Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning

OPTIMAL theory's claims about motivation lack evidence in the motor learning literature

Motivation is commonly recognized by researchers and practitioners as a key factor for motor learning. The OPTIMAL theory of motor learning (Wulf & Lewthwaite, 2016) claims that practice conditions that enhance learners' expectancies for future successful outcomes or that are autonomy supportive are motivating, thus leading to better learning. To examine the current evidence of the association between motivation and motor learning, we searched the literature for studies that manipulated expectancies and/or autonomy support. Specifically, our goals were to assess whether these manipulations resulted in group differences in motivation and, if so, whether increased motivation was associated with learning advantages. Results showed that out of 166 experiments, only 21% (n = 35) included at least one measure of motivation, even though this is the main factor proposed by OPTIMAL theory to explain the learning benefits of these manipulations. Among those, only 23% (n = 8) found group-level effects on motivation, suggesting that these manipulations might not be as motivating as expected. Of the eight experiments that found a group-level effect on motivation, five also observed learning benefits, offering limited evidence that when practice conditions increase motivation, learning is more likely to occur. Overall, the small number of studies assessing motivation precludes any reliable conclusions on the association between motivation and motor learning from being drawn. Together, our results question whether manipulations implemented in the research lines supporting OPTIMAL theory are indeed motivating and highlight the lack of sufficient evidence in these literatures to support that increased motivation benefits motor learning.

Attentional Focus Strategies Can Improve Performance of Postural Control in Runners

Attentional focus strategies, especially external focus, are associated with improvements in mechanisms of postural control. This can be important in reducing sports injuries in practices such as running, which has seen an increase in adherence. However, the impacts of these strategies on postural control in runners are unclear. This study aimed to investigate the effects of internal and external focus strategies on postural control performance with different bases of support tasks in runners. A total of 19 young adults (18-38 years old) were divided into a running group (n = 9) and a control group (n = 10). Posturography tests were performed on stable and unstable surfaces, under control, and internal and external focus conditions. The distance, mean velocity, and total velocity of the center of pressure were analyzed (p ≤ .05). There was a reduction in oscillation under external focus compared to internal and control conditions, as well as under internal focus compared to the control condition. A Group × Surface × Focus interaction for the variables distance and mean velocity in the mediolateral direction was found only for the control group. However, no significant effects were found between groups for postural control performance. Attentional focus strategies were able to reduce postural sway, with external focus condition being the most effective. Practitioners can benefit from these strategies to increase postural control performance to help reduce the number of injuries and improve sports performance. It is speculated that the effects of attentional control strategies on postural control may differ depending on the specific adaptations of each sport.

Investigation of eye movement characteristics during free throws at varying intensities among basketball players and its correlation with free throw percentage

BACKGROUND

Free throws serve as a crucial scoring mechanism in basketball games. As the level of basketball and the intensity of competition continue to improve, the frequency of free throw attempts gradually rises. However, with heightened game intensity, maintaining a consistent free throw success rate becomes increasingly challenging. The aim of this study was to investigate the eye movement characteristics exhibited by basketball players during free throws of varying intensities, as well as explore the relationship between these eye movement characteristics and free throw percentage.

METHODS

Twenty elite female basketball players were recruited to perform free throws at varying exercise intensities (low, moderate, and high) while wearing an eye tracker device. Eye tracking data was collected using the Tobii Glasses 3 eye tracker. Additionally, the Polar team pro, a heart rate monitoring system manufactured in Finland, was utilized to monitor participants' heart rates during different exercise intensities.

RESULTS

The average number of fixations on the hoop and net during free throws of varying intensities exhibited statistically significant differences (P < 0.05). The fixation durations of the hoop, backboard, and net exhibited statistically significant differences (P < 0.05). Notably, the hoop accounted for the highest proportion of the overall average fixation duration. high-intensity free throws necessitate lengthier processing durations compared to low-intensity and medium-intensity free throws. Furthermore, for free throws of moderate intensity, there was a significant negative correlation between the number of fixations on the hoop and free throw percentage (P < 0.05). Conversely, for high intensity free throws, there was a significant positive correlation between the fixation duration on the hoop and free throw percentage (P < 0.05).

CONCLUSIONS

Under the three kinds of sports intensity, the players mainly focus on the hoop position, the moderate intensity free throw has the best stability, and the information search strategy and information processing efficiency are the highest. In high intensity free throws, the longer the fixation duration at the hoop, the higher the free throw percentage; The higher the number of fixations at the hoop, the lower the percentage of free throws.

Effectiveness of virtual reality training compared to balance-specific training and conventional training on balance and gross motor functions of children with cerebral palsy: A double blinded randomized controlled trial

PURPOSE

The purpose of this study was to compare the clinical efficacy of a virtual reality rehabilitation-based training (VRT) with balance-specific training (BST) and conventional training (CT) on the balance and gross motor functions (GMF) of children with cerebral palsy (CwCP).

METHODS

This study was a double blinded, randomized controlled trial. Participants were recruited from different CP rehabilitation centers and clinics and were then randomly allocated using the block randomization method into three groups: (1) group 1 (VRT using a set of Xbox 360 games that triggered balance), (2) group 2 (BST applying a protocol of 13 exercises to enhance balance in different conditions), and (3) control group 3 (CT using traditional physiotherapy techniques). All groups received 18 sessions over six weeks, three sessions per week, each lasting 60 minutes. Participants were assessed at three timepoints (baseline, post-treatment, and follow-up) using the Pediatric Balance Scale (PBS), the Gross Motor Function Measure (GMFM D & E), the Five Times Sit-To-Stand Test, and upper and lower segments' center of mass (COM) displacement (UCOM and LCOM).

RESULTS

A total of 46 CwCP participated in this study. The repeated measures ANOVA revealed a statistically significant difference between groups in the dependent variables, except for the GMFM (D & E) and the PBS (p < 0.05 and partial η2 = 0.473). The post-hoc test showed a statistically significant difference in favor of the VRT group compared to other groups in terms of right UCOM (p < 0.05) with a large effect size of the time*group interaction (partial η2 = 0.87). Moreover, there was a statistically significant effect of time (i.e., baseline to post-treatment and baseline to follow-up) with F (18, 23) = 59.954, p < 0.05, Wilks' lambda = 0.021, partial η2 = 0.979.

CONCLUSION

The findings revealed that VRT was not superior to BST in the rehabilitation of balance and GMF in CwCP aged four to 12 years. However, when compared to CT, better results were reported. Furthermore, it appears that customized programs lead to greater improvements in balance than commercial programs. Future studies are needed to assess the physiological effects of the three types of rehabilitation interventions using more advanced measurement tools, such as functional magnetic resonance imaging, following VRT protocols.

Motivation Unraveled: Giving Choice to Football Players to Improve Anterior Cruciate Ligament Injury Prevention

ABSTRACT

Benjaminse, A, Nijmeijer, EM, Gokeler, A, Broekhaar, DC, and Cortes, N. Motivation unraveled: giving choice to football players to improve anterior cruciate ligament injury prevention. J Strength Cond Res XX(X): 000-000, 2024-Providing athletes some control over a training session facilitates motor skill acquisition. This is a promising concept to use in anterior cruciate ligament (ACL) injury prevention, as the key for risk reduction is to improve quality of movement. The goal of this study was to better understand why improved motor learning occurred when football players had the opportunity to choose when to receive feedback when practicing sidestep cutting (SSC) movements. Healthy male recreational football players (n = 22, 22.9 ± 1.7 years, 185.5 ± 7.2 cm, 79.3 ± 9.2 kg) were included and assigned to the self-control (SC) or the yoked (YK) group. The players performed anticipated and unanticipated SSC. They received video instructions and were instructed to "copy the movement of the model to the best of their ability." During the training blocks, the SC group could ask for feedback, whereas the YK group could not. Cutting movement assessment scores (CMAS) were measured to test quality of movement and the Intrinsic Motivation Inventory was administered to measure constructs of motivation. In the anticipated condition, SC group showed better scores in immediate post and the retention test compared with pretest (p < 0.001), whereas the YK group showed worse scores in the retention test compared with immediate posttest (p = 0.001). Perceived competence (p = 0.017) and self-efficacy (p = 0.032) were consistent factors that correlated with improved CMAS in the SC group. This has given us innovative insights into underlying mechanisms optimizing the quality of movement, necessary to improve current ACL injury prevention approaches.

Components of effective exergame-based training to improve cognitive functioning in middle-aged to older adults - A systematic review and meta-analysis

BACKGROUND

Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training.

OBJECTIVES

This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA).

METHODS

We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA.

RESULTS

The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions.

CONCLUSION

The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research.

PROSPERO REGISTRATION NUMBER

CRD42023418593; prospectively registered, date of registration: 1 May 2023.

A novel model for developing thrust joint manipulation skills: a teaching and learning perspective

Spinal and extremity thrust joint manipulation (TJM) has been shown to be an effective intervention when treating patients with various musculoskeletal conditions. Learning skilled TJM requires the proper execution of many discrete tasks. If any of these are missing, effectiveness and safety may be limited. While it is accepted that practice and feedback are important when physical therapists are learning clinical tasks, the best type of practice has not been identified for learning to perform TJM tasks. In this paper, we propose an educational model for instruction of joint manipulation that: 1) standardizes feedback terminology and 2) describes a core set of four discrete tasks (lift, drop, pull, and combination-rotation) that apply to most TJM tasks. The model includes instructing TJM tasks followed by identifying key errors related to the components of setup and thrust. Once these key errors have been identified, intentional practice activities are provided to address the noted positional and movement errors. Finally, reassessment is performed to determine if errors have diminished. This model is similar to the test-retest approach that is commonly used when treating patients. We hope this educational model will provide a framework for teaching TJM and will also foster future research.

Fundamental processes in sensorimotor learning: Reasoning, refinement, and retrieval

Motor learning is often viewed as a unitary process that operates outside of conscious awareness. This perspective has led to the development of sophisticated models designed to elucidate the mechanisms of implicit sensorimotor learning. In this review, we argue for a broader perspective, emphasizing the contribution of explicit strategies to sensorimotor learning tasks. Furthermore, we propose a theoretical framework for motor learning that consists of three fundamental processes: reasoning, the process of understanding action-outcome relationships; refinement, the process of optimizing sensorimotor and cognitive parameters to achieve motor goals; and retrieval, the process of inferring the context and recalling a control policy. We anticipate that this '3R' framework for understanding how complex movements are learned will open exciting avenues for future research at the intersection between cognition and action.

Important findings of a technology-assisted in-home music-based intervention for individuals with stroke: a small feasibility study

PURPOSE

To examine the feasibility of stroke survivors receiving music-based rehabilitation via a mobile app.

MATERIALS AND METHODS

We recruited ten chronic stroke survivors who were community-dwelling with mild-moderate upper extremity (UE) paresis. Participants were encouraged to exercise their paretic UE with a commercial instrument training app, Yousician, with a piano keyboard at home for three weeks. The feasibility of the training was measured by: (a) the acceptance of using the app to receive in-home piano training (e.g., daily usage time, exit interview) and (b) the effects of the app functionality as a rehabilitation tool (e.g., participants' motor improvements after training).

RESULTS

Our small sample size of participants demonstrated general positive feedback and self-motivation (e.g., interest in extended training time) about using a mobile app to receive in-home, music-based UE training. Participants showed no trend of declined usage and practiced on average ∼33 min per day for 4-5 days per week during the 3-week participation. We also observed positive results in the Fugl-Meyer Assessment, Action Research Arm Test, and Nine Hole Peg Test after training.

CONCLUSIONS

This study provided insight into the feasibility of delivering music-based interventions through mobile health (mHealth) technology for stroke populations. Although this was a small sample size, participants' positive and negative comments and feedback provided useful information for future rehab app development. We suggest four ways to further improve and design a patient-oriented app to facilitate the use of a mHealth app to deliver in-home music-based interventions for stroke survivors.

Observe, Practice, and Improve? Enhancing Sidestep Cutting Execution in Talented Female Soccer Players: A Four-Week Intervention Program With Video Instruction

ABSTRACT

Nijmeijer, EM, Kempe, M, Elferink-Gemser, MT, and Benjaminse A. Observe, practice and improve? Enhancing sidestep cutting (SSC) execution in talented female soccer players: A four-week intervention program with video instruction. J Strength Cond Res 38(8): e430-e439, 2024-Implicit learning has the potential to improve movement execution and reduce injury risk. Previous research showed beneficial effects of short-term interventions with implicit learning in male athletes. However, research on long-term interventions in female athletes is lacking. The aim of this study was to examine the effects of a 4-week intervention with video instruction on movement execution of SSC, a task that is highly related with anterior cruciate ligament (ACL) injury risk, in female athletes. Twenty talented adolescent female soccer players were part of the control (CTRL, n = 10) or video instruction (VIDEO, n = 10) group. All subjects practiced 4 weeks and received general task instructions. In addition, the VIDEO group received expert video instruction during practice. Lower extremity kinematics and kinetics and vertical ground reaction force of SSC were examined during baseline, immediate post, and 1-week retention tests. After nonlinear registration, differences between each subject and the expert she had seen were determined. These differences were analyzed with SPM1D 2-way ANOVA. No interaction effects between time and group were found ( p > 0.05). Main effects of time were found in the frontal plane. In particular, smaller deviations of subjects compared with the seen expert of the knee adduction ( p = 0.005, 97.9-100% stance phase [SP]) and hip abduction ( p = 0.005, 11.5-13.8% SP) and adduction ( p < 0.001, 33.4-87.7% SP) moments were found in immediate post compared with baseline. These frontal plane short-term improvements, replicating earlier findings in both sexes, may lower ACL injury risk. The large observed interindividual differences over time may have concealed the long-term effects of video instruction at the group level.

Focused attention and intrinsic motivation using animations for instruction of fundamental motor skills in children with Down syndrome

BACKGROUND

Children with Down syndrome (DS) demonstrate poorer performance in locomotor and ball skills than children with typical development. During motor assessment, keeping children's attention and motivation is challenging, especially for children with DS, which may affect the test outcomes. This study aimed first to examine the impact of examiner and App-animation demonstrations during the assessment on the performance of fundamental motor skills, focus of attention and intrinsic motivation for children with DS and neurotypical development (NTD). The secondary aim was to examine the differences in those outcomes between children with DS and neurotypical development.

METHODS

A sample of 24 children (10 with DS and 14 with NTD) aged between 3 and 10 years were subjected to two motor performance assessment protocols: a traditional protocol using the Gross Motor Development Test-3 (TGMD-3) and a protocol using animations from an application as support for TGMD-3 (AppP). The focus of attention was obtained from video recordings during protocol instruction (number of eye shifts, eye shift time, instruction focus time, number of instructions required and total instruction time). Intrinsic motivation was assessed by the Intrinsic Motivation Inventory (IMI) at the end of each protocol.

RESULTS

The results showed no significant differences between the protocols for locomotor skills, ball skills and gross motor index. However, children with NTD outperformed those with DS in these skills. When analysing the focus of attention, children with DS showed greater ocular deviations and longer instruction time requested in the traditional protocol compared with AppP, even when compared with NDT children. When comparing protocols in both groups, AppP demonstrated fewer ocular deviations and shorter ocular deviation times. Regarding intrinsic motivation, children with DS in the traditional protocol had lower motivation scores than those with NTD. Regarding the purchase of protocols, in both groups, the AppP presented higher scores for interest/pleasure, perceived competence and general motivation, with lower pressure/tension.

CONCLUSION

The animated application (AppP) proved effective as a visual support during the TGMD-3 assessment, particularly benefiting children with DS by enhancing motivation and attention.

Pragmatic approach to mobilizing individuals with critical illness due to COVID-19: clinical perspective

PURPOSE

To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19.

METHODS

Clinical perspective developed through reflective clinical practice and narrative review of best available evidence.

RESULTS

Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines.

CONCLUSIONS

Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions.

Differential performance on a motor task according to the preference for task-irrelevant elements that are chosen or assigned: A randomized controlled study

This study explored the impact of choice and preference for what is chosen or assigned on performance on a motor task. Using an experimental design with a dart-throwing task, 90 novice participants were randomized into four groups: Choice-Like condition, Choice-Dislike condition, Assigned-Like condition, and Assigned-Dislike condition, resulting of the manipulation of choice (vs. assignation) of a task-irrelevant element and preference (irrelevant element: darts color and design). The study found that participants who were given the opportunity to choose their own dart for a throwing task performed better than those who were not given the choice. Participants who threw a dart they preferred also had better scores than those who threw a dart they did not like. However, the interactive effects of choice and preference on performance were inconclusive, and whereas being assigned with a disliked element was the worst condition for performance, and being allowed to choose preferred elements the most facilitatory one, nothing else can be concluded on the impact of both conditions alone or in combination. These results suggest that both choice and preference can positively impact performance in closed motor learning tasks and have practical applications for training and execution in athletic performance. Further investigations are warranted to delve into the interplay of choice and preference in diverse contexts and populations.

The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis

The priorities of individuals with chronic stroke are not always reflected in clinical practice. This study provides insight into meaningful factors related to long-term motor recovery in stroke survivors. Thirty individuals with chronic stroke participated in semi-structured interviews about movement, recovery, and barriers to and facilitators of mobility and paretic arm use. The interviews were analyzed using inductive thematic analysis. Three categories, the individual, environment, and task, defined five emergent themes. Individual: (1) mindset is a strong and consistent influencer of daily physical activity and overall recovery; (2) severe physical impairment limits physical activity and recovery, regardless of other factors; and (3) a negative perception of disability impacts mindset and willingness to move in public. Environment: (4) social and physical environments influence physical activity and recovery. Task: (5) participation in meaningful activities increases physical activity and promotes long-term recovery. Strategies to incorporate paretic arm use, exercise, and encouragement from others facilitate physical activity. Insufficient paretic limb function, environmental obstacles, and fear are barriers to physical activity. Neurorehabilitation must address the factors that are meaningful to stroke survivors. Building motor capacity is essential and must be integrated with factors such as a positive mindset and proper environment. Individual differences reinforce the need for personalized care.

Improved Quadriceps Torque Production With Optimized Biofeedback in Patients After Anterior Cruciate Ligament Reconstruction

Hogg, JA, Barger, NB, Bruce, JR, White, CC, Myer, GD, and Diekfuss, JA. Improved quadriceps torque production with optimized biofeedback in patients after anterior cruciate ligament reconstruction. J Strength Cond Res XX(X): 000–000, 2024—Optimizing performance through intrinsic motivation and attention for learning: prevention rehabilitation exercise play (OPTIMAL PREP) training strategies incorporate motor learning principles to enhance movement acquisition and retention. We aimed to use OPTIMAL PREP biofeedback to evaluate its potential to improve quadriceps and hamstring torque production in patients with anterior cruciate ligament reconstruction (ACL-R). Thirteen subjects 23 ± 19 months post ACL-R completed 5 concentric quadriceps/hamstrings repetitions on an isokinetic dynamometer for each limb and counterbalanced condition at 60°·s−1. For the control condition, subjects were instructed to perform the exercise “as hard and fast as possible.” For the OPTIMAL PREP condition, subjects were additionally told that “Research shows that if you focus on moving the line on the screen (external focus) you will exhibit greater quadriceps output (enhanced expectancies)” and were given the choice of graphical representation for the biofeedback (autonomy support). Quadriceps and hamstrings peak torque, rate of force development, and torque-angle waveforms were analyzed with 2 × 2 RMANOVAs (a priori >0.06). The ACL-R limb demonstrated increased quadriceps peak torque in the OPTIMAL PREP condition than in the control condition ( = 0.13, interaction p = 0.21, pairwise Cohen's d = 0.63). Anterior cruciate ligament reconstruction limb quadriceps deficits remained near terminal extension (14–45°; peak Cohen's d = 0.57, p < 0.001). For hamstrings peak torque, we observed moderate effects for condition (OPTIMAL PREP greater; = 0.10, p = 0.29) and limb (uninvolved greater; = 0.13, p = 0.22). Easily implementable OPTIMAL PREP training strategies improved ACL-R limb quadriceps torque production, resulting in between-limb parity. However, asymmetries still existed near terminal extension.

Does Dyadic Practice Interfere with the Type of Motor Learning Promoted by Analogy Instructions?

We investigated whether allowing individuals to exchange verbal information during dyadic practice changed the effect of analogy instructions intended to strengthen explicit motor learning by an implicit means. Forty-three right-handed college students performed golf putting, aiming at a target three meters away. Participants were assigned to one of two groups: Dyadic Practice Analogy Instruction or Individual Practice Analogy Instruction. Participants in the Dyadic Practice group were allowed to communicate with one another about the task during their practice. Before practice, participants performed a working memory capacity test. Both groups performed 180 trials of golf distributed across three days. On each day, there were four blocks of 15 trials. On the third day, participants reported the explicit rules they used to learn the task and they completed the Intrinsic Motivation Inventory. On the fourth day, they took three learning tests: retention, dual-task transfer, and social pressure transfer tests. Results of the retention test indicated that both groups learned the task comparably. Similarly, there were no significant group differences between the participants' number of explicit rules learned and their motivation levels on either of the transfer tests. Finally, only the participants in the Dyadic Practice Analogy Group showed a significant correlation between their performance on the dual-task transfer test and their working memory capacity. Overall, we found that dyadic practice did not interfere with the implicit type of motor learning promoted by analogy instruction (i.e., implicit learning).

Effects of external verbal cueing on countermovement rebound jump performance

This study examined the effects of three external verbal cues on countermovement rebound jump (CMRJ) performance. Twenty-five recreational athletes completed nine jumps with distinct height, velocity and combined cue focus. A general linear model analysis of variance was used to evaluate systematic bias between conditions (p < 0.05). The height and velocity cues significantly altered jump height and contact times in both jumps during the CMRJ, respectively (p ≤ 0.002). The combined cue significantly reduced contact time while increasing leg stiffness compared to the height cue (p ≤ 0.038). It also increased jump height compared to the velocity cue (p ≤ 0.005) in both jumps, resulting in the highest explosive power and reactive strength values among all conditions. Furthermore, the combined cue enhanced the positive ankle contribution compared to the height cue (p = 0.020) and increased positive hip and negative knee joint work compared to the velocity cue (p ≤ 0.040) in the second jump of the CMRJ. These findings advise practitioners to use the height cue to maximise jump height, the velocity cue to minimise contact times and the combined cue to maximise explosive power and reactive strength.

Visuomotor adaptation across the lifespan

Being able to adapt our movements to changing circumstances allows people to maintain performance across a wide range of tasks throughout life, but it is unclear whether visuomotor learning abilities are fully developed in young children and, if so, whether they remain stable in the elderly. There is limited evidence of changes in motor adaptation ability throughout life, and the findings are inconsistent. Therefore, our goal was to compare visuomotor learning abilities throughout the lifespan. We used a shorter, gamified experimental task and collected data from participants in 5 age groups. Young children (M = 7 years), older children (M = 11 years), young adults (M = 20 years), adults (M = 40 years) and older adults (M = 67 years) adapted to a 45° visuomotor rotation in a centre-out reaching task. Across measures of rate of adaptation, extent of learning, rate of unlearning, generalization, and savings, we found that all groups performed similarly. That is, at least for short bouts of gamified learning, children and older adults perform just as well as young adults.

Self-Controlled Feedback in Motor Learning: The Effects Depend on the Frequency of Request

The benefits of allowing learners to control when to receive knowledge of results (KR) compared to a yoked group has been recently challenged and postulated to be mild at best. A potential explanation for such dissident findings is that individuals differentially utilize the autonomy provided by the self-controlled condition, which, in its turn, affects the outcomes. Therefore, the present study investigated the effects of self-controlled KR on motor learning focusing on the frequency of KR requests when performing an anticipatory timing task. Self-controlled groups were created based on participants' KR frequency of request (High, Medium, and Low referring to fifth, third, and first quintile) and, then, Yoked groups were created self-control condition pairing the KR request of the Self-controlled groups. We also measured self-efficacy and processing time as means to verify potential correlates. The results supported the expected interaction. While no difference between self-controlled and yoked groups were found for low frequencies of KR, a moderate amount of KR request was related to better results for the self-controlled group. Nonetheless, the opposite trend was observed for high frequencies of KR; the yoked group was superior to the self-controlled group. The results of this study allow us to conclude that the choices made, and not just the possibility of choosing, seem to define the benefits of KR self-control in motor learning.

5-HT1A and 5-HT2A receptor effects on recognition memory, motor/exploratory behaviors, emotionality and regional dopamine transporter binding in the rat

Both dopamine (DA) and serotonin (5-HT) play key roles in numerous functions including motor control, stress response and learning. So far, there is scarce or conflicting evidence about the effects of 5-HT1A and 5-HT2A receptor (R) agonists and antagonists on recognition memory in the rat. This also holds for their effect on cerebral DA as well as 5-HT release. In the present study, we assessed the effects of the 5-HT1AR agonist 8-OH-DPAT and antagonist WAY100,635 and the 5-HT2AR agonist DOI and antagonist altanserin (ALT) on rat behaviors. Moreover, we investigated their impact on monoamine efflux by measuring monoamine transporter binding in various regions of the rat brain. After injection of either 8-OH-DPAT (3 mg/kg), WAY100,635 (0.4 mg/kg), DOI (0.1 mg/kg), ALT (1 mg/kg) or the respective vehicle (saline, DMSO), rats underwent an object and place recognition memory test in the open field. Upon the assessment of object exploration, motor/exploratory parameters and feces excretion, rats were administered the monoamine transporter radioligand N-o-fluoropropyl-2b-carbomethoxy-3b-(4-[123I]iodophenyl)-nortropane ([123I]-FP-CIT; 8.9 ± 2.6 MBq) into the tail vein. Regional radioactivity accumulations in the rat brain were determined post mortem. Compared vehicle, administration of 8-OH-DPAT impaired memory for place, decreased rearing behavior, and increased ambulation as well as head-shoulder movements. DOI administration led to a reduction in rearing behavior but an increase in head-shoulder motility relative to vehicle. Feces excretion was diminished after ALT relative to vehicle. Dopamine transporter (DAT) binding was increased in the caudateputamen (CP), but decreased in the nucleus accumbens (NAC) after 8-OH-DPAT relative to vehicle. Moreover, DAT binding was decreased in the NAC after ALT relative to vehicle. Findings indicate that 5-HT1AR inhibition and 5-HT2AR activation may impair memory for place. Furthermore, results imply associations not only between recognition memory, motor/exploratory behavior and emotionality but also between the respective parameters and the levels of available DA in CP and NAC.

Lived experiences of physical therapists treating traumatic knee injury using integrated psychological training (MOTIFS): a qualitative interview study

BACKGROUND

The novel Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) training model, which began development in 2018, integrates psychological training into physical rehabilitation in knee-injured people.

OBJECTIVE

This qualitative interview study aims to understand, interpret, and describe how physical therapists perceive using the MOTIFS Model.

METHODS

One-on-one semi-structured interviews were conducted with six physical therapists familiar with the MOTIFS model and eight with experience with care-as-usual training only, analyzed using Interpretive Phenomenological Analysis.

RESULTS

Two major themes were generated in the MOTIFS group: 1) "MOTIFS increases psychological focus during rehabilitation training"; and 2) "Care-as-Usual training is mainly physical, and lacks the necessary psychological focus." Physical therapists perceived structured methods of addressing psychological factors, such as using imagery to influence patients' motivation, fear, and preparation for return to activity. Three major themes were generated in the Care-as-Usual group: 1) "Rehabilitation is mainly to restore physical function"; 2) "Rehabilitation training includes a biopsychosocial interaction"; and 3) "Psychological factors are important to address, but strategies are lacking."

CONCLUSION

Physical therapists perceive MOTIFS as a method of consciously shifting perspective toward an increased focus on psychological factors in knee-injury rehabilitation. Results indicate that a training model with integrated psychological strategies to create more holistic rehabilitation may be beneficial.

Response of Knee Joint Biomechanics to Landing Under Internal and External Focus of Attention in Female Volleyball Players

The aim of this study was to examine the effect of attentional focus instructions on the biomechanical variables associated with the risk of anterior cruciate ligament injury of the knee joint during a drop landing task using a time series analysis. Ten female volleyball players (age: 20.4 ± 0.8 years, height: 169.7 ± 7.1 cm, mass: 57.6 ± 3.1 kg, experience: 6.3 ± 0.8 years) performed landings from a 50 cm height under three different attentional focus conditions: (1) external focus (focus on landing as soft as possible), (2) internal focus (focus on bending your knees when you land), and (3) control (no-focus instruction). Statistical parameter mapping in the sagittal plane during the crucial first 30% of landing time showed a significant effect of attentional focus instructions. Despite the similarity in landing performance across foci instructions, adopting an external focus instruction promoted reduced vertical ground reaction force and lower sagittal flexion moment during the first 30% of execution time compared to internal focus, suggesting reduced knee loading. Therefore, adopting an external focus of attention was suggested to reduce most biomechanical risk variables in the sagittal plane associated with anterior cruciate ligament injuries, compared to internal focus and control condition. No significant differences were found in the frontal and horizontal planes between the conditions during this crucial interval.

The effects of auditory consequences on visuomotor adaptation and motor memory

Sensorimotor adaptation is a form of motor learning that is essential for maintaining motor performance across the lifespan and is integral to recovery of function after neurological injury. Recent research indicates that experiencing a balance-threatening physical consequence when making a movement error during adaptation can enhance subsequent motor memory. This is perhaps not surprising, as learning to avoid injury is critical for our survival and well-being. Reward and punishment can also differentially modify aspects of motor learning. However, it remains unclear whether other forms of non-physical consequences can impact motor learning. Here we tested the hypothesis that a loud acoustic stimulus linked to a movement error during adaptation could lead to greater generalization and consolidation. Two groups of participants (n = 12 each) adapted to a new, prism-induced visuomotor mapping while performing a precision walking task. One group experienced an unexpected loud acoustic stimulus (85 dB tone) when making foot-placement errors during adaptation. This auditory consequence group adapted faster and showed greater generalization with an interlimb transfer task, but not greater generalization to an obstacle avoidance task. Both groups showed faster relearning (i.e., savings) during the second testing session one week later despite the presence of an interference block of trials following initial adaptation, indicating successful consolidation. However, we did not find significant differences between groups with relearning during session 2. Overall, our results suggest that auditory consequences may serve as a useful method to improve motor learning, though further research is required.

The effects of reward and punishment on the performance of ping-pong ball bouncing

Introduction

Reward and punishment modulate behavior. In real-world motor skill learning, reward and punishment have been found to have dissociable effects on optimizing motor skill learning, but the scientific basis for these effects is largely unknown.

Methods

In the present study, we investigated the effects of reward and punishment on the performance of real-world motor skill learning. Specifically, three groups of participants were trained and tested on a ping-pong ball bouncing task for three consecutive days. The training and testing sessions were identical across the three days: participants were trained with their right (dominant) hand each day under conditions of either reward, punishment, or a neutral control condition (neither). Before and after the training session, all participants were tested with their right and left hands without any feedback.

Results

We found that punishment promoted early learning, while reward promoted late learning. Reward facilitated short-term memory, while punishment impaired long-term memory. Both reward and punishment interfered with long-term memory gains. Interestingly, the effects of reward and punishment transferred to the left hand.

Discussion

The results show that reward and punishment have different effects on real-world motor skill learning. The effects change with training and transfer readily to novel contexts. The results suggest that reward and punishment may act on different learning processes and engage different neural mechanisms during real-world motor skill learning. In addition, high-level metacognitive processes may be enabled by the additional reinforcement feedback during real-world motor skill learning. Our findings provide new insights into the mechanisms underlying motor learning, and may have important implications for practical applications such as sports training and motor rehabilitation.

Identifying the Qualities of Attention and the Attentional Style in Indoor Team Sports: A Gender Comparison

Attention is an essential psychological component in sports games, which conditions sports success. The purpose of this study was to identify the attention style (internal or external) and the weight of attention qualities depending on the practiced team sport (basketball, volleyball, or handball) and gender (female or male), in athletes aged 15-18. A total of 177 active athletes (87 female (mean age ± standard deviation: 16.07 ± 0.94 years) and 90 male (mean age ± standard deviation: 15.96 ± 0.82 years)) were involved in the study, including 62 handball players (28 female and 34 male), 58 volleyball players (30 female and 28 male) and 57 basketball players (29 female and 28 male). In the study, two questionnaires were applied: one implemented to identify the attentive style with the two dimensions internal and external (standardized), called questionnaire for the assessment of attentional style in athletes (QASA), and one designed by us, called questionnaire to identify the weights of attention qualities according to the characteristics of the practiced sport (QAQCS), aiming to identify the most relevant quality of attention, depending on the practiced sport. Cronbach's alpha for both questionnaires was between 0.701 and 0.855. The results recorded in the present study reveal a variation in the attentional style between the groups of athletes and between genders. The results of the study highlight that in handball, girls have a predominantly external style with a total of 10.213 points; in boys' handball, the predominant focus of attention is internal with a total score of 9.087 points. Girls' volleyball focus of attention is predominantly external, with 8.999 points; in boys' volleyball, the attention style is internal, registering a score of 9.713 points. In girls' basketball, the predominant focus of attention is internal, with a total score of 8.516 points; in boys' basketball, the external attention style is predominant, with 9.213 points. Looking at the weight of attention qualities, it was found that the most relevant for girls is concentration and mobility for handball players, stability was identified in volleyball, and distributiveness in basketball. In boys' handball teams, mobility is the most essential, just like in basketball, and in volleyball it was found that stability has the biggest impact. ANOVA analysis highlighted statistically significant differences between groups of sports games by gender category, at both subscales of (QASA), as well as QAQCS, p < 0.05. The results of our study highlight differences between the attentional styles and their qualities in relation to the gender and the specific sport played, which determines differentiated approaches to these psychological components.

Partnered dance evokes greater intrinsic motivation than home exercise as therapeutic activity for chemotherapy-induced deficits: secondary results of a randomized, controlled clinical trial

Introduction

Dance has been proposed to support superior intrinsic motivation over non-dance forms of therapeutic physical activity. However, this hypothesis has yet to be evaluated empirically, particularly among populations living with neuropathology such as survivors of cancer with neurologic complications from chemotherapy treatment. Questions about motivation are relevant to clinical outcomes because motivation mediates neuroplasticity. We conducted this secondary analysis of a randomized-controlled study to begin to investigate the relationships between personal motivation and neurophysiologic effects of dance-based intervention for healthy aging among populations with neurologic complications of cancer.

Methods

We measured motivation using the Intrinsic Motivation Inventory, a validated patient-reported outcome from the psychological approach of Self Determination Theory. We assessed intrinsic motivation, extrinsic motivation, and satisfaction with intervention within a randomized controlled trial of dance versus exercise designed to alleviate symptoms of chemotherapy-induced impairment. Fifty-two survivors of breast cancer with chemotherapy-induced neuropathy diagnosis and associated sensorimotor functional deficits were randomized (1:1) to 8 weeks of partnered dance or home exercise, performed biweekly (NCT05114005; R21-AG068831).

Results

While satisfaction did not differ between interventions, intrinsic motivation was higher among participants randomized to dance than those randomized to exercise (p < 0.0001 at all timepoints: 2 weeks, 4 weeks, 6 weeks, and 8 weeks of intervention), as was extrinsic motivation at 2 weeks (p = 0.04) and 8 weeks (p = 0.01).

Discussion

These data provide evidence that social dance is more motivating than the type of home exercise generally recommended as therapeutic physical activity. The results inform directions for future study of the effect of dance-based therapeutics on embodied agency, neuroplastic changes, and clinically-relevant neuropathic improvement.

Improvisation and live accompaniment increase motor response and reward during a music playing task

Music provides a reward that can enhance learning and motivation in humans. While music is often combined with exercise to improve performance and upregulate mood, the relationship between music-induced reward and motor output is poorly understood. Here, we study music reward and motor output at the same time by capitalizing on music playing. Specifically, we investigate the effects of music improvisation and live accompaniment on motor, autonomic, and affective responses. Thirty adults performed a drumming task while (i) improvising or maintaining the beat and (ii) with live or recorded accompaniment. Motor response was characterized by acceleration of hand movements (accelerometry), wrist flexor and extensor muscle activation (electromyography), and the drum strike count (i.e., the number of drum strikes played). Autonomic arousal was measured by tonic response of electrodermal activity (EDA) and heart rate (HR). Affective responses were measured by a 12-item Likert scale. The combination of improvisation and live accompaniment, as compared to all other conditions, significantly increased acceleration of hand movements and muscle activation, as well as participant reports of reward during music playing. Improvisation, regardless of type of accompaniment, increased the drum strike count and autonomic arousal (including tonic EDA responses and several measures of HR), as well as participant reports of challenge. Importantly, increased motor response was associated with increased reward ratings during music improvisation, but not while participants were maintaining the beat. The increased motor responses achieved with improvisation and live accompaniment have important implications for enhancing dose of movement during exercise and physical rehabilitation.

Either Autonomy Support or Enhanced Expectancies Delivered Via Virtual-Reality Benefits Frontal-Plane Single-Leg Squatting Kinematics

Our purpose in this study was to determine the effects of a virtual reality intervention delivering specific motivational motor learning manipulations of either autonomy support (AS) or enhanced expectancies (EE) on frontal plane single-leg squatting kinematics. We allocated 45 participants (21 male, 24 female) demonstrating knee, hip, and trunk frontal plane mechanics associated with elevated anterior cruciate ligament injury risk to one of three groups (control, AS, or EE). Participants mimicked an avatar performing five sets of eight repetitions of exemplary single-leg squats. AS participants were given the added option of choosing the color of their avatar. EE participants received real-time biofeedback in the form of green highlights on the avatar that remained on as long as the participant maintained pre-determined 'safe' frontal plane mechanics. We measured peak frontal plane knee, hip, and trunk angles before (baseline) and immediately following (post) the intervention. The control group demonstrated greater increases in knee abduction angle (Δ = +2.3°) than did the AS (Δ = +0.1°) and EE groups (Δ = -0.4°) (p = .003; η2p = .28). All groups demonstrated increased peak hip adduction (p = .01, ηp2 = .18) (control Δ = +1.5°; AS Δ = +3.2°; EE Δ = +0.7°). Hip adduction worsened in all groups. AS and EE motivation strategies appeared to mitigate maladaptive frontal plane knee mechanics.

Self-Controlled Video Feedback Facilitates the Learning of Tactical Skills in Tennis

Purpose: This study aimed to examine the effect of self-controlled video feedback on the learning of tactical motor skills in tennis, and additionally, whether this was affected by learners' self-efficacy and self-regulative skills. Method: Twenty-three intermediately skilled tennis players were assigned to either a self-controlled group that was provided video feedback on request or a yoked group that received an identical, externally controlled video feedback schedule. In three training sessions participants practiced serve and volley play. Video feedback with attentional cueing and transitional statements that focused solely on individual tactical gameplay was provided by a licensed tennis coach. Individual tactical performance was measured with a custom designed Tactical Tennis Tool (TTT) in a pretest, posttest and in a one-week retention test. Before each test self-efficacy was measured, and a questionnaire was administered to measure self-regulative skills. Results: Analyses revealed significantly larger improvements in tactical performance relative to the pretest for the self-controlled group than for the yoked group in both the posttest and the one-week retention test. No differences were found in self-efficacy. Finally, the improvements in tactical performance were not predicted by self-efficacy and/or self-regulative skills. Conclusion: The advantage of self-controlled video feedback extends to the learning of a complex tactical task in tennis. Future research should verify the observed benefits of a self-controlled learning environment in comparison to a coach-controlled learning environment.

Does having an external focus in immersive virtual reality increase range of motion in people with neck pain?

BACKGROUND

When instructing exercises to improve Range of Motion (ROM), clinicians often create an internal focus of attention, while motor performance may improve more when using an external focus.

OBJECTIVES

Using Virtual Reality (VR), we investigated the effect of tasks with an internal and external focus on maximal ROM in people with neck pain and explored whether this effect was associated with fear of movement.

METHOD

In this cross-over experimental design study, the cervical ROM of 54 participants was measured while performing a target-seeking exercise in a VR-environment (external focus task) and during three maximal rotation and flexion-extension movements with the VR-headset on, without signal (internal focus task). The main statistical analysis included two dependent T-tests. Pearson correlation coefficients were calculated to investigate whether the differences in ROM in both conditions were correlated to fear of movement.

RESULTS

Maximal neck rotation was larger in the external focus condition than in the internal focus condition (mean difference: 26.4°, 95% CI [20.6, 32.3]; p < 0.001, d = 1.24). However, there was a difference favouring the internal focus condition for flexion-extension (mean difference: 8.2°, 95% CI [-14.9, -1.5]; p = 0.018, d = 0.33). The variability in ROM was not explained by variability in fear of movement (for all correlations p ≥ 0.197).

CONCLUSION

An external focus resulted in a larger range of rotation, but our flexion-extension findings suggest that the task has to be specific to elicit such an effect. Further research, using a task that sufficiently elicits movement in all directions, is needed to determine the value of an external focus during exercise.

Motivation and music interventions in adults: A systematic review

ABSTRACTMusic is increasingly used in a wide array of settings, from clinical recovery to sports or well-being interventions. Motivation related to music is often considered as a possible working mechanism for music to facilitate these processes, however this has not previously been systematically evaluated. The current systematic review considered studies that involved music (therapy) interventions, together with motivation-related measures such as wanting to practise, liking the musical activities, or patient adherence to an intervention. Our objective was to examine whether music is related to increased motivation in task performance and/or rehabilitation settings, and whether this is in turn related to better clinical or training outcomes. Seventy-nine studies met the inclusion criteria, the majority of which (85%) indicated an increased level of motivation with music as compared to without. Moreover, in those studies where motivation was increased, clinical or other outcomes were improved in most cases (90%). These results support the notion of motivation as an underlying mechanism of music-based interventions, but more robust evidence is needed to ascertain which mechanisms are crucial in increasing motivation from a behavioural, cognitive, and neurobiological point of view, as well as how motivational mechanisms relate to other factors of effectiveness in music-based paradigms.

Understanding task "challenge" in stroke rehabilitation: an interdisciplinary concept analysis

PURPOSE

Rehabilitation plays a critical role in minimising disability after stroke, with the concept of "challenge" proposed to be essential to rehabilitation efficacy and outcomes. This review unpacks how challenge is conceptualised in stroke rehabilitation literature from the perspectives of physiotherapy, occupational therapy, speech-language therapy and people with stroke. A secondary purpose was to provide a definition of challenge that is applicable to stroke rehabilitation.

METHODS

Principle-based concept analysis was utilised to examine challenge within the stroke rehabilitation literature. Forty-two papers were included. Data analysis involved immersion, analytical questioning, coding and synthesis to elicit the conceptual components of challenge.

RESULTS

Challenge was understood as a multidimensional and dynamic concept with three facets: nominal, functional and perceived challenge. Functional and perceived challenge were integral to optimal challenge. Optimal challenge was central to enhancing the outcomes and experiences of people with stroke, in rehabilitation and everyday life.

CONCLUSIONS

Challenge is a key concept which, when carefully optimised to the person's ability and experience, may positively influence their learning, recovery and engagement after stroke. This review lays a conceptual foundation for better understanding, operationalisation and advancement of challenge, offering important implications for addressing the growing burden of stroke disability, through rehabilitation.

The effect of a visual illusion and self-controlled practice on motor learning in children at risk for developmental coordination disorder

Numerous efforts have been made to test the OPTIMAL theory of motor learning in healthy children and adult populations. However, only a small number of studies have tested this theory in children with cognitive-motor disorders, such as developmental coordination disorder (DCD). The present study aims to examine the individual and additive effects of a visual illusion and self-controlled practice on a golf putting task in children at risk for DCD based on the OPTIMAL theory. Forty children at risk for DCD (mean age = 8.57 ± 1.05 years) were randomly assigned to four experimental groups (1-small visual illusion + self-controlled practice; 2-big visual illusion + self-controlled practice; 3-small visual illusion + yoked; 4-big visual illusion + yoked). Following 12 pretest trials of a golf putting task, the participants completed 5 blocks of 12 trials of practice on the first day. A retention test (12 trials) and a transfer dual-task test (12 trials) were conducted on the second day. The results indicated that in retention test the big visual illusion + self-controlled practice group was significantly better than the small visual illusion + yoked group (p = 0.01), while there was not any other significant difference between groups at retention test as well as between all groups at practice phase and transfer test (p > 0.05 for all comparisons). In other words, an additive effect has been observed just in the retention test but not the practice phase as well as transfer test. In general, the results of this study support the OPTIMAL theory of motor learning in children at risk for DCD and suggests to all educators who work with these children to use the combination of the visual illusion with self-controlled practice to improve the motor learning of children at risk for DCD.

Evaluating initial usability of a hand augmentation device across a large and diverse sample

The advancement of motor augmentation and the broader domain of human-machine interaction rely on a seamless integration with users' physical and cognitive capabilities. These considerations may markedly fluctuate among individuals on the basis of their age, form, and abilities. There is a need to develop a standard for considering these diversity needs and preferences to guide technological development, and large-scale testing can provide us with evidence for such considerations. Public engagement events provide an important opportunity to build a bidirectional discourse with potential users for the codevelopment of inclusive and accessible technologies. We exhibited the Third Thumb, a hand augmentation device, at a public engagement event and tested participants from the general public, who are often not involved in such early technological development of wearable robotic technology. We focused on wearability (fit and control), ability to successfully operate the device, and ability levels across diversity factors relevant for physical technologies (gender, handedness, and age). Our inclusive design was successful in 99.3% of our diverse sample of 596 individuals tested (age range from 3 to 96 years). Ninety-eight percent of participants were further able to successfully manipulate objects using the extra thumb during the first minute of use, with no significant influences of gender, handedness, or affinity for hobbies involving the hands. Performance was generally poorer among younger children (aged ≤11 years). Although older and younger adults performed the task comparably, we identified age costs with the older adults. Our findings offer tangible demonstration of the initial usability of the Third Thumb for a broad demographic.

Validation of the motivated strategies for learning questionnaire and instructional materials motivation survey

PURPOSE

To validate the Motivated Strategies for Learning Questionnaire (MSLQ), which measures learner motivations; and the Instructional Materials Motivation Survey (IMMS), which measures the motivational properties of educational activities.

METHODS

Participants (333 pharmacists, physicians, and advanced practice providers) completed the MSLQ, IMMS, Congruence-Personalization Questionnaire (CPQ), and a knowledge test immediately following an online learning module (April 2021). We randomly divided data for split-sample analysis using confirmatory factor analysis (CFA), exploratory factor analysis (EFA), and the multitrait-multimethod matrix.

RESULTS

Cronbach alpha was ≥0.70 for most domains. CFA using sample 1 demonstrated suboptimal fit for both instruments, including 3 negatively-worded IMMS items with particularly low loadings. Revised IMMS (RIMMS) scores (which omit negatively-worded items) demonstrated better fit. Guided by EFA, we identified a novel 3-domain, 11-item 'MSLQ-Short Form-Revised' (MSLQ-SFR, with domains: Interest, Self-efficacy, and Attribution) and the 4-domain, 12-item RIMMS as the best models. CFA using sample 2 confirmed good fit. Correlations among MSLQ-SFR, RIMMS, and CPQ scores aligned with predictions; correlations with knowledge scores were small.

CONCLUSIONS

Original MSLQ and IMMS scores show poor model fit, with negatively-worded items notably divergent. Revised, shorter models-the MSLQ-SFR and RIMMS-show satisfactory model fit (internal structure) and relations with other variables.

Treatment for Childhood Apraxia of Speech: Past, Present, and Future

PURPOSE

The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS.

METHOD

Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?"

RESULTS

A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied.

CONCLUSIONS

A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.

Effect of Verbal Encouragement on Postural Balance in Individuals with Intellectual Disabilities

This study investigated the effect of verbal encouragement (VE) on static and dynamic balance in individuals with intellectual disabilities (IDs). A total of 13 mild IDs and 12 moderate IDs participants underwent static balance tests (bipedal stance on firm surface, under open eyes (OEs) and closed eyes (CEs), and foam surface, unipedal stance on firm surface) and dynamic balance assessments (Y Balance Test (YBT) and Expanded Timed Up-and-Go Test (ETUGT)) under VE and no VE (NO/VE) conditions. VE significantly reduced center of pressure mean velocity (CoPVm) values for mild IDs in firm bipedal CEs conditions. The mild IDs group exhibited improved YBT scores and enhanced ETUGT performances for both groups under VE. Incorporating VE as a motivational strategy in balance training interventions can positively impact static and dynamic balance in individuals with mild IDs, especially in challenging conditions like unipedal stances on firm surfaces.

Gender differences in learning and study strategies impact medical students' preclinical and USMLE step 1 examination performance

BACKGROUND

Evaluation of students' learning strategies can enhance academic support. Few studies have investigated differences in learning strategies between male and female students as well as their impact on United States Medical Licensing Examination® (USMLE) Step 1 and preclinical performance.

METHODS

The Learning and Study Strategies Inventory (LASSI) was administered to the classes of 2019-2024 (female (n = 350) and male (n = 262)). Students' performance on preclinical first-year (M1) courses, preclinical second-year (M2) courses, and USMLE Step 1 was recorded. An independent t-test evaluated differences between females and males on each LASSI scale. A Pearson product moment correlation determined which LASSI scales correlated with preclinical performance and USMLE Step 1 examinations.

RESULTS

Of the 10 LASSI scales, Anxiety, Attention, Information Processing, Selecting Main Idea, Test Strategies and Using Academic Resources showed significant differences between genders. Females reported higher levels of Anxiety (p < 0.001), which significantly influenced their performance. While males and females scored similarly in Concentration, Motivation, and Time Management, these scales were significant predictors of performance variation in females. Test Strategies was the largest contributor to performance variation for all students, regardless of gender.

CONCLUSION

Gender differences in learning influence performance on STEP1. Consideration of this study's results will allow for targeted interventions for academic success.

Utilization and Perception of Peer-Support After Lower Limb Loss in the United States: Potential Benefits on Mobility Outcomes

OBJECTIVE

To examine participants' experiences with peer-support after lower limb loss (LLL) and the associations between the peer-support experience (perceived benefits and barriers) and mobility outcomes.

DESIGN

Quantitative and qualitative descriptive study with a cross-sectional design.

SETTING

National survey (distributed to 169 peer-support groups in 44 states in the US).

PARTICIPANTS

The survey was completed by 82 individuals with a major lower limb amputation (53% female, 54% over 55 years of age; N=82).

MAIN OUTCOME MEASURES

A 32-item survey to examine respondents' experiences in peer-support activities. Prosthetic mobility was measured using the Prosthetic Limb Users Survey of Mobility (PLUS-M).

RESULTS

Two out of 3 respondents received some forms of peer-support after amputation. Among them 75% reported peer-support having a positive effect on their outlook on life, and 78% reported that information gained from peer-support was helpful. Companionship, altruistic acts, and gaining information on how to cope with amputation were the top themes of why respondents enjoyed the peer-support experience. Nearly all (94%) respondents would recommend peer-support to other people with LLL. Individuals who received peer-support exhibited a trend of greater mobility (55th vs 36th percentile on PLUS-M; P=.055).

CONCLUSION

Individuals with LLL reported generally positive experiences regarding their engagement in peer-support activities. Peer-support groups are viewed as a helpful source for both information and emotional support, potentially benefiting functional and psychological recovery after amputation. Individuals who have received peer-support also exhibited greater mobility.

Return to sports after an ACL reconstruction in 2024 - A glass half full? A narrative review

A successful return to sports (RTS) after an anterior cruciate ligament reconstruction (ACLR) is multifactorial, and therefore difficult and challenging. Unfortunately, low percentages of patients RTS, and for those who succeed, one-fifth of patients will sustain a second ACL injury. Over the past years, test batteries were developed to assess whether patients can RTS with a low risk for a second ACL injury risk. Low rates of patients who meet RTS criteria were found, coupled with the insufficiency of current RTS test batteries in predicting second ACL injuries suggesting poor sensitivity. The result of an RTS test is likely to reflect the content of a rehabilitation program, raising critical questions regarding what we are offering patients within the rehabilitation programme. Are we preparing our patients well enough for the high demands of complex situations within pivoting team sports? This narrative review offers insights from key lessons of the last 15 years on 1) RTS testing, 2) the content of rehabilitation, and 3) the RTS continuum, all from a "helicopter perspective".

Motor Learning Following Stroke: Mechanisms of Learning and Techniques to Augment Neuroplasticity

Sensorimotor impairments are common after stroke requiring stroke survivors to relearn lost motor skills or acquire new ones in order to engage in daily activities. Thus, motor skill learning is a cornerstone of stroke rehabilitation. This article provides an overview of motor control and learning theories that inform stroke rehabilitation interventions, discusses principles of neuroplasticity, and provides a summary of practice conditions and techniques that can be used to augment motor learning and neuroplasticity in stroke rehabilitation.

Effect of positive social comparative feedback on the resting state connectivity of dopaminergic neural pathways: A preliminary investigation

Positive social comparative feedback is hypothesized to generate a dopamine response in the brain, similar to reward, by enhancing expectancies to support motor skill learning. However, no studies have utilized neuroimaging to examine this hypothesized dopaminergic mechanism. Therefore, the aim of this preliminary study was to investigate the effect of positive social comparative feedback on dopaminergic neural pathways measured by resting state connectivity. Thirty individuals practiced an implicit, motor sequence learning task and were assigned to groups that differed in feedback type. One group received feedback about their actual response time to complete the task (RT ONLY), while the other group received feedback about their response time with positive social comparison (RT + POS). Magnetic resonance imaging was acquired at the beginning and end of repetitive motor practice with feedback to measure practice-dependent changes in resting state brain connectivity. While both groups showed improvements in task performance and increases in performance expectancies, ventral tegmental area and the left nucleus accumbens (mesolimbic dopamine pathway) resting state connectivity increased in the RT + POS group but not in the RT ONLY group. Instead, the RT ONLY group showed increased connectivity between ventral tegmental area and primary motor cortex. Positive social comparative feedback during practice of a motor sequence task may induce a dopaminergic response in the brain along the mesolimbic pathway. However, given that absence of effects on expectancies and motor learning, more robust and individualized approaches may be needed to provide beneficial psychological and behavioral effects.

Go/No-Go Ratios Modulate Inhibition-Related Brain Activity: An Event-Related Potential Study

(1) Background: Response inhibition refers to the conscious ability to suppress behavioral responses, which is crucial for effective cognitive control. Currently, research on response inhibition remains controversial, and the neurobiological mechanisms associated with response inhibition are still being explored. The Go/No-Go task is a widely used paradigm that can be used to effectively assess response inhibition capability. While many studies have utilized equal numbers of Go and No-Go trials, how different ratios affect response inhibition remains unknown; (2) Methods: This study investigated the impact of different ratios of Go and No-Go conditions on response inhibition using the Go/No-Go task combined with event-related potential (ERP) techniques; (3) Results: The results showed that as the proportion of Go trials decreased, behavioral performance in Go trials significantly improved in terms of response time, while error rates in No-Go trials gradually decreased. Additionally, the NoGo-P3 component at the central average electrodes (Cz, C1, C2, FCz, FC1, FC2, PCz, PC1, and PC2) exhibited reduced amplitude and latency; (4) Conclusions: These findings indicate that different ratios in Go/No-Go tasks influence response inhibition, with the brain adjusting processing capabilities and rates for response inhibition. This effect may be related to the brain's predictive mechanism model.

Implementing a student-centered stroke intervention and prevention education program; evaluating motivation, cognitive load, and performance among middle school students

Background

In this study, we investigated the association between motivation, cognitive load, difficulty, and performance in a stroke education outreach program implemented for middle school students.

Methods

Various interactive instructional activities were developed to engage students throughout the program to assess cognitive and intrinsic load arising from learner implementation of various tasks in a stroke education program for middle school kids. Performance was measured using a post-test to assess knowledge gained by the 6th, 7th, and 8th-grade middle school students. A short questionnaire was also administered to collect data on students' motivation using the ARCS model to asses attention, relevance, confidence, and satisfaction. In addition, we evaluated difficulty level and cognitive load. The relationship between performance and motivation was assessed using Pearson's correlation.

Results

In our results, there was no significant difference (p > 0.05) in performance between the 6th, 7th, and 8th-grade students. The difference in performance, cognitive load (mental effort and difficulty), or motivation between the 6th, 7th, and 8 t-grade students was not significant (p > 0.05). The correlation between motivation and performance was significant (r = 0.87, p = 0.001), while the correlation between mental effort and performance was not significant (r = 0.34, p = 0.270). Also, the correlation between difficulty and performance was not significant (r = 0.38, p = 0.361). In the ARCS motivation model, attention, and confidence received the lowest mean scores (3.9), while relevance received the highest score (4.3).

Conclusion

Our findings reveal the importance of implementing novel activities to enhance students' motivation to improve performance in the implementation of stroke education outreach programs for middle school students.

Evaluating tactile feedback in addition to kinesthetic feedback for haptic shape rendering: a pilot study

In current virtual reality settings for motor skill training, only visual information is usually provided regarding the virtual objects the trainee interacts with. However, information gathered through cutaneous (tactile feedback) and muscle mechanoreceptors (kinesthetic feedback) regarding, e.g., object shape, is crucial to successfully interact with those objects. To provide this essential information, previous haptic interfaces have targeted to render either tactile or kinesthetic feedback while the effectiveness of multimodal tactile and kinesthetic feedback on the perception of the characteristics of virtual objects still remains largely unexplored. Here, we present the results from an experiment we conducted with sixteen participants to evaluate the effectiveness of multimodal tactile and kinesthetic feedback on shape perception. Using a within-subject design, participants were asked to reproduce virtual shapes after exploring them without visual feedback and with either congruent tactile and kinesthetic feedback or with only kinesthetic feedback. Tactile feedback was provided with a cable-driven platform mounted on the fingertip, while kinesthetic feedback was provided using a haptic glove. To measure the participants' ability to perceive and reproduce the rendered shapes, we measured the time participants spent exploring and reproducing the shapes and the error between the rendered and reproduced shapes after exploration. Furthermore, we assessed the participants' workload and motivation using well-established questionnaires. We found that concurrent tactile and kinesthetic feedback during shape exploration resulted in lower reproduction errors and longer reproduction times. The longer reproduction times for the combined condition may indicate that participants could learn the shapes better and, thus, were more careful when reproducing them. We did not find differences between conditions in the time spent exploring the shapes or the participants' workload and motivation. The lack of differences in workload between conditions could be attributed to the reported minimal-to-intermediate workload levels, suggesting that there was little room to further reduce the workload. Our work highlights the potential advantages of multimodal congruent tactile and kinesthetic feedback when interacting with tangible virtual objects with applications in virtual simulators for hands-on training applications.

Dopaminergic mesolimbic structural reserve is positively linked to better outcome after severe stroke

The concept of brain reserve capacity has emerged in stroke recovery research in recent years. Imaging-based biomarkers of brain health have helped to better understand outcome variability in clinical cohorts. Still, outcome inferences are far from being satisfactory, particularly in patients with severe initial deficits. Neurorehabilitation after stroke is a complex process, comprising adaption and learning processes, which, on their part, are critically influenced by motivational and reward-related cognitive processes. Amongst others, dopaminergic neurotransmission is a key contributor to these mechanisms. The question arises, whether the amount of structural reserve capacity in the dopaminergic system might inform about outcome variability after severe stroke. For this purpose, this study analysed imaging and clinical data of 42 severely impaired acute stroke patients. Brain volumetry was performed within the first 2 weeks after the event using the Computational Anatomy Toolbox CAT12, grey matter volume estimates were collected for seven key areas of the human dopaminergic system along the mesocortical, mesolimbic and nigrostriatal pathways. Ordinal logistic regression models related regional volumes to the functional outcome, operationalized by the modified Rankin Scale, obtained 3-6 months after stroke. Models were adjusted for age, lesion volume and initial impairment. The main finding was that larger volumes of the amygdala and the nucleus accumbens at baseline were positively associated with a more favourable outcome. These data suggest a link between the structural state of mesolimbic key areas contributing to motor learning, motivational and reward-related brain networks and potentially the success of neurorehabilitation. They might also provide novel evidence to reconsider dopaminergic interventions particularly in severely impaired stroke patients to enhance recovery after stroke.

Effects of self-efficacy on frontal midline theta power and golf putting performance

Introduction

Self-efficacy (SE), defined as an individual's belief in their ability to complete a task, is linked to top-down attentional control, influencing motor performance in sports. Although the behavioral effects of SE are well-documented, there is a lack of research on the mechanisms through which SE affects sports performance. Our research aims to elucidate the neurophysiological mechanisms that underlie the impact of self-efficacy on sports performance. Specifically, we intend to explore the effects of low and high SE on frontal midline theta (Fmθ) activity, associated with sustained top-down attention, and on motor performance.

Methods

We recruited thirty-four professional golfers to perform 60 putts, during which their electroencephalographic activity was monitored. SE levels were assessed using a visual analog scale from 0 to 10 before each putt, with scores categorized into higher or lower SE based on each golfer's individual average score.

Results

Paired t-tests indicated that trials with higher SE scores had a higher putting success rate than those with lower SE scores (53.3% vs. 46.7%). Furthermore, trials associated with higher SE scores exhibited lower Fmθ activity compared to those with lower SE scores (4.49 vs. 5.18).

Discussion

Our results suggest that higher SE is associated with reduced top-down attentional control, leading to improved putting performance. These findings support Bandura's theory of SE, which suggests that the effects of efficacy beliefs are mediated by cognitive, motivational, emotional, and decision-making processes. This study sheds light on the intermediate processes of SE by examining its impact on the anticipation of outcomes, sports performance, and attentional control prior to putting.

Focus of attention in musical learning and music performance: a systematic review and discussion of focus instructions and outcome measures

The topic of attentional focus (focus of attention, FOA) in musical learning and performance has recently received increasing interest, as the growing number of empirical studies inspired by the established FOA paradigm in sports by Wulf and colleagues in 1998. The current systematical review aims at collecting, abstracting, and categorizing relevant data to show which kinds of FOA instructions were applied in experimental designs and what kinds of dependent variables were used to measure the effects of FOA instruction on musical performance. The three main inclusion criteria in the selection process were experimental design, detailed descriptions of FOA instructions, and outcome measures (OMs). A systematic search was conducted with a complex search term in four scientific databases in March 2023. For presenting and synthesizing results, we used data collection and an inductive-deductive data categorization. Fifteen studies with a total sample size of 401 participants were included out of 387 records initially identified. We collected 53 different FOA instruction citations from the 15 studies and classified them into 9 FOA subcategories, of which the most applied were bodily focus (21%), sound focus (15%), and visual focus (14%). Selected studies used 63 OMs that were abstracted to 10 different OM categories with expert ratings (27%) and acoustical analysis (22%) as the most applied dependent variables. Data categorization and abstraction of additional study information show multiple combinations of FOA instructions, OMs, participants' instruments and expertise, and musical tasks. Finally, studies show no consistent results of superiority of either external or internal or otherwise different FOA considering positive effects on musical performance. Limitations of the review lie in the small study sample, possible criticism of applied eligibility criteria, and subjectivity of data categorization. We propose a research agenda with a more exploratory approach that comprehensively and qualitatively examines the dimensions of musical goals to create a database that could provide a foundation for developing a music-specific FOA model.