Can you feel the force just right? Tactile force feedback for training of minimally invasive surgery-evaluation of vibration feedback for adequate force application.

BACKGROUND: Tissue handling is a crucial skill for surgeons and is challenging to learn. The aim of this study was to develop laparoscopic instruments with different integrated tactile vibration feedback by varying different tactile modalities and assess its effect on tissue handling skills. METHODS: Standard laparoscopic instruments were equipped with a vibration effector, which was controlled by a microcomputer attached to a force sensor platform. One of three different vibration feedbacks (F1: double vibration > 2 N; F2: increasing vibration relative to force; F3: one vibration > 1.5 N and double vibration > 2 N) was applied to the instruments. In this multicenter crossover trial, surgical novices and expert surgeons performed two laparoscopic tasks (Peg transfer, laparoscopic suture, and knot) each with all the three vibration feedback modalities and once without any feedback, in a randomized order. The primary endpoint was force exertion. RESULTS: A total of 57 subjects (15 surgeons, 42 surgical novices) were included in the trial. In the Peg transfer task, there were no differences between the tactile feedback modalities in terms of force application. However, in subgroup analysis, the use of F2 resulted in a significantly lower mean-force application (p-value = 0.02) among the student group. In the laparoscopic suture and knot task, all participants exerted significantly lower mean and peak forces using F2 (p-value < 0.01). These findings remained significant after subgroup analysis for both, the student and surgeon groups individually. The condition without tactile feedback led to the highest mean and peak force exertion compared to the three other feedback modalities. CONCLUSION: Continuous tactile vibration feedback decreases the mean and peak force applied during laparoscopic training tasks. This effect is more pronounced in demanding tasks such as laparoscopic suturing and knot tying and might be more beneficial for students. Laparoscopic tasks without feedback lead to increased force application.

How does the modality of delivering force feedback influence the performance and learning of surgical suturing skills? We don't know, but we better find out! A review.

BACKGROUND: Force feedback is a critical element for performing and learning surgical suturing skill. Force feedback is impoverished or not present at all in non-open surgery (i.e., in simulation, laparoscopic, and robotic-assisted surgery), but it can be augmented using different modalities. This rapid, systematic review examines how the modality of delivering force feedback influences the performance and learning of surgical suturing skills. METHODS: An electronic search was performed on PubMed/MEDLINE, Web of Science, and Embase databases to identify relevant articles. The results were synthesized using vote counting based on direction of effect. RESULTS: A total of nine studies of medium-to-low quality were included. The synthesis of results suggests that the visual modality could be more beneficial than the tactile and auditory modalities in improving force control and that auditory and tactile modalities could be more beneficial than the visual modality in improving suturing performance. Results are mixed and unclear with regards to how modality affects the reduction of force magnitude and unclear when unimodal was compared to multimodal feedback. The studies have a general low level of evidence. CONCLUSION: The low number of studies with low methodological quality and low level of evidence (most were proof of concept) prevents us from drawing any meaningful conclusion and as such it is currently unknown whether and how force feedback modality influences surgical suturing skill. Speculatively, the visual modality may be more beneficial for improving the control of exerted force, while auditory and tactile modalities may be more effective in improving the overall suturing performance. We consider the issue of feedback modality to be highly relevant in this field, and we encourage future research to conduct further investigation integrating principles from learning psychology and neuroscience: identify feedback goal, context, and skill level and then design and compare feedback modalities accordingly.

A real-time feedback method to reduce loading rate during running: Effect of combining direct and indirect feedback.

Impact loading plays a key role in the pathophysiology of running-related injuries. Providing real-time feedback may be an effective strategy to reduce impact loading; however, it is currently unclear what an effective training method to help runners achieve a habitual low loading rate is. We subjected 20 healthy non-runners to a structured sequence of direct and indirect biofeedback designed to facilitate broader exploration of neuro-mechanical workspace for potential movement solutions (indirect feedback on cadence and foot-strike angle) and to refine and converge upon an optimal sub-set of that space to match the task goal (direct feedback on loading rate). While indirect biofeedback on foot-strike angle yielded a lower impact load than providing direct biofeedback on loading rate, compared to indirect biofeedback on foot-strike angle, providing direct feedback on loading rate statistically increased (+58%, p = 0.007) the range of goal-relevant solutions participants used to lower their impact loading. Results showed that structured feedback was effective in increasing the range of input parameters that match the task goal, hence expanding the size of goal-relevant solutions, which may benefit running performance under changing environmental constraints.

Implementation of a modified sport programme to increase participation: Key stakeholder perspectives.

Modified sports, whereby equipment and rules are manipulated to facilitate skill performance, have been shown to promote skill learning and potentially increase participation. However, it is currently unexplored how key stakeholders - coaches and key figures working in National associations - who are critical stakeholders in implementing and delivering sport programmes, perceive modified sport. This study explored how tennis coaches and key figures working within tennis National associations perceived the impact of implementing a modified tennis campaign on participation and skill development in children and adults. Key figures and coaches around the world completed an online questionnaire. Both groups considered that modified tennis was positively associated with increasing and sustaining participation, skill learning, talent development and people's attitude towards tennis. Furthermore, participants thought that a rule change (i.e., use of a low-compression ball in children competitions) and the campaign's core messages (i.e., "serve, rally, score" and "easy, fun, and healthy") have been critical for the success of the campaign. These results support previous research on the positive impact of modified tennis on skill development and provide a further impetus on implementing modified sports to increase participation. Other sports can adopt similar strategies to improve their modified programmes.

Associations of physical activity dose and movement quality with executive functions in socioeconomically disadvantaged children aged 5-6 years.

BACKGROUND: Growing up in areas of high deprivation can negatively impact children's movement behaviours and cognitive development. Enhancing the quantity and quality of children's movement experiences is believed to enhance cognitive development. This study investigated the association of three different modes of movement assessment, movement proficiency and divergent movement ability (collectively understood as motor competence) and PA dose with executive function in a low socio-economic demographic. Demographics, motor competence, and a combination of motor competence and physical activity were hypothesized to be significantly predictor of executive functions. METHOD: In this cross-sectional study, 360 children aged 5-6 years from deprived areas were assessed using three movement assessments: wrist-worn accelerometery for physical activity dose, Test of Gross Motor Development-3 for movement proficiency, and divergent movement assessment. Executive function, including inhibitory control, working memory, and cognitive flexibility, was measured using the NIH Toolbox on an iPad. Multiple linear regression models were designed to evaluate the independent and combined association of demographics, movement competence and physical activity variables with executive function. RESULTS: The regression analysis, with demographic factors only, explained 12% of EF variance (r2 = 0.12 95%CI 0.06-0.18). In addition to this demographics the model with divergent movement explained 19% of EF variance (r2 = 0.19 95% CI = 0.12-0.28), the model with movement proficiency explained 16% of EF variance (r2 = 0.16 95% CI = 0.08-0.26) and the model with PA dose explained 13% of EF variance (r2 = 0.13 95% CI = 0.07-0.20). In these models both divergent movement and proficiency were significant predictors, whilst physical activity variables were not. The final models, combining motor competence and physical activity variables, explained 24% and 23% of EF variance (r2 = 0.24 CI = 0.14-0.33 and r2 = 0.23 CI = 0.14-0.32). In these models, motor competence variables were significant predictors, and only vigorous physical activity and Euclidean Norm Minus One emerged as significant PA dose predictors. DISCUSSION: These findings emphasise that motor competence and physical activity variables better predict executive functions when they are combined. When considered individually both motor competence variables were significant predictors of executive function whilst physical activity variables were not. Importantly, among the two movement competence facets, divergent movement assessment exhibited the strongest association with executive function. Future interventions should consider how to facilitate both movement and cognitive development in children. Future interventions should consider both the interplay of movement quality and quantity and the importance of environments that invite children's exploratory movement behavior.

Benefits of Enacting and Observing Gestures on Foreign Language Vocabulary Learning: A Systematic Review and Meta-Analysis.

The integration of physical movements, such as gestures, into learning holds potential for enhancing foreign language (L2) education. Uncovering whether actively performing gestures during L2 learning is more, or equally, effective compared to simply observing such movements is central to deepening our understanding of the efficacy of movement-based learning strategies. Here, we present a meta-analysis of seven studies containing 309 participants that compares the effects of gesture self-enactment and observation on L2 vocabulary learning. The results showed that gesture observation was just as effective for L2 learning as gesture enactment, based on free recall, cued L2 recognition, and cued native language recognition performance, with a large dispersion of true effect across studies. Gesture observation may be sufficient for inducing embodied L2 learning benefits, in support of theories positing shared mechanisms underlying enactment and observation. Future studies should examine the effects of gesture-based learning over longer time periods with larger sample sizes and more diverse word classes.

A Skill Acquisition Perspective on the Impact of Exergaming Technology on Foundational Movement Skill Development in Children 3-12 Years: A Systematic Review and Meta-analysis.

BACKGROUND: Sedentary, digital screen time in children represents a major concern due to its detrimental effect on children's development. Nowadays, however, advances in technology allow children to actively interact with a digital screen using their whole body (e.g., exergaming), providing potential for movement learning. Exergaming technology may prove valuable in supporting children's development of foundational movement skills (FMS). OBJECTIVE: To examine the impact of exergaming technology on the development of FMS in children 3-12 years through a skill acquisition lens. METHODS: Systematic review and meta-analysis were conducted following the PRISMA guidelines. Web of Science, PubMed, PsycINFO and SPORTDiscus databases were searched between 2007 and 2022. Studies were eligible if they conducted an exergaming intervention to improve FMS in typically developing children aged three to twelve with a control group, using a baseline and post-intervention assessment design. FMS outcomes were pooled with a random effects model. RESULTS: Nine trials (4 RCTs, 2 cluster RCTs and 3 non-randomized trials) of varying methodological quality (2 had low, 6 had some concerns, and 1 had a high risk of bias) were included, with a total of 783 participants. FMS outcome measures across studies comprised object control skills, locomotor skills, coordination, agility, balance and balance-related skills. The meta-analysis included showed a small positive effect in favor of the exergaming intervention (r = 0.24 [95% confidence interval: 0.11-0.36]). CONCLUSION: Our results indicate that screen-based technology that requires an active engagement of the child can promote the development of FMS. Considering that FMS are the foundation of a child's physical, mental, health and academic development, this finding could lead to a reshaping of the perception of digital screen-based technology and the role this should play in children's lives. We speculate that the observed benefits most likely depend upon the quality of information-movement coupling specificity and the motor learning strategies built into the exergame and/or the intervention design. We do not believe this is dependent on the type of FMS being performed or the amount of practice. We recommend therefore that future research should examine how practitioners (school teachers, coaches and parents) can facilitate the interaction between a child and exergaming technology.

Deliberate Practice and Motor Learning Principles to Underpin the Design of Training Interventions for Improving Lifting Movement in the Occupational Sector: A Perspective and a Pilot Study on the Role of Augmented Feedback.

Spine posture during repetitive lifting is one of the main risk factors for low-back injuries in the occupational sector. It is thus critical to design appropriate intervention strategies for training workers to improve their posture, reducing load on the spine during lifting. The main approach to train safe lifting to workers has been educational; however, systematic reviews and meta-analyses have shown that this approach does not improve lifting movement nor reduces the risk of low back injury. One of the main limitations of this approach lies in the amount, quality and context of practice of the lifting movement. In this article, first we argue for integrating psychologically-grounded perspectives of practice design in the development of training interventions for safe lifting. Principles from deliberate practice and motor learning are combined and integrated. Given the complexity of lifting, a training intervention should occur in the workplace and invite workers to repeatedly practice/perform the lifting movement with the clear goal of improving their lifting-related body posture. Augmented feedback has a central role in creating the suitable condition for achieving such intervention. Second, we focus on spine bending as risk factor and present a pilot study examining the benefits and boundary conditions of different feedback modalities for reducing bending during lifting. The results showed how feedback modalities meet differently key requirements of deliberate practice conditions, i.e., feedback has to be informative, individualized and actionable. Following the proposed approach, psychology will gain an active role in the development of training interventions, contributing to finding solutions for a reduction of risk factors for workers.

A Perspective on Implementing Movement Sonification to Influence Movement (and Eventually Cognitive) Creativity.

Creativity represents an important feature in a variety of daily-life and domain-specific contexts. Recent evidence indicates that physical movement serves as a key resource for exploring and generating task-relevant creative ideas, supporting the embodied perspective on creative cognition. An intuitive link between movement and creative cognition is movement creativity. The process of exploring the movement solutions an environment offers (i.e., affordances) and exploiting novel, functional, and creative movements may translate to and improve how individuals explore and generate novel ideas. Opening perception to the variety of affordances ("conventional" and novel) an environment offers drives creative movement. Teachers and coaches can promote this process by designing a learning environment that invites performers to consider and utilize novel movement solutions. In this article, we present a rationale for using movement sonification to promote creative movement. Movement sonification consists of mapping a movement parameter into sound, with a sound being triggered or changing according to how movement unfolds. We argue that movement sonification can facilitate the emergence of creative movement via enhancing perception of currently performed movements and invite performers to utilize novel affordances, and emphasizing information for regulating subsequent creative actions. We exemplify this concept in a creative dance intervention for children during physical education classes. In conclusion, we contend that learning to explore original dance sequences using movement sonification may provide a meaningful link between creative movement and creative cognition. Children may use their minds and bodies as tools for creative thinking and exploration, such as shaping letters with their bodies.

Scaling sports equipment for children promotes functional movement variability.

Scaling sports equipment to match the physical development of children allows motor skills to be performed with greater success and with more desirable movement patterns. It is unknown, however, how scaled equipment affects movement variability - a key factor associated with coordination. Our aim was to identify whether scaled sports equipment facilitates coordination and functional movement variability in children when performing a hitting for accuracy task in tennis. Twenty-five children were asked to execute a forehand stroke with the aim of hitting the ball to a target located 10 metres away. Participants performed the task in two conditions - a scaled equipment condition and a full-sized equipment condition. Scaled equipment led to superior hitting accuracy and greater temporal stability of the swing compared to full-sized equipment. Scaled equipment also afforded the emergence of a functional coupling between upper arm and forearm movement variability which helped regulate the distance between the shoulder and the racket. Comparatively there was a lack of coupling when full-sized equipment was used. Hence, scaled equipment promoted functional movement variability, whereas full-sized equipment resulted in the freezing of mechanical degrees of freedom. This suggests that children's skill acquisition could be hindered and potentially regress when using inappropriately sized equipment.

Test-Retest Reliability of the Yo-Yo Test: A Systematic Review.

BACKGROUND: The Yo-Yo test is widely used both in the practical and research contexts; however, its true test-retest reliability remains unclear. OBJECTIVE: The present systematic review aims to identify studies that have examined the test-retest reliability of the Yo-Yo test and summarize their results. METHODS: A search of ten databases was performed to find studies that have investigated test-retest reliability of any variant of the Yo-Yo test. The COSMIN checklist was employed to assess the methodological quality of the included studies. RESULTS: Nineteen studies of excellent or moderate methodological quality were included. When considering all variants of the Yo-Yo test, the included studies reported intra-class correlation coefficients for test-retest reliability ranging from 0.78 to 0.98 where 62% of all intra-class correlation coefficients were higher than 0.90, while 97% of intra-class correlation coefficients were higher than 0.80. The coefficients of variation ranged from 3.7 to 19.0%. Regardless of the variant of the test, the participants' familiarization with the test, and previous sport experience, the intra-class correlation coefficients generally seem high (≥ 0.90) and coefficients of variation low (< 10%). CONCLUSIONS: The results of this review indicate that the Yo-Yo test (in all its variants) generally has good-to-excellent test-retest reliability. The evidence concerning reliability arises from 19 included studies that were of moderate or high methodological quality. Considering that most of the included studies examined the Yo-Yo intermittent recovery level 1 test while including Association Football players, more reliability studies examining Yo-Yo intermittent recovery level 2 test and Yo-Yo intermittent endurance level 1 and level 2 tests, and in the context of sports other than Association Football as well as in non-athletic populations, are required. Finally, future studies should explicitly state the type of intra-class correlation coefficient used for the reliability data analysis to allow for better between-study comparisons.

Futsal task constraints promote transfer of passing skill to soccer task constraints.

This study investigated how learning a passing skill with futsal or soccer task constraints influenced transfer to a new task. Futsal (n = 24, 13.6 ± 1.2 years old, 7.0 ± 1.6 years of experience) and soccer (n = 24, 13.6 ± 1.2 years old, 6.8 ± 1.2 years of experience) players performed two 5v5 + goalkeeper modified games - a futsal-like task (small playing area with the futsal ball) and soccer-like task (large playing area with the soccer ball). Participants' passing accuracy and their orientation of attention were assessed during the two tasks. The futsal group improved their passing accuracy (ES = 0.75 ± 0.61) from the futsal-like to the soccer-like task, and they were more accurate than soccer players (ES = 2.98 ± 2.96). Conversely, the soccer group's passing accuracy remained stable across the two tasks (ES = 0.10 ± 0.52) and it was similar to the futsal group in the futsal-like task (ES = 0.58 ± 1.93). This indicates a higher magnitude of transfer (and adaptability) from performing passes in a small playing area with short time to act - futsal task constraints - to a larger playing area with longer time - soccer task constraints - than vice-versa. Furthermore, the futsal group showed a higher adaptation of attention orientation to the affordances that emerged with the soccer task constraints, which is suggested to be one of the main mechanisms promoting skill transfer. These results encourage soccer practitioners to introduce futsal task constraints to fast-track players' ability to functionally adapt perception-action coupling.

Long-term Practice with Domain-Specific Task Constraints Influences Perceptual Skills.

The long-term impact of practice with different task constraints on perceptual skill is relatively un-explored. This study examined the influence of extensive practice, i.e., more than a 1000 h of structured practice, with domain-specific task constraints on perceptual skill associated with the passing action. Despite performing the same passing skill, it is not known whether long-term exposure to specific soccer or futsal task constraints influences the players' attunement to environmental information. This study examined this issue by assessing the attention orientation of soccer (n = 24) and futsal players (n = 24) during modified games (6 vs. 6). Futsal players had higher scanning behavior during ball reception and control (40% more ball-player attention alternations) while soccer players mainly scanned the environment when not in ball possession (25% more attention alternations). We suggest that the behavioral differences found are elicited by the extensive domain-specific practice. That is, the higher number of players in soccer, and by a more intense game and easier to control ball in futsal. This study provides new insights into the long-term effects of practicing with specific task constraints.