Immediate effects of verbal instructions with internal focus of attention and external focus of attention on forward reach movement while standing.

[Purpose] This study aimed to examine the immediate effects of verbal instructions with an internal and external focus of attention on forward reach movement while standing. [Participants and Methods] Thirty-seven healthy young males performed reach movement in three conditions: control, internal focus of attention, and external focus of attention. The measurements recorded were the movement distance of the third metacarpal bone (reach distance), the distance of the center of pressure, and the movement angles between the acromion and malleolus lateralis and between the acromion and trochanter major. [Results] Compared to the control condition, the internal focus of attention condition had a lower reach distance, angles between the acromion and malleolus lateralis and between the acromion and trochanter major, and center of pressure distance. In contrast, compared to the control condition, the external focus of attention condition showed higher reach distance and angles between the acromion and malleolus lateralis and between the acromion and trochanter major. The change rate of reach distance in the internal and external focus of attention conditions correlated significantly with the change rates of the angles between the acromion and malleolus lateralis and between the acromion and trochanter major. [Conclusion] Verbal instructions with attentional focus resulted in the simultaneous adjustment of the positional relationship between trunk and hip and immediately affected the reach distance. Our findings suggest that verbal instruction with attentional focus is an important factor affecting reach movement.

The Effects of Attentional Focus Instructions Specific to Body Movements on Movement Quality and Performance.

Contexts: Directing an individual's attention to the effect of the movements (external focus) has been shown to improve performance than directing attention to body movements (internal focus). However, the effect of attentional focus instructions specific to movement quality has not been investigated thoroughly. OBJECTIVE: To compare the effects of internal and external focus instructions specific to body movements. DESIGN: Mixed design, 2 (sex) × 2 (instructions). SETTINGS: Laboratory setting. PARTICIPANTS: A total of 40 participants (males, n = 20; mean [SD]; age = 22.0 [2.19] y; height = 179.33 [5.90] cm; mass = 77.7 [13.04] kg; females, n = 20; age = 22.0 [3.87] y; height = 164.84 [5.80] cm; mass = 71.48 [20.66] kg) were recruited. INTERVENTION: Participants completed 2 consecutive jumps (ie, a forward jump from a height and then a maximal vertical jump) with internal focus and external focus instructions. External focus was elicited by placing pieces of tape on the participants' legs. MAIN OUTCOME MEASURES: Landing quality was measured by the Landing Error Scoring System to assess movement quality, and the vertical jump height was measured by Vertec. RESULTS: The performance results showed that the external focus condition resulted in superior vertical jump height compared with the internal focus condition (P < .05). Although landing quality did not show significant differences between 2 conditions, the effect size (η2 = .09) indicated that landing quality was better when participants adopted an external, rather than an internal focus of attention (P = .07). CONCLUSIONS: The body-oriented instructions can be provided externally by adding artificial external cues and directing attention to them. Importantly, the findings were evident in a qualitative assessment that can be adopted by practitioners. The results suggest that practitioners should adopt an external focus cue for performance and also consider using an external focus for movement quality.

What is the most effective verbal instruction for correctly contracting the pelvic floor muscles?

AIMS: The purpose of the present study was to compare the effectiveness of four different verbal instructions in correctly contracting pelvic floor muscles (PFMs), examined as a displacement of the pelvic floor by transabdominal ultrasound. METHODS: Fifty-six female undergraduate physiotherapy students, mean age 24.2 ± 2.5 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, suprapubically over the lower abdomen and angled at 15-30° from the vertical depending. The participants were randomly divided into two groups: posterior and anterior. Each group received four different verbal instructions as to how to correctly contract the PFMs. Only one verbal instruction differed between the groups: "squeeze the anus" (posterior group) compared with "stop the flow of urine" (anterior group). RESULTS: In the posterior group, 27 participants (90%) performed a correct contraction compared with 17 participants (65%) in the anterior group, thus demonstrating a statistically significant difference in favor of the "anus" instruction (P = 0.025). Forty-seven participants (84%) exhibited a downward movement during the verbal instruction combining transversus abdominis contractions with breathing, that is, "take a moderate breath in, let the breath out then draw in and lift your pelvic floor." CONCLUSIONS: Our findings suggest that the most effective verbal instruction for correctly contracting the PFMs among 56 physiotherapy students was the posterior instruction of "squeezing the anus." The majority (90%) of participants succeeded in correctly contracting the PFMs.

Effects of different verbal instructions on change of lumbar multifidus muscle thickness in asymptomatic adults and in patients with low back pain.

BACKGROUND: Spinal stabilisation exercise has been shown to be effective in the rehabilitation of low back pain (LBP). Due to the isometric nature of spinal stabilisation exercise, manual therapists use various verbal instructions to elicit lumbar multifidus muscle contraction. OBJECTIVES: The purpose of this study was to assess whether or not three verbal instructions would alter muscle thickness of the lumbar multifidus muscle differently in asymptomatic individuals and patients with LBP. METHODS: Three verbal instructions were selected for this study: (1) swell the muscle underneath the transducer, (2) draw your belly button in towards your spinal column and (3) think about tilting your pelvis but without really doing it. Lumbar multifidus muscle thickness was determined using parasagittal ultrasound (US) imaging. Measurements of muscle thickness were collected at rest and during verbal instructions from 21 asymptomatic adults and 21 patients with LBP. Percent changes of muscle thickness during contraction and at rest were compared between groups and across verbal instructions. RESULTS: ANOVA results showed no significant interaction for both L4-5 and L5-S1, but a significant main effect of verbal instruction (P = 0.049) at L4-5.Post hoc analysis showed a greater increase with verbal instruction #3 than verbal instruction #2 (P = 0.009). There was no significant main effect of group at either segment. DISCUSSION: The results of the study suggest that both groups responded similarly to the three verbal instructions. Verbal instructions may increase lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.

Retrospective reversal of extinction of conditioned fear by instruction.

In the present study, we examined the impact of verbal instruction during extinction of human fear-conditioning. We extended the study of Raes, De Houwer, Verschuere, and De Raedt (2011) by controlling for context conditioning and recording unconditioned stimulus expectancy online in a within-subject design. We informed participants of an alternative reason for the absence of the aversive unconditioned stimulus after extinction had been carried out, to see if such instruction could induce retrospective protection from extinction. The results demonstrated that both the expectancy of an aversive outcome and conditioned skin conductance were significantly increased for the conditioned stimulus targeted by the instruction. Thus extinction was reversed by the concurrent presence of an alternative cause for the absence of the unconditioned stimulus.

Acute Effect of Video Feedback on Self-Regulation and Proprioceptive Control of Standing Back Tuck Somersault in the Absence of Vision.

The purpose of this study was to assess the immediate effect of video feedback on the regulation and control of the standing back tuck somersault in the absence of vision. Two groups of male parkour athletes performed the standing back tuck somersault under both open and closed eyes conditions. The first group received video feedback, while the second group received verbal feedback. Concurrent analysis, including kinetic data from a force plate (Kistler Quattro-Jump) and kinematic data in two-dimensional by Kinovea freeware, was employed for motion and technical performance analysis. The results indicate that the loss of vision during the standing back tuck somersault affected only the take-off and ungrouping angle, as well as the vertical velocity and displacement. These effects were consistent regardless of the type of feedback provided (i.e., video feedback or verbal feedback). Furthermore, a significant Vision × Feedback interaction was observed at the level of technical performance. This suggests that the use of video feedback enabled the parkour athletes to maintain a high level of technical performance both with and without vision (i.e., 13.56 vs. 13.00 points, respectively, p > .05 and d = 2.233). However, the verbal feedback group technical performance declined significantly under the no-vision condition compared with the vision condition (13.14 vs. 10.25 points, respectively, with and without vision, p < .001 and d = 2.382). We concluded that when the movement is proprioceptively controlled (i.e., without vision), the video feedback enables the athletes to globally assess the technical deficiencies arising from the lack of vision and to correct them. These findings are discussed based on parkour athletes' ability to evaluate the kinematic parameters of the movement.

Teaching categories via examples and explanations.

People often learn categories through interaction with knowledgeable others who may use verbal explanations, visual exemplars, or both, to share their knowledge. Verbal and nonverbal means of pedagogical communication are commonly used in conjunction, but their respective roles are not fully understood. In this work, we studied how well these modes of communication work with different category structures. We conducted two experiments to investigate the effect of perceptual confusability and stimulus dimensionality on the effectiveness of verbal, exemplar-based, and mixed communication. One group of participants - teachers - learned a categorization rule and prepared learning materials for the students. Students studied the materials prepared for them and then demonstrated their knowledge on test stimuli. All communication modes were generally successful, but not equivalent, with mixed communication consistently showing best results. When teachers were free to generate as many visual exemplars or words as they wish, verbal and exemplar-based communication showed similar performance, although the verbal channel was slightly less reliable in situations requiring high perceptual precision. At the same time, verbal communication was better suited to handling high-dimensional stimuli when communication volume was restricted. We believe that our work serves as an important step towards studying language as a means for pedagogical category leaning.

Verbal Instruction for Pelvic Floor Muscle Contraction among Healthy Young Males.

Teaching Pelvic Floor Muscle (PFM) contraction is a challenging task for clinicians and patients, as these muscles cannot be directly visualized. Thus, this study's objective is to compare the effectiveness of six verbal instructions for contracting the PFM among young men, as observed with transabdominal ultrasound imaging. Thirty-five male physiotherapy students, mean age 25.9 ± 1.9 years, participated in the study. A 6 MHz 35-mm curved linear array ultrasound transducer (Mindray M5) was placed in the transverse plane, supra-pubically, and angled 15-30° from the vertical plane. During crook lying, participants received six verbal instructions for contracting the PFM, with bladder base displacement and endurance evaluated. Following the instructions, "squeeze your anus", "shorten the penis", and "elevate the scrotum", over 91% of the participants performed a cranial (upward) bladder base displacement. During instruction six, "draw in", which involves breathing, the PFM, and the transversus abdominis, only 25% performed cranial bladder base displacement (p < 0.001), and the endurance was the lowest (p < 0.001). Our findings suggest that several simple verbal instructions can be used for teaching PFM contraction to young males. Moreover, two instructions should be avoided: "draw in" and the general instruction "squeeze your PFM", as they did not produce effective elevation of the bladder base.

Comparison of abdominal muscle activity with various verbal instructions and onset activity analysis during draw-in maneuver.

Draw-in is a promising intervention for regaining isolated control of the transverse abdominis (TrA). Exercises to stimulate isolated contractions are needed; however, the appropriate methods are unclear. The objectives of this study were to examine how the muscle activity and muscle activity ratio of abdominal muscles change with various verbal instructions and to determine the onset of the abdominal muscles during draw-in. The participants were 21 healthy men. TrA electromyography was performed using fine-wire electrodes, and the internal oblique (IO), external oblique (EO), and rectus abdominis (RA) were determined using surface electrodes. The participants performed seven abdominal exercises according to verbal instructions and isolated voluntary contraction of the TrA for more than 5 sec. The TrA showed higher activity in bracing. IO and EO activities were highest in bracing, whereas RA showed the highest activity in maximum bracing. TrA/IO and TrA/EO were not significantly different between conditions. The results of the onset activity analysis of the abdominal muscles during the draw-in maneuver showed that the TrA was significantly earlier than the other muscles. The activity ratios of TrA to IO and EO were highly individualized and did not differ according to the verbal instruction. Maximum draw-in showed more significant IO activity, and bracing showed co-contraction of the superficial and deep abdominal muscles. During draw-in, the TrA initiated the earliest activity among the abdominal muscles and then isolated activity for 1.1 sec.

Open-Label Placebo Administration Decreases Pain in Elderly Patients With Symptomatic Knee Osteoarthritis - A Randomized Controlled Trial.

Background: Recent studies indicate that the administration of open-label placebos (OLP) can improve symptoms in various medical conditions. The primary aim of this 3-week randomized controlled trial was to examine the effects of OLP treatments on pain, functional disability, and mobility in patients with arthritic knee pain. Methods: Sixty patients (55% females; mean age, 66.9 ± 9.7 SD years) were randomized to one of two OLP treatments (n = 41) or no treatment (NT; n = 19). OLP treatments were accompanied by the verbal suggestion "to decrease pain" (OLP-pain, n = 20) or "to improve mood" (OLP-mood, n = 21). Pain and mood levels were monitored on 11-point Numeric Rating Scales (NRSs) in a patient diary, and global clinical improvement (CGI-I) was assessed at the end of the study. At baseline and after 21 days, patients filled in validated questionnaires to assess symptoms and functional disability of the knee (WOMAC), mental and physical quality of life (SF-36), state anxiety (STAI-state), perceived stress (PSQ-20), and self-efficacy (GSE). In addition, knee mobility (neutral zero-method), heart rate variability (HRV), and diurnal cortisol levels were evaluated before and after treatment. Results: Evaluation of daily pain ratings indicated significant pain decrease in the OLP groups compared to NT (p = 0.013, d = 0.64), with no difference between the OLP-pain and the OLP-mood groups (p = 0.856, d = 0.05). OLP treatment also improved WOMAC pain (p = 0.036, d = 0.55), again with no difference between the two OLP groups (p = 0.65, d = 0.17). WOMAC function and stiffness, knee mobility, stress, state anxiety, quality of life, and self-efficacy did not change differently between groups. Conclusion: OLP treatment improved knee pain in elderly patients with symptomatic knee osteoarthritis (OA), while functional disability and mobility of the knee did not change. The content of the verbal suggestion was of minor importance. OLP administration may be considered as supportive analgesic treatment in elderly patients with symptomatic knee OA. Trial Registration: German Clinical Trials Register (https://www.drks.de/), DRKS00015191 (retrospectively registered).

Mind-Muscle Connection: Verbal Instructions Alter Electromyographic Activity for Elbow Flexors and Extensors During Co-Contraction Training.

Co-contraction training has demonstrated similar electromyographic (EMG) activity levels compared to conventional strength training. Since verbal instructions can increase EMG activity on target muscles during conventional exercises, the same should occur during co-contraction. In this study we analyzed whether different verbal instructions would alter the EMG activity of target muscles - biceps brachii (BB) and triceps brachii lateral head (TB) - during co-contraction training for the elbow joint. Seventeen males with experience in strength training performed a co-contraction set in two verbal instruction conditions to emphasize either elbow flexion or elbow extension. Surface electrodes were fixed over biceps brachii and triceps brachii lateral head muscles. We measured EMG mean amplitude and analyzed data with 2-way ANOVA. We found a significant interaction between muscle and verbal instruction (p = 0.002). Post hoc tests indicated that verbal instructions (p = 0.001) influenced the BB EMG activity (elbow flexion: M = 68.74, SD = 17.96%; elbow extension: M = 53.47, SD = 16.13%); and also showed difference (p = 0.006) in the EMG activity between BB and TB with verbal instruction emphasizing the elbow extension (BB: M = 53.47, SD = 16.13%; TB: M = 69.18, SD = 21.79%). There was a difference in the EMG ratio of BB/TB (p = 0.001) when focusing on elbow flexion (M = 1.09, SD = 0.30) versus elbow extension (M = 0.81, SD = 0.25). As verbal instruction modified the magnitude of muscle recruitment during co-contractions for elbow joint muscles, there is a clear mind-muscle connection of importance to this method of training. Also, of importance to trainers, verbal instructions seemed to affect individuals differentially.

Assistive Navigation Using Deep Reinforcement Learning Guiding Robot With UWB/Voice Beacons and Semantic Feedbacks for Blind and Visually Impaired People.

Facilitating navigation in pedestrian environments is critical for enabling people who are blind and visually impaired (BVI) to achieve independent mobility. A deep reinforcement learning (DRL)-based assistive guiding robot with ultrawide-bandwidth (UWB) beacons that can navigate through routes with designated waypoints was designed in this study. Typically, a simultaneous localization and mapping (SLAM) framework is used to estimate the robot pose and navigational goal; however, SLAM frameworks are vulnerable in certain dynamic environments. The proposed navigation method is a learning approach based on state-of-the-art DRL and can effectively avoid obstacles. When used with UWB beacons, the proposed strategy is suitable for environments with dynamic pedestrians. We also designed a handle device with an audio interface that enables BVI users to interact with the guiding robot through intuitive feedback. The UWB beacons were installed with an audio interface to obtain environmental information. The on-handle and on-beacon verbal feedback provides points of interests and turn-by-turn information to BVI users. BVI users were recruited in this study to conduct navigation tasks in different scenarios. A route was designed in a simulated ward to represent daily activities. In real-world situations, SLAM-based state estimation might be affected by dynamic obstacles, and the visual-based trail may suffer from occlusions from pedestrians or other obstacles. The proposed system successfully navigated through environments with dynamic pedestrians, in which systems based on existing SLAM algorithms have failed.

Verbal Cuing Is Not the Path to Enlightenment. Psychological Effects of a 10-Session Hatha Yoga Practice.

Verbal instructions provided during yoga classes can differ substantially. Yoga instructors might choose to focus on the physical aspects of yoga (e.g., by emphasizing the characteristics of the poses), or they might take a more spiritual approach (e.g., by mentioning energy flow and chakras). The present study investigated the effects of verbal cues during yoga practice on various psychological measures. Eighty-four female students (22.0 ± 3.80 years) participated in the study. Two groups attended a beginner level hatha yoga course in which physically identical exercise was accompanied by different verbal cues. The so-called "Sport group" (N = 27) received instructions referring primarily to the physical aspects of yoga practice, while the "Spiritual group" (N = 23) was additionally provided with philosophical and spiritual information. A control group (N = 34) did not receive any intervention. Mindfulness, body awareness, spirituality, and affect were assessed 1 week before and after the training. 2 × 3 mixed (time × intervention) ANOVAs did not show an interaction effect for any of the variables. However, when the two yoga groups were merged and compared to the control group, we found that spirituality increased, and negative affect decreased among yoga participants. In conclusion, yoga practice might influence psychological functioning through its physical components, independent of the style of verbal instructions provided.

Watching or Listening: How Visual and Verbal Information Contribute to Learning a Complex Dance Phrase.

While learning from observation is generally regarded as major learning mode for motor actions, evidence from dance practice suggests that learning dance movement through verbal instruction might provide a promising way to support dancers' individual interpretation of and identification with the movement material. In this multidisciplinary project, we conducted a study on the learning of dance movement through two modalities, observation of a human model in a video clip and listening to the audio-recording of a verbal movement instruction. Eighteen second year dance students learned two dance phrases, one from observation and one from verbal instruction, and were video-recorded performing the learned material. In a second learning step, they were presented the complementary information from the other modality, and their performance was recorded again. A third recording was carried out in a retention test 10 days after learning. Completeness scores representing the recall of the dance phrases, expert ratings addressing the performance quality and questionnaires reflecting the participants' personal impressions were used to evaluate and compare the performance at different stages of the learning process. Results show that learning from observation resulted in better learning outcomes in terms of both recall and approximation of the model phrase, whereas individual interpretation of the learned movement material was rated equally good after initially verbal and initially visual learning. According to the questionnaires, most participants preferred learning initially from observation and found it more familiar, which points toward an influence of learning habit caused by common training practice. The findings suggest that learning dance movement initially from observation is more beneficial than from verbal instruction, and add aspects with regards to multimodal movement learning with potential relevance for dance teaching and training.

Reliability of unipodal and bipodal counter movement jump landings in a recreational male population.

Movement patterns during landing have been suggested to be related to injury risk. The purpose of this study was to determine the inter-session reliability of kinematic variables and ground reaction forces during landing in a population of male recreational athletes after a counter movement jump. Both unipodal and bipodal landings were evaluated. Furthermore, the possibility to improve landing reliability with a verbal instruction was also studied. Twenty-four male volunteers with no history of lower extremity trauma were randomly assigned to two groups (with and without verbal landing instruction). An optoelectronic 3D system and force plates were used to measure the lower limb joint angles and the ground reaction forces during landing. Intraclass correlation values show moderate to excellent inter-session reliability for the bipodal task (ICC average: 0.80, range: 0.46-0.97) and poor to excellent reliability for the unipodal task (ICC average: >0.75, range: 0.20-0.95). However, large standard errors of measurement values at the ankle joint at impact (27.6 ± 11.5°) and for the vertical ground reaction forces (394 ± 1091 N) show that some variables may not be usable in practice. The verbal instruction had a negative effect on the reliability of unipodal landing but improved the reliability of bipodal landing. These findings show that the reliability of a landing task is influenced by its motor complexity as well as the instruction given to the subject.

Perception of active head rotation in patients with severe left unilateral spatial neglect.

Unilateral spatial neglect is a common neurological syndrome following predominantly right hemisphere damage, and is characterized by a failure to perceive and report stimuli in the contralesional side of space. To test the reference shift hypothesis that contralesional spatial neglect in right-brain-damaged patients is attributed to a rightward deviation of the egocentric reference frame, we measured the final angular position to which controls and left-side neglect patients actively turned their head toward the left in response to a verbal instruction given from each of three locations-right, left, and front-in two conditions, with and without visual feedback. When neglect patients were asked to "look straight ahead", they deviated about 30° toward the right in the eyes-open condition. However, the rightward deviation was markedly reduced in the eyes-closed condition. Regardless of visual feedback, there was no significant difference between controls and neglect patients in the final angular position of active head rotation when the verbal instruction came from the subject's left or front side; however, the final angular position was significantly smaller in the neglect patients than in the controls when the verbal instruction was given from the right. These results support the contention that cervico-vestibular stimulation during active head rotation restores spatial remapping and sensori-motor correlations and so improves neglect without affecting the position of the egocentric reference; however, once left-side neglect patients respond to verbal instruction from the right side, they are unable to disengage attention from the hemispace, and the performance of head rotation is disturbed.

Verbal Instruction Model (VIM) in voice therapy.

The stumbling-block in voice therapy is the patient's generalization of the new voice behavior in everyday life. Traditionally voice therapy is based on demonstration, i.e. during the therapy session the speech therapist uses her own voice and body to demonstrate for the patient how to produce voice in different training tasks. During the last decade a new voice therapy strategy, the Verbal Instruction Model (VIM), has been developed by the author. In VIM the speech therapist uses verbal instructions instead of demonstration when conveying the training tasks to the patient. Our clinical experience has shown that VIM seems to help getting over the stumbling-block of generalization. However, evidence for VIM voice therapy outcome remains to be scientifically studied and confirmed. The purpose of this paper is to describe VIM voice therapy and to discuss therapy strategies in the light of motor learning principles.

Immediate video feedback on ramp, wheelie, and curb wheelchair skill training for persons with spinal cord injury.

We hypothesized that the effects of immediate video feedback (IVF) on training ramp, wheelie, and curb wheelchair skills for persons with spinal cord injury (SCI) would be equivalent to or better than the traditional wheelchair skill training. Participants were manual wheelchair users with recent SCI (thoracic 1-lumbar 1) who were matched (9 pairs) on motor function level, age, and sex and randomly assigned to a control group (conventional training) or an experimental group (IVF training). Participants learned three wheelchair skills and then went through the wheelchair skill competency test, retention test, and transfer test. Paired t-tests were used to examine the differences in training time (minutes), spotter intervention needed (counts), and successful rate in performance between the two groups. A 2 (groups) x 3 (skills) x 3 (tests) repeated-measures analysis of variance and Bonferroni adjustment test were used to examine differences between groups on wheelchair skills and tests. No differences were found between two groups in training times (minutes) on three wheelchair skills (experimental vs control: ramp 14.92 +/- 5.80 vs 11.69 +/- 7.85; wheelie 17.79 +/- 6.03 vs 19.92 +/- 13.42; and curb 38.35 +/-23.01 vs 48.59 +/- 15.21). This study demonstrated that IVF for training manual wheelchair skills may produce similar results as the conventional training and may be an alternative training method for wheelchair skills.

Verbal-motor attention-focusing instructions influence kinematics and performance on a golf-putting task.

The authors examined how varying the content of verbal-motor instructions and requesting an internal versus external focus influenced the kinematics and outcome of a golf putting task. On Day 1, 30 novices performed 120 trials with the instruction to focus attention either on performing a pendulum-like movement (internal) or on the desired ball path (external). After 20 retention trials on Day 2, they performed 20 transfer trials with the opposite instruction. Group differences for retention and a group by block interaction showed that external instruction enhanced movement outcome. Kinematic data indicated that specific instruction content influenced outcomes by eliciting changes in movement execution. Switching from the external to the internal focus instruction resulted in a more pendulum-like movement.

Discussion on Quality Education of Clinical Medical Students / 中华医学教育探索杂志

To improve the quality education of medical students,we should attach importance to the construction of teaching staff,improve learning environment,strengthen selected course construction and arrange for students to take social practice.