Grand challenge for movement science and sport psychology: embracing the social-cognitive-affective-motor nature of motor behavior

Guiding Principles for the Practice of Integrative Physical Therapy

Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition.

IMPACT

This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.

Training for "Worst-Case" Scenarios in Sidestepping: Unifying Strength and Conditioning and Perception-Action Approaches

Sidesteps can impose high demands on the knee joint and lead to non-contact anterior cruciate ligament (ACL) injuries. Understanding how different constraints shape an athlete's movement strategy and the associated joint demands can help design training interventions to increase injury resilience. Motor capacities, such as muscular strength and power, act as boundaries for the safe execution of perceptual-motor skills and co-determine the emergence of unique movement strategies. Increasing single- and multi-joint strength enables a broader solution space for movement strategies and increases load tolerance. Manipulating task constraints during sidesteps can be used in the training process to systematically expose athletes to increasing demands (on the knee joint or any joint or structure) in preparation for "worst-case" scenarios. In particular, the type and timing of information available influence the preparation time, subsequently affecting the movement strategy and the associated magnitude of external knee joint loading (e.g., knee valgus moment). While an athlete's perceptual-cognitive skills contribute to the preparation time during in situ scenarios, attempts to further improve those skills with the aim of increasing athlete preparation time prior to "worst-case" scenarios are yet to demonstrate conclusive evidence of transfer to on-field situations. Therefore, in the current article, we reflect on the impact of different interacting constraints that influence the execution of sidesteps during in situ scenarios and impose high demands on the knee joint. Subsequently, we discuss how an integrated perspective, drawing on knowledge and perspectives from strength and conditioning and perception-action, may enhance an athlete's ability to withstand "worst-case" scenarios and adapt to perform varied movement executions when sidestepping.

Changes in dual-task cognitive performance elicited by physical exertion vary with motor task

Background

Integrated movement and cognitive load paradigms are used to expose impairments associated with concussion and musculoskeletal injury. There is currently little information on the discriminatory nature of dual-task complexity and the relative influence of physical exertion on cognitive outcomes.

Purpose

Assess cognitive performance while under motor conditions of increasing complexity before and after a standardized exercise protocol.

Methods

34 participants were recruited (17 male and 17 female; 24 ± 1.4 yrs). A modified Eriksen flanker test was used to assess cognitive performance under four conditions (seated, single-leg stance, walking, and lateral stepping) before and after a 20-min moderate-to vigorous intensity treadmill protocol. The flanker test consisted of 20 sets of 5-arrow configurations, appearing in random order. To complete the response to cognitive stimulus, participants held a smartphone horizontally and were instructed to respond as quickly and as accurately as possible by tilting the device in the direction corresponding to the orientation of the middle arrow. The metrics used for analysis included average reaction time (ms), inverse efficiency index (average reaction time penalized for incorrect responses), and conflict effect (the average time cost of responding to an incongruent repetition vs. a congruent repetition). Mixed effects (condition by time) RMANOVAs were conducted to examine the effects of motor task complexity and physical exertion on cognitive performance.

Results

There was a condition by time interaction for inverse efficiency index (p < 0.001), in which participants displayed higher cognitive efficiency for the pre-activity lateral stepping condition compared to the other three conditions (Cohen's d = 1.3–1.6). For reaction time and conflict effect, there were main effects for condition (p = 0.004 and 0.006, respectively), in which performance during lateral stepping was improved in relation to the seated condition (reaction time Cohen's d = 0.68; conflict effect Cohen's d = 0.64).

Conclusion

Participants tended to display better dual-task cognitive performance under more stimulating or complex motor tasks before physical exertion, likely associated with the inverted-U arousal-performance relationship. When using dual-task assessments, clinicians should be mindful of the accompanying motor task and baseline exertion levels and their potential to disrupt or optimize cognitive performance.

Association of pain-related threat beliefs and disability with postural control and trunk motion in individuals with low back pain: a systematic review and meta-analysis

PURPOSE

Low back pain (LBP) individuals with high levels of fear of pain might display changes in motor behavior, which leads to disability. This study aimed to systematically review the influence of pain-related threat beliefs or disability on trunk kinematic or postural control in LBP.

METHOD

Eight electronic databases were searched from January 1990 to July 1, 2020. Meta-analysis using random-effect model was performed for 18 studies on the association between pain-related threat beliefs or disability and lumbar range of motion. Pearson r correlations were used as the effect size.

RESULT

Negative correlations were observed between lumbar range of motion (ROM) and pain-related threat beliefs (r = - 0.31, p < 0.01, 95% CI: - 0.39, - 0.24) and disability (r =  - 0.24, p < 0.01, 95% CI: - 0.40, - 0.21). Nonsignificant correlations were reported between pain-related threat beliefs and center of pressure parameters during static standing in 75% of the studies. In 33% of the studies, moderate negative correlations between disability and postural control were observed.

CONCLUSION

Motor behaviors are influenced by several factors, and therefore, the relatively weak associations observed between reduced lumbar ROM with higher pain-related threat beliefs and perceived disability, and postural control with disability are to be expected. This could aid clinicians in the assessment and planning rehabilitation interventions.

LEVEL OF EVIDENCE I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

Future Portrait of the Athletic Brain: Mechanistic Understanding of Human Sport Performance Via Animal Neurophysiology of Motor Behavior

Sport performances are often showcases of skilled motor control. Efforts to understand the neural processes subserving such movements may teach us about general principles of behavior, similarly to how studies on neurological patients have guided early work in cognitive neuroscience. While investigations on non-human animal models offer valuable information on the neural dynamics of skilled motor control that is still difficult to obtain from humans, sport sciences have paid relatively little attention to these mechanisms. Similarly, knowledge emerging from the study of sport performance could inspire innovative experiments in animal neurophysiology, but the latter has been only partially applied. Here, we advocate that fostering interactions between these two seemingly distant fields, i.e., animal neurophysiology and sport sciences, may lead to mutual benefits. For instance, recording and manipulating the activity from neurons of behaving animals offer a unique viewpoint on the computations for motor control, with potentially untapped relevance for motor skills development in athletes. To stimulate such transdisciplinary dialog, in the present article, we also discuss steps for the reverse translation of sport sciences findings to animal models and the evaluation of comparability between animal models of a given sport and athletes. In the final section of the article, we envision that some approaches developed for animal neurophysiology could translate to sport sciences anytime soon (e.g., advanced tracking methods) or in the future (e.g., novel brain stimulation techniques) and could be used to monitor and manipulate motor skills, with implications for human performance extending well beyond sport.

Maximal force production requires OPTIMAL conditions

The OPTIMAL theory of motor learning identifies several motivational and attentional factors that draw out latent motor performance capabilities. One implication of the OPTIMAL theory of motor learning (Wulf & Lewthwaite, 2016) is that standardized motor performance assessments likely do not reflect maximal capabilities unless they are "optimized" with appropriate testing conditions. The present study examined the effects of three key motivational (enhanced expectancies, EE, and autonomy support, AS) and attentional (external focus, EF) variables in the OPTIMAL theory on maximum force production. In Experiment 1, a handgrip strength task was used. EE, AS, and EF were implemented, in a counterbalanced order, on consecutive trial blocks in an optimized group. A control group performed all blocks under neutral conditions. While there were no group differences on Block 1 (baseline), the optimized group outperformed the control group on all other blocks. In Experiment 2, participants performed two one-repetition maximum (1-RM) squat lift tests, separated by one week. Two groups, an optimized group and control group, had similar 1-RM values on the first test performed under neutral conditions. However, on the second test, a group performing under optimized conditions (EE, AS, EF) showed an increase in 1-RM, while there was no change from the first to the second test for a control group. We argue that standard test conditions may not produce true maximal performance. The findings corroborate the importance of key factors in the OPTIMAL theory and should be applied to ensure accurate strength performance assessment.

Optimizing Bowling Performance

The present study examined the influence on motor performance of key variables described in the OPTIMAL (Optimizing Performance Through Intrinsic Motivation and Attention for Learning) theory of motor learning: enhanced expectancies for future performance, autonomy support, and an external focus. Participants performed a nine-pin bowling task. In the optimized group, enhanced expectancies, autonomy support, and an external focus were implemented on three successive blocks of 12 trials. In the control group, participants performed all trials under “neutral” conditions. The optimized group outperformed the control group on all blocks. The findings corroborate the importance of key variables in the OPTIMAL theory by demonstrating immediate benefits of their implementation for motor performance.

Motor Skill Development and Youth Physical Activity: A Social Psychological Perspective

Children and youth participate in physical activities to develop and demonstrate physical competence, attain social acceptance and approval, and experience enjoyment. Satisfying these motives enhances interest in sustaining physical activity, which contributes to improved motor skills, self-confidence, social relationships, and other positive outcomes. My essay explores motor skill development and youth physical activity through a social psychological lens and the benefits of integrating scientific knowledge from our respective fields to inform research and professional practice. Motor development and sport psychology researchers can collaborate to address critical issues related to motor and perceived competence and physical activity. I recommend five ways for integrating knowledge: (1) applying social psychological theory to guide research questions, (2) using more longitudinal designs, (3) using a variety of quantitative and qualitative methods, (4) designing studies on physical literacy, and (5) employing a positive youth development (PYD) approach for improving motor and social-emotional skills. These efforts can assist teachers, coaches, and parents in creating opportunities for youth to learn and improve fundamental motor and sport skills and to achieve feelings of competence, autonomy, relatedness, and joy for motivating a lifetime of physical activity.

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

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

Relatedness support enhances motor learning

The present experiment was designed to test the effects of practice with relatedness support on motor learning. Forty-five young adults practiced a task in which they were required to learn to swim the front crawl stroke for one length in an indoor swimming pool (25 m) using 50% of the maximal speed. In the relatedness support condition (RS group), the instructions emphasized acknowledgement, caring, and interest in the participants' experiences, while in the relatedness thwart condition (RTh group), instructions emphasized disinterest in the participant as a person. A third, neutral condition (Control group) did not receive specific relatedness instructions. One day after practice, participants completed retention and transfer tests. The RS group demonstrated greater improvement in performance during practice and enhanced learning relative to the RTh and Control groups, while the RTh group showed decreased learning compared with the Control group. Furthermore, RS participants reported higher motivation and greater positive affect than the RTh and Control groups. The present findings demonstrate that relatedness support enhances the learning of motor skills. They also highlight motivational and affective effects that are observed when learners are provided with relatedness support.

Reported Expressive Suppression in Daily Life Is Associated with Slower Action Planning

Objectives Growing evidence demonstrates that (a) executive functioning (EF) becomes deleteriously affected by engagement in the emotion regulation strategy known as expressive suppression and (b) EF shows considerable functional and neuroanatomical overlap with motor output. The current study aimed to bridge these two literatures by examining the relationships between naturally occurring expressive suppression and several different aspects of motor output, including action planning, action learning, and motor-control speed and accuracy. In addition, we investigated whether any identified relationships could be explained by EF. Methods Fifty-one healthy young adults completed selected subtests from the Delis-Kaplan Executive Function System as indices of EF, a self-report measure of expressive suppression, and a computerized motor sequencing task (Push Turn Taptap task; PTT) designed to assess action planning, action learning, and motor control speed and accuracy. Results Hierarchical regressions using each aspect of PTT performance as the dependent variable revealed that higher than usual self-reported expressive suppression on the day of testing (relative to the 2 weeks preceding testing) was associated with longer action-planning latencies. This relationship was fully explained by EF. No other PTT variables related to expressive suppression on the day of testing. Conclusions These results suggest that increased expressive suppression in daily life is associated with slower action planning, an aspect of motor output that is reliant on EF, highlighting the importance of factors that lead to intra-individual fluctuations in EF and motor performance. (JINS, 2016, 22, 671-681).

Self-control behaviors during the learning of a cascade juggling task

This study examined the self-control behaviors of participants learning a 3-ball cascade juggle. Participants chose when they would receive one of four types of instructional assistance: (a) instructions; (b) video demonstration; (c) knowledge of performance (KP); and (d) knowledge of results (KR). Juggling proficiency was divided into three categories based on catches per attempt during retention and transfer testing. In general, participants decreased their requests for instructions and video demonstration throughout acquisition. For the most proficient performers, requests for KR increased over practice. Post-experimental interviews revealed that participants requested KR after primarily good attempts and KP after both good and bad attempts. Participant-reported reasons for requesting feedback included the confirmation of success (KR) and identification of technique flaws (KP). Overall, the findings suggest that self-control behaviors are more complex than previously demonstrated and that participants use self-control differently depending upon the type of assistance available, individual preferences, and learning needs.

Impacts of autonomy-supportive versus controlling instructional language on motor learning

The authors examined the influence of autonomy-supportive (ASL), controlling (CL), and neutral instructional language (NL) on motor skill learning (cricket bowling action). Prior to and several times during the practice phase, participants watched the same video demonstration of the bowling action but with different voice-over instructions. The instructions were designed to provide the same technical information but to vary in terms of the degree of choice performers would perceive when executing the task. In addition to measurements of throwing accuracy (i.e., deviation from the target), perceived choice, self-efficacy, and positive and negative affect were assessed at the end of the practice phase and after a retention test without demonstrations and instructions on Day 2. ASL resulted in perceptions of greater choice, higher self-efficacy, and more positive affect during practice than CL, and enhanced learning as demonstrated by retention test performance. Thus, granting learners autonomy appeared to endow them with confidence in their ability, diminished needs for control of negative emotional responses, and created more positive affect, which may help consolidate motor memories.

A transformative subfield in rehabilitation science at the nexus of new technologies, aging, and disability

We argue that a silo research and training approach is no longer sufficient to provide real solutions to the complex humanitarian, social, and financial problems brought about by global trends in aging and the increased prevalence of multiple chronic conditions that limit independence and activities of daily living. This perspective highlights the opportunities for collaborative research and training in a new multidisciplinary science of rehabilitation enabled by growing knowledge and information along scientifically and clinically meaningful lines. The recent proliferation of eHealth technologies offers opportunities for development of low-cost, simple, interactive media prevention, health maintenance, and continued functional recovery programs using a chronic care model designed to promote engagement and participation. With two examples - long-term disability consequential to (1) hip fracture and (2) manual wheelchair use - we outline the developing science for a collaborative and transformative nexus team capable of accelerating an understanding of ways to restore independence and improve quality of life, in the long-term. We conclude with a set of recommendations for the design of interactive media systems to both increase acceptability and stimulate research.

Effects of age and pathology on stance modifications in response to increased postural threat

This study investigated modifications to standing posture in response to elevated postural anxiety evoked by a potential physical threat to stability. Sixteen young adults, 16 older adults and 16 patients diagnosed with Parkinson's disease (PD) stood with or without the expectation of a threat to their posture (i.e., external trunk perturbation). This method allowed for the assessment of the effects of anticipatory anxiety on standing posture associated with an ecologically valid and direct threat to stability. Our manipulation was successful as all participants, independent of age and disease, reported significant increases in postural anxiety when anticipating a threat to their posture. The trunk sway modifications observed in response to elevated postural anxiety were dependent on age and disease. Young adults showed increased trunk sway in both pitch and roll directions while older adults demonstrated decreased trunk sway but only in the roll direction when standing and expecting a threat to posture compared to standing without this threat. Individuals with PD showed no significant changes in trunk pitch or roll sway when anticipating a threat to posture compared to standing without this threat. Our findings suggest that the effects of postural anxiety on postural control are dependent on the context associated with the postural threat, and age and disease status.

Affective infrastructures: toward a cultural neuropsychology of sport

Recently there has been a turn toward considerations of embodiment, cognition, and context in sport studies. Many researchers have argued that the traditional focus on clinical psychology and performance enhancement within the discipline is incomplete, and now emphasize the importance of athletes’ social and familial contexts in a research paradigm that examines interconnections between movement, cognition, emotion, and the social and cultural context in which movement takes place. While it is important that the sport studies focus is being expanded to consider these interactions, I will argue that this model is still incomplete in that it is missing a fundamental variable – that of our evolutionary neurobiological roots. I will use the work of affective neuroscientists Jaak Panksepp and Stephen Porges to show that because sport so clearly activates neural systems that function at both proximate and ultimate levels of causation, it can be seen to serve fundamental needs for affective balance. A neurobiology of affect shows how the evolution of the mammalian autonomic nervous system has resulted in neurophysiological substrates for affective processes and stress responses, and has wide-ranging implications for sport studies in terms of suggesting what forms of coaching might be the most effective in what context. I propose the term cultural neuropsychology of sport as a descriptor for a model that examines the relationships between neurophysiological substrates and athletes’ social and familial contexts in terms of how these variables facilitate or fail to facilitate athletes’ neuroceptions of safety, which in turn have a direct impact on their performance. A cultural neuropsychological model of sport might thereby be seen to elaborate a relationship between proximate and ultimate mechanisms in concretely applied ways.

Reduced frequency of knowledge of results enhances learning in persons with Parkinson's disease

Parkinson's disease (PD) is a progressive neurological disorder, known to cause a large number of motor and non-motor limitations. Research related to factors that affect motor control and learning in people with PD is still relatively limited. The purpose of this study was to compare the effects of different frequencies (100 versus 66%) of knowledge of results (KR) on the learning of a motor skill with spatial demands in participants with PD. Twenty individuals with PD were randomly assigned to one of two groups. The 100% group received KR after each trial, while the 66% group received KR on two thirds of the trials. A linear positioning task with a spatial target was used. Participants carried out the task with the dominant hand while blindfolded. In the acquisition and retention phases, the goal was to position the cursor at a distance of 60 cm from the starting point. The hypothesis was that participants with PD, who practiced with a reduced KR frequency, would demonstrate more effective learning than those who practiced with a 100% KR frequency, similar to previous findings with adults without neurological disorders. The results showed differences between the groups in the retention phase (without KR): The 66% KR group was more accurate and less variable in their performance than the 100% KR group. Thus, reducing KR frequency can enhance motor learning in persons with PD, similar to what has previously been found for unimpaired participants.

Frequent external-focus feedback enhances motor learning

The present study examined the hypothesis that feedback inducing an external focus of attention enhances motor learning if it is provided frequently (i.e., 100%) rather than less frequently. Children (10- to 12-year-olds) practiced a soccer throw-in task and were provided feedback about movement form. The feedback statements, provided either after every (100%) or every third (33%) practice trial, were similar in content but induced either an internal focus (body-movement related) or external focus (movement-effect related). The results demonstrated that learning of the movement form was enhanced by external-focus feedback after every trial (100%) relative to external-focus feedback after every third trial (33%) or internal-focus feedback (100%, 33%), as demonstrated by immediate and delayed transfer tests without feedback. There was no difference between the two internal-focus feedback groups. These findings indicate that the attentional focus induced by feedback is an important factor in determining the effectiveness of different feedback frequencies. We argue that the informational properties of feedback cannot sufficiently account for these and related findings, and suggest that the attentional role of feedback be given greater consideration in future studies.