Exploring the impact of interactive movement-based anatomy learning in real classroom setting among kinesiology students.

Descriptive and functional anatomy is one of the most important sciences for kinesiology students. Anatomy learning requires spatial and motor imagery abilities. Learning anatomy is complex when teaching methods and instructional tools do not appropriately develop spatial and motor imagery abilities. Recent technological developments such as three-dimensional (3D) digital tools allow to overcome those difficulties, especially when 3D tools require strong interactions with the learners. Besides interactive digital tools, embodied learning or learning in motion is an effective method for a wide variety of sciences including anatomy. The aim of this study was to explore the impact of combining movement execution with 3D animation visualization on anatomy learning in a real classroom teaching context. To do so, the results of two groups of kinesiology students during three official assessments were compared. The experimental group (n = 60) learned functional anatomy by combining movement execution with traditional knowledge acquisition (e.g., 3D animations visualization, problem-based learning exercises). The control group (n = 61) had the same material but did not execute the movements during problem-solving exercises. Although no differences were found between both groups on early and mid-semester examinations, significant difference appeared at the end of the semester with an advantage for the experimental group. This exploratory study suggests that embodied learning is beneficial in improving functional anatomy learning. Therefore, it would be interesting to integrate such type of pedagogical approach within the kinesiology curriculum.

Effects of relaxing breathing paired with cardiac biofeedback on performance and relaxation during critical simulated situations: a prospective randomized controlled trial.

BACKGROUND: Active participation in high-fidelity simulation remains stressful for residents. Increased stress levels elicited during such simulation impacts performance. We tested whether relaxing breathing, paired or not with cardiac biofeedback, could lead to enhanced performance of residents during simulation. METHODS: This randomized pilot study involved the fifth-year anesthesiology and critical care residents who participated in high-fidelity at Lyon medical simulation center in 2019. Residents were randomized into three parallel interventions: relaxing breathing, relaxing breathing paired with cardiac biofeedback, and control. Each intervention was applied for five minutes immediately after the scenario briefing. The primary endpoint was the overall performance during the simulation rated by two blinded independent investigators. The secondary endpoints included component scores of overall performance and changes in psychological states. RESULTS: Thirty-four residents were included. Compared to the control group, residents in the relaxing breathing (+ 7%, 98.3% CI: 0.3 to 13.7, P = 0.013) and relaxing breathing paired with cardiac biofeedback (+ 8%, 98.3% CI: 0.82 to 14.81, P = 0.009) groups had a higher overall performance score. Following the interventions, compared to the control group, stress level was lower when participants had performed relaxing breathing alone (P = 0.029) or paired with biofeedback (P = 0.035). The internal relaxation level was higher in both the relaxing breathing alone (P = 0.016) and paired with biofeedback groups (P = 0.035). CONCLUSIONS: Performing five minutes of relaxing breathing before the scenario resulted in better overall simulation performance. These preliminary findings suggest that short breathing interventions are effective in improving performance during simulation. TRIAL REGISTRATION: The study protocol was retrospectively registered on clinicaltrials.gov ( NCT04141124 , 28/10/2019).

Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis.

This systematic review and meta-analysis aims to identify and quantify the current available evidence of hypnosis efficacy to manage pain in patients with chronic musculoskeletal and neuropathic pain. Randomized Control Trials (RCTs) with hypnosis and/or self-hypnosis treatment used to manage musculoskeletal and/or neuropathic chronic pain in adults and assessing pain intensity were included. Reviews, meta-analyses, non-randomized clinical trials, case reports and meeting abstracts were excluded. Five databases, up until May 13th 2021, were used to search for RCTs using hypnosis to manage chronic musculoskeletal and/or neuropathic pain. The protocol is registered on PROSPERO register (CRD42020180298) and no specific funding was received for this review. The risk of bias asessement was conducted according to the revised Cochrane risk of bias tool for randomized control trials (RoB 2.0). Nine eligible RCTs including a total of 530 participants were considered. The main analyses showed a moderate decrease in pain intensity (Hedge's g: -0.42; p = 0.025 after intervention, Hedge's g: -0.37; p = 0.027 after short-term follow-up) and pain interference (Hedge's g: -0.39; p = 0.029) following hypnosis compared to control interventions. A significant moderate to large effect size of hypnosis compared to controls was found for at 8 sessions or more (Hedge's g: -0.555; p = 0.034), compared to a small and not statistically significant effect for fewer than 8 sessions (Hedge's g: -0.299; p = 0.19). These findings suggest that a hypnosis treatment lasting a minimum of 8 sessions could offer an effective complementary approach to manage chronic musculoskeletal and neuropathic pain. Future research is needed to delineate the relevance of hypnosis in practice and its most efficient prescription.

Combining proactive transcranial stimulation and cardiac biofeedback to substantially manage harmful stress effects.

BACKGROUND: Previous studies have identified the dorsolateral prefrontal cortex (dlPFC) as a core region in cognitive emotional regulation. Transcranial direct current stimulations of the dlPFC (tDCS) and heart-rate variability biofeedback (BFB) are known to regulate emotional processes. However, the effect of these interventions applied either alone or concomitantly during an anticipatory stress remains unexplored. OBJECTIVE: The study investigated the effect of anodal tDCS and BFB, alone or combined, on psychophysiological stress responses and cognitive functioning. METHODS: Following a stress anticipation induction, 80 participants were randomized into four groups and subjected to a 15-min intervention: neutral video viewing (ctrl), left dlPFC anodal tDCS (tdcs), heart-rate variability biofeedback (bfb), or a combined treatment (bfb + tdcs). Participants were then immediately confronted with the stressor, which was followed by an assessment of executive functions. Psychophysiological stress responses were assessed throughout the experiment (heart rate, heart-rate variability, salivary cortisol). RESULTS: The tdcs did not modulate stress responses. Compared with both ctrl and tdcs interventions, bfb reduced physiological stress and improved executive functions after the stressor. The main finding revealed that bfb + tdcs was the most effective intervention, yielding greater reduction in psychological and physiological stress responses than bfb. CONCLUSIONS: Combining preventive tDCS with BFB is a relevant interventional approach to reduce psychophysiological stress responses, hence offering a new and non-invasive treatment of stress-related disorders. Biofeedback may be particularly useful for preparing for an important stressful event when performance is decisive.

Motor imagery practice benefits during arm immobilization.

Motor imagery (MI) is known to engage motor networks and is increasingly used as a relevant strategy in functional rehabilitation following immobilization, whereas its effects when applied during immobilization remain underexplored. Here, we hypothesized that MI practice during 11 h of arm-immobilization prevents immobilization-related changes at the sensorimotor and cortical representations of hand, as well as on sleep features. Fourteen participants were tested after a normal day (without immobilization), followed by two 11-h periods of immobilization, either with concomitant MI treatment or control tasks, one week apart. At the end of each condition, participants were tested on a hand laterality judgment task, then underwent transcranial magnetic stimulation to measure cortical excitability of the primary motor cortices (M1), followed by a night of sleep during which polysomnography data was recorded. We show that MI treatment applied during arm immobilization had beneficial effects on (1) the sensorimotor representation of hands, (2) the cortical excitability over M1 contralateral to arm-immobilization, and (3) sleep spindles over both M1s during the post-immobilization night. Furthermore, (4) the time spent in REM sleep was significantly longer, following the MI treatment. Altogether, these results support that implementing MI during immobilization may limit deleterious effects of limb disuse, at several levels of sensorimotor functioning.

Implementing biofeedback as a proactive coping strategy: Psychological and physiological effects on anticipatory stress.

Anticipating a stressful situation involves psychophysiological reactions before the occurrence of the overt stress event. The current challenge in the stress domain is to characterize anticipatory stress reactions and how to effectively modulate them. The present study aimed to characterize the anticipation period and evaluate the benefits of a heart-rate variability biofeedback (BFB) intervention designed to manage anticipatory stress. Healthy participants were exposed to an anticipation stress period (15 min) during which they either practised BFB (stress + bfb, n = 15) or watched a neutral video (stress + video, n = 14). Anticipatory stress was effectively induced by the Trier Social Anticipatory Stress (TSAS) protocol, specifically designed for this study. Control participants, without anticipation stress, practised BFB for an equivalent time (ctrl + bfb, n = 15). Subsequently, all participants performed a set of cognitive tasks assessing executive functions. Heart-rate variability (cardiac coherence, standard deviation of the R-R intervals, root mean square of successive difference measure) and the evolution of the perceived psychological state were measured during the anticipation period. Self-reported judgements of how the intervention influenced stress and performance were further assessed. The main result showed that BFB is a relevant proactive stress-coping method. Compared with the stress + video group, participants who practised BFB attained higher cardiac coherence scores. Post-intervention self-reported measures revealed that BFB contributed to reduce psychological stress and increase perceived levels of performance. Together, these findings provide practical guidelines for examining the stress anticipation period by means of the TSAS protocol.

Acquisition and consolidation of sequential footstep movements with physical and motor imagery practice.

Sleep-dependent performance enhancement has been consistently reported after explicit sequential finger learning, even using motor imagery practice (MIP), but whether similar sleep benefits occur after explicit sequential gross motor learning with the lower limbs has been addressed less often. Here, we investigated both acquisition and consolidation processes in an innovative sequential footstep task performed either physically or mentally. Forty-eight healthy young participants were tested before and after physical practice (PP) or MIP on the footstep task, following either a night of sleep (PPsleep and MIPsleep groups) or an equivalent daytime period (PPday and MIPday groups). Results showed that all groups improved motor performance following the acquisition session, albeit the magnitude of enhancement in the MIP groups remained lower relative to the PP groups. Importantly, only the MIPsleep group further improved performance after a night of sleep, while the other groups stabilized their performance after consolidation. Together, these findings demonstrate a sleep-dependent gain in performance after MIP in a sequential motor task with the lower limbs but not after PP. Overall, the present study is of particular importance in the context of motor learning and functional rehabilitation.

Acute stress affects implicit but not explicit motor imagery: A pilot study.

Motor imagery (MI) is the capacity to mentally perform one or a set of movements without concomitant overt action. MI training has been show to enhance the subsequent motor performance. While the benefits of MI to manage stress have been extensively documented, the reverse impact of stress on MI received far less attention. The present study thus aimed to evaluate whether acute stress might influence MI abilities. Thirty participants were assigned either to a stress or a control group. The Socially Evaluated Cold Pressor Test (SECPT) was used to induce stress, with heart rate, electrodermal activity, salivary cortisol, and self-report perceived levels of stress being monitored during the experiment. Stress induction was followed by both implicit (laterality judgment) and explicit (sequential pointing) MI tasks. Main results showed a deleterious impact of stress on implicit MI, while explicit MI was not altered. These exploratory findings provide a deeper understanding of stress effects on cognition, and practically support that under stressful conditions, as during a sport competition or rehabilitation contexts, explicit MI should be prioritized.

Effect of Physical Fatigue Elicited by Continuous and Intermittent Exercise on Motor Imagery Ability.

Purpose: The ability to perform motor imagery (MI) might be impaired by the physical fatigue elicited during training. Interestingly, there is also theoretical support for a more limited influence of fatigue in the existing literature. Method: We evaluated MI ability before and after two exercise protocols: (i) a continuous exercise of 20 min performed on a cycle ergometer at 80% of the secondary ventilatory threshold (Continuous exercise), and (ii) an intermittent exercise of 20 min involving sprints at maximal intensity performed with regular intervals (Intermittent exercise). MI ability evaluations were performed using validated behavioral (mental chronometry) and psychometric (subjective reports) methods. MI ability evaluations included mental rehearsal of a motor sequence which involved the main effectors of the exercise protocols (walking), and mental rehearsal of a motor task which did not involve the main somatic effectors of the exercise protocols (pointing movements with the upper limbs). Results: Mental chronometry showed that MI ability was degraded only after Intermittent exercise, while self-report measures of MI vividness revealed that MI ability was primarily impaired during MI of the walking task. Conclusions: Present results suggest that Intermittent exercise engaging anaerobic processes of energy expenditure, but not Continuous exercise engaging aerobic processes of energy expenditure, impaired MI ability. Findings are discussed in relation to the internal models theory of motor simulation, specifically changes in current state of the motor system under the fatigued state-affecting motor predictions. Present findings may contribute to successful applications of MI training in sports and rehabilitation.

Effects of Action Observation and Action Observation Combined with Motor Imagery on Maximal Isometric Strength.

Action observation (AO) alone or combined with motor imagery (AO + MI) has been shown to engage the motor system. While recent findings support the potential relevance of both techniques to enhance muscle function, this issue has received limited scientific scrutiny. In the present study, we implemented a counterbalanced conditions design where 21 participants performed 10 maximal isometric contractions (12-s duration) of elbow flexor muscles against a force platform. During the inter-trial rest periods, participants completed i) AO of the same task performed by an expert athlete, ii) AO + MI, i.e. observation of an expert athlete while concurrently imagining oneself performing the same task, and iii) watching passively a video documentary about basketball shooting (Control). During force trials, we recorded the total force and integrated electromyograms from the biceps brachii and anterior deltoideus. We also measured skin conductance from two finger electrodes as an index of sympathetic nervous system activity. Both AO and AO + MI outperformed the Control condition in terms of total force (2.79-3.68%, p < 0.001). For all conditions, we recorded a positive relationship between the biceps brachii activation and the total force developed during the task. However, only during AO was a positive relationship observed between the activation of the anterior deltoideus and the total force. We interpreted the results with reference to the statements of the psycho-neuromuscular theory of mental practice. Present findings extend current knowledge regarding the priming effects of AO and AO + MI on muscle function, and may contribute to the optimization of training programs in sports and rehabilitation.

Acquisition and consolidation of implicit motor learning with physical and mental practice across multiple days of anodal tDCS.

BACKGROUND: Acquisition and consolidation of a new motor skill occurs gradually over long time span. Motor imagery (MI) and brain stimulation have been showed as beneficial approaches that boost motor learning, but little is known about the extent of their combined effects. OBJECTIVE: Here, we aimed to investigate, for the first time, whether delivering multiple sessions of transcranial direct current stimulation (tDCS) over primary motor cortex during physical and MI practice might improve implicit motor sequence learning in a young population. METHODS: Participants practiced a serial reaction time task (SRTT) either physically or through MI, and concomitantly received either an anodal (excitatory) or sham stimulation over the primary motor cortex during three successive days. The effect of anodal tDCS on the general motor skill and sequence specific learning were assessed on both acquisition (within-day) and consolidation (between-day) processes. We further compared the magnitude of motor learning reached after a single and three daily sessions of tDCS. RESULTS: The main finding showed that anodal tDCS boosted MI practice, but not physical practice, during the first acquisition session. A second major result showed that compared to sham stimulation, multiple daily session of anodal tDCS, for both types of practice, resulted in greater implicit motor sequence learning rather than a single session of stimulation. CONCLUSIONS: The present study is of particular importance in the context of rehabilitation, where we postulate that scheduling mental training when patients are not able to perform physical movement might beneficiate from concomitant and consecutive brain stimulation sessions over M1 to promote functional recovery.

Breathing with the mind: Effects of motor imagery on breath-hold performance.

We aimed at studying the effect of Motor Imagery (MI), i.e., the mental representation of a movement without executing it, on breath-holding performance. Classical guidelines for efficient MI interventions advocate for a congruent MI practice with regards to the requirements of the physical performance, specifically in terms of physiological arousal. We specifically aimed at studying whether an incongruent form of MI practice might enhance the breath-hold performance. In a counterbalanced design including three experimental sessions, participants engaged in maximal breath-hold trials while concomitantly performing i) MI of breathing, ii) MI of breath-hold, and iii) an "ecological" breath-hold trial, i.e., without specific instructions of MI practice. In addition to breath-hold durations, we measured the cardiac activity and blood oxygen saturation. Performance was improved during MI of breathing (73.06 s ±â€¯24.53) compared to both MI of breath-hold (70.57 s ±â€¯18.15) and the control condition (67.67 s ±â€¯19.27) (p < 0.05). The mechanisms underlying breath-hold performance improvements during MI of breathing remain uncertain. MI of breathing might participate to decrease the threat perception associated with breath-holding, presumably due to psychological and physiological effects associated with the internal simulation of a breathing body state.

Benefits of Motor Imagery for Human Space Flight: A Brief Review of Current Knowledge and Future Applications.

Motor imagery (MI) is arguably one of the most remarkable capacities of the human mind. There is now strong experimental evidence that MI contributes to substantial improvements in motor learning and performance. The therapeutic benefits of MI in promoting motor recovery among patients with motor impairments have also been reported. Despite promising theoretical and experimental findings, the utility of MI in adapting to unusual conditions, such as weightlessness during space flight, has received far less attention. In this review, we consider how, why, where, and when MI might be used by astronauts, and further evaluate the optimum MI content. Practically, we suggest that MI might be performed before, during, and after exposure to microgravity, respectively, to prepare for the rapid changes in gravitational forces after launch and to reduce the adverse effects of weightlessness exposition. Moreover, MI has potential role in facilitating re-adaptation when returning to Earth after long exposure to microgravity. Suggestions for further research include a focus on the multi-sensory aspects of MI, the requirement to use temporal characteristics as a measurement tool, and to account for the knowledge-base or metacognitive processes underlying optimal MI implementation.

Online and Offline Performance Gains Following Motor Imagery Practice: A Comprehensive Review of Behavioral and Neuroimaging Studies.

There is now compelling evidence that motor imagery (MI) promotes motor learning. While MI has been shown to influence the early stages of the learning process, recent data revealed that sleep also contributes to the consolidation of the memory trace. How such "online" and "offline" processes take place and how they interact to impact the neural underpinnings of movements has received little attention. The aim of the present review is twofold: (i) providing an overview of recent applied and fundamental studies investigating the effects of MI practice (MIP) on motor learning; and (ii) detangling applied and fundamental findings in support of a sleep contribution to motor consolidation after MIP. We conclude with an integrative approach of online and offline learning resulting from intense MIP in healthy participants, and underline research avenues in the motor learning/clinical domains.

Corrigendum: Experts bodies, experts minds: how physical and mental training shape the brain.

[This corrects the article on p. 280 in vol. 8, PMID: 24847236.].

Variable motor imagery training induces sleep memory consolidation and transfer improvements.

Motor-skill practice in repetitive or variable orders leads to better within-day acquisition and facilitates retention and transfer, respectively. This practice pattern effect has been robustly found for physical practice, but little is known about its effect after motor imagery (MI) practice. In the present study, we investigated the effect of constant or variable MI practice, and the consolidation following a day-time or a sleep interval. The physical performance was assessed before (pre-test) and after MI training (post-test), as well as after a night or day-time consolidation (retention test). Finally, a transfer test on an unpracticed task was further performed. Results revealed that in all participants, performance increased significantly in the post-test when compared with the pre-test, while only subjects in the variable MI training showed further gains in performance in the retention test following a night of sleep, and exhibited the best transfer of performance to a novel visuomotor sequence. In contrast, subjects in the constant MI training did not show any delayed performance gain following both day and sleep-consolidation. Overall, and for the first time, these findings partially support the practice pattern effect of motor learning with MI, and further highlight a new difference between mental and physical practice, especially on consolidation. To conclude, variable MI practice, rather than constant, seems to be the valuable condition that should be considered in the practical implications of mental training in motor learning and rehabilitation.

Experts bodies, experts minds: How physical and mental training shape the brain.

Skill learning is the improvement in perceptual, cognitive, or motor performance following practice. Expert performance levels can be achieved with well-organized knowledge, using sophisticated and specific mental representations and cognitive processing, applying automatic sequences quickly and efficiently, being able to deal with large amounts of information, and many other challenging task demands and situations that otherwise paralyze the performance of novices. The neural reorganizations that occur with expertise reflect the optimization of the neurocognitive resources to deal with the complex computational load needed to achieve peak performance. As such, capitalizing on neuronal plasticity, brain modifications take place over time-practice and during the consolidation process. One major challenge is to investigate the neural substrates and cognitive mechanisms engaged in expertise, and to define "expertise" from its neural and cognitive underpinnings. Recent insights showed that many brain structures are recruited during task performance, but only activity in regions related to domain-specific knowledge distinguishes experts from novices. The present review focuses on three expertise domains placed across a motor to mental gradient of skill learning: sequential motor skill, mental simulation of the movement (motor imagery), and meditation as a paradigmatic example of "pure" mental training. We first describe results on each specific domain from the initial skill acquisition to expert performance, including recent results on the corresponding underlying neural mechanisms. We then discuss differences and similarities between these domains with the aim to identify the highlights of the neurocognitive processes underpinning expertise, and conclude with suggestions for future research.

When music tempo affects the temporal congruence between physical practice and motor imagery.

When people listen to music, they hear beat and a metrical structure in the rhythm; these perceived patterns enable coordination with the music. A clear correspondence between the tempo of actual movement (e.g., walking) and that of music has been demonstrated, but whether similar coordination occurs during motor imagery is unknown. Twenty participants walked naturally for 8m, either physically or mentally, while listening to slow and fast music, or not listening to anything at all (control condition). Executed and imagined walking times were recorded to assess the temporal congruence between physical practice (PP) and motor imagery (MI). Results showed a difference when comparing slow and fast time conditions, but each of these durations did not differ from soundless condition times, hence showing that body movement may not necessarily change in order to synchronize with music. However, the main finding revealed that the ability to achieve temporal congruence between PP and MI times was altered when listening to either slow or fast music. These data suggest that when physical movement is modulated with respect to the musical tempo, the MI efficacy of the corresponding movement may be affected by the rhythm of the music. Practical applications in sport are discussed as athletes frequently listen to music before competing while they mentally practice their movements to be performed.

Declarative interference affects off-line processing of motor imagery learning during both sleep and wakefulness.

Retroactive interference from a declarative memory can prevent the consolidation of motor skill memories over wakefulness, but not over a night of sleep. Recently, motor imagery (MI) learning has been showed to allow for a stronger resistance against procedural interference rather than physical practice, but whether declarative interference might impact sleep-dependent consolidation process of an explicit finger tapping task learned with MI remains unknown. To address this issue, 57 subjects mentally rehearsed an explicit finger tapping sequence, and half of them were then requested to practice an interferential declarative task. All participants were re-tested on the initial procedural task either after a night of sleep or a similar daytime interval. The main findings provided evidence that declarative interference affected MI consolidation both over the night- and wakefulness intervals. These results extend our previous findings by underlying that declarative interference might impact more strongly explicit MI practice than physical practice, hence suggesting that MI might rely on declarative memory rather than exclusively on procedural memory system. The relationship between declarative and procedural memories during MI practice, as well as during off-line consolidation, is discussed.

Selective delayed gains following motor imagery of complex movements.

Recent studies suggest that a night of sleep may play a similar functional role following motor imagery (MI) practice. Here we examined whether offline gains following MI of a finger tapping sequence depends on the degree of complexity of the motor sequence, and whether this improvement differentially affects the individual transitions of the motor-sequence pattern being learned. The data revealed greater delayed performance gains in motor skill procedures that were most difficult, with larger sleep-dependent overnight improvement for movements involving bimanual coordination. The analyses of single transitions between sequence elements further revealed greatest overnight improvement in speed for the slowest (i.e., most difficult) transitions at the re-test. These findings suggest that sleep-related performance gains for imagined movements depend on motor skill complexity, and that difficult transition movements are most effectively enhanced after a night of sleep.