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.

Feedback protocol of 'fading knowledge of results' is effective for prolonging motor learning retention

[Purpose] “Knowledge of results” (KR) is information about the success of an action relative to a goal. A reduced frequency of “knowledge of results” reportedly promotes motor learning more than a high frequency. However, the effect of gradually diminishing or increasing “knowledge of results” pattern has been rarely studied and is controversial. We investigated the effectiveness of diminishing “knowledge of results” pattern in motor learning. [Participants and Methods] Forty-six healthy adults were randomly assigned to either the 100% KR, 50% KR, or faded KR group. Participants were tasked with exerting 60% of their maximum voluntary contraction of their left shoulder flexion muscle in an isometric exercise. Participants practiced the task 20 times a day for 4 days. A pretest and posttest were conducted before and immediately after the acquisition, respectively. Retention tests were conducted 1 day, 1 week, and 2 weeks after the acquisition. [Results] The absolute error was significantly reduced in the posttest in the faded KR and 50% KR cohorts. However, there was no significant difference in the 100% KR group. In the faded KR subjects, the improvement effect was observed up to 1 week following acquisition. [Conclusion] Faded “knowledge of results” productively prolongs the effect of motor learning.

Extrinsic feedback and upper limb motor skill learning in typically-developing children and children with cerebral palsy: Review

BACKGROUND

Improvment of upper limb motor skills occurs through motor learning that can be enhanced by providing extrinsic feedback. Different types and frequencies of feedback are discussed but specific guidelines for use of feedback for motor learning in typically-developing (TD) children and children with Cerebral Palsy (CP) are not available.

OBJECTIVE

Identify the most effective modalities and frequencies of feedback for improving upper limb motor skills in TD children and children with CP.

METHODS

Ovid MEDLINE, Cochrane, PEDro and PubMed-NCBI were searched from 1950 to December 2015 to identify English-language articles addressing the role of extrinsic feedback on upper limb motor learning in TD children and children with CP. Nine studies were selected with a total of 243 TD children and 102 children with CP. Study quality was evaluated using the Downs and Black scale and levels of evidence were determined with Sackett's quality ratings.

RESULTS

There was a lack of consistency in the modalities and frequencies of feedback delivery used to improve motor learning in TD children and in children with CP. Moreover, the complexity of the task to be learned influenced the degree of motor learning achieved.

CONCLUSION

A better understanding of the influence of feedback on motor learning is needed to optimize motor skill acquisition in children with CP.

Effects of Knowledge of Results Frequency on the Learning of Generalized Motor Programs and Parameters under Conditions of Constant Practice

The present study investigated the effects of the frequency of knowledge of results (KR) on both generalized motor programs and parameters. Two experiments were conducted that compared two frequencies of KR in terms of generalized motor programs and parameters: (1) the first experiment compared the effects of KR frequency on generalized motor programs in the 100% and 50% groups; and (2) the second experiment compared the effects of reduced KR frequency on parameters in the 100% and 50% groups. In the first experiment, results showed that the 50% group exhibited smaller relative timing errors than did the 100% group, but absolute timing errors in the transfer test were similar between these two groups. In the second experiment, both groups exhibited similar relative and absolute timing errors. These results suggested that the beneficial effects of reduced KR frequency were restricted to generalized motor programs.

Effects of knowledge of results (KR) frequency in the learning of a timing skill: absolute versus relative KR frequency

The interaction between the amount of practice and frequency of Knowledge of Results (KR) was investigated in a timing skill. In the acquisition phase the task involved 90 trials of releasing a knob and transporting three tennis balls from three near recipients to three far ones in a specific sequence and target time. The retention test performed 24 hr. later had the same sequence of transport but a new target time was required. In both phases, absolute error and standard deviation plus constant error was measured. The five groups differed in relation to frequency of KR and amount of practice. The results showed that intermediate frequencies as well as higher frequencies of KR elicited better performance during the retention test.

Efeitos do conhecimento de resultados autocontrolado na aprendizagem motora

O objetivo do presente estudo foi analisar três diferentes estratégias de fornecer conhecimento de resultados (CR): autocontrolado, yoked pareado por tentativa e yoked pareado pela frequência média total de CR, na prática aleatória. A amostra foi constituída por 45 voluntários universitários, distribuídos em três grupos (n= 15 sujeitos). A tarefa consistiu em pressionar as teclas 2, 4, 8 e 6 do teclado numérico de um computador, em três diferentes tempos alvo (700, 900 e 1100 ms), praticados aleatoriamente. O experimento constou de fase de aquisição e testes de retenção e transferência atrasados. A análise dos dados foi realizada por meio da ANOVA e não foi constatada diferença significativa entre os grupos. Os resultados demonstraram que não houve efeito das frequências autocontroladas para a aprendizagem motora quando se utiliza a prática aleatória. Além disso, uma nova possibilidade de parear o grupo autocontrolado foi apresentada.