Optimal Training for Movement Acquisition and Transfer: Does "Externally Focused" Visual Biofeedback Promote Implicit Motor Learning?

CONTEXT: Visual biofeedback has been shown to facilitate injury-resistant movement acquisition in adolescent athletes. Visual biofeedback is typically thought to foster implicit learning by stimulating athletes to focus attention externally (on movement outcome). However, biofeedback may also induce explicit learning if the athlete uses the visual information to consciously guide movement execution (via an internal focus). OBJECTIVE: To determine the degree to which athletes reported statements indicating implicit or explicit motor learning after engaging in a visual biofeedback intervention. DESIGN: Prospective cohort study. SETTING: Three-dimensional motion-analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: Twenty-five adolescent female soccer athletes (age = 15.0 ± 1.5 years, height = 165.7 ± 5.9 cm, mass = 59.4 ± 10.6 kg). INTERVENTIONS: Standard 6-week neuromuscular training intervention (three 90-minute sessions/wk), with added visual biofeedback sessions (2 sessions/wk). For the biofeedback training, participants performed squatting and jumping movements while interacting with a visual rectangular stimulus that mapped key parameters associated with injury risk. After the last biofeedback session in each week, participants answered open-ended questions to probe learning strategies. MAIN OUTCOME MEASURE(S): Responses to the open-ended questions were categorized as externally focused (ie, on movement outcome, suggestive of implicit learning), internally focused (ie, on movement itself, suggestive of explicit learning), mixed focus, or other. RESULTS: A total of 171 open-ended responses were collected. Most of the responses that could be categorized (39.2%) were externally focused (41.8%), followed by mixed (38.8%) and internally focused (19.4%). The frequency of externally focused statements increased from week 1 (18%) to week 6 (50%). CONCLUSIONS: Although most statements were externally focused (suggesting implicit learning), the relatively large proportion of internal- and mixed-focus statements suggested that many athletes also engaged in explicit motor learning, especially in early practice sessions. Therefore, biofeedback may affect motor learning through a mixture of implicit and explicit learning.

Immersive Real-Time Biofeedback Optimized With Enhanced Expectancies Improves Motor Learning: A Feasibility Study.

CONTEXT: An Optimizing Performance through Intrinsic Motivation and Attention for Learning theory-based motor learning intervention delivering autonomy support and enhanced expectancies (EE) shows promise for reducing cognitive-motor dual-task costs, or the relative difference in primary task performance when completed with and without a secondary cognitive task, that facilitate adaptive injury-resistant movement response. The current pilot study sought to determine the effectiveness of an autonomy support versus an EE-enhanced virtual reality motor learning intervention to reduce dual-task costs during single-leg balance. DESIGN: Within-subjects 3 × 3 trial. METHODS: Twenty-one male and 24 female participants, between the ages of 18 and 30 years, with no history of concussion, vertigo, lower-extremity surgery, or lower-extremity injuries the previous 6 months, were recruited for training sessions on consecutive days. Training consisted of 5 × 8 single-leg squats on each leg, during which all participants mimicked an avatar through virtual reality goggles. The autonomy support group chose an avatar color, and the EE group received positive kinematic biofeedback. Baseline, immediate, and delayed retention testing consisted of single-leg balancing under single- and dual-task conditions. Mixed-model analysis of variances compared dual-task costs for center of pressure velocity and SD between groups on each limb. RESULTS: On the right side, dual-task costs for anterior-posterior center of pressure mean and SD were reduced in the EE group (mean Δ = -51.40, Cohen d = 0.80 and SD Δ = -66.00%, Cohen d = 0.88) compared with the control group (mean Δ = -22.09, Cohen d = 0.33 and SD Δ = -36.10%, Cohen d = 0.68) from baseline to immediate retention. CONCLUSIONS: These findings indicate that EE strategies that can be easily implemented in a clinic or sport setting may be superior to task-irrelevant AS approaches for influencing injury-resistant movement adaptations.

Children's motor imagery modality dominance modulates the role of attentional focus in motor skill learning.

We investigated whether children's motor imagery dominance modulated the relationship between attentional focus and motor learning of a tossing task. One hundred and thirty-eight boys (age: M = 10.13, SD = 0.65) completed the Movement Imagery Questionnaire - Children (MIQ-C) to determine imagery modality dominance (kinesthetic, internal-visual, external-visual) and were randomly assigned to either an internal (n = 71) or external (n = 67) attentional focus group. Participants completed 60 trials of a tossing task with their non-dominant hand on day 1. Participants in the internal focus group were asked "to focus on the throwing arm", whereas participants in the external focus group were instructed "to focus on the ball." A retention test was conducted 24 h later to assess motor learning. Overall, the results from a nested, multiple linear regression analysis indicated the degree to which internal or external focus influences children's throwing accuracy is dependent upon their motor imagery modality dominance. Specifically, higher levels of external-visual imagery dominance resulted in greater motor learning for children adopting an external focus. In contrast, higher values of kinesthetic imagery dominance resulted in reduced motor learning for children who adopted an external focus. Despite the need for future research, we recommend motor imagery modality dominance assessments be considered when investigating the influence of attentional focus on motor learning, particularly when the target population is children.

Real-time biofeedback integrated into neuromuscular training reduces high-risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation.

Prospective evidence indicates that functional biomechanics and brain connectivity may predispose an athlete to an anterior cruciate ligament injury, revealing novel neural linkages for targeted neuromuscular training interventions. The purpose of this study was to determine the efficacy of a real-time biofeedback system for altering knee biomechanics and brain functional connectivity. Seventeen healthy, young, physically active female athletes completed 6 weeks of augmented neuromuscular training (aNMT) utilizing real-time, interactive visual biofeedback and 13 served as untrained controls. A drop vertical jump and resting state functional magnetic resonance imaging were separately completed at pre- and posttest time points to assess sensorimotor adaptation. The aNMT group had a significant reduction in peak knee abduction moment (pKAM) compared to controls (p = .03, d = 0.71). The aNMT group also exhibited a significant increase in functional connectivity between the right supplementary motor area and the left thalamus (p = .0473 after false discovery rate correction). Greater percent change in pKAM was also related to increased connectivity between the right cerebellum and right thalamus for the aNMT group (p = .0292 after false discovery rate correction, r2  = .62). No significant changes were observed for the controls (ps > .05). Our data provide preliminary evidence of potential neural mechanisms for aNMT-induced motor adaptations that reduce injury risk. Future research is warranted to understand the role of neuromuscular training alone and how each component of aNMT influences biomechanics and functional connectivity.

An expert's mind in action: Assessing attentional focus, workload and performance in a dynamic, naturalistic environment.

The aims of this study were to (1) to explore attentional strategies in expert judo players and (2) investigate how attentional focus affects performance effectiveness and perceptions of workload in expert judo players during real competitions. Fourteen expert male judo players participated in the study. A simulated recall method was used following participants' competition to explore contents of attention qualitatively. The data analysis process for the qualitative portion of the study was an iterative process between inductive and deductive analyses. Quantitative analyses of performance outcomes and workload were then associated with the qualitative findings. Qualitative results revealed that the focus of attention was dynamic and complex, with technical aspects of the movements as the highest identified focus. Quantitative analyses revealed that reporting a lower quantity of attentional cues and higher percentage of focus on opponent resulted in higher performance effectiveness and less perceptions of workload. This study indicates that cognitive control and automaticity may work in a synergistic manner for successful skill execution in expert performance.