Frequent external-focus feedback enhances motor learning

An external focus promotes motor learning of an aiming task in individuals with hearing impairments

Research has shown that external relative to internal focus (IF) instructions may improve motor performance as well as cognitive function (e.g., attentional stability and task-focus). The aim of the study was to examine the influence of attentional focus instructions on skill acquisition and learning of an aiming task in individuals with hearing impairments. The participants (N = 39, Mage = 17.87 ± 1.88 years) performed a bowling task with their dominant hand to knock down as many pins as possible. On day 1, they were randomly divided into three attentional focus groups; IF (focus on your throwing hand), external focus (EF) (focus on the pins), and control (no-focus) instructions. Each participant performed 36 trials, divided into 3 blocks of 12 trials. Attentional focus instructions were given before each block, with a brief reminder provided after each 3 trials. On day 2, retention and transfer (further distance) tests were performed. Results showed that while there were no significant differences between groups in the pre-test, the EF group outperformed both IF and control groups in retention and transfer tests. No significant difference was found between the control and IF. The findings suggest that the advantages of the external relative to the IF and no-focus instructions may generalize to individuals with hearing impairments.

Motor Learning and the Interactions Between Working Memory and Practice Schedule

The benefits of less repetitive practice schedules on motor learning are usually described in terms of greater demand for memory processes. The present study aimed to investigate the interactions between working memory and practice schedule and their effects on motor learning. Forty female participants had their WMC evaluated by the N-back test and were randomly allocated to either the variable random (VP) or the constant practice (CP) groups. In the acquisition phase, participants practiced 120 trials of a sequential key-pressing task with two goals: learning the relative and the absolute timing. Delayed retention and transfer tests occurred 24 h after the acquisition phase. Participants performed 12 trials of the motor task. Results showed that in the CP, learners with a high level of WMC presented better motor performance in the transfer test than learners with a low level of WMC. In the RP, no difference between WMC levels was found. Learners with a high level of WMC in the CP presented the same motor performance as learners in the RP regardless of the WMC level in the transfer test. In conclusion, learners with a high WMC could compensate for the poor working memory stimulation of a more repetitive practice schedule. The high WMC did not seem to exert an additional benefit when learners were well stimulated by a less repetitive practice schedule.

Skill acquisition interventions for the learning of sports-related skills: A scoping review of randomised controlled trials

BACKGROUND

Skill acquisition science is the study of how motor skills are acquired, developed and/or learned. There is substantive evidence for general motor skill acquisition in controlled laboratory settings yet the literature on the learning of sports-related skills is typically less conclusive.

OBJECTIVES

This scoping review aimed to summarise the current literature on skill acquisition intervention studies examining the learning of sports-related skills as part of a randomised controlled trial, by synthesizing and extracting the most relevant features.

METHODS

Four electronic databases (PsychINFO, PubMed, SPORTDiscus and Web of Science) were searched for relevant studies. The sample characteristics of these studies were extracted, and summarised. Two systematic searches of the literature were conducted. In the first search, eighty-six studies were retained. A second search was conducted in July 2022 to include new studies and specifically focused on the inclusion of within-subject design studies, resulting in the inclusion of 35 additional studies. A third search was conducted in May 2023 to include new studies resulting in the inclusion of 10 additional studies.

RESULTS

One hundred and thirty studies across 29 sports were included in the review. The vast majority of the studies in this scoping review (n = 104) examined the learning of a sport-related skill in participants with no experience. Twenty-eight percent of all retained studies (n = 35) considered only the learning of a golf skill, and all studies were practiced in a laboratory environment, examining closed motor skills (n = 130). The most common intervention categories reported were attention (n = 22), instruction and demonstration (n = 20), practice design (n = 20), and perceptual training (n = 19). Nearly half of all studies used an immediate retention test within 48 h of the cessation of practice (n = 63), and just over one quarter of studies (n = 34) reported incorporating some form of transfer test. Eighty-six percent (n = 112) reported positive findings.

CONCLUSIONS

The skewed focus on golf skills across a small number of skill acquisition interventions, the inconsistent use and reporting of performance measures, practice durations and measures of learning alongside the relatively small sample sizes consisting mostly of inexperienced learners and the skewed publication of positive findings should warrant caution. More empirical studies across a broader range of sports and with more consistent methodologies are needed to develop a robust pool of literature that can support academics and practitioners interested in which skill acquisition interventions could be used to influence the learning of sports-related skills.

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).

Implicit motor learning in children with autism spectrum disorder: current approaches and future directions

Motor dysfunction is increasingly being viewed as a core characteristic of autism spectrum disorder (ASD) in children. In particular, children with ASD have difficulty in learning new motor skills and there is a need to develop effective methods to improve this. Previous research has found that children with ASD may retain the ability to implicitly learn motor skills in comparison to their explicit learning of motor skills, which is typically impaired. This literature mini review focuses on summarizing the study of implicit learning in the acquisition of motor skills in children with ASD. First, we briefly introduce several common implicit learning methods in children's motor skill learning. Second, we focus on the role of two important implicit learning approaches in motor skill learning, namely, an external focus of attention and analogy learning. Finally, based on our review of the existing studies, we present an outlook for future research and the areas that need to be improved in the practical teaching of implicit learning in the acquisition of motor skills in children with ASD.

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

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

Within-session and between-session effects of auditory biofeedback training on center of pressure location during gait in patients with chronic ankle instability

OBJECTIVES

To establish preliminary gait training dosage parameters for patients with chronic ankle instability (CAI) by determining the within-session and between-session effects of auditory biofeedback training on center of pressure (COP) location during gait.

DESIGN

Observational Longitudinal.

SETTING

Laboratory.

PARTICIPANTS

19 participants with CAI, 8 participants who did not receive auditory biofeedback (NoFeedback group) and 11 participants who did receive auditory biofeedback (AuditoryFeedback group) over an 8-session 2-week intervention.

MAIN OUTCOME MEASURES

COP location was measured at the start and at each 5-min interval during treadmill walking across all eight 30-min training sessions.

RESULTS

The AuditoryFeedback group had significant within-session lateral-to-medial shifts in COP location during only session-1 at the 15-min (45% of stance; peak mean difference = 4.6 mm), 20-min (35% and 45%; 4.2 mm), and 30-min time intervals (35% and 45%; 4.1 mm). Furthermore, the AuditoryFeedback group had significant between-session lateral-to-medial shifts in COP location at session-5 (35-55% of stance; 4.2 mm), session-7 (35%-95%; 6.7 mm), and session-8 (35%-95%; 7.7 mm). The NoFeedback group had no significant changes in COP location within-sessions or between-sessions.

CONCLUSIONS

Participants with CAI who received auditory biofeedback during gait needed an average of 15-min during session-1 to meaningfully shift their COP location medially and 4-sessions before retaining the adapted gait pattern.

Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis

Background

There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input.

Objectives

To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs.

Data sources

We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched.

Eligibility criteria

Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes.

Data collection and analysis

Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool.

Main results

We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis.

Limitations

By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias.

Conclusions and implications

There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.

Does modifying visual feedback facilitate learning to write new pseudoletters?

Learning to write relies on the efficient integration of visual and proprioceptive feedback, with a transition from a control, based on the visual inspection of the written trace at the beginning of the learning process to a more predictive control, based mainly on handwriting movement, in proficient writers. The aim of this study was to test the effect of a partial deletion of the written trace, as well as the effect of supplementary visual information, on handwriting kinematics in a learning task. Twenty-four adults learned to write six new pseudoletters using their non-dominant hand on a touch screen digital tablet. Three pseudoletters were trained with modified visual feedback conditions and the other three, in the control condition, i.e. without any visual modification. Results revealed that, in the short-term, the pseudoletters learned with modified visual feedback were traced faster and more fluently than those learned in the control condition, without spatial accuracy reduction. This method seems to be efficient in adults, which is a prerequisite before testing a method with children.

Immediate Effect of Self-Modelling with Internal Versus External Focus of Attention on Teaching/Learning Gymnastics Motor-Skills

The aim of this study was to identify the immediate effect of self-modelling with different focus of attention strategies (i.e., internal vs. external) on the teaching/learning of gymnastics motor-skills. Fifty-nine non-gymnast students participated in this study and were divided into three groups (i.e., an external focus group (EF), an internal focus group (IF), and a control group (CG)). Each participant’s performance of the back dismount in the parallel bars was assessed before the experiment (i.e., base-score), and each participant was asked to provide a self-evaluation of their performance and their efficiency percentage. Afterwards, participants received a specific learning session (i.e., self-modelling with external focus, self-modelling with internal focus, or traditional learning with verbal instruction) and performed the back dismount in the parallel bars again immediately after (i.e., final score). Four international judges evaluated performance of our participants. The results showed that the EF and IF outperformed the CG in the final score. Importantly, a significant difference between the base and the final score was observed in the EF and IF, but not in the CG. In addition, the EF showed the highest percentage of improvement (Δ-score) and self-estimation scores compared to the two other groups. In conclusion, this study supports the adoption of external focus of attention for teaching/learning gymnastics motor-skills.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

TRIAL REGISTRATION

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

Effects of gait training with auditory biofeedback on biomechanics and talar cartilage characteristics in individuals with chronic ankle instability: A randomized controlled trial

BACKGROUND

Altered walking gait is a typical impairment following ankle sprains which may increase susceptibility to recurring injuries and development of posttraumatic osteoarthritis at the ankle. There is a lack of targeted gait training interventions focusing on specific modifications in individuals with chronic ankle instability (CAI). Additionally, there is a need to focus on cartilage health changes following gait training to mitigate osteoarthritis progression.

RESEARCH QUESTION

To determine the immediate and retention effects of gait training using auditory biofeedback (AudFB) in patients with chronic ankle instability (CAI) on biomechanics and talar cartilage characteristics.

METHODS

Eighteen participants with CAI were randomly assigned into Control (n = 7) or AudFB (n = 11) groups. Each group completed 8-sessions of 30-minute treadmill walking. The AudFB group received biofeedback through a pressure sensor fashioned to the lateral foot and instructions to walk while avoiding noise from the sensor. The Control group did not receive instructions during sessions. An in-shoe insole system measured peak pressure, maximum force, and center of the pressure gait line (COP) during walking. Ultrasonography captured talar cartilage thickness and echo intensity before and after walking. Biomechanics and ultrasound were measured at baseline, immediately, and 1-week after the intervention. Repeated measures mixed-methods analysis of variance assessed changes within groups across time.

RESULTS

The AudFB group significantly reduced pressure and force in the lateral foot and medially shifted their COP at Immediate and 1-week Post. There were no observed changes in the Control group. In addition, neither group demonstrated changes in ultrasound measures at follow-up.

SIGNIFICANCE

Implementation of auditory biofeedback during gait training can be a valuable tool for clinicians treating patients with CAI.

The Best of Two Different Visual Instructions in Improving Precision Ball-Throwing and Standing Long Jump Performances in Primary School Children

Two observational learning approaches have been shown to be successful in improving children's motor performances: one is "technique-focused", another is "goal-focused". In this study, we sought to compare the effectiveness of these two strategies, thus testing for the more efficient method of observational learning to enhance motor skills in primary school children. To this end, two experiments were designed. Experiment 1 involved a precision ball throwing task. Experiment 2 involved a standing long jump task. A total of 792 subjects (aged 6-11) participated in this study and were divided into technique-focus (Experiment 1 n = 200; Experiment 2 n = 66), goal-focus (Experiment 1 n = 195; Experiment 2 n = 68), and control groups (Experiment 1 n = 199; Experiment 2 n = 64). The experiments were divided into pretest, practice, and retention phases. During the practice phase, the technique-focus and goal-focus groups were given different visual instructions on how to perform the task. The results showed that children aged 10-11 belonging to the technique-focus group performed significantly better in the practice phase than both the goal-focus and the control group (p < 0.001), but only for the precision ball throwing task. These findings could be useful for training adaptation in the context of motor learning and skills acquisition.

Does the combination of physical activity and attention training affect the motor skills and cognitive activities of individuals with mild intellectual disability?

Individuals with mild intellectual disability (MID) were worse than their peers who typically develop in motor skills and attention-demanding assignments. In this study, effect of a 14-week physical activity and attention training practise on the motor skills, visual retention, perception and attention levels of students with MID were analysed. Twenty-two individuals between 7 and 14 ages participated voluntarily. Activities based on developing attention skills and physical activities enhancing fine-gross motor skills (40 + 60 min./2 days/14 weeks) were given to the experimental group. d2 Test of Attention, Benton Visual Retention and Bruininks-Oseretsky Test of Motor Proficiency-2nd version tests were used as data collection tools. There was significant difference in terms of total number of items processed, commissions, raw score of errors, total number of items minus error scores, concentration performance, Benton visual retention test and perception, fine motor skill precision, fine motor skill integration, manual dexterity and upper-limb coordination values regarding group and time dependant (p< .05). However, there was no significant difference in omissions and fluctuation rate values (p> .05). As a result; it is determined that the combination of physical activity and attention training practises features a positive effect on visual retention, perception, attention and motor skill levels of students with MID.

Effect of simplifying the body model to compute the energy parameters in pole vaulting

This study compared changes in the energy-time profiles in pole vaulting using several body models. Two-dimensional kinematics were collected from 20 successful vaults (5.20-6.01 m) performed by 10 athletes during a national meet. The linear and angular kinetic, potential, and total mechanical energy-time profiles were obtained from three pole vaulter models composed of 12, 5, and 3 segments (M12, M5, and M3, respectively), as well as calculated and approximated centre of mass models. One-dimensional statistical parametric mapping was used to compare these energy-time profiles from the models, while agreements of discrete energy parameters were assessed. For all the studied energy-time profiles, there was a main effect (0.05 < p < 0.001) of the models, but pairwise comparisons showed that M5 presented the lowest differences with M12 in comparison with the other models (M3 and approximated centre of mass models). In addition, M5 showed better agreement (lower bias and small effect size) with M12 for the studied energy parameters compared to the other models. Therefore, M5 may be a reliable option to simplify the body model and speed up the computation of the energy-time profiles of the pole vaulter.

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.

Fine motor skills and attention level of individuals with mild intellectual disability getting education in inclusive classrooms and special education schools

In this study, the difference between fine motor skills and attention levels of children with mild intellectual disabilities (MID) who get education in inclusive classrooms and special education schools and the relationship between fine motor skills and attention levels were analysed. A total of 176 children with MID between the ages of 9-14, who get education in inclusive classrooms (n = 96) and special education schools (N = 80), participated in the study. Bruininks-Oseretsky Test of Motor Proficiency-Second Version (BOT-2) and Bourdon Attention Tests were applied as data tools. Fine Motor Precision (FMP), Fine Motor Integration (FMI) and Attention levels of the children in inclusive classrooms were higher than those who get education at special education schools (p < .05). In all parameters of the children of inclusive classrooms and special education schools (except the parameters of FMP-6: Folding Paper and FMI-8: Copying Overlapping Pencils), there was a positive correlation between attention and fine motor skill values (p < .05). The fact that children with MID get inclusive education with typically developing peers contributes more to these individuals in terms of fine motor skills and attention parameters. However, more extensive work is needed in this field.

Implicit motor learning in primary school children: A systematic review

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

Rupture, reconstruction, and rehabilitation: A multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury

BACKGROUND

Despite surgical reconstruction and extensive rehabilitation, persistent quadriceps inhibition, gait asymmetry, and functional impairment remain prevalent in patients after anterior cruciate ligament (ACL) injury. A combination of reports have suggested underlying central nervous system adaptations in those after injury govern long-term neuromuscular impairments. The classic assumption has been to attribute neurophysiologic deficits to components of injury, but other factors across the continuum of care (e.g. surgery, perioperative analgesia, and rehabilitative strategies) have been largely overlooked.

OBJECTIVE

This review provides a multidisciplinary perspective to 1) provide a narrative review of studies reporting neuroplasticity following ACL injury in order to inform clinicians of the current state of literature and 2) provide a mechanistic framework of neurophysiologic deficits with potential clinical implications across all phases of injury and recovery (injury, surgery, and rehabilitation) RESULTS: Studies using a variety of neurophysiologic modalities have demonstrated peripheral and central nervous system adaptations in those with prior ACL injury. Longitudinal investigations suggest neurophysiologic changes at spinal-reflexive and corticospinal pathways follow a unique timecourse across injury, surgery, and rehabilitation.

CONCLUSION

Clinicians should consider the unique injury, surgery, anesthesia, and rehabilitation on central nervous system adaptations. Therapeutic strategies across the continuum of care may be beneficial to mitigate maladaptive neuroplasticity in those after ACL injury.

The effect of attentional instructions during modeling on gaze behavior and throwing accuracy in 7 to 10 year-old children

Research has shown the effectiveness of attentional instructions and observation on the performance and learning in children. However, there is little research on the effects of instruction that manipulates attentional focus during observation. The purpose of the study was to investigate performance following instructions that directed an individual to focus internally or externally during the viewing of a model. Eye tracking was also used to investigate the visual search strategy under different instructional groups. 24 children between the ages of 7 and 10 years were randomly divided into an internal (IFM) or external (EFM) modeling group. Children performed a 10-trial pre-test to measure throwing accuracy and quiet eye duration (QED). Following pre-test, children observed a model performing the correct overarm throw 10 times while eye movement was recorded. They then performed a 10-trial post-test. Results revealed that both groups improved accuracy from pre-test to post-test (p < .001) and increased QED from pre- to post-test (p < .001). It was also observed that EFM had greater accuracy and (p = .01) and longer QED (p < .001) than IFM during post-testing. Evidence was also observed for adherence to the attentional focus strategy as EFM and IFM looked more frequently at the specific cue provided (p < .001). Directing visual attention to the movement effects while observing a model significantly benefits motor performance and learning in children. Changing the focus of instruction to an external focus improved both throwing accuracy and increased QED.

Restricting ankle dorsiflexion does not mitigate the benefits of external focus of attention on landing biomechanics in healthy females

PURPOSE

Restricted ankle dorsiflexion can promote aberrant biomechanics associated with risk for knee injury during dynamic activities. Attentionally focused instructions have been used to improve high-risk knee biomechanics during landing tasks. Yet, it is unknown whether attentionally focused instruction can effectively improve landing patterns in the presence of a mechanical restriction on the ankle. Therefore, our purpose was to determine whether restricting ankle dorsiflexion by use of bracing mitigated the effects of attentional foci on landing biomechanics in healthy females.

METHODS

We used a crossover design to investigate lower extremity biomechanics in 19 healthy females between the ages of 18-35 during a series of jump-landing tasks. Participants completed 6 blocks of 3 jump-landings on separate force platforms in a randomized order based on brace condition (brace, no brace) and mode of attentional foci (neutral, internal focus [IF], external focus [EF]). Attentionally focused instructions were provided immediately prior to 3 practice jump-landings, followed by 5 test jump-landings with self-controlled feedback only.

RESULTS

Ankle bracing decreased peak dorsiflexion and sagittal range of motion (ROM) (mean difference: 5.7-5.8°), and peak inversion and frontal ROM (mean difference: 2.4-3.0°). However, hip flexion ROM (mean difference: 1.8°) increased compared to the no brace condition. Regardless of ankle bracing, EF instruction increased peak hip flexion (mean difference: 4.9°) and hip flexion range of motion (mean difference: 3.8-4.6°), while decreasing peak knee valgus (mean difference: 0.8-1.0°) and knee valgus moment (mean difference: 0.04 Nm/kg). Additionally, EF instruction increased peak hip abduction to a similar degree when braced (mean difference: 3.6-4.0°) and not braced (mean difference: 2.1-2.5°). Lastly, EF instruction increased hip abduction ROM only when braced (mean difference: 2.3-2.4°), but decreased peak knee valgus power only when not braced (mean difference: 0.18 W/kg).

CONCLUSIONS

Our findings indicate that mechanically restricting ankle dorsiflexion does not mitigate the ability of EF instruction to enhance jump-landing performance by means of improving hip and knee biomechanics in healthy females. However, our findings suggest an improved ability to control the rate of knee valgus loading when not braced. Therefore, we conclude that EF instruction remains a viable clinical strategy to improve landing patterns in the presence of restricted ankle dorsiflexion, yet this approach may be ineffective to reduce the rate of knee joint loading.

Learning outcomes physiotherapy in neurology – a structured consensus finding of the Austrian University Network Physiotherapy in Neurology (ÖHPN) / Learning Outcomes Physiotherapie in der Neurologie – eine strukturierte Konsensfindung des österreichischen Hochschulnetzwerkes Physiotherapie in der Neurologie (ÖHPN)

Background

European Standards and Guidelines for Quality Assurance in tertiary education at Universities of Applied Sciences recommend a high level of competence orientation. This can be achieved and evaluated by the definition of Learning Outcomes. Furthermore, these Outcomes can assure a comparison of the level of education after graduation. Efforts should be made to achieve this form of Quality Assurance for the professional education of physiotherapists.

Objective

The aim of this paper is to state consensus of the Austrian Universities of Applied Sciences Network for Physiotherapy in Neurology through the definition of shared Learning Outcomes for the field of Neurology for undergraduate physiotherapy students.

Methods

Based on the guidelines of the European Qualification Framework (EQF), Physio Austria (Austrian Association of Physiotherapists) published the competency profile for physiotherapists describing learning outcomes of EQF levels 6 as the first study cycle with Bachelor degree. Specific learning outcomes for Physiotherapy in Neurology were added for the further development and differentiated assurance of Quality Standards in coordination with experts from the Universities of Applied Sciences in Austria.

Results

In addition to the Learning Outcomes described in the competency profile of Physio Austria, this consensus paper describes those specifically for the EQF Level 6 of physiotherapy in neurology. Specifications in neurology were made for the following roles: Expert in Physiotherapy, Communicator, Teamworker, Health Promoter, Innovator, Health Professional.

Conclusion

Recommendations for quality assurance in tertiary education are actively pursued across all participating Universities of Applied Sciences. This allows a better comparability of the educational standards in Physiotherapy in Neurology in Europe as well as internationally. This is of great importance for physiotherapists as health professionals.

Design and Evaluation of SONIS, a Wearable Biofeedback System for Gait Retraining

Herein, we introduce SONIS, a wearable system to support gait rehabilitation training after a lower extremity trauma, which combines a sensing sock with a smartphone application. SONIS provides interactive, corrective, real-time feedback combining visual and auditory cues. We report the design of SONIS and its evaluation by patients and therapists, which indicates acceptance by targeted users, credibility as a rehabilitation tool, and a positive user experience. SONIS demonstrates how to successfully combine a number of feedback strategies and modalities: graphical, verbal, and music feedback on gait quality during training (knowledge of performance) and verbal and vibrotactile feedback on gait tracking (knowledge of results).

Effects of external focus of attention on learning static balance among girls with ADHD

Study aim: The purpose of this study was to examine the effects of adopting an external focus of attention on motor learning among girls with ADHD aged seven and eleven years.

Material and methods: Twenty-four seven-year-old and 24 eleven-year-old female children with symptoms of ADHD were randomly assigned to groups receiving either external focus of attention (EXT) instructions or internal focus of attention (INT) instructions, making four experimental groups: EXT-7, INT-7, EXT-11, and INT-11. Participants performed a pretest followed by five training blocks under an external or internal instruction and were then given a retention test one day later. After training, we employed a manipulation check to verify the children’s type and intensity of focus.

Results: Adopting an external focus of attention, compared to an internal focus of attention, led to better motor learning among girls with ADHD (F 1, 44 = 5.08, p = 0.029, η2 = 0.10). In addition, adopting an external focus of attention reduced the children’s tendency to focus on self. Older children performed better than younger children in balance time (F 1, 44 = 16.10, p < 0.001, η2 = 0.26).

Conclusions: Our results indicate that propositions of the OPTIMAL theory can be extended to children with ADHD.

Extrinsic feedback from a feedback device promotes the learning of range of motion measurements

[Purpose] Although it is widely recognized that feedback is important for skill acquisition or improvement, feedback is not completely utilized in physical therapy education. Therefore, we aimed to verify the effect of extrinsic feedback from a feedback device on proficiency in range of motion measurements by a universal goniometer. [Participants and Methods] The participants included 22 physical therapy students who were randomly assigned to feedback (n=11) and non-feedback groups (n=11). The passive right knee flexion range of motion was set as the measurement task. The experiment consisted of a pretest phase, practice trials, and a posttest phase. In the pretest phase, all participants conducted three measurements without extrinsic feedback. Extrinsic feedback related to measurement error from a device was given only to the feedback group. The posttest was conducted 24 hours after the practice trials with the same content as that in the pretest. [Results] The improvement rate from pretest to posttest was greater in the feedback group than in the non-feedback group. The results indicated that the measurement error decreases with extrinsic measurement error-related feedback during practice. [Conclusion] The utilization of extrinsic feedback from a feedback device is effective for enhancing range of motion measurement skills.

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

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

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

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

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

The effects of instructional cues on performance and mechanics during a gross motor movement

Externally focused instructions specific to performance have shown to improve body mechanics (Gokeler et al., 2015; Welling, Benjaminse, Gokeler, & Otten, 2016). However, the effect of using an external focus instruction may have been more profound if the content of the instruction had been relevant to mechanics. Therefore, the present study examined the effects of externally focused instructions specific to performance and externally focused instructions specific to body mechanics on mechanics and performance. Twenty-four adults (n = 12 males; n = 12 females) performed a series of drop jumps following external focus cues that were specific to performance and landing mechanics. Participants completed a drop jump followed by a maximal effort vertical jump. The initial contact, maximal angle, and range of motion at the knee in the sagittal and frontal plane motion were measured for mechanics and the height of the second vertical jump was measured for performance. The results suggest external focus instructions specific to performance are beneficial for performance, but not for improving landing mechanics. This suggests that external focus instructions must be specific to the contents of the instruction.

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.

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

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

Investigation of Feedback Schedules on Speech Motor Learning in Older Adults

BACKGROUND

The principles of motor learning (PML) emerged from studies of limb motor skills in healthy, young adults. The applicability of these principles to speech motor learning, and to older adults, is uncertain.

AIMS

The purpose of this study was to examine one PML, feedback frequency, and its effect on retention and generalization of a novel speech and comparable tracing task.

METHODS

Sixty older adults completed a speech motor learning task requiring the production of a novel phrase at speaking rates 2 times and 3 times slower than habitual rate. Participants also completed a limb motor learning task requiring the tracing of a sine wave 2x and 3x slower than habitual rate. Participants were randomly assigned to receive feedback every trial, every 5th trial, or every 10th trial. Mean absolute error was measured to examine immediate generalization, delayed generalization, and 2-day retention.

FINDINGS

Results suggested that feedback frequency did not have an effect on the retention and generalization of the speech or manual task, supporting the small but growing literature highlighting the constraints of generalizing the PML to other modalities and populations.

The Influence of Attentional Focus on Balance Control over Seven Days of Training

This study examined the training effect of attentional focus (external focus, internal focus, or no focus instructions) on a dynamic balance task. Participants completed baseline balance testing, seven consecutive days of dynamic balance board training, and retention testing 24 hours after the last session. The novel finding of this study was the presence of a training effect on balance control when adopting an external focus relative to an internal focus or no focus instructions. Further, we report the unique observation that more patterned behavior was adopted regardless of the focus instructions. These findings provide insight into how instructions can be altered to enhance human balance control and complement the constrained-action hypothesis.

Implicit video feedback produces positive changes in landing mechanics

BACKGROUND

Implicit (IF) and explicit (EF) feedback are two motor learning strategies demonstrated to alter movement patterns. There is conflicting evidence on which strategy produces better outcomes. The purpose of this study was to examine the effects of reduced IF and EF video feedback on lower extremity landing mechanics.

METHODS

Thirty participants (24 ± 2 years, 1.7 ± 0.1 m, 70 ± 11 kg) were randomly assigned to three groups: IF (n = 10), EF (n = 10), and control (CG) (n = 10). They performed twelve box-drop jumps three times a week on the training sessions for six weeks. Only IF and EF groups received video feedback on the training sessions. IF was cued to focus their attention on the overall jump, while EF was cued to focus on position of their knees. 3D lower extremity biomechanics were tested on testing sessions with no feedback. All sessions were at least 24 h apart from another. Testing sessions included baseline testing (pretest), testing after 3 training sessions with 100% feedback (pst1), testing after 6 training sessions with 33.3% feedback (pst2), testing after 6 training sessions with 16.6% feedback (Pst3), and testing 1 month after with no feedback (retention - ret). ANOVA compared differences between groups and time at initial contact and peak for hip flexion (HF, °) and abduction angle (HA, °), hip abduction moment (HAM, Nm/kgm), knee flexion (KF, °) and abduction angle (KA, °), knee abduction moment (KAM, Nm/kgm) and VGRF (N) (p < 0.05).

RESULTS

A significant main effect for group was found between IF and EF groups for HA (IF = - 6.7 ± 4; EF = - 9.4 ± 4.1) and KAM (IF = 0.05 ± 0.2; EF = - 0.07 ± 0.2) at initial contact, and peaks HA (IF = - 3.5 ± 4.5; EF = - 7.9 ± 4.7) and HAM (IF = 1.1 ± 0.6; EF = 0.9 ± 0.4). A significant main effect for time at initial contact for HF (pre = 32.4 ± 3.2; pst2 = 36.9 ± 3.2; pst3 = 37.9 ± 3.7; ret. = 34.1 ± 3.7), HAM (pre = 0.1 ± 0.1; pst1 = 0.04 ± 0.1; pst3 = 0.1 ± 0.01), KA (pre = 0.7 ± 1.1; pst1 = 0.2 ± 1.2; pst3 = 1.7 ± 1), and KAM (pre = 0.003 ± 0.1; pst3 = 0.01 ± 0.1) was found.

DISCUSSION/CONCLUSION

We found that implicit feedback produced positive changes in landing mechanics while explicit feedback degraded motor learning. Our results indicate that implicit feedback should be used in programs to lower the ACL injury risk. We suggest that implicit feedback should be frequent in the beginning and not be reduced as much following the acquisition phase.

Effect of Concurrent Visual Feedback Frequency on Postural Control Learning in Adolescents

The purpose was to find better augmented visual feedback frequency (100% or 67%) for learning a balance task in adolescents. Thirty subjects were divided randomly into a control group, and 100% and 67% feedback groups. The three groups performed pretest (3 trials), practice (12 trials), posttest (3 trials) and retention (3 trials, 24 hours later). The reduced feedback group showed lower RMS in the posttest than in the pretest (p = 0.04). The control and reduced feedback groups showed significant lower median frequency in the posttest than in the pretest (p < 0.05). Both feedback groups showed lower values in retention than in the pretest (p < 0.05). Even when the effect of feedback frequency could not be detected in motor learning, 67% of the feedback was recommended for motor adaptation.

Implementation of motor learning principles in physical therapy practice: Survey of physical therapists' perceptions and reported implementation

INTRODUCTION

The field of motor learning (ML) plays a pivotal role in physical therapy (PT), and its implementation has been shown to improve intervention outcomes. The objective of this study was to assess physical therapists' ML-related self-efficacy, self-reported implementation, and environmental workplace factors. An additional aim was to report the psychometric properties of a questionnaire that was developed to assess the above-mentioned constructs.

METHODS

An observational, cross-sectional survey was completed by 289 physical therapists (average age: 38.7 (9.7), with 11.3 (9.7) years of experience and 74% female). Construct validity, internal consistency, and test-retest reliability were tested. The main outcome measures were the scores of the three scales of the questionnaire, referring to self-efficacy in ML, implementation of ML principles, and workplace environment features.

RESULTS

The questionnaire had sound psychometric qualities. Respondents perceived ML as an integral part of PT. ML-related self-efficacy and implementation of ML principles were moderate (2.95/5 (0.7) and 3.04/5(0.8), respectively). PT practice had a significant effect on ML-related self-efficacy (p = 0.035) and implementation (p = 0.0031). Respondents who had undergone ML training in their graduate program reported higher ML-related self-efficacy (p = 0.007). Respondents who had postgraduate training in ML reported significantly more extensive implementation (p = 0.024). Lack of knowledge and lack of time were perceived as the major barriers to implementation.

CONCLUSIONS

Level of self-efficacy might be insufficient to support the systematic implementation of ML principles in practice. Addressing impeding individual- and organizational-level factors might facilitate ML self-efficacy and implementation. Postgraduate education facilitates ML implementation.

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

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

The Differential Effects of Attentional Focus in Children with Moderate and Profound Visual Impairments

It has been consistently reported that an external focus of attention leads to better motor performance than an internal focus, but no research to date has explored this effect in a population with visual impairments (VI). External focus statements typically reference something in the environment (e.g., target) that may be difficult to conceptualize for people with VI since they cannot generate a visual representation of the object of focus. Internal focus statements could be more closely identifiable with proprioception that is not impaired in this population. Recent studies have reported that sighted adults with temporarily obstructed vision are able to receive an external focus benefit when performing discrete tasks (i.e., golf putt and vertical jump), however, it is unclear if those with VI would experience the same benefit. The purpose of this investigation was to compare how an internal focus and external focus impact the balance of children with VI. Eighteen children with VI were grouped into a moderate (n = 11) and a profound VI group (n = 7). Participants completed a familiarization trial, an internal focus trial (i.e., focusing on feet) and an external focus trial (i.e., focusing on markers) in a counterbalanced order. The moderate VI group had a lower root mean square error while using an external focus (p = 0.04), while the profound VI group did not differ between conditions (p > 0.05). These results suggest that while performing a task reliant on sensory feedback, an external focus benefit may be dependent on the severity of VI. Further research is needed to examine whether external focus statements can be presented in a way that may be more intuitive to those with profound VI. These findings may help to influence how professionals in health-related fields (e.g., physical therapist and physical educators) give instructions on motor performance to populations with VI.

Verbal augmented feedback in the rehabilitation of lower extremity musculoskeletal dysfunctions: a systematic review

Background

Verbal augmented feedback (VAF) is commonly used in physiotherapy rehabilitation of individuals with lower extremity musculoskeletal dysfunction or to induce motor learning for injury prevention. Its effectiveness for acquisition, retention and transfer of learning of new skills in this population is unknown.

Objectives

First, to investigate the effect of VAF for rehabilitation and prevention of lower extremity musculoskeletal dysfunction. Second, to determine its effect on motor learning and the stages of acquisition, retention and transfer in this population.

Design

Systematic review designed in accordance with the Centre for Reviews and Dissemination and reported in line with Preferred Reporting Items for Systematic Review and Meta-analysis.

Method

MEDLINE, Embase, PubMed and five additional databases were searched to identify primary studies with a focus on VAF for prevention and rehabilitation of lower extremity musculoskeletal dysfunction. One reviewer screened the titles and abstracts. Two reviewers retrieved full text articles for final inclusion. The first reviewer extracted data, whereas the second reviewer audited. Two reviewers independently assessed risk of bias and quality of evidence using Cochrane Collaboration’s tool and Grading of Recommendations Assessment, Development and Evaluation, respectively.

Results

Six studies were included, with a total sample of 304 participants. Participants included patients with lateral ankle sprain (n=76), postoperative ACL reconstruction (n=16) and healthy individuals in injury prevention (n=212). All six studies included acquisition, whereas retention was found in five studies. Only one study examined transfer of the achieved motor learning (n=36). VAF was found to be effective for improving lower extremity biomechanics and postural control with moderate evidence from five studies.

Conclusion

VAF should be considered in the rehabilitation of lower extremity musculoskeletal dysfunctions. However, it cannot be unequivocally confirmed that VAF is effective in this population, owing to study heterogeneity and a lack of high-quality evidence. Nevertheless, positive effects on lower extremity biomechanics and postural control have been identified. This suggests that further research into this topic is warranted where an investigation of long-term effects of interventions is required. All stages (acquisition, retention and transfer) should be evaluated.

Virtual Normalization of Physical Impairment: A Pilot Study to Evaluate Motor Learning in Presence of Physical Impairment

Motor learning is a critical component of the rehabilitation process; however, it can be difficult to separate the fundamental causes of a learning deficit when physical impairment is a confounding factor. In this paper, a new technique is proposed to augment the residual ability of physically impaired patients with a robotic rehabilitation exoskeleton, such that motor learning can be studied independently of physical impairment. The proposed technique augments the velocity of an on-screen cursor relative to the restricted physical motion. Radial Basis Functions (RBFs) are used to both model velocity and derive a function to scale velocity as a function of workspace position. Two variations of the algorithm are presented for comparison. In a cross-over pilot study, healthy participants were recruited and subjected to a simulated impairment to constrain their motion, imposed by the cable-driven wrist exoskeleton. Participants then completed a sinusoidal tracking task, in which the algorithms were statistically shown to augment the cursor velocity in the constrained state such that it matched position-dependent velocities recorded in the healthy state. A kinematic task was then designed as a motor-learning case study where the algorithms were statistically shown to allow participants to achieve the same performance when their motion was constrained as when unconstrained. The results of the pilot study provide motivation for further research into the use of this technique, thus providing a tool with which motor-learning can be studied in neurologically impaired populations. This could be used to give physiotherapists greater insight into underlying causes of motor learning deficits, consequently facilitating and enhancing subject-specific therapy regimes.

Effects of visual and auditory guidance on bimanual coordination complexity

Perceptual guidance of movement with simple visual or temporal information can facilitate performance of difficult coordination patterns. Guidance may override coordination constraints that usually limit stability of bimanual coordination to only in-phase and anti-phase. Movement dynamics, however, might not have the same characteristics with and without perceptual guidance. Do visual and auditory guidance produce qualitatively different dynamical organization of movement? An anti-phase wrist flexion and extension coordination task was performed under no specific perceptual guidance, under temporal guidance with a metronome, and under visual guidance with a Lissajous plot. For the time series of amplitudes, periods and relative phases, temporal correlations were measured with Detrended Fluctuation Analysis and complexity levels were measured with multiscale entropy. Temporal correlations of amplitudes and relative phases deviated from the typical 1/f variation towards more random variation under visual guidance. The same was observed for the series of periods under temporal guidance. Complexity levels for all time series were lower in visual guidance, but higher for periods under temporal guidance. Perceptual simplification of the task's goal may produce enhancement of performance, but it is accompanied by changes in the details of movement organization that may be relevant to explain dependence and poor retention after practice under guidance.

The Effects of Positive and Negative Feedback on Maximal Voluntary Contraction Level of the Biceps Brachii Muscle: Moderating Roles of Gender and Conscientiousness

We investigated the effect of positive and negative feedback on maximal voluntary contraction (MVC) of the biceps brachii muscle and explored the mediating effects of gender and conscientiousness. During elbow flexion, MVCs were measured in positive, negative, and no-feedback conditions. Participants were divided into high- and low-conscientiousness groups based on the median split of their scores on Tatar's five-factor personality inventory. Considering all participants 46 college student athletes (21 female, 28 male), positive feedback led to a greater MVC percentage change (-5.76%) than did negative feedback (2.2%). MVC percentage change in the positive feedback condition differed significantly by gender, but the negative feedback condition did not. Thus, positive feedback increased female athletes' MVC level by 3.49%, but decreased male athletes' MVC level by 15.6%. For conscientiousness, MVC percentage change in the positive feedback condition did not differ according to high and low conscientiousness. However, conscientiousness interacted with gender in the positive feedback condition, increasing MVC in high-conscientiousness female athletes and decreasing MVC in low-conscientiousness female athletes. Positive feedback decreased MVC in both high- and low-conscientiousness male athletes.

Improved children's motor learning of the basketball free shooting pattern by associating subjective error estimation and extrinsic feedback

This study aimed at assessing the interaction between subjective error estimation and frequency of extrinsic feedback in the learning of the basketball free shooting pattern by children. 10- to 12-year olds were assigned to 1 of 4 groups combining subjective error estimation and relative frequency of extrinsic feedback (33% × 100%). Analysis of performance was based on quality of movement pattern. Analysis showed superior learning of the group combining error estimation and 100% feedback frequency, both groups receiving feedback on 33% of trials achieved intermediate results, and the group combining no requirement of error estimation and 100% feedback frequency had the poorest learning. Our results show the benefit of subjective error estimation in association with high frequency of extrinsic feedback in children's motor learning of a sport motor pattern.

Identification of temporal factors related to shot performance for indoor recurve archery

The purpose of this study was to investigate the temporal phases of the archery shot cycle that distinguish the arrows distance from centre, in an attempt to understand critical factors that affect performance. Fifteen archers of varying ability each performed 30 shots at 18 m. Fourteen potential predictor variables were measured for statistical modelling by stepwise multiple linear regression. The results show that pre-shot time (pre-performance routine), follow-through time (post-performance routine), aiming time, speed of the arrow and the %variation in clicker-release time, account for 7.7% of the variation in predicting shot performance. The results have implications for practice demonstrating factors that coaches should focus on to develop their athletes. Further work on pre-, but more importantly, post-performance routines are needed generally within sport research as they are lacking and have been shown to be important contributing factors in a number of sports.