Motor learning in children: feedback effects on skill acquisition

Feasibility and Effects of a Neuromuscular Warm-Up Based on the Physical Literacy Model for 8-12-Year-Old-Children

Background: Physical literacy and injury prevention strategies use similar movement-related constructs and can be connected to develop comprehensive interventions. We aimed to test the feasibility and effects of a neuromuscular warm-up based on physical literacy and injury prevention strategies for 8-12-year-old children. Methods: We conducted a cluster non-randomized controlled trial. We defined a priori feasibility criteria and studied the effects of the intervention on physical literacy constructs, movement competence, and neuromuscular performance. We used generalized linear mixed models controlling for covariates and clustering with a significance level of 0.001. Results: We recruited 18 groups (n = 363) and randomly allocated nine to intervention (n = 179; female = 63.7%, age = 9.8 ± 1 years) and nine to control (n = 184, female = 53.3%, age = 9.9 ± 0.9 years). We met four of seven feasibility criteria (i.e. recruitment, adherence, enjoyment, perceived exertion). The three feasibility criteria that were not met (i.e. compliance, fidelity, follow-up) were slightly below the predefined threshold (90%). Model-adjusted mean differences for physical literacy constructs, movement competence, vertical jump height, horizontal jump distance, 20-m sprint time, and dynamic balance favored the intervention (p < .001). Conclusion: The feasibility evidence indicates that the intervention should be slightly modified before implementing it in a larger study. The observed mean differences are promising and can be used in planning future interventions.

Visual feedbacks influence short-term learning of torque versus motion profile with robotic guidance among young adults

Robotic assistance can improve the learning of complex motor skills. However, the assistance designed and used up to now mainly guides motor commands for trajectory learning, not dynamics learning. The present study explored how a complex motor skill involving the right arm can be learned without suppressing task dynamics, by means of an innovative device with robotic guidance that allows a torque versus motion profile to be learned with admittance control. In addition, we assessed how concurrent visual feedback on this profile can enhance learning without creating dependency, by means of a fading procedure (i.e., feedback reduction across trials). On Day 1, a Control group performed an acquisition session (6 blocks) featuring concurrent visual feedback, while a Fading group performed the session with a gradual reduction in feedback (from 100% to 0% over the 6 blocks). On Day 2, both groups performed a block first without feedback (i.e., Transfer test), then with feedback (i.e., Retention test). Results revealed that on Day 1, movement rehearsal induced a significant improvement in spatiotemporal parameters for the Control group, compared with the Fading group. On Day 2, the opposite was found when this visual feedback was removed, as the Fading group performed significantly better than the Control group on the Transfer test. Vision allows a relationship to be established between the required torque and the motion profile. Its suppression then forces the processing of more intrinsic information, leading to the development of a stable internal representation of the task.

Evaluating the influence of feedback on motor skill learning and motor performance for children with developmental coordination disorder: a systematic review

Introduction

Children with developmental coordination disorder (DCD) have difficulties with learning and performing physical tasks. It is well known that task-specific practice is effective in improving motor skills. Additional feedback during practice may function as a quality improvement mechanism and therefore enhance motor skill outcomes.

Aims

To investigate the effect of different forms of feedback on motor learning and motor performance in children with DCD.

Methods

A systematic review was conducted (registration CRD42020175118) to investigate the effectiveness of different types of feedback, compared to other forms of feedback, or no additional feedback, on motor learning and motor performance outcomes in children with DCD. The search was run across six electronic databases (last search January 2024). Two reviewers independently screened studies for inclusion, assessed the quality of included studies, and extracted relevant data. A narrative synthesis was performed and included studies that assessed motor learning and/or performance outcomes following an intervention that delivered a specific form of feedback in comparison to another form of feedback or no specific feedback.

Results

14 articles from 13 trials were included in this review. Feedback was delivered by providing various forms of feedback, including: knowledge of results, focus of attention and augmented feedback delivered via technology. No significant differences were found between different forms of feedback for motor learning or performance outcomes for children with DCD. Interventions that used technology (with augmented feedback) to deliver the intervention were found to be as effective as traditional therapy. All groups who participated in therapy, regardless of the presence or type of feedback received, improved in overall scores on a motor performance outcome assessment.

Conclusion

Despite the clear rationale for using feedback-oriented interventions for children with DCD, there is surprisingly limited and low-quality research. There is no clear evidence that one form of feedback is more effective than another, although it appears that feedback delivered via technology may be as effective as feedback delivered in traditional therapy interventions for children with DCD. Further exploration is required from appropriately powered and well-designed trials.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=175118, identifier (CRD42020175118).

Effect of Reduced Feedback Frequencies on Motor Learning in a Postural Control Task in Young Adults

The effects of the use of reduced feedback frequencies on motor learning remain controversial in the scientific literature. At present, there is still controversy about the guidance hypothesis, with some works supporting it and others contradicting it. To shed light on this topic, an experiment was conducted with four groups, each with different feedback frequencies (0%, 33%, 67%, and 100%), which were evaluated three times (pre-test, post-test, and retention) during a postural control task. In addition, we tested whether there was a transfer in performance to another similar task involving postural control. As a result, only the 67% feedback group showed an improvement in their task performance in the post-test and retention evaluations. Nevertheless, neither group showed differences in motor transfer performance compared to another postural control task. In conclusion, the findings of this paper corroborate the hypothesis of guidance and suggest that the use of a reduced frequency of 67% is a better option for improving motor learning than options that offer feedback at a lower frequency, at all trials or not at all.

Motor learning in golf-a systematic review

Golf is a sport that consists of complex movement skills that need to be executed with utmost precision. Consequently, motor skill learning plays a crucial role in golf, and large numbers of studies address various methods of motor learning. In the present review, we give a systematic overview of randomized controlled trials (RCTs) on motor learning of golf-specific motor skills. Three electronic databases were searched for RCTs looking at the effect of at least one learning method on performance in a golf-specific motor task. We grouped the studies depending on the learning strategies "cognitive training", "practice scheduling", "augmented feedback", "implicit and explicit learning" and "focus of attention". Fifty-two RCTs met the eligibility criteria and were included in the systematic review. Superior methods within their respective strategies were an external focus of attention and increasing contextual interference, as well as errorless learning. For "cognitive training" and "augmented feedback", no single method can be considered the most favorable. The overall biggest limitations were the lack of statistical power for more than half of the RCTs, and the fact that most studies of the present review investigated simple putting tasks in novices only. Although we have shown superiority of specific learning methods, transferability of the recommendations that can be derived from simple golf tasks in novices to sport-specific tasks in advanced players still has to be demonstrated and require study designs with the intention to provide practical recommendations for coaches and athletes in the sport of golf.

Normative values and factors affecting Pediatric Reach Tests in Saudi children aged 6-11 years in the eastern province: cross-sectional study

Background

The Pediatric Reach Tests (PRTs) assess balance while standing-the Functional Reach Test (FRT) and Lateral Reach Test (LRT)-and in a sitting position-the Modified Functional Reach Test (MFRT) and Modified Lateral Reach Test (MLRT). Normative values have not been fully evaluated in Saudi children. The objectives are; to estimate the normative values for PRTs; investigate the correlation between the PRTs and demographic/anthropometric characteristics; and develop predictive equations for the PRTs.

Methods

In this cross-sectional study, 251 children aged 6-11 were recruited. The PRTs were measured and correlated with demographic/anthropometric variables. A stepwise regression was conducted to develop the predictive equations for the PRT scores.

Results

The mean and standard deviations (in cm) of the PRT scores were as follows: FRT = 20.02 ± 4.31; LRT = 13.42 ± 3.38; MFRT = 21.49 ± 4.70, and MLRT = 14.64 ± 3.66. Several significant correlations were found. Moderate correlations existed between the PRT scores and age, height, upper extremity length, lower extremity length, and foot length; there was a weak correlation with body mass index. Weight was moderately correlated with FRT and MFRT and weakly correlated with LRT and MLRT. The correlation between the base of support and LRT was moderate and was weak with FRT, MFRT, and MLRT. A weak correlation was found between sex and LRT. Age and height were the most predictive of PRT scores.

Conclusion

This study provided PRT normative values that can be used as a clinical reference for evaluating balance in typically developing children.

Effects of dynamic and isometric motor practice on position control, force control and corticomuscular coherence in preadolescent children

In this study, we investigated the effects of motor practice with an emphasis on either position or force control on motor performance, motor accuracy and variability in preadolescent children. Furthermore, we investigated corticomuscular coherence and potential changes following motor practice. We designed a setup allowing discrete wrist flexions of the non-dominant hand and tested motor accuracy and variability when the task was to generate specific movement endpoints (15-75 deg) or force levels (5-25% MVC). All participants were tested in both tasks at baseline and post motor practice without augmented feedback on performance. Following baseline assessment, participants (44 children aged 9-11 years) were randomly assigned to either position (PC) or force control (FC) motor practice or a resting control group (CON). The PC and FC groups performed four blocks of 40 trials motor practice with augmented feedback on performance. Following practice, improvements in movement accuracy were significantly greater in the PC group compared to the FC and CON groups (p < 0.001). None of the groups displayed changes in force task performance indicating no benefits of force control motor practice and low transfer between tasks (p-values:0.08-0.45). Corticomuscular coherence (C4-FCR) was demonstrated during the hold phase in both tasks with no difference between tasks. Corticomuscular coherence did not change from baseline to post practice in any group. Our findings demonstrate that preadolescent children improve position control following dynamic accuracy motor practice. Contrary to previous findings in adults, preadolescent children displayed smaller or no improvements in force control following isometric motor practice, low transfer between tasks and no changes in corticomuscular coherence.

Bridging Motor Learning Principles with Physiotherapy Specific Scoliosis Exercises: a Perspective Article

AIM

This perspective paper illustrates the usefulness of explicitly integrating motor learning terminology with evolving therapeutic approaches. Physiotherapy specific scoliosis exercises (PSSEs) include a growing number of approaches to scoliosis management and serve as an example of this integration.

METHODS

Three quintessential patient cases (a young hypermobile adolescent, a post-pubescent teen, and an adult with childhood diagnosis of scoliosis) serve to contrast the clinical decision-making process for a PSSE plan of care when organized within a motor learning framework.

CONCLUSIONS AND IMPLICATIONS

As intervention approaches evolve, aligning the unique terminologies from different schools of thought with motor learning constructs would provide a common language for clinicians, academics and researchers to facilitate comparison of approaches and organize intervention care plans. Linking a motor learning framework and terminology to PSSE may facilitate comparison of PSSE treatment approaches by clinicians, academics, and researchers, as well as advance the global quality of care for patients with scoliosis.

Neither Too Easy Nor Too Difficult: Effects of Different Success Criteria on Motor Skill Acquisition in Children

The purpose of this study was to examine the effects of different success criteria on motor learning in children. Forty-eight children threw soft-golf balls toward a circular target using their nondominant arm. On Day 1, they performed six blocks of 12 trials from 5.5 m. On Day 3, they performed a 12-trial retention test followed by a 12-trial transfer test. Participants were randomly assigned to one of four groups: difficult criteria for success, relatively easy criteria for success (RES), easy criteria for success, and control. Results demonstrated that there was a significant difference between the RES and control groups in their throwing accuracy on the retention and transfer tests, and the RES group had the highest score compared with the other two groups. This research suggests that providing relatively easy criteria facilitates motor skill acquisition in children.

Using Inertial Measurement Unit Sensor Single Axis Rotation Angles for Knee and Hip Flexion Angle Calculations During Gait

BACKGROUND

Hip and knee flexion joint motions are frequently examined in clinical practice using camera based motion capture (CBMC) systems; however, these systems require elaborate setups and dedicated space. Inertial measurement unit (IMU) based systems avoid these disadvantages but require validation before widespread adoption. Moreover, it is important for clinical practice to determine the stability of these systems for prolonged evaluation periods. The purpose of this study was to assess the validity of a three-sensor inertial measurement unit system for calculating hip and knee flexion angles during gait by comparing with a gold standard CBMC system. Validity was also examined before and after a treadmill walking session.

METHODS

Twenty healthy participants were tested. Twenty seconds of gait at preferred walking speed were analyzed before and after thirty-two minutes of treadmill walking using previously validated CBMC methods and with a custom IMU model. Measurement validity for the IMU system was evaluated using Bland & Altman 95 percent limits of agreement, linear regression, mean absolute error and root mean square error. The effects of a measurement zeroing calibration strategy were also investigated.

RESULTS

Strong measurement agreement was observed for both hip and knee flexion angles, although overall agreement for the hip exceeded that for the knee. Linear regressions between the datasets for each participant illustrated strong (> 0.94) relationships between IMU and CBMC measurements. More significant changes between timepoints were observed for the knee than for the hip. Error values were generally reduced when zeroing calibration was implemented.

CONCLUSION

The IMU system presented in this study is a convenient and accessible technique to measure joint angles. The protocol described in the current study can be easily applied in the clinical setting for evaluation of clinical populations. Additional development work on sensor placement and calibration methods may further increase the accuracy of such methods. Clinical translation statement: The IMU system presented in this study is a convenient and accessible technique to measure joint angles. Additional developmentwork on sensor placement and calibration methods may further increase the accuracy of such methods.

Do Primary School Children Benefit from Drop-Jump Training with Different Schedules of Augmented Feedback about the Jump Height?

In children, the training of jumps leads to improved jumping and running performance. Augmented feedback about the jump height is known to facilitate performance improvements in adults. In the present study, the impact of augmented feedback on jumping performance was investigated in 4th grade primary school children executing drop-jump training for 8 weeks (24 sessions, 3 times/week). Ten children (eight males, two females, aged 9.6 ± 0.3 years), received feedback for 8 weeks, and 11 children (nine males, two females, aged 9.5 ± 0.2 years) received feedback only during the last 4 weeks. Drop-jumps training was integrated in physical education classes. Drop-jump and countermovement-jump heights were improved after 24 training sessions (p < 0.01 for both types of jumps in both groups). Ground contact times of drop-jumps were quite long (>200 ms) and not altered by training, and the reactive strength index of drop-jumps was between 0.75 and 1.5 in most children. Augmented feedback did not facilitate jumping performance like in previous studies with adult participants. In contrast, withholding augmented feedback during the first 4 weeks of training was associated with a reduction in jumping performance (p < 0.01 for drop-jumps, p < 0.05 for countermovement-jumps). Finally, improvements did not transfer to functional motor tasks containing jumps. According to the costs and outcomes we do not recommend drop-jump training with augmented feedback about the jump height for 4th grade physical education classes.

Preventive Training Program Feedback Complexity, Movement Control, and Performance in Youth Athletes

CONTEXT

Preventive training programs (PTPs) reduce injury risk by improving movement control. Corrective feedback is important; however, many cues at once may be too complicated for athletes.

OBJECTIVE

To compare movement control and long-jump (LJ) changes in youth athletes participating in a season-long PTP, with simplified feedback, traditional feedback, or a warmup of the coaches' choosing.

DESIGN

Cluster-randomized controlled trial.

SETTING

Soccer fields.

PATIENTS OR OTHER PARTICIPANTS

A total of 420 athletes (simplified feedback = 173, traditional feedback = 118, and control = 129; age = 11 ± 3 years).

INTERVENTION(S)

Teams were randomized into the simplified PTP, traditional PTP, or control group. Simplified and traditional PTPs lasted 10 to 12 minutes and used the same exercises. The simplified PTP provided only sagittal-plane feedback (eg, "get low"), and the traditional PTP provided feedback targeting all motion planes (eg, "don't let your knees cave inward"). Research assistants administered the PTP warmups 2 to 3 times/week for the season. Control team coaches chose and ran their own warmup strategies.

MAIN OUTCOME MEASURE(S)

Participants completed 4 sessions (preseason [PRE], postseason [POST] at approximately 8 weeks after PRE, retention 1 [R1] at 6 weeks postseason, and retention 2 [R2] at 12 weeks postseason). They performed 3 trials of a jump-landing task, which was evaluated using the Landing Error Scoring System (LESS) and 2 recorded standing LJ trials at each test session. A time series panel was used to evaluate group differences across time points for the LESS and LJ.

RESULTS

Change score analyses revealed improvements in the LESS score from PRE to POST for all groups. Improvements from PRE were retained at R1 and R2 for the intervention groups (simplified and traditional). The traditional group demonstrated better LJ performance at POST (P < .001) and R1 (P = .049) than the simplified or control group.

CONCLUSIONS

Simplified cues were as effective as traditional cues in improving LESS scores from PRE to POST season. Participating in PTPs, regardless of their complexity, likely provides movement benefits.

Visual Feedback in Augmented Reality to Walk at Predefined Speed Cross-Sectional Study Including Children With Cerebral Palsy

In an augmented reality environment, the range of possible real-time visual feedback is extensive. This study aimed to compare the impact of six scenarios in augmented reality combining four visual feedback characteristics on achieving a target walking speed. The six scenarios have been developed for Microsoft Hololens augmented reality headset. The four feedback characteristics that we have varied were: Color; Spatial anchoring; Speed of the feedback, and Persistence. Each characteristic could have different values (for example, the color could be unicolor, bicolor, or gradient). Participants had to walk for two consecutive walking trials for each scenario: at their maximal speed and an intermediate speed. Mean speed, percentage of time spent above or around target speed, and time to reach target speed were compared between scenarios using mixed linear models. A total of 25 children with disabilities have been included. The feasibility and user experience were excellent. Mean speed during scenario 6, which displayed feedback with gradient color, attached to the world, with a speed relative to the player equal to his speed, and that disappeared over time, was significantly higher than other scenarios and control (p =0.003). Participants spent 80.98% of time above target speed during scenario 6. This scenario mixed the best combination of feedback characteristics to exceed the target walking speed (p=0.0058). Scenarios 5 and 6, which shared the same feedback characteristics for spatial anchoring (world-locked) and feedback speed (equal to the player speed), decreased the time to reach the target speed (p=0.019). Delivering multi-modal feedback has been recognized as more effective for improving motor performance. Therefore, our results showed that not all visual feedback had the same impact on performance. Further studies are required to test the weight of each feedback characteristic and their possible interactions inside each scenario. This study was registered in the ClinicalTrials.gov database (NCT04460833).

Use of Observational Learning to Promote Motor Skill Learning in Physical Education: A Systematic Review

Observational learning is an effective pedagogical approach that can influence students' motor skill development at every level of physical education (PE). This study aimed to systematically summarize the evidence on observational learning for motor skill learning in PE and to generalize the evidence on the effect of model formats and verbal cues during observational learning. An electronic search of eight databases was conducted. Eighteen studies were included and their methodological quality was assessed using the Physiotherapy Evidence Database Scale. Best evidence synthesis (BES) was used to assess levels of evidence. Strong evidence supported the effect of observational learning on students' motor skill learning compared to students who did not participate in observational learning. Moderate evidence suggested that there is no significant difference in the effectiveness of observing an expert model compared to a self-model. Conflicting evidence was identified for the effect of the presence of verbal cues compared to the absence of verbal cues during observational learning. The results suggest that observational learning is useful for students' motor skill learning in PE. Given the influences of potential factors, we recommend that future studies investigate how observational learning interacts with verbal cues on students' motor skill learning.

Physical activity promoting teaching practices and children’s physical activity within physical education lessons underpinned by motor learning theory (SAMPLE-PE)

Purpose

Movement competence is a key outcome for primary physical education (PE) curricula. As movement development in children emerges through physical activity (PA), it is important to determine the extent of PA promotion within movement competence focused teaching pedagogies. Therefore, this study aimed to assess children’s moderate-to-vigorous PA (MVPA) and related teaching practices in primary PE within Linear pedagogy and Nonlinear pedagogy and to compare this to current practice within PE delivery in primary schools.

Methods

Participants (n = 162, 53% females, 5-6y) were recruited from 9 primary schools within the SAMPLE-PE cluster randomised controlled trial. Schools were randomly-allocated to one of three conditions: Linear pedagogy, Nonlinear pedagogy, or control. Nonlinear and Linear pedagogy intervention schools received a PE curriculum delivered by trained deliverers over 15 weeks, while control schools followed usual practice. Children’s MVPA was measured during 3 PE lessons (44 PE lessons in total) using an ActiGraph GT9X accelerometer worn on their non-dominant wrist. Differences between conditions for children’s MVPA were analysed using multilevel model analysis. Negative binomial models were used to analyse teaching practices data.

Results

No differences were found between Linear pedagogy, Nonlinear pedagogy and the control group for children’s MVPA levels during PE. Linear and Nonlinear interventions generally included higher percentages of MVPA promoting teaching practices (e.g., Motor Content) and lower MVPA reducing teaching practices (e.g., Management), compared to the control group. Teaching practices observed in Linear and Nonlinear interventions were in line with the respective pedagogical principles.

Conclusions

Linear and Nonlinear pedagogical approaches in PE do not negatively impact MVPA compared to usual practice. Nevertheless, practitioners may need to refine these pedagogical approaches to improve MVPA alongside movement competence.

Age-dependent Upper Limb Myoelectric Control Capability in Typically Developing Children

Research in EMG-based control of prostheses has mainly utilized adult subjects who have fully developed neuromuscular control. Little is known about children's ability to generate consistent EMG signals necessary to control artificial limbs with multiple degrees of freedom. As a first step to address this gap, experiments were designed to validate and benchmark two experimental protocols that quantify the ability to coordinate forearm muscle contractions in typically developing children. Able-bodied, healthy adults and children participated in our experiments that aimed to measure an individual's ability to use myoelectric control interfaces. In the first experiment, participants performed 8 repetitions of 16 different hand/wrist movements. Using offline classification analysis based on Support Vector Machine, we quantified their ability to consistently produce distinguishable muscle contraction patterns. We demonstrated that children had a smaller number of highly independent movements (can be classified with >90% accuracy) than adults did. The second experiment measured participants' ability to control the position of a cursor on a 1-DoF virtual slide using proportional EMG control with three different visuomotor gain levels. We found that children had higher failure rates and slower average target acquisitions than adults did, primarily due to longer correction times that did not improve over repetitive practice. We also found that the performance in both experiments was age-dependent in children. The results of this study provide novel insights into the technical and empirical basis to better understand neuromuscular development in children with upper-limb loss.

A Pilot Study Comparing the Effects of Concurrent and Terminal Visual Feedback on Standing Balance in Older Adults

While balance training with concurrent feedback has been shown to improve real-time balance in older adults, terminal feedback may simplify implementation outside of clinical settings. Similarly, visual feedback is particularly well-suited for use outside the clinic as it is relatively easily understood and accessible via ubiquitous mobile devices (e.g., smartphones) with little additional peripheral equipment. However, differences in the effects of concurrent and terminal visual feedback are not yet well understood. We therefore performed a pilot study that directly compared the immediate effects of concurrent and terminal visual feedback as a first and necessary step in the future design of visual feedback technologies for balance training outside of clinical settings. Nineteen healthy older adults participated in a single balance training session during which they performed 38 trials of a single balance exercise including trials with concurrent, terminal or no visual feedback. Analysis of trunk angular position and velocity features recorded via an inertial measurement unit indicated that sway angles decreased with training regardless of feedback type, but sway velocity increased with concurrent feedback and decreased with terminal feedback. After removing feedback, training with either feedback type yielded decreased mean velocity, but only terminal feedback yielded decreased sway angles. Consequently, this study suggests that, for older adults, terminal visual feedback may be a viable alternative to concurrent visual feedback for short duration single-task balance training. Terminal feedback provided using ubiquitous devices should be further explored for balance training outside of clinical settings.

Upper Body Physical Rehabilitation for Children with Ataxia through IMU-Based Exergame

BACKGROUND

Children with ataxia experience balance and movement coordination difficulties and needs intensive physical intervention to maintain functional abilities and counteract the disorder. Exergaming represents a valuable strategy to provide engaging physical intervention to children with ataxia, sustaining their motivation to perform the intervention. This paper aims to describe the effect of a home-conducted exergame-based exercise training for upper body movements control of children with ataxia on their ataxic symptoms, walking ability, and hand dexterity.

METHODS

Eighteen children with ataxia were randomly divided into intervention and control groups. Participants in the intervention group were asked to follow a 12-week motor activity program at home using the Niurion® exergame. Blind assessments of participants' ataxic symptoms, dominant and non-dominant hand dexterity, and walking ability were conducted.

RESULTS

On average, the participants performed the intervention for 61.5% of the expected time. At the end of the training, participants in the intervention group showed improved hand dexterity that worsened in the control group.

CONCLUSION

The presented exergame enhanced the participants' hand dexterity. However, there is a need for exergames capable of maintaining a high level of players' motivation in playing. It is advisable to plan a mixed intervention to take care of the multiple aspects of the disorder.

Effectiveness of the Type of Feedback on Learning to Pass in Volleyball

Objective: To determine which type of feedback (visual, verbal, or both combined) facilitates to a greater extent the learning of a specific skill (passing in volleyball). Methods: Three groups of students between 14 and 15 years of age belonging to the third year of Compulsory Secondary Education in a Spanish public high school (n = 58) were randomly assigned a type of feedback implemented in the part of the syllabus dedicated to volleyball. The students’ knowledge, motor performance, accuracy, and self-perception about the action were evaluated before and after the intervention and enjoyment afterwards. Results: All the groups obtained improvements in all the variables studied (p < .05); the verbal and visual feedback group was the one that obtained greater improvements, showing also a greater enjoyment than the visual feedback group. Conclusions: It has been found that the use of the combination of verbal and visual feedback is most recommended for learning a specific skill, such as passing in volleyball.

The recommendation for learners to be provided with control over their feedback schedule is questioned in a self-controlled learning paradigm

Evidence that self-controlled feedback schedules are more effective for motor learning than yoked or predetermined schedules has been used to forward the recommendation that practitioners should provide choice to learners over when they would like to receive feedback. This recommendation can be questioned because the typical comparison groups in such experimentation do not well represent the applied setting. Consequently, comparison groups that better map onto the applied setting are needed. To this end, three groups learned a golf putting task: (1) self-controlled, (2) traditional-yoked, and (3) a group who were led to believe their KR schedule was being controlled by a golf coach. Participants (N = 60) completed a pre-test, acquisition phase, and delayed post-tests (retention/transfer). No group differences during the post-tests for mean radial error, F(2, 54) = 2.71, p = .075, or bivariate variable error, F(2, 56) = 0.11, p = .896, were found. Thus, the typical self-controlled learning advantage was not observed. Given the failure to replicate self-controlled benefits, combined with the fact there is little research that has directly compared self-controlled feedback schedules to coach-controlled schedules, we argue more evidence is needed before advocating that learners be provided choice over their feedback schedule.

Differences between adults and adolescents in responding to hip and knee pattern feedback during gait

Visual feedback techniques have shown potential in interventions aiming to retrain deviated gait patterns. Understanding the abilities of different age groups to modify their gait is needed to optimize interventions. Twelve adults (6F, 6 M; 26.3 ± 5.9 yrs.) and twelve adolescents (4F, 8 M; 13.6 ± 2.3 yrs) without disabilities participated in one training session. During the session, the responses to a visual kinematic feedback task in which one hip or knee target pattern was modified while unmodified target patterns were maintained in the other hip and knee joints were investigated. Limb orientation and acceleration data were collected using Inertial Measurement Units (IMU) (Xsens Awinda, Enschede, The Netherlands) with a sampling frequency of 60 Hz. Adults tended to outperform adolescents in tracking modified target patterns and showed smaller errors in unmodified regions of modified patterns (p = 0.045); they also outperformed adolescents in unmodified joints (Contralateral Hip: p = 0.003; Contralateral Knee: p = 0.002; Ipsilateral Joint: p = 0.048). These findings suggest different levels of awareness of the need and/or ability to minimize errors across joints, in turn suggesting the need for specialization of training for these age groups.

Optimizing Motor Learning: Difficulty Manipulation Combined with Feedback- Frequency Enhance Under-Time-Pressure Fine-Motor-Coordination Skill Acquisition and Retention

Improving acquisition and retention of new motor skills is of great importance. This study investigated the effects of progressive task difficulty manipulation (TD), combined with varying knowledge of results frequencies (KR) on performance accuracy and consistency when learning novel fine motor coordination tasks, and examined relationships between novel fine motor task performance and executive function (EF), working memory (WM), and perceived difficulty (PD). Thirty-six, right-handed, novice physical-education students (age = 10.72 ± 0.89 years) participated; participants were separated into three groups, receiving varying KR frequency (100%KR, 50%KR, and 33%KR). For each group, distance to the target was increased progressively (2 m, 2.37 m, and 3.56 m) to obtain three difficulty levels. We assessed performance during test sessions (pretest, post-test, Retention1 and Retention2) under free (FC) and time pressure (TPC) conditions. Results revealed that under FC, 100%KR improved significantly. Results revealed significant linear improvements in accuracy for 50%KR and 33%KR under TPC. New findings indicate that the association between TD and KR (50%KR) may provide more appropriate cognitive loads compared to 33%KR and 100%KR groups. These have implications for practitioners because, while strategies are clearly necessary for improving learning, the efficacy of the process appears to be based on the characteristics of the learners.

The Effects of Manipulating Task Difficulty and Feedback Frequency on Children's Dart Throwing Accuracy and Consistency

In the present study we investigated the effects of manipulating task difficulty (constant vs. progressive difficulty) and frequency of knowledge of results (KR) on the accuracy and consistency of children's performance of a novel fine motor coordination task (dart throwing). We assigned 69 right-handed physical education (PE) students (M age = 10.73, SD = 0.89 years) to progressive (PDG) or constant difficulty (CDG) groups. PDG and CDG were each split into three subgroups who received varying KR frequency (100%KR, 50%KR, and 33%KR), creating a total of six groups. We increased difficulty in the PDG by manipulating the distance to the target (2 m, 2.37 m, and 3.56 m), while distance to the target was constant for CDG throughout the experiment (2.37 m). We conducted performance assessments during familiarization (pre-test), acquisition (post-test), and retention (retention testing) learning phases under both normal condition (NC) and a time pressure condition (TPC). Repeated-measures analysis of variance revealed a significant effect of difficulty manipulation on skill learning under both NC and TPC. Further analyses revealed that skill learning was enhanced by progressive difficulty manipulation. However, learning was not affected by KR frequency changes. Progressive difficulty practice enhanced both accuracy and consistency, specifically at retention testing. These results suggest that motor learning in children may be enhanced by practicing with progressive increases in difficulty. PE teachers are encouraged to gradually introduce difficulty levels in motor learning tasks that require high accuracy.

Optimizing Feedback Frequency in Motor Learning: Self-Controlled and Moderate Frequency KR Enhance Skill Acquisition

The purpose of this study was to compare the relative effects of self-controlled knowledge of results (SCKR) to other KR schedules of varying relative frequency (25%, 50%, and 100% of acquisition trials) on motor skill learning. Participants received basic instructions on the soccer overhead throw and then performed 50 acquisition trials, during which KR was provided according to the assigned schedule, followed by a retention test, during which no KR was provided. Retention scores were highest for the SCKR and 50% KR frequency groups who shared comparable absolute KR frequency and distribution relative to successful versus unsuccessful trials. These results indicated that both self-control and moderate frequency feedback enhanced learning, supporting an inverted U-shaped effect of feedback frequency on skill acquisition.

Effect of Physical Guidance on Learning a Tracking Task in Children with Cerebral Palsy

The purpose of this study was to investigate the effect of physical guidance (PG) frequency on learning a tracking task in children with hemiplegic spastic cerebral palsy (CP). For this purpose, 25 children, aged 7–15 years with CP affecting the left side of the body, who were classified in levels II–III of Manual Abilities Classification System (MACS) and levels III–IV of Gross Motor Function Classification System (GMFCS), were recruited from 10 clinical centers. A pre-test including two blocks of 12 trials of the tracking task without any PG was performed by all participants, after that they were assigned into five homogenous groups (with 100%, 75%, 50%, 25%, and 0% of PG) through blocked randomization according to their age. All participants involved in an intervention consisted of eight sessions (four blocks of 12 trials in each session) practicing a tracking task. The 0% PG group received no PG, the 25% PG group received PG for three trials, the 50% PG group received PG for six trials, the 75% PG group received PG for nine trials, and the 100% PG group received PG for all twelve trials. PG consisted of placing the experimenter’s hand around the child’s less-involved hand guiding to stay on the track and complete the task. Learning was inferred by acquisition and delayed retention tests. The results showed that the higher frequency of PG led to more accurate performance during practice phase. However, the group that received 75% PG had significantly better performance compared to the other groups in the retention phase. It is concluded that optimum level of PG, about 75% of trials, can be helpful for learning a tracking task in children with spastic hemiplegic CP, supporting the challenge point framework.

Feedback cues improve the alignment and technique of children performing ACL injury prevention exercises

OBJECTIVES

The appropriateness of neuromuscular training exercises across different age groups has not yet been investigated, particularly in younger children. The purpose of this study was to determine which neuromuscular training exercises can be performed with proper neutral alignment in various age groups.

METHODS

Seven exercises were selected for evaluation in children ranging from 8 to 17 years of age who were recruited from schools and youth sports organisations. Participants completed two trials of each exercise and were judged on maintaining neutral body alignment after receiving visual/verbal instruction on the first trial and feedback cues on the second trial. Three evaluators judged each exercise, which was deemed as correct when at least two evaluators agreed that neutral alignment was maintained. Comparisons were made across ages and between sex using the χ² test or Fisher's exact test. The proportions of participants who performed the exercise correctly were also compared before and after feedback cues were provided.

RESULTS

A total of 360 participants were evaluated (8-11 years: 165, 54% female; 12-15 years: 136, 40% female, 16-17 years: 59, 53% female). There were no significant differences in performance across ages and sex for nearly all exercises. The majority of children were not able to complete the exercises with proper alignment. The use of feedback cues significantly increased the proportion of participants who correctly completed the exercise (p<0.001).

CONCLUSIONS

These results demonstrate the importance of training coaches and physical education teachers to provide cues that reinforce proper technique during anterior cruciate ligament injury prevention exercises. Children should perform common neuromuscular training exercises with feedback on proper technique.

LEVEL OF EVIDENCE

IV (case series).

The influence of type of feedback during tablet-based delivery of intensive treatment for childhood apraxia of speech

PURPOSE

One of the key principles of motor learning supports using knowledge of results feedback (KR, i.e., whether a response was correct / incorrect only) during high intensity motor practice, rather than knowledge of performance (KP, i.e., whether and how a response was correct/incorrect). In the future, mobile technology equipped with automatic speech recognition (ASR) could provide KR feedback, enabling this practice to move outside the clinic, supplementing speech pathology sessions and reducing burden on already stretched speech-language pathology resources. Here, we employ a randomized controlled trial design to test the impact of KR vs KP feedback on children's response to the Nuffield Dyspraxia Programme 3, delivered through an android tablet. At the time of testing, ASR was not feasible and so correctness of responses was decided by the treating clinician.

METHOD

Fourteen children with CAS, aged 4-10 years, participated in a parallel group design, matched for age and severity of CAS. Both groups attended a university clinic for 1-hr therapy sessions 4 days a week for 3 weeks. One group received high frequency feedback comprised of both KR and KP, in the style of traditional, face-to-face intensive intervention on all days. The other group received high frequency KR + KP feedback on 1 day per week and high frequency KR feedback on the other 3 days per week, simulating the service delivery model of one clinic session per week supported by tablet-based home practice.

RESULTS

Both groups had significantly improved speech outcomes at 4-months post-treatment. Post-hoc comparisons suggested that only the KP group showed a significant change from pre- to immediately post-treatment but the group difference had dissipated by 1-month post-treatment. Heterogeneity in response to intervention within the groups suggests that other factors, not measured here, may be having a substantive influence on response to intervention and feedback type.

CONCLUSION

Mobile technology has the potential to increase motivation and engagement with therapy and to mitigate barriers associated with distance and access to speech pathology services. Further research is needed to explore the influence of type and frequency of feedback on motor learning, optimal timing for transitioning from KP to KR feedback, and how these parameters interact with task, child and context-related factors.

Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study

Background

Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access.

Objective

This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence.

Methods

For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed.

Results

A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67).

Conclusions

The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

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.

Skill Acquisition Methods Fostering Physical Literacy in Early-Physical Education (SAMPLE-PE): Rationale and Study Protocol for a Cluster Randomized Controlled Trial in 5-6-Year-Old Children From Deprived Areas of North West England

BACKGROUND

There is a need for interdisciplinary research to better understand how pedagogical approaches in primary physical education (PE) can support the linked development of physical, cognitive and affective aspects of physical literacy and physical activity behaviors in young children living in deprived areas. The Skill Acquisition Methods fostering Physical Literacy in Early-Physical Education (SAMPLE-PE) study aims to examine the efficacy of two different pedagogies for PE, underpinned by theories of motor learning, to foster physical literacy.

METHODS

SAMPLE-PE will be evaluated through a cluster-randomized controlled trial targeting 5-6 year old children from schools located in areas of high deprivation in Merseyside, North-West England. Schools will be randomly allocated to one of three conditions: Linear Pedagogy, Non-linear Pedagogy, or Control. Non-linear and Linear Pedagogy intervention primary schools will receive a PE curriculum delivered by trained coaches over 15 weeks, while control schools will follow their usual practice. Data will be collected at baseline (T0), immediately post-intervention (T1), and 6 months after the intervention has finished (T2). Children's movement competence is the primary outcome in this trial. Secondary outcomes include physical activity, perceived competence, motivation, executive functions, and self-regulation. An extensive process evaluation will also examine implementation factors such as intervention context, reach, dose, fidelity and acceptability.

DISCUSSION

The SAMPLE-PE project will enable better understanding surrounding how to operationalise physical literacy through enrichment of PE practices in early PE. The study will provide robust scientific evidence regarding the efficacy of underpinning PE pedagogy with theories of motor learning to promote the development of physical literacy.

TRIAL REGISTRATION

Retrospectively registered on 5th September 2018 at ClinicalTrials.gov, a resource provided by the U.S. National Library of Medicine (Identifier: NCT03551366).

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy

BACKGROUND

Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination.

AIMS

We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy.

METHODS AND PROCEDURES

Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months.

OUTCOMES AND RESULTS

Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention.

CONCLUSIONS AND IMPLICATIONS

Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

The Effects of Combined Movement and Storytelling Intervention on Motor Skills in South Asian and White Children Aged 5-6 Years Living in the United Kingdom

Early motor development has an important role in promoting physical activity (PA) during childhood and across the lifespan. Children from South Asian backgrounds are less active and have poorer motor skills, thus identifying the need for early motor skill instruction. This study examines the effect of a movement and storytelling intervention on South Asian children’s motor skills. Following ethics approval and consent, 39 children (46% South Asian) participated in a 12-week movement and storytelling intervention. Pre and post, seven motor skills (run, jump, throw, catch, stationary dribble, roll, and kick) were assessed using Children’s Activity and Movement in Preschool Study protocol. At baseline, South Asian children had poorer performance of motor skills. Following the intervention, all children improved their motor skills, with a bigger improvement observed for South Asian children. Early intervention provided remedial benefits to delays in motor skills and narrowed the motor skills gap in ethnic groups.

Movement Competency Training Delivery: At School or Online? A Pilot Study of High-School Athletes

Movement competency (MC) development of high-school athletes can prepare them for the requirements of physical preparation training and the demands of sport. The aim of this study was to explore the physical effects of and athlete compliance to coach-led versus self-directed training approaches in this population. Thirty-nine high-school athletes (19 male, 14.5 ± 0.3 years old; 20 female, 14.6 ± 0.3 years) were allocated into two groups for a physical preparation program to improve MC. Groups were prescribed either (i) one face-to-face and one online (F2F, n = 18), or (ii) two online (OL, n = 21) sessions per week for 16-weeks. Before and after the intervention, the Athlete Introductory Movement Screen (AIMS) was used to assess MC alongside common physical capacity measures (triple-hop, star-excursion balance, medicine ball throw, 40m sprint and countermovement jump). Dropout left 22 participants with pre-post physical scores. Compliance with online training was low and F2F session attendance moderate. Semi-structured interviews were conducted to assess participant perceptions following the intervention. Assessing individual responses, the F2F group had a higher proportion of positive responders to AIMS scores, yet capacity measures were inconclusive across groups. Face-to-face coaching when acquiring MCs as part of physical preparation, may provide greater positive perceptions towards training compared to self-directed online prescriptions, and thereby greater compliance.

Effect of practice on learning to maintain balance under dynamic conditions in children: are there sex differences?

Background

In youth, sex-related differences in balance performances have been reported with girls usually outperforming same-aged boys. However, it is not known whether sex also has an influence on learning of a new balance task in primary school-aged children. Therefore, the present study investigated sex-related differences in children learning to maintain balance under dynamic conditions.

Methods

Thirty-two children (16 girls, 16 boys) aged 8.5 ± 0.5 years practiced balancing on a stabilometer (i.e., to keep it as horizontal as possible) for seven trials (90 s each) on two consecutive days. Knowledge of results (KR) (i.e., time in balance) was provided after each trial. On day three learning was assessed using a retention test (i.e., balance task only) and a test of automation (i.e., balance plus concurrent motor interference task). Root-mean-square-error (RMSE) was recorded for all trials and used for further analysis.

Results

During practicing (Day 1, Day 2) RMSE values significantly decreased over the days (p = 0.019, d = 0.92) and trials (p = 0.003, d = 0.70) in boys and girls. Further, the main effect of sex showed a tendency toward significance (p = 0.082, d = 0.67). On day 3, the girls showed significantly smaller RMSE values compared to boys in the retention (p = 0.012, d = 1.00) and transfer test (p = 0.045, d = 0.74).

Conclusions

Performance increases during the acquisition phase tended to be larger in girls than in boys. Further, learning (i.e., retention and automation) was significantly larger in girls compared to boys. Therefore, practitioners (e.g., teachers, coaches) should supply boys and grils with balance exercises of various task difficulties and complexities to address their diverse learning progress.

Exercise and Physical Therapy Interventions for Children with Ataxia: A Systematic Review

The effectiveness of exercise and physical therapy for children with ataxia is poorly understood. The aim of this systematic review was to critically evaluate the range, scope and methodological quality of studies investigating the effectiveness of exercise and physical therapy interventions for children with ataxia. The following databases were searched: AMED, CENTRAL, CDSR, CINAHL, ClinicalTrials.gov, EMBASE, Ovid MEDLINE, PEDro and Web of Science. No limits were placed on language, type of study or year of publication. Two reviewers independently determined whether the studies met the inclusion criteria, extracted all relevant outcomes, and conducted methodological quality assessments. A total of 1988 studies were identified, and 124 full texts were screened. Twenty studies were included in the review. A total of 40 children (aged 5-18 years) with ataxia as a primary impairment participated in the included studies. Data were able to be extracted from eleven studies with a total of 21 children (aged 5-18 years), with a range of cerebellar pathology. The studies reported promising results but were of low methodological quality (no RCTs), used small sample sizes and were heterogeneous in terms of interventions, participants and outcomes. No firm conclusions can be made about the effectiveness of exercise and physical therapy for children with ataxia. There is a need for further high-quality child-centred research.

Dynamic Temporal and Tactile Cueing: A Treatment Strategy for Childhood Apraxia of Speech

Purpose The purpose of this article is to describe a treatment approach, Dynamic Temporal and Tactile Cueing (DTTC), and to provide clinicians and clinical researchers a clear understanding of the theory and principles that contributed to the design of the treatment as well as the clinical decisions that must be made when implementing it. While brief descriptions of DTTC have been provided in textbooks, a complete summary of the rationale, essential elements, method, and procedures has not yet been published. Such a summary is important so that clinicians can gain a better understanding of and more confidence in using the method for appropriate children. Furthermore, this article provides clinicians and clinical researchers essential information for measurement of fidelity. Method The important elements of the DTTC method with rationale for their inclusion are described. The temporal hierarchy of DTTC is depicted, and the dynamic procedure is described in detail, with suggestions for fidelity measurement. Finally, a discussion of important decisions clinicians must make when implementing DTTC is presented. Conclusions The goal of DTTC is to improve the efficiency of neural processing for the development and refinement of sensorimotor planning and programming. The rationale for DTTC in general, as well as the key elements important to its administration, are supported by models of speech production and theories of motor learning. Important clinical decisions regarding stimuli, organization of practice, and feedback are based on principles of motor learning in order to facilitate acquisition, retention, and continued improvement of motor speech skills.

Injury prevention programmes with plyometric and strengthening exercises improve on-field performance: a systematic review

Importance

Injury prevention programmes (IPPs) have been demonstrated to be highly efficacious in protecting young athletes from anterior cruciate ligament and other lower-extremity injuries. However, the effectiveness of these programme in practice has been limited due to poor adherence among coaches of organised sports teams.

Objective

A change in messaging from injury reduction to performance enhancement may be an effective strategy for improving adherence. We conducted a systematic review to address whether implementing IPP can also provide benefits on sports performance as measured by on-field tests.

Evidence review

Data Sources: PubMed, EMBASE and Cochrane Library databases were searched from January 2000 to August 2018.

Study Selection: English-language studies were selected if they evaluated on-field performance testing before and after participation in the IPP or compared with another programme/control. No limitations were placed on study design or study population. Studies were excluded if they evaluated programme without an explicit focus on injury prevention or reported on injury risk factors that were not related to athletic performance.

Study design

Systematic review

Data extraction

Study design, population, sport and level, comparison group and duration/frequency of the IPP were extracted from full-text articles. The results of performance testing were summarised into the following categories: balance, sprinting, agility, jumping, physical fitness and sport-specific skills.

Findings

The evidence shows that IPP can have beneficial effects on measures of sports performance and physical fitness. Factors that resulted in significant improvement included longer frequency and duration of the programme, as well as inclusion of plyometric and muscle strengthening exercises.

Conclusions

There is a wide variety of measures used for athletic performance. IPPs that are done more frequently for longer durations and that include strengthening and plyometric exercises have been shown to improve athletic performance. Enhanced performance with tests that can be conducted on the field with existing equipment may help convince coaches and athletes to improve adherence with the IPP exercises.

Level of evidence

Level II

Young children are more likely to cheat after overhearing that a classmate is smart

Research on moral socialization has largely focused on the role of direct communication and has almost completely ignored a potentially rich source of social influence: evaluative comments that children overhear. We examined for the first time whether overheard comments can shape children's moral behavior. Three- and 5-year-old children (N = 200) participated in a guessing game in which they were instructed not to cheat by peeking. We randomly assigned children to a condition in which they overheard an experimenter tell another adult that a classmate who was no longer present is smart, or to a control condition in which the overheard conversation consisted of non-social information. We found that 5-year-olds, but not 3-year-olds, cheated significantly more often if they overheard the classmate praised for being smart. These findings show that the effects of ability praise can spread far beyond the intended recipient to influence the behavior of children who are mere observers, and they suggest that overheard evaluative comments can be an important force in shaping moral development.

Visual kinematic feedback enhances the execution of a novel knee flexion gait pattern in children and adolescents

BACKGROUND

Altered knee motion is one of the most common gait deviations in pediatric populations with gait disorders. The potential for pediatric gait retraining using visual feedback based on knee kinematic patterns is under-explored.

RESEARCH QUESTION

This study investigated whether pediatric participants could successfully modify knee flexion patterns in response to a visual kinematic feedback system (VKFS).

METHODS

Knee flexion angles from twelve typically developing children and adolescents (6 M, 6 F; 11.9 ± 2.7 years) were calculated using wearable inertial measurement units. Participants were tested while walking on a treadmill using pattern based visual feedback (FB). Four novel target patterns which amplified or attenuated swing phase peak knee flexion were tested. No feedback (NFB) tests assessed the participant's ability to independently reproduce the patterns. Mean absolute cycle error (MACE) and magnitude of peak knee flexion error (PK) were calculated during the last 10 strides of FB and NFB trials. Pre-exposure reference values (R) were also calculated.

RESULTS AND SIGNIFICANCE

PK-FB was significantly smaller (p < 0.05) than PK-R for all targets. Average values for PK-NFB were higher than for PK-FB, although PK-NFB remained significantly lower than PK-R for two targets. Contrary to one of the study's hypotheses, MACE-FB and MACE-NFB were larger than MACE-R. The study provided evidence that pediatric participants were able to modify peak knee flexion during gait in the sense targeted by the VKFS. Analysis suggested that MACE increases were explained by increases in gait cycle deviation outside of the changed region.

Effect of Injury Prevention Programs on Lower Extremity Performance in Youth Athletes: A Systematic Review

BACKGROUND

Understanding how existing youth injury prevention programs affect specific modifiable injury risk factors will inform future program development for youth athletes.

OBJECTIVE

To comprehensively evaluate the effects of injury prevention programs on the modifiable intrinsic risk factors associated with lower extremity performance in youth athletes.

DATA SOURCES

This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, EBSCOhost [including CINAHL, Medline, and SPORTDiscus], and PEDro). Secondary references were appraised for relevant articles. Article types included randomized or cluster randomized controlled trials and randomized cohort designs with youth athletes engaged in organized sports, along with outcomes that included at least 1 physical performance outcome measure.

STUDY SELECTION

Eight studies met inclusion and exclusion criteria and were reviewed by 2 independent reviewers, with a third consulted in the case of disagreement, which was not needed.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Included studies underwent review of methodological quality using the Physiotherapy Evidence Database scale.

RESULTS

Studies included mixed-sex samples of youth athletes who predominantly participated in soccer at different skill levels. The FIFA 11+ series was the most commonly used injury prevention program. Among studies, the mean percentage of improvement identified was 11.3% for force generation, 5.7% for coordination, 5.2% for posture, and 5.2% for balance. The lowest mean percentage improvement was in speed (2.2%). Endurance was not significantly affected by any of the programs.

CONCLUSION

This systematic review shows that injury prevention programs improve several modifiable intrinsic risk factors of lower extremity performance among youth athletes, particularly force generation. However, several intrinsic risk factors were either not significantly affected or specifically addressed by existing programs.

Adolescents’ Postural Control Learning According to the Frequency of Knowledge of Process

Feedback is one of the most influential factors for motor skills learning. Physical Education teachers commonly use verbal cues to provide knowledge of process (KP) when teaching motor skills, but the ideal presentation frequency for KP in adolescents is unclear. The aim of this study was to compare the effectiveness of the frequency of KP (i.e., 100%, 67%, 0%) on dynamic balance. Thirty adolescents, age 14–15 years, participated in the study. Performance on a stabilometer platform was used to assess dynamic balance. Participants received feedback after each trial (100%), in two out of three trials (67%), or no feedback during 12 30-s trials of practice. Adolescents who received feedback (67% or 100%) required lower mean velocity to maintain similar dynamic balance performance (i.e., root mean square). Moreover, adolescents receiving 100% feedback had a higher α-scaling than those who did not received it. During the post-test and the retention, both 67% and 100% KP frequencies were effective at improving postural control, compared to the no feedback control.

Practice modulates motor-related beta oscillations differently in adolescents and adults

KEY POINTS

Magnetoencephalography data were acquired during a leg force task in pre-/post-practice sessions in adolescents and adults. Strong peri-movement alpha and beta oscillations were mapped to the cortex. Following practice, performance improved and beta oscillations were altered. Beta oscillations decreased in the sensorimotor cortex in adolescents after practice, but increased in adults. No pre-/post-practice differences were detected for alpha oscillations.

ABSTRACT

There is considerable evidence that there are motor performance and practice differences between adolescents and adults. Behavioural studies have suggested that these motor performance differences are simply due to experience. However, the neurophysiological nexus for these motor performance differences remains unknown. The present study investigates the short-term changes (e.g. fast motor learning) in the alpha and beta event-related desynchronizations (ERDs) associated with practising an ankle plantarflexion motor action. To this end, we utilized magnetoencephalography to identify changes in the alpha and beta ERDs in healthy adolescents (n = 21; age = 14 ± 2.1 years) and middle-aged adults (n = 22; age = 36.6 ± 5 years) after practising an isometric ankle plantarflexion target-matching task. After practice, all of the participants matched more targets and matched the targets faster, and had improved accuracy, faster reaction times and faster force production. However, the motor performance of the adults exceeded what was seen in the adolescents regardless of practice. In conjunction with the behavioural results, the strength of the beta ERDs across the motor planning and execution stages was reduced after practice in the sensorimotor cortices of the adolescents, but was stronger in the adults. No pre-/post-practice changes were found in the alpha ERDs. These outcomes suggest that there are age-dependent changes in the sensorimotor cortical oscillations after practising a motor task. We suspect that these noted differences might be related to familiarity with the motor task, GABA levels and/or maturational differences in the integrity of the white matter fibre tracts that comprise the respective cortical areas.

Training Youth With SCI to Improve Efficiency and Biomechanics of Wheelchair Propulsion: A Pilot Study

Background: Long-term manual wheelchair users are at an increased risk of developing upper extremity (UE) joint pain and injuries due to the repetitive nature of wheelchair propulsion. Youth who sustain spinal cord injuries (SCIs) may be at even greater risk due to the many years they may be wheelchair dependent. There has been a decreasing trend in duration of initial rehabilitation, therefore little time is spent on training of proper wheelchair propulsion. An objective evaluation along with proper training may help prevent the risk of UE pain and injuries over time. Objective: To develop a training program to improve the efficiency and biomechanics of wheelchair propulsion in youth with SCI and evaluate changes made following propulsive training. Methods: Manual wheelchair users between 4 and 21 years old with SCI were recruited from one hospital. Demographic and clinical measures were collected and the subjects completed the Wheelchair User's Shoulder Pain Index. SmartWheel metrics were collected at baseline and following propulsive training on a roller system. Analyses assessed differences in SmartWheel metrics pre and post training. Results: The 23 participants were between 7 and 19 years of age; 57% were male and 69% with paraplegia. Significant improvements were found for SmartWheel metrics of peak backwards force that improved from -3.08 Newtons (N) ± 2.1 pre training to -2.37 N ± 1.9 (p = .041) post training and for push mechanical effectiveness that improved from .575 ± .14 at baseline to .631 ± .17 post training (p = .033). Conclusion: Our results suggest that an objective wheelchair assessment and propulsive training may be a valuable tool for youth with SCI.

Teaching the Use of a Long Cane Step by Step: Suggestions for Progressive, Methodical Instruction

A fundamental part of the orientation and mobility curriculum is the acquisition and retention of skills in using a long cane automatically and proficiently to detect and negotiate obstacles and drop-offs. Using practitioners’ experiences and the principles of learning theory, instructors can monitor students’ advancement and adapt teaching strategies to optimize the results.

Preliminary Efficacy of a Friendly Constraint-Induced Therapy (Friendly-CIT) Program on Motor and Psychosocial Outcomes in Children with Cerebral Palsy

AIMS

Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy.

METHODS

In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated.

RESULTS

Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT.

CONCLUSION

Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.

Does Narrative Feedback Enhance Children's Motor Learning in a Virtual Environment?

Augmented feedback has motivational and informational functions in motor learning, and is a key feature of practice in a virtual environment (VE). This study evaluated the impact of narrative (story-based) feedback as compared to standard feedback during practice of a novel task in a VE on typically developing children's motor learning, motivation and engagement. Thirty-eight children practiced navigating through a virtual path, receiving narrative or non-narrative feedback following each trial. All participants improved their performance on retention but not transfer, with no significant differences between groups. Self-reported engagement was associated with acquisition, retention and transfer for both groups. A narrative approach to feedback delivery did not offer an additive benefit; additional affective advantages of augmented feedback for motor learning in VEs should be explored.