Children's learning of tennis skills is facilitated by external focus instructions

The effectiveness of different attentional foci on the acquisition of sport-specific motor skills in healthy adults: a systematic review with network meta-analysis

Background

The acquisition of motor skills is a key element in many sports. A motor learning principle, which is frequently used to support skill acquisition is the application of different attentional foci. The effectiveness of different attentional foci on performance and the learning of motor skills has been investigated in various sports using randomised controlled trials. The aim of the present study was to investigate the effectiveness of different attentional foci (such as external (EFA) and internal attentional foci (IFA), but also holistic and switching foci) on the performance and learning of a sport-specific motor task in healthy individuals.

Methods

This study was a systematic review with network meta-analysis. We followed the Prisma reporting guideline and the Cochrane handbook for systematic reviews. Cinahl, Embase, Medline and Cochrane Central were searched for eligible studies. Network meta-analyses were performed for the post-acquisition, retention and transfer test endpoints.

Results

Twelve studies were included in the review. At post-acquisition an EFA was the most effective intervention compared to the control intervention (SMD: 0.9855; 95% CI [0.4-1.57]; p: 0.001). At the retention and transfer test endpoints, a holistic focus of attention had the highest effectiveness compared to an IFA (SMD 0.75; 95% CI [-0.1 to 1.6]; p: 0.09) and (SMD 1.16; 95% CI [0.47-1.86]; p: 0.001).

Discussion

For all three endpoints, we analysed a greater effectiveness of an EFA and holistic focus compared to an IFA. Several promising different attentional focus interventions were identified. The largest effects were analysed for a holistic focus. However, only one study used this intervention and therefore there remains uncertainty about the effectiveness. With regard to the inconsistency observed, the analysis at post-acquisition should be interpreted with caution. Modified versions of the EFA were the imagined and the dynamic EFA. Both were only explored in single studies and should therefore be investigated in further follow-up studies that directly compare them.

Attentional focus strategies in racket sports: A systematic review

The body of evidence has shown that the external focus of attention (EF) rather than the internal focus of attention (IF) enhances motor skill learning and performance. Within racket sports which require a high level of motor control, anticipation skills, and mental preparedness, effectively directing attention is essential to elicit improvements in athletic performance. The present review aimed to evaluate the scientific evidence concerning the effects of attentional focus instructions on motor learning and performance in racket sports. We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The study was registered with the Open Science Framework (osf.io/m4zat). Four electronic databases (Web of Science, Scopus, MEDLINE, and SPORTDiscus) were searched for original research publications. Inclusion criteria were: peer-reviewed journals; healthy and free from injury participants; attentional focus literature specific to the external or internal focus; attentional focus related to motor learning or motor performance; studies included at least one comparator (e.g., different attentional focus group, or control groups with neutral or no specific instruction); publications in which task(s) or skill(s) related to one of the racket sports (tennis, table tennis, badminton, squash, or padel). The initial search yielded 2005 studies. Finally, 9 studies were included in the quantitative analysis. Overall, the results indicated that EF benefits the learning and performance of racket sport skills, compared to IF and over control conditions. The findings suggest that coaches and practitioners should consider the adoption of EF to optimize racket skills performance, particularly in novice or low-skilled athletes.

Attentional Focus Strategies for Promoting Children's Motor Learning: A Scoping Review With a Learner-Task-Environment Framework

There is emerging evidence that attentional focus instructions and feedback may help children with motor learning. However, information relevant to learner characteristics, settings, and contexts in which attentional focus strategies can be used has not been synthesized. Therefore, in this review, we adopted a learner-task-environment framework to map the evidence to date related to attentional focus strategies in children's motor learning. We adapted the framework for scoping reviews put forth by Arksey and O'Malley (2005) and the enhanced protocol recommended by the Joanna Briggs Institute (Peters et al., 2021). Two researchers (a) identified the research question, (b) identified relevant studies, (c) selected studies, (d) charted the data, and (e) collated, summarized, and reported these results. We included 30 papers, all of which used an experimental or quasi-experimental design. Most studies have focused on typically developing children and those in middle childhood as learners. The movement tasks in these studies included isolated fundamental movement skills and sport-related tasks. All but one study were situated in non-clinical settings (i.e., school, laboratory). We found limited use of attentional focus strategies for learning movement tasks in early childhood, especially among children with neurodevelopmental disorders. Movement tasks were mostly isolated skills, and there was extremely limited application to clinical settings.

The effect of internal and external focus of attention on tennis skill acquisition in children

Objective

The aim of this study was to examine the effect of internal and external focus attention instructions on learning the tennis groundstroke (forehand-backhand drive) for children.

Methods

A total of 60 (30 girls, 30 boys) children aged 10.24 ± 0.48 years were included in the study. Children were randomly divided into three groups: External Focused Group (EFG), Internal Focused Group (IFG), and Control Group (CG).

Results

In the pre-training tests of tennis skill (TST) and tennis transfer (TTT), there was no significant difference between the three groups (EFG, IFG, and CG) according to one-way ANOVA results (p > 0.05). Significant interaction was determined between groups and measurements in a repeated-measures ANOVA analysis (three groups, three measurements) and TST and TTT (p < 0.01). According to the post-hoc analysis, it was determined that the TST results increased significantly in the EFG compared to the IFG and CG, and there was no significant difference in the TTT between the EFG and IFG, but both groups showed significant improvements compared to the CG.

Conclusion

Instructions to children to focus attention externally facilitate learning the groundstroke (forehand-backhand) technique, which is one of the basic tennis techniques.

Influence of Visual and Haptic Cues on Motor Learning: Insights from Tennis Skill Acquisition in Children

Underdevelopment of cognitive abilities in children, such as memory and attention, may make the use of verbal instructions difficult for learning new motor skills. The objective of this study was to evaluate whether visual and haptic cues which emphasize certain instructions facilitate skill acquisition in young tennis players. Twenty children were distributed in 2 groups: experimental (EXP) and control (CON). EXP received a racket with visual and haptic cues while CON trained with a classic racket. The task consisted of playing 30 consecutive forehands during a pretest and 16 weeks post-intervention. EXP displayed a larger improvement both in their technique (better ready position, more balls hit in front and to the side of the body) and in their performance (more points scored), highlighting the positive impact of visual and haptic cues during the early stage of motor learning.

How can instructions and feedback with external focus be shaped to enhance motor learning in children? A systematic review

AIM

This systematic review investigates the effectiveness of instructions and feedback with external focus applied with reduced frequency, self-controlled timing and/or in visual or auditory form, on the performance of functional gross motor tasks in children aged 2 to 18 with typical or atypical development.

METHODS

Four databases (PubMed, Web of Science, Scopus, Embase) were systematically searched (last updated May 31st 2021). Inclusion criteria were: 1. children aged 2 to 18 years old; 2. Instructions/feedback with external focus applied with reduced frequency, self-controlled timing, and/or visual or auditory form as intervention, to learn functional gross motor tasks; 3. Instructions/feedback with external focus applied with continuous frequency, instructor-controlled timing, and/or verbal form as control; 4. performance measure as outcome; 5. (randomized) controlled studies. Article selection and risk of bias assessment (with the Cochrane risk of bias tools) was conducted by two reviewers independently. Due to heterogeneity in study characteristics and incompleteness of the reported data, a best-evidence synthesis was performed.

RESULTS

Thirteen studies of low methodological quality were included, investigating effectiveness of reduced frequencies (n = 8), self-controlled timing (n = 5) and visual form (n = 1) on motor performance of inexperienced typically (n = 348) and atypically (n = 195) developing children, for acquisition, retention and/or transfer. For accuracy, conflicting or no evidence was found for most comparisons, at most time points. However, there was moderate evidence that self-controlled feedback was most effective for retention, and limited evidence that visual analogy was most effective for retention and transfer. To improve quality of movement, there was limited evidence that continuous frequency was most effective for retention and transfer.

CONCLUSION

More methodologically sound studies are needed to draw conclusions about the preferred frequency, timing or form. However, we cautiously advise considering self-controlled feedback, visual instructions, and continuous frequency.

TRIAL REGISTRATION

Registration: Prospero CRD42021225723. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021225723.

Instructions for External Focus of Attention Improved Taekwondo Kicking Performance Only Among Less Skilled Youth

External focus of attention (EFA) studies among children have yielded more equivocal results than have those among adults. Some investigators have found an internal focus of attention (IFA) advantage in children and have explained their results by children’s generally lower skill levels, compared to adults. According to the constrained action hypothesis, children’s lower skill levels are not yet associated with over-learned automatic movement patterns, so their motor performance is not disrupted by IFA instructions. In this study, our objective was to examine a possible interaction effect between children’s skill levels and their exposure to either IFA or EFA instructions on motor performance. Our participants were 40 10–15-year-old taekwondo competitors of higher and lower skill levels (based on both the participant’s experience and their test performance) who engaged in a taekwondo kicking movement before and after either IFA or EFA instructions. We found improved kicking performance with EFA versus IFA instructions only among less versus more skilled participants.

Implicit motor learning in primary school children: A systematic review

The aim of this study was to assess the current state of evidence and methodological quality of studies on implicit and explicit motor learning in both typically developing children and children with developmental disorders. A systematic literature review was conducted on the experimental literature published up to April 2020. A total of 25 studies were included. Studies were evaluated on methodological quality, paradigm used, and level of evidence. The results showed that implicit paradigms are as effective as explicit paradigms in both groups of children. Studies are predominantly experimental in nature involving mostly upper limb aiming tasks. The few studies that were performed outside the lab (n = 5) suggest superior efficacy of the implicit paradigm. Methodological quality varied between studies and was not always of sufficient standard to allow conclusions. In particular, manipulation checks were only performed in 13 studies (52% of all studies), limiting conclusions. Further progress can be made by focussing on improving methodological quality through retention testing by the inclusion of a control group, by the inclusion of a manipulation check, and via assessment of relevant co-variables, such as working memory, age, and motor competence.

The effects of external and internal focus of attention on motor learning and promoting learner’s focus

Study aim: External focus of attention is considered as a critical factor in the OPTIMAL theory of motor learning. This theory proposes that external focus of attention facilitates motor performance and learning because it promotes focusing on the task goal. However, the effects of external focus of attention on focusing on the task goal are not well understood. The aim of this study was, therefore, to investigate the effects of an external focus of attention versus an internal focus of attention on motor learning and promoting focus of the learner on the task goal.

Material and methods: Thirty-six right-handed male students (mean age 21.16 ± 1.85 years old) with no prior experiences with the motor task were randomly assigned to three groups: external focus, internal focus, and control groups. Participants were asked to throw darts at a target during an acquisition phase (10 blocks of six trials each) and during subsequent retention and transfer tests. Throwing accuracy and focus on the task goal were measured as dependent variables. Analysis of variance (ANOVA) with repeated measures as well as a one-way ANOVA was used to analyze the differences in accuracy scores between groups during the acquisition phase as well as retention and transfer tests, respectively. The significance level was set at p < .05. The author supervised all phases of the experiment.

Results: The results showed that adopting an external focus promoted a focus on the task goal and resulted in significantly better motor learning than adopting an internal focus and control conditions (p < 0.05).

Conclusions: The findings of the present study provided support for the propositions of the OPTIMAL theory and showed that adopting an external focus of attention promotes focus of the learner on the task goal. The results are discussed in terms of benefits of external focus instructions for facilitating motor learning and goal-action coupling.

External relative to internal attentional focus enhances motor performance and learning in visually impaired individuals

Background: Research has demonstrated the advantages of an external relative to internal focus of attention for enhancing motor performance and learning across diverse tasks, contexts and populations. However, research has yet to examine whether this finding holds true for individuals who have a major visual impairment in discrete and locomotion-based continuous motor tasks.Methods: In experiment 1, twenty-four visually impaired participants were asked to kick a soccer ball with their dominant foot to a target 7 meters away. Participants performed 10 trials within an internal focus (concentration on inside of the foot), external focus (concentration on the ball), and control (no focus instructions) conditions, in a counterbalanced order. In experiment 2, thirty-nine visually impaired adults were asked to ride a rehabilitation Pedalo for a distance of 7 meters. Participants were randomly assigned to either an internal focus (focus on the feet), external focus (focus on the platform), or control (no focus instructions) group. Retention and transfer tests were conducted on day 2.Results: An external focus resulted in more accurate kicks and faster pedalo movement times compared to an internal focus.Conclusions: These findings indicate that visual information does not mediate external focus benefits for motor performance and learning.Implications for RehabilitationPractitioners should use instructions that encourage visually impaired individuals who are going through rehabilitation to adopt an appropriate focus of attention for enhancing motor performance and learning of discrete or locomotion-based motor skills.Instructions that foster an external focus, relative to an internal focus, enhances performance of both discrete and continuous motor skills in individuals with visual impairment.

Use of virtual reality intervention to improve reaction time in children with cerebral palsy: A randomized controlled trial

PURPOSE

The purpose of this study was to investigate the training effects of Virtual Reality (VR) intervention program on reaction time in children with cerebral palsy.

METHODS

Thirty boys ranging from 7 to 12 years (mean = 11.20; SD = .76) were selected by available sampling method and randomly divided into the experimental and control groups. Simple Reaction Time (SRT) and Discriminative Reaction Time (DRT) were measured at baseline and 1 day after completion of VR intervention. Multivariate analysis of variance (MANOVA) and paired sample t-test were performed to analyze the results.

RESULTS

MANOVA test revealed significant effects for group in posttest phase, with lower reaction time in both measures for the experimental group. Based on paired sample t-test results, both RT measures significantly improved in experimental group following the VR intervention program.

CONCLUSIONS

This paper proposes VR as a promising tool into the rehabilitation process for improving reaction time in children with cerebral palsy.

Individual Differences Influencing Immediate Effects of Internal and External Focus Instructions on Children's Motor Performance

PURPOSE

A large pool of evidence supports the beneficial effect of an external focus of attention on motor skill performance in adults. In children, this effect has been studied less and results are inconclusive. Importantly, individual differences are often not taken into account. We investigated the role of working memory, conscious motor control, and task-specific focus preferences on performance with an internal and external focus of attention in children.

METHODS

Twenty-five children practiced a golf putting task in both an internal focus condition and external focus condition. Performance was defined as the average distance toward the hole in 3 blocks of 10 trials. Task-specific focus preference was determined by asking how much effort it took to apply the instruction in each condition. In addition, working memory capacity and conscious motor control were assessed.

RESULTS

Children improved performance in both the internal focus condition and external focus condition (ŋ_p² = .47), with no difference between conditions (ŋ_p² = .01). Task-specific focus preference was the only factor moderately related to the difference between performance with an internal focus and performance with an external focus (r = .56), indicating better performance for the preferred instruction in Block 3.

CONCLUSION

Children can benefit from instruction with both an internal and external focus of attention to improve short-term motor performance. Individual, task-specific focus preference influenced the effect of the instructions, with children performing better with their preferred focus. The results highlight that individual differences are a key factor in the effectiveness in children's motor performance. The precise mechanisms underpinning this effect warrant further research.

Effects of attentional focus on motor learning in children with autism spectrum disorder

Inability to acquire a new motor skill is a common motor difficulty in children with autism spectrum disorder. The purpose of this study is to examine whether the motor learning benefits of an external focus of attention for typically developing children and children with intellectual disabilities could also be applied to children with autism spectrum disorder. Children ( N = 65; mean age = 10.01 years) diagnosed with high-functioning autism spectrum disorder were randomly assigned into one of the three groups: external focus ( n = 22), internal focus ( n = 22), and control ( n = 21). They were required to throw beanbags at a static target for 50 acquisition trials, 10 retention trials, and 10 transfer trials. While all three groups learnt the skills in a similar manner during the acquisition phase, the internal focus group demonstrated more robust motor performance than the external focus group and the control group in both retention and transfer tests, while there was no difference between the external focus group and the control group in both retention and transfer tests. The findings provide evidence that internal focus of attention may be more effective for facilitating motor learning in children with autism spectrum disorder. However, further study is needed to determine the factors contributing to this finding.