice in the hypophonic subject group: 100% KR paired with Blocked practice increased motor performance, but degraded motor learning.

CONCLUSIONS

Fundamental motor learning principles were explored within the context of a voice training paradigm. Practice with a high CI and low frequency of KR degraded performance during short-term acquisition but enhanced long-term performance effects of motor learning. Voice clinicians and teachers may benefit by implementing motor learning theory into practice during training and treatment sessions.

The Role of Collaborative Observational Practice and Feedback-Discourse to Promote Remote Acquisition of Technical Surgical Skills

INTRODUCTION

Acquisition of technical skills remotely in a decentralized model requires an efficacious way of providing feedback. The primary objective was to test the efficacy of various forms of feedback on the acquisition of surgical skills by medical students.

METHODS

Forty volunteers were randomized to four experimental groups, differing from the nature of feedback (free text versus structured) and who provided the feedback (expert versus peer learners). They had to perform sutures and upload attempts on a learning management system to receive interactive feedback. The pretest and retention test performances were assessed.

RESULTS

All groups significantly improved from pretests to retention tests; however, participants using checklist showed statistically lower improvements than the other groups, which did not differ from each other.

CONCLUSIONS

Remote learners can acquire surgical skills, and most importantly, peers who provide feedback, are as effective as experts if they use open-ended comments and not checklists.

Presence of an Overhead Goal Does Not Improve the Effectiveness of Jump Training

ABSTRACT

Akbaş, A, Marszałek, W, and Król, H. Presence of an overhead goal does not improve the effectiveness of jump training. J Strength Cond Res 37(4): e280-e288, 2023-This study investigated the effectiveness of jump training with and without an overhead goal (OG) on a modified countermovement jump (CMJ) tested in a similar manner, with and without OG. Fifty-two men divided into 3 groups-trained with OG, trained without OG, and untrained-were examined: before the commencement of training; after 2, 4, and 6 weeks of training; and 2 weeks after the discontinuation of training. Each session consisted of 50 modified CMJ and was performed 3 times per week. Countermovement jump height, mean power, peak power, countermovement depth, and take-off phase time were quantified, and the statistical level was set at p < 0.05. Although the results showed the beneficial effect of OG on jump height ( p < 0.01), the training with OG did not bring significantly better results than training without OG. In addition, the group trained without OG improved after 2 weeks in both testing conditions (with and without OG), whereas the group trained with OG improved after 2 weeks when tested with OG and only after 6 weeks when tested without OG. We believe the use of OG in jump training may be detrimental when the OG is withdrawn from the testing procedure because of its strong motivational and feedback features. Consequently, athletes in disciplines which require them to jump toward an object located over their head during a game, e.g., a ball or crossbar, should be tested with the presence of OG. Despite this, OG is still an important factor in maximizing jump performance.

How to benefit from augmented feedback? The influence of motivational and informational content of augmented feedback and the influence of task complexity

Augmented feedback (aF) positively influences motor performance by enhancing motivation and/or by providing information about task execution. It was speculated that aF-induced performance increments that rely on motivation should also occur when providing incorrect aF, while performance increments that rely on guidance towards "successful executions" (i.e. improved performances) should only occur when aF is correct. We further hypothesised that the informational content of aF is more important in more complex motor tasks. Thus, 32 participants received two forms of aF (correct, incorrect) during maximal voluntary contractions (MVC's; maximise force without time constraints; less complex) and maximal explosive contractions (MEC's; maximise force in the shortest possible way; more complex) of the knee extensors. Peak torque (MVC), peak rate of torque development (MEC) and EMG signals of rectus femoris (RF) and vastus lateralis were recorded. Correct and incorrect aF significantly enhanced MVC performance, indicating that performance improvements resulted mainly from the motivational property of aF. The observed trend towards increased RF muscle activity supports this conclusion. In contrast, while correct aF positively impacted MEC performance, incorrect aF had a negative influence. This indicates that the informational property of aF guided participants towards movement executions resulting in improved (correct aF) or decreased (incorrect aF) performances. The observed simultaneous decrease in muscle activity suggests that participants changed motor strategy, supporting the guiding role of aF. Our results demonstrate that the motivational aspect of aF dominates in maximal tasks with lower complexity (MVC), while the informational aspect is used during more complex maximal tasks (MEC).HIGHLIGHTS Augmented feedback (aF) can influence performance by enhancing the motivation and/or by providing information about the execution of a task.Our results demonstrate that over the short-term, the motivational aspect of aF dominates in maximal tasks with lower complexity (maximal voluntary contractions). In contrast, the informational aspect will predominantly be used during more complex maximal tasks (maximal explosive contractions).This is the first study distinguishing between the motivational and informational aspects of aF during maximal motor tasks. Future research should focus on the long-term effects of these two separate aspects of aF.

EMG space similarity feedback promotes learning of expert-like muscle activation patterns in a complex motor skill

Augmented feedback provided by a coach or augmented reality system can facilitate the acquisition of a motor skill. Verbal instructions and visual aids can be effective in providing feedback about the kinematics of the desired movements. However, many skills require mastering not only kinematic, but also complex kinetic patterns, for which feedback is harder to convey. Here, we propose the electromyography (EMG) space similarity feedback, which may indirectly convey kinematic and kinetic feedback by comparing the muscle activations of the learner and an expert in the task. The EMG space similarity feedback is a score that reflects how well a set of muscle synergies extracted from the expert can reconstruct the learner's EMG when performing the task. We tested the EMG space similarity feedback in a virtual bimanual polishing task that uses a robotic system to simulate the dynamics of a real polishing operation. We measured the expert's and learner's EMG from eight muscles in each arm during the real and virtual polishing tasks, respectively. The goal of the virtual task was to smoothen the surface of a virtual object. Therefore, we defined performance in the task as the smoothness of the object at the end of a trial. We separated learners into real feedback and null feedback groups to assess the effects of the EMG space similarity feedback. The real and null feedback groups received veridic and no EMG space similarity feedback, respectively. Subjects participated in five training sessions on different days, and we evaluated their performance on each day. Subjects in both groups were able to increase smoothness throughout the training sessions, with no significant differences between groups. However, subjects in the real feedback group were able to improve in the EMG space similarity score to a significantly greater extent than the null feedback group. Additionally, subjects in the real feedback group produced muscle activations that became increasingly consistent with an important muscle synergy found in the expert. Our results indicate that the EMG space similarity feedback promotes acquiring expert-like muscle activation patterns, suggesting that it may assist in the acquisition of complex motor skills.

The impact of augmented feedback (and technology) on learning and teaching cricket skill: A systematic review with meta-analysis

Augmented feedback, including that provided using technology, can elicit multifaceted benefits on perceptual-motor learning and performance of sporting skills. However, current considerations of the applied value in supporting learning and teaching cricket skill is limited. This systematic review with meta-analysis aimed to understand the role and effectiveness of feedback-involved interventions on skill-based performance outcomes in cricket-related research. Six electronic databases were searched (SPORTDiscus, CINAHL, MEDLINE, Scopus, Web of Science and PsycINFO). Of 8,262 records identified, 11 studies met inclusion criteria; five of which were included in meta-analyses. Given no studies with an isolated feedback intervention-arm were identified, the two meta-analyses explored anticipation-based studies consisting of an intervention that included augmented feedback; positioned with respect to the key motor skill concepts of perception (anticipation accuracy) and action (performance success). Despite results highlighting improved performance outcomes for the feedback-involved intervention groups, with a large effect size for improved anticipation accuracy (Hedge's g = 1.21, 95% CIs [-0.37, 2.78]) and a medium effect size for overall performance success (Hedge's g = 0.55, 95% CIs [-0.39, 1.50]), results were not statistically significant and should be interpreted with caution given the wide confidence intervals. Considering the small number of studies available, in addition to the lack of isolated feedback protocols, further research is warranted to thoroughly explore the impact of augmented feedback on skill-based performance in cricket. Beyond the meta-analyses, the review also explored all included studies from an ecological dynamics perspective; presenting future avenues of research framed around evaluating the applied value of using augmented feedback (mediated with or without technology) for learning and teaching skill in cricket. Trial registration The protocol was preregistered with Open Science Framework (osf.io/384pd).

AI provides congruent and prescriptive feedback for squat form: qualitative assessment of coaching provided by AI and physical therapist

Objectives: To assess style and themes of feedback provided by artificial intelligence (AI) mobile application and physical therapist (PT) to participants during bodyweight squat exercise. Methods: Research population was age 20-35, without any pre-existing condition that precluded participation in bodyweight exercise. Qualitative methodology followed directed content analysis. Cohen's kappa coefficient verified consistency between coders. Results: Both AI and PT groups had seven female and eight male participants. Three themes emerged: affirmation schema, correction paradigms and physical assessments. Average kappa coefficient calculated for all codes was 0.96, a value that indicates almost perfect agreement. Conclusion: Themes generated highlight the AI focus on congruent, descriptive and prescriptive feedback, while the PT demonstrated multipoint improvement capabilities. Further research should establish feedback comparisons with multiple PTs and correlate qualitative data with additional quantitative data on performance outcomes based on feedback.

The Effects of Combined Verbal Encouragement and Technical Instruction on Technical Skills and Psychophysiological Responses During Small-Sided Handball Games Exercise in Physical Education

To examine the effects of combined positive verbal encouragement and general technical guidelines on technical and psychophysiological parameters in pupils during a small-sided handball passing game. Twenty secondary school pupils (age, 16 ± 1 years; body mass, 55.3 ± 6.6 kg; body height, 1.77 ± 0.13 m; BMI, 22.6 ± 2.2 kg m⁻¹) performed small-sided games (2 × 10 min) with three conditions: small-sided game (1) with combined verbal encouragement and technical instruction; (2) with technical instruction; (3) without any instruction (control) in which the passes for each pupil in each set was measured together with the rate of perceived exertion (RPE) and feeling mood after the first and second set. Results: A two-way analysis of variance demonstrated that the combined condition resulted in more passes compared to the technical instruction and control conditions, while the number of passes increased in set 2 for all conditions. RPE and the feeling mood were also differently between the conditions. Combined verbal encouragement and technical instruction during handball exercise were more beneficial for optimal passing numbers, positive mood with less perception of physical effort compared to only technical instruction and a control condition. The results evidenced positive acute effects of combined verbal encouragement and technical instruction during handball, indicating the usefulness of these training methods for optimal passing numbers, positive mood with less perception of physical effort in physical education pupils. Future studies should evaluate the applicability combined verbal encouragement and technical skills in the training of other conditioning capacities and the individual responsiveness of players toward verbal encouragement tasks.

The Effects of a Real-Time Visual Kinetic Feedback Intervention on Shock Attenuation of the Equestrian Rider's Trunk: A Pilot Study

Augmented feedback (provided by an external source) has been commonly used by practitioners who are introducing or re-educating movement patterns as a valuable tool of instruction. This study aimed to evaluate the effects of real-time visual kinetic feedback on a horse-riding coaching session. Sixteen riders volunteered to take part in this study. They performed a pre-intervention trial, a 20-min coaching intervention, and a post-intervention trial. The participants randomly received a coaching + feedback intervention or a coaching-only intervention. Forces at the bit and stirrups were recorded at trot and canter. Thirteen inertial measuring units were fitted to the horse's forelimbs and poll, to the stirrups, cantle of the saddle, distal part of the bridles, 1st sacrum vertebrae of the rider (S1), 7th cervical vertebrae of the rider (C7), wrists of the rider, and helmet. The shock attenuation (SA) between helmet:saddle and between C7:S1 and absolute force output were calculated. Changes in SA and force output were compared between groups by two-way repeated measures ANOVA (group^*time) both at trot and canter. Statistical significance was set at p < 0.05. SA was significantly lower in both groups and conditions after the intervention. C7:S1 SA was significantly lower in the feedback + coaching group at canter and trot, and helmet:saddle SA was significantly lower in the feedback + coaching group at trot than in the coaching group. A significant increase in force was observed in all the groups on the stirrups at trot and canter, but no significant changes were observed on rein forces. Implementing sports wearables that provide such type of information might be of remarkable benefit for the rider's development and performance.

Masterclass: Hypermobility and hypermobility related disorders

INTRODUCTION

Hypermobile joints display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility may present in a single joint, a few joints or in multiple joints and may be congenital or acquired with training, disease or injury. Hypermobile joints may be asymptomatic or may be associated with pain, fatigue, multisystemic complaints and significant disability. Furthermore, joint hypermobility may be a sign of an underlying hereditary disorder of connective tissue.

PURPOSE

This masterclass aims to provides a state-of-the-art review of the aetiology, epidemiology, clinical presentation, assessment and management of joint hypermobility and hypermobility related disorders using an evidence based and biopsychosocial approach. The new framework for classifying the spectrum of joint hypermobility disorders along with new diagnostic criteria for the hypermobile Ehlers Danlos syndrome, published by an international consortium of clinical experts and researchers in 2017 is integrated into the paper.

IMPLICATIONS FOR PRACTICE

People with joint hypermobility related disorders present to healthcare professionals with a wide range of symptoms which extend beyond the musculoskeletal system. Early recognition and treatment are key to effective management. A biopsychosocial and patient empowerment approach to functional restoration is recommended.

Empirical Evidence for the Functionality Hypothesis in Motor Learning: The Effect of an Attentional Focus Is Task Dependent

A large body of research suggests that during learning motor skills, focusing on environmental effects of the movement (external focus) generally leads to better performance than focusing on one’s own body (internal focus). The functionality hypothesis states, in contrast, that the superiority of any attentional focus is task dependent. The present study aimed to test the predictions of the latter and searched for underlying mechanisms and task characteristics for one or the other focus being more functional. In Experiment 1, we examined whether the internal focus is superior in a difficult body-oriented balance task. In Experiment 2, we added visual feedback and investigated whether this would enhance the functionality of the external focus. In both experiments, the participants stood one-legged on a balance board and had to shift their centre of pressure (COP) to predefined target points. Per instruction, they were asked to interpret their attentional focus on the COP as either internal (the sole of the foot) or external (the platform). In Experiment 1, the external focus was induced through a mental image. The internal focus group performed significantly better, thereby supporting the functionality hypothesis. In Experiment 2, the COP was dynamically visualized on a screen. The internal focus superiority vanished. We suggest that the internal focus is more functional in motor-learning situations that provide more effect information through body-internal senses than through body-external senses. In these cases, the external focus hampers learning because it is associated with additional cognitive load.

Augmented feedback for manual wheelchair propulsion technique training in a virtual reality simulator

BACKGROUND

Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback (AF) may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing AF with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.

METHODS

Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency AF group received AF in the form of knowledge of performance throughout all propulsion training; the faded AF group received this AF in a faded schedule (high relative frequency of AF early in practice, with relative frequency of AF provision diminishing throughout practice); and the control group underwent training with no AF. Propulsion assessments were performed at baseline and 48 h after practice in both virtual and real environments to measure retention and transfer, respectively.

RESULTS

Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant between-group differences were also found between the high-frequency and faded feedback groups.

CONCLUSION

Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes AF regarding propulsion biomechanics.

Acute Effects of Verbal Encouragement and Listening to Preferred Music on Maximal Repeated Change-of-Direction Performance in Adolescent Elite Basketball Players—Preliminary Report

Verbal encouragement (VE) and listening to preferred music (PM) are considered effective ergogenic methods in strength and conditioning, but studies examining the effectiveness of these two methods simultaneously are lacking. This study analyzed the influence of PM and VE on repeated change-of-direction performance (R-CoD) in elite young basketball players. On alternate days, 18 elite young basketball players (17.2 ± 0.61 years; 189.8 ± 7 cm; 71.6 ± 6.7 kg; body fat: 12.3 ± 2.5%) were assessed on R-CoD under three randomized conditions: team-selected PM, VE, and control condition. Total time (TT), peak time (PT), and fatigue index were registered and compared across conditions. Significant differences across conditions were evidenced for TT and PT (F-test = 6.96 and 4.15, p < 0.05; large effect size), with better results in VE and PM than in the control condition and no significant differences between VE and PM. No correlations were evidenced between changes that occurred as a result of VE and those which occurred as a result of PM, indicating individual responsiveness of the players to VE and PM. The results evidenced positive acute effects of VE and PM on R-CoD performance, indicating the usefulness of these training methods in the conditioning of youth basketball players. Future studies should evaluate the applicability of VE and PM in the training of other conditioning capacities and the individual responsiveness of players toward VE and PM.

Beyond animated skeletons: How can biomechanical feedback be used to enhance sports performance?

Biomechanical feedback technologies are becoming increasingly prevalent in elite athletic training environments but how the kinematic and kinetic data they produce can be best used to improve sports techniques and enhance sports performance is unclear. This paper draws on theoretical and empirical developments in the motor control, skill acquisition, and sports biomechanics literatures to offer practical guidance and strategic direction on this issue. It is argued that the information produced by biomechanical feedback technologies can only describe, with varying degrees of accuracy, what patterns of coordination and control are being adopted by the athlete but, crucially, it cannot prescribe how these patterns of coordination and control should be modified to enhance sports performance. As conventional statistical and theoretical modelling paradigms in applied sports biomechanics provide limited information about patterns of coordination and control, and do not permit the identification of athlete-specific optimum sports techniques, objective criteria on which to base technical modifications that will consistently lead to enhanced performance outcomes cannot reliably be established for individual athletes. Given these limitations, an alternative approach, which is harmonious with the tenets of dynamical systems theory and aligned with the pioneering insights of Bernstein (1967) on skill acquisition, is advocated. This approach involves using kinematic and kinetic data to channel the athlete's search towards their own unique 'optimum' pattern of coordination and control as they actively explore their perceptual-motor workspace during practice. This approach appears to be the most efficacious use of kinematic and kinetic data given current biomechanical knowledge about sports techniques and the apparent inability of existing biomechanical modelling approaches to accurately predict how technique changes will impact on performance outcomes for individual athletes.

The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial

This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.

How to Serve Faster in Tennis: The Influence of an Altered Focus of Attention and Augmented Feedback on Service Speed in Elite Players

ABSTRACT

Keller, M, Kuhn, YA, Lüthy, F, and Taube, W. How to serve faster in tennis: the influence of an altered focus of attention and augmented feedback on service speed in elite players. J Strength Cond Res 35(4): 1119-1126, 2021-Different approaches, such as providing augmented feedback (AF) or adopting an external focus of attention (EF), have been shown to directly enhance performance in recreational athletes. Furthermore, research has shown that combining AF with EF (AF + EF) results in superior performance compared to AF and EF alone. Here, we tested the influence of AF, EF, AF + EF, and an internal focus of attention (IF) on service speed in elite tennis players. High-level national tennis players (19.2 ± 3.7 years) were asked to serve flat serves to a target zone with maximum speed. With respect to service speed, a significant main effect of condition was found (p ≤ 0.001). Post hoc comparisons revealed faster serves for AF compared to control serves without instruction/feedback (p < 0.01) and compared to EF (p < 0.05), whereas no significant difference was found between EF and IF (p = 0.81). The fastest service speeds were found in the AF condition, whereas the combination of AF + EF did not further promote performance. The number of serves landed in the target zone did not differ between conditions (p = 0.17). Thus, no speed-accuracy trade-off was found, indicating that enhanced service speeds did not result in less serves landed in the target zone. Augmented feedback seems most beneficial to instantly enhance tennis serve performance. In contrast to previous studies with recreational sportsmen, EF did not differ from IF, providing further evidence that expertise level and task-relevant instructions mediate the influence of attentional focus on motor performance.

Perception of changes in bar velocity as a resistance training monitoring tool for athletes

PURPOSE

To investigate if perception of changes in bar velocity (PCV) can be used as a substitute for velocity tracking devices commonly used to monitor resistance-exercises.

METHODS

Twenty-one professional male soccer athletes (21±4 years) first went through a load-power profile assessment to determine their optimal power load in the back-squat. In the next three experimental sessions, athletes completed four sets of six repetitions loaded with optimal power load. Starting from the second repetition, athletes reported their PCV of each repetition as a percentage of the first repetition. Accuracy of PCV was calculated as the absolute difference between PCV and the actual percentage change from the first repetition in bar velocity measured with a linear-encoder. The second and fourth sessions served as the pre- and post-intervention sessions, in which athletes received no feedback about their PCV accuracy. The third session served as the intervention session, in which athletes received verbal and visual feedback about their PCV accuracy levels after each set.

RESULTS

The estimated accuracy of PCV decreased from an average error of 7% in the pre-intervention to an average error of 4.7% in the post-intervention session (95% confidence levels of difference: 1.5, 3.0).

CONCLUSION

Athletes with velocity based training experience begin with a reasonable PCV accuracy rates which can be meaningfully improved after a single session that includes accuracy feedback. When velocity tracking devices are impractical or absent, PCV can be implemented as a resistance training monitoring tool.

The Effects of Short-Term Visual Feedback Training on the Stability of the Roundhouse Kicking Technique in Young Karatekas

The aim of this study was to assess the efficacy of using real-time visual feedback (VF) during a one-week balance training intervention on postural sway parameters in young karatekas. Twenty-six young male karatekas (age = 14.0 ± 2.3 years) were randomly divided into two groups: real-time VF training (VFT; n = 14) and control (CTRL; n = 12). Their center of pressure (COP) displacement (path length, COPpl; distance from origin, COPod) was assessed pre- and post-training on a Wii Balance Board platform in two positions (Flex: knee of the supporting leg slightly bent, maximum hip and leg flexion of the other leg; Kick: knee of the supporting leg slightly bent, mawashi-geri posture for the kicking leg). Both groups trained twice a day for seven days, performing a one-legged stance on the non-dominant limb in the Kick position. During the training, VFT received real-time VF of COP displacement, while CTRL looked at a fixed point. No interaction effect was found (p > 0.05). VFT exhibited greater changes pre- and post-training in Flex COPpl (-25.2%, g = 1.5), Kick COPpl (-24.1%, g = 1.3), and Kick COPod (-44.1%, g = 1.0) compared to CTRL (-0.9--13.0%, g-range: 0.1-0.7). It is possible that superimposing real-time VF to a week-long balance training intervention could induce a greater sport-specific balance-training effect in young karatekas.

The placebo effect in breath holding: a preliminary behavioral investigation

PURPOSE

This study seeks to evaluate effects of expectations and conditioning on dry breath holding.

METHODS

Sixty healthy volunteers were subdivided into 3 groups and were tested across 4 breath holding trials. Participants of the Control group (C) did not undergo any manipulation. Participants of the placebo (P) and nocebo (N) groups were told that they would inhale O2 (actually sham O2) or CO2 (actually sham CO2) along with opposite information that this would enhance or worsen their breath holding time, respectively. Opposite conditioning paradigms based on false visual feedback were employed to reinforce participants' positive (placebo) and negative (nocebo) beliefs.

RESULTS

The P group showed the greater increase in breath holding time from baseline to the last trial (p = 0.0001) and the longest breath holding time in the last trial compared to the C group (p = 0.02) and the N group (p = 0.0001). Additionally, in the last trial the P group showed a greater decrease in peripheral oxygen saturation (SpO2) as compared to the C group (p = 0.04) and the N group (p = 0.001). Heart rate (HR) was accelerated in the N group during breath holding (in comparison to the P group [p = 0.04] and C group [p = 0.04]).

CONCLUSIONS

Psychological components can affect behavioral and physiological parameters in breath holding. This study may inform future research about the role of placebo and nocebo effects for conditions in which critical functions are at play.

The Efficacy of Simultaneously Training 2 Motion Targets During a Squat Using Auditory Feedback

Auditory feedback is a simple, low-cost training solution that can be used in rehabilitation, motor learning, and performance development. The use has been limited to the instruction of a single kinematic or kinetic target. The goal of this study was to determine if auditory feedback could be used to simultaneously train 2 lower-extremity parameters to perform a bodyweight back squat. A total of 42 healthy, young, recreationally active males participated in a 4-week training program to improve squat biomechanics. The Trained group (n = 22) received 4 weeks of auditory feedback. Feedback focused on knee flexion angle and center of pressure under the foot at maximum squat depth. The Control group (n = 20) performed squats without feedback. Subjects were tested pre, post, and 1 week after training. The Trained group achieved average target knee flexion angle within 1.73 (1.31) deg (P < .001) after training and 5.36 (3.29) deg (P < .01) at retention. While achieving target knee flexion angle, the Trained group maintained target center of pressure (P < .001). The Control group improved knee range of motion, but were not able to achieve both parameter targets at maximum squat depth (P < .90). Results from this study demonstrate that auditory feedback is an effective way to train 2 independent biomechanical targets simultaneously.

Learning new sport actions: Pilot study to investigate the imitative and the verbal instructive teaching methods in motor education

The aim of the project was to investigate the effects of two strategies of teaching new sport actions on performance of eight-year-old children: observational-imitative method (OIM) and descriptive-directive method (DDM). The OIM group was provided with a pre-practice instruction in the form of expert modeling observation by an expert athlete. The DDM group received only verbal explanations of few selected static images. Thirty-six children (18 males and 18 females, mean age = 8,8) participated in the experiment. Subjects were randomly assigned to the OIM or DDM groups. Participants were instructed to perform four sport motor sequences never performed before (shoulder stand, soccer action, vortex howler throw, step action). Actions were videotaped and 2D kinematic analysis performed. A 10-point Likert questionnaire was administered to blind sport experts to assess the correctness and accuracy of each action. Results suggest that the OIM is the most effective instruction method when participants have no experience with the sport action to be performed. On the contrary, if the athlete needs to learn specific aspects of an exercise (such as grasping a tool) the best method is the DDM. In fact, detailed information on how to grab the vortex helped children in throwing it. We also found gender differences which might reflect cultural influences in specific sports (e.g. soccer). Finally, repetition of the exercise also improved the DDM group's performance. This has potential applications in sport teaching, suggesting that in the absence of a model performing the action to be imitated, the DDM can be as effective as the OIM if the observer repeats the sport action many times.

Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study

Background

Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs.

Objective

The aims of this study were to explore patients’ rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system.

Methods

This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of “Rehabilitation” and “Technology” and performed a thematic analysis on the interview data.

Results

Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer–specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support.

Conclusions

There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance.

The effects of positive and negative verbal feedback on repeated force production

Studies indicate that providing subjects with positiveaugmented feedback (PAF) enhances motor learning and performance compared to negative- (NAF), or no-feedback. However, in the majority of these studies, the performance feedback was provided relative to a peer-group (e.g., "your performance is higher/lower than the norm"). Here we examined how different, and less explored types of PF and NF, influenced repeated force production of 22 resistance-trained subjects (50%-males). On three occasions, subjects completed 12 isometric maximal voluntary contractions (MVC) with their elbow flexors, while electromyography (EMG) was collected from their biceps and triceps brachii muscles. After every second repetition, subjects received either PF (e.g., "You are looking great."), NF (e.g., "You are not trying."), or no-feedback. All measurements were normalized to pre-test MVCs and reported aspercentages. Subjects applied greater forces in the NF condition compared to the PF (4.3%, 95%CI: 2.8, 5.8) and no-feedback (7.9%, 95%CI: 6.4, 9.4) conditions. Similarly, subjects demonstrated greater biceps EMG activity in the NF compared to the PF (6.6%, 95%CI: 3.7, 9.4) and no-feedback (2.8%, 95%CI: 9.9, 15.6) conditions. We speculate that NF can lead subjects to exert greater forces bysignaling that their efforts are lacking. These results indicate that under some circumstances, NF can have practical benefits over no-feedback and even PF; however, we note that NF should be delivered with caution since it may also hinder motivation and self-efficacy over time.

Sex Differences in Maintaining the Requested Handgrip Force Enhanced by Auditory or Visual Feedback

Thus far, the differences in effect of auditory or visual feedback in motor learning have presented results derived from mixed groups and sex differences have not been considered. However, perception and processing of auditory stimuli and performance of visual motor tasks appear to be sex-related. The purpose of this study was to investigate the learning of the simple motor task of maintaining a requested handgrip force in separate male and female groups. A total of 31 volunteers (15 males, 16 females) were randomly assigned to one of four experimental groups with defined sex and training conditions (audio or visual feedback). Participants performed training sessions over a period of six days, for which auditory or visual feedback was provided, and the effectiveness of both types of signals was compared. The evident learning effect was found in all groups, and the main effect of sex was significant among visual groups in favor of the males (p < 0.05). On the other hand, the main effect of feedback conditions was found to be significant among females, beneficially in the case of auditory displays (p < 0.05). The results lead to the conclusion that an equal number of males and females in mixed experimental groups may be supportive to obtain reliable results. Moreover, in motor-learning studies conducted on females only, a design including auditory feedback would be more suitable.

Effect of Self-Controlled and Regulated Feedback on Motor Skill Performance and Learning: A Meta-Analytic Study

The purpose of this study was to use the meta-analytic approach to assess the effectiveness of self-controlled (SC) and regulated (R) feedback on motor skill performance (MSP). Random effects model using the standardized mean difference effect size (ES) was used to pool results. A total of 86 ES, retrieved from 18 studies, were calculated and separated into three types of feedback: SC, R, and yoked group (YG). In acquisition phase, SC (ES = 1.872; CI_95% = 1.014, 2.730), R (ES = 0.852; CI_95% = 0.614, 1.090), and YG (ES = 1.492; CI_95% = 0.266, 2.718) significantly improved MSP. In retention phase, SC and YG had a nonsignificant decrease in MSP, R (ES = -0.819; CI_95% = -1.207, -0.430) significantly decrease MSP. Several factors were analyzed as moderator variables. Results suggest that SC feedback enhances learning.

Perception of changes in bar velocity in resistance training: Accuracy levels within and between exercises

Velocity-based training is a method used to monitor resistance-training programs based on repetition velocities measured with tracking devices. Since velocity measuring devices can be expensive and impractical, trainee's perception of changes in velocity (PCV) may be used as a possible substitute. Here, 20 resistance-trained males first completed 1 Repetition Maximum (RM) tests in the bench-press and squat. Then, in three counterbalanced sessions, participants completed four sets of eight repetitions in both exercises using 60%1RM (two-sessions) or 70%1RM. Starting from the second repetition, participants reported their PCV of each repetition as a percentage of the first repetition. Accuracy of PCV was calculated as the difference between PCV and actual changes in velocity measured with a linear-encoder. Three key findings emerged. First, the absolute error in the bench-press and squat was ≈5.8 percentage-points in the second repetition, and increased to 13.2 and 16.7 percentage-points, respectively, by the eighth repetition. Second, participants reduced the absolute error in the second 60%1RM session compared to the first by ≈1.7 in both exercises (p ≤ 0.007). Third, participants were 4.2 times more likely to underestimate changes velocity in the squat compared to the bench-press. The gradual increments in the absolute error suggest that PCV may be better suited for sets of fewer repetitions (e.g., 4-5) and wider velocity-loss threshold ranges (e.g., 5-10%). The reduced absolute error in the second 60%1RM session suggests that PCV accuracy can be improved with practice. The systematic underestimation error in the squat suggests that a correction factor may increase PCV accuracy in this exercise.

Effects of physical therapy interventions on balance ability in people with traumatic brain injury: A systematic review

BACKGROUND

Balance deficits are common impairments in individuals with post-traumatic brain injury (TBI). Balance deficits can restrict the activities of daily living and productive participation in social life. To date, no systematic reviews have examined the impact of physical therapy intervention on balance post-TBI.

OBJECTIVE

To examine the effects of physical therapy interventions on balance impairments in individuals with TBI.

METHODS

We systematically searched in PubMed, EMBASE, Scopus, PEDro, MEDLINE, REHABDATA, and Web of Science for randomized controlled trials (RCTs), clinical control trials, and pilot studies that examined the effects of physical therapy interventions on balance deficits in individuals post-TBI. The methodological quality was estimated using the Physiotherapy Evidence Database (PEDro) scale.

RESULTS

Eight studies published from 2003 to 2019 were included in this study. A total of 259 TBI participants post-TBI were included in this review, 71 (27.41%) of which were females. The methodological quality of the selected studies ranged from low to high. There were no significant differences between experimental interventions, virtual reality (VR), vestibular rehabilitation therapy (VRT), control group interventions, and other traditional physical therapy interventions.

CONCLUSIONS

The evidence about the effects of the physical therapy interventions in improving the balance ability post-TBI was limited. Further randomized controlled trials are strongly warranted to understand the role of physical therapy in patients with TBI who complain about balance deficits.

Skill acquisition is enhanced by reducing trial-to-trial repetition

Developing approaches to improve motor skill learning is of considerable interest across multiple disciplines. Previous research has typically shown that repeating the same action on consecutive trials enhances short-term performance but has detrimental effects on longer term skill acquisition. However, most prior research has contrasted the effects of repetition only at the block level; in the current study we examined the effects of repeating individual trials embedded in a larger randomized block, a feature that is often overlooked when random trial orders are generated in learning tasks. With 4 days of practice, a "Minimal Repeats" group, who rarely experienced repeating stimuli on consecutive trials during training, improved to a greater extent than a "Frequent Repeats" group, who were frequently presented with repeating stimuli on consecutive trials during training. Our results extend the previous finding of the beneficial effects of random compared with blocked practice on performance, showing that reduced trial-to-trial repetition during training is favorable with regard to skill learning. This research highlights that limiting the number of repeats on consecutive trials is a simple behavioral manipulation that can enhance the process of skill learning. Data/analysis code and Supplemental Material are available at https://osf.io/p3278/.NEW & NOTEWORTHY Numerous studies have shown that performing different subtasks across consecutive blocks of trials enhances learning. We examined whether the same effect would occur on a trial-to-trial level. Our Minimal Repeats group, who primarily responded to different stimuli on consecutive trials, learned more than our Frequent Repeats group, who frequently responded to the same stimulus on consecutive trials. This shows that minimizing trial-to-trial repetition is a simple and easily applicable manipulation that can enhance learning.

Shared attention for action selection and action monitoring in goal-directed reaching

Dual-task studies have shown higher sensitivity for stimuli presented at the targets of upcoming actions. We examined whether attention is directed to action targets for the purpose of action selection, or if attention is directed to these locations because they are expected to provide feedback about movement outcomes. In our experiment, endpoint accuracy feedback was spatially separated from the action targets to determine whether attention would be allocated to (a) the action targets, (b) the expected source of feedback, or (c) to both locations. Participants reached towards a location indicated by an arrow while identifying a discrimination target that could appear in any one of eight possible locations. Discrimination target accuracy was used as a measure of attention allocation. Participants were unable to see their hand during reaching and were provided with a small monetary reward for each accurate movement. Discrimination target accuracy was best at action targets but was also enhanced at the spatially separated feedback locations. Separating feedback from the reaching targets did not diminish discrimination accuracy at the movement targets but did result in delayed movement initiation and reduced reaching accuracy, relative to when feedback was presented at the reaching target. The results suggest attention is required for both action planning and monitoring movement outcomes. Dividing attention between these functions negatively impacts action performance.

Neuromuscular Mechanisms Underlying Changes in Force Production during an Attentional Focus Task

We examined the effects of attentional focus cues on maximal voluntary force output of the elbow flexors and the underlying physiological mechanisms. Eleven males participated in two randomized experimental sessions. In each session, four randomized blocks of three maximal voluntary contractions (MVC) were performed. The blocks consisted of two externally and two internally attentional focus cued blocks. In one of the sessions, corticospinal excitability (CSE) was measured. During the stimulation session transcranial magnetic, transmastoid and Erb’s point stimulations were used to induce motor evoked potentials (MEPs), cervicomedullary MEP (CMEPs) and maximal muscle action potential (Mmax), respectively in the biceps brachii. Across both sessions forces were lower (p = 0.024) under the internal (282.4 ± 60.3 N) compared to the external condition (310.7 ± 11.3 N). Muscle co-activation was greater (p = 0.016) under the internal (26.3 ± 11.5%) compared with the external condition (21.5 ± 9.4%). There was no change in CSE. Across both sessions, force measurements were lower (p = 0.033) during the stimulation (279.0 ± 47.1 N) compared with the no-stimulation session (314.1 ± 57.5 N). In conclusion, external focus increased force, likely due to reduced co-activation. Stimulating the corticospinal pathway may confound attentional focus. The stimulations may distract participants from the cues and/or disrupt areas of the cortex responsible for attention and focus.

Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review

Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.

From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice

BACKGROUND

The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap.

PURPOSE

This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework.

DATA SOURCES

The data sources used were PubMed, CINAHL, and PsychInfo databases.

STUDY SELECTION

Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017.

DATA EXTRACTION

Twelve of 62 relevant articles met the inclusion criteria.

DATA SYNTHESIS

Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral.

LIMITATIONS

Papers published before the year 2000 were excluded.

CONCLUSION

The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.

Real-Time Auditory Feedback-Induced Adaptation to Walking Among Seniors Using the Heel2Toe Sensor: Proof-of-Concept Study

Background

Evidence shows that gait training in older adults is effective in improving the gait pattern, but the effects abate with cessation of training. During gait training, therapists use a number of verbal and visual cues to place the heel first when stepping. This simple strategy changes posture from stooped to upright, lengthens the stride, stimulates pelvic and trunk rotation, and facilitates arm swing. These principles guided the development of the Heel2Toe sensor that provides real-time auditory feedback for each good step, in which the heel strikes first.

Objective

This feasibility study aimed (1) to contribute evidence toward the feasibility and efficacy potential for home use of the Heel2Toe sensor that provides real-time feedback and (2) to estimate changes in gait parameters after five training sessions using the sensor.

Methods

A pre-post study included 5 training sessions over 2 weeks in the community on a purposive sample of six seniors. Proportion of good steps, angular velocity (AV) at each step, and cadence over a 2- minute period were assessed as was usability and experience.

Results

All gait parameters, proportion of good steps, AV, and duration of walking bouts improved. The coefficient of variation of AV decreased, indicating consistency of stepping.

Conclusions

Efficacy potential and feasibility of the Heel2Toe sensor were demonstrated.

Real-time feedback by wearables in running: Current approaches, challenges and suggestions for improvements

Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.

The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial

Background

Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.

Objective

The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.

Methods

From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.

Results

Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.

Conclusions

The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.

Trial Registration

German Clinical Trials Register DRKS00010009; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010009

Association Between Plantarflexion Torque Variability In Quiet Stance And During Force And Position Tasks

This study examined the association between plantarflexion torque variability during quiet bipedal standing (QS) and during plantarflexion force- and position-matching tasks (FT and PT, respectively). In QS, participants stood still over a force plate, and the mean plantarflexion torque level exerted by each subject in QS (divided by 2 to give the torque due to a single leg) served as the target torque level for right leg FT and PT (performed with the participants seated with their right knee fully extended). During FT participants controlled the force level exerted by the foot against a rigid restraint, while during PT they controlled the angular position of the ankle when sustaining equivalent inertial loads. Standard deviation (SD) of plantarflexion torque was computed from torque signals acquired during periods with and without visual feedback. Significant correlations were found between plantarflexion torque variability in QS and FT (r = 0.8615, p < 0.0001 and r = 0.8838, p = 0.0003 for visual and no visual conditions, respectively) as well as between QS and PT (r = 0.8046, p = 0.003 and r = 0.7332, p = 0.0103 for visual and no visual conditions, respectively), regardless of vision availability. No significant differences were found between the correlations for Qs vs FT and QS vs PT (t(8) = 0.4778, p = 0.6455 and t(8) = 1.6819, p = 0.1310 for visual and no visual conditions, respectively), as assessed by "Hotelling-Williams" tests for equality among dependent correlations. The results indicate that simple measurements of plantarflexion torque fluctuations during FT and PT may be used to estimate balance ability. From a practical standpoint, it is suggested that rehabilitation protocols designed to regain/improve balance function may be based on the performance of FTs or PTs executed in a seated position.

Effect of Verbal Instruction on Motor Learning Ability of Anaerobic and Explosive Exercises in Physical Education University Students

This study investigated the effect of motor learning with informational feedback into response to anaerobic exercises with and without motor learning tasks in handball physical education university students. Participants were randomly divided into two groups: experimental group (EG, n = 10) and control group (CG, n = 10). Measurements of T-half test, 15-m and 30-m sprints, and ZIG-ZAG test were assessed in both groups before (T1), between (T2) a 4-week intervention program, and after (T3) an 8-week intervention program, which included agility and speed teaching with (EG) or without (CG) informational feedback (i.e., verbal instruction). The test-retest reliability for all tests was excellent, and the ICC ranged from 0.76 (ZIG-ZAG test) to 0.99 (Agility T test). The interday measurement error was clearly below 1% in all tests (CV range: 0.2-0.8). Time effects for the Agility T test (p = 0.012, η p 2 = 0.245) and the 15-m sprint (p = 0.035, η p 2 = 0.190) were found. For the Agility T test, a total interaction effect (p = 0.001, η p 2 = 0.380) and a partial interaction effect were calculated between T2 and T3 (p < 0.001, η p 2 = 0.603). A large effect size (d = 0.87) was observed in the EG from T2 to T3. The second relevant (d ≥ 0.5) effect size was calculated for the parameter sprint 30 m. The CG showed a significant sprint performance reduction from T2 to T3 (d = -0.60; parameter: sprint 30 m). All other effect sizes were less than 0.44. The ZIG-ZAG test revealed the largest main and partial effect sizes for all parameters. The EG showed the largest improvement (d = 2.00) between T2 and T3. The results demonstrate that motor learning with informational feedback improves performances of Agility T test, sprint, and ZIG-ZAG performance. It appears that a well-formulated verbal instruction may induce performance enhancement in young trainees in educational environment.

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature

Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low quality studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.

Recognizing and Effectively Managing Hypermobility-Related Conditions

Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) can cause widespread or chronic pain, fatigue, and proprioceptive and coordination deficits resulting in functional restrictions. These conditions are common and often unrecognized, and patients are likely to present in physical therapy for musculoskeletal injuries, pain, or coordination deficits. Although physical therapy is considered central to managing these conditions, many patients report pain and iatrogenic injuries due to inappropriate interventions. The diagnostic classification for these conditions was revised in 2017 to supersede previous diagnostic categories of Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome-hypermobility type/type III. It is now known that these conditions affect multiple body systems and not just joints and that patients require a holistic approach. This Perspective article will describe the 2017 diagnostic classification system, clinical presentation, examination, evaluation, and management of patients with HSD/hEDS. Both adult and pediatric cases are presented to illustrate the patient management concepts discussed. This knowledge can lead to more effective management of this patient population.

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.