The after-effects of occupational whole-body vibration on human cognitive, visual, and motor function: A systematic review

Whole-body vibration (WBV) is prevalent in labour-related activities and can have adverse effects on the health and performance of the individuals exposed. However, evidence regarding the extent to which human functionality is affected following occupational WBV exposure has not been collated. The current systematic review sought to synthesize existing literature and assess the strength and direction of evidence regarding the acute after-effects of occupational WBV exposure on cognition, visual function, postural stability, and motor control. We conducted a comprehensive search of AMED, CINAHL, MEDLINE, PubMED, Psychology and Behavioural Sciences Collection, SPORTDiscus, APA PsychInfo, Cochrane Library, EMBASE, HMIC, Global Health, ProQuest Central, Scopus, Web of Science, and the US National Technical Information Service on April 26, 2023. Studies that quantified vibration exposure and measured acute changes in cognition, visual function, postural stability, and motor control from baseline to post-vibration were considered without date restriction. Out of the 2663 studies identified, 32 were eligible for inclusion. Based on the Risk of Bias in Non-Randomized Studies of Exposure (ROBINS-E) tool, the studies demonstrated low (66%), moderate (25%) and high risk of bias (9%). The findings indicate that after exposure to WBV, postural stability either deteriorates or remains unchanged. Inconsistent effects of WBV on cognition were reported, while visual function and motor control showed no pronounced changes following WBV. This might be attributed to assessment limitations such as learning effects in neuropsychological and motor tasks, and non-functional measures of vision employed. There was a lack of consistency in the characterization of vibration exposure and the assessment of associated effects on functional performance. Current evidence is therefore insufficient to provide definitive guidance for updating occupational health and safety regulations regarding WBV. However, this review highlights the potential for WBV to jeopardize post-exposure human performance and, consequently, safety. The completion of the review was supported by a UKRI EPSRC training grant. The review has been registered on PROSPERO (ref CRD42023391075).

Can cognitive training capitalise on near transfer effects? Limited evidence of transfer following online inhibition training in a randomised-controlled trial

Despite early promise, cognitive training research has failed to deliver consistent real-world benefits and questions have been raised about the experimental rigour of many studies. Several meta-analyses have suggested that there is little to no evidence for transfer of training from computerised tasks to real-world skills. More targeted training approaches that aim to optimise performance on specific tasks have, however, shown more promising effects. In particular, the use of inhibition training for improving shoot/don't-shoot decision-making has returned positive far transfer effects. In the present work, we tested whether an online inhibition training task could generate near and mid-transfer effects in the context of response inhibition tasks. As there has been relatively little testing of retention effects in the literature to date, we also examined whether any benefits would persist over a 1-month interval. In a pre-registered, randomised-controlled trial, participants (n = 73) were allocated to either an inhibition training programme (six training sessions of a visual search task with singleton distractor) or a closely matched active control task (that omitted the distractor element). We assessed near transfer to a Flanker task, and mid-transfer to a computerised shoot/don't-shoot task. There was evidence for a near transfer effect, but no evidence for mid-transfer. There was also no evidence that the magnitude of training improvement was related to transfer task performance. This finding adds to the growing body of literature questioning the effectiveness of cognitive training. Given previous positive findings, however, there may still be value in continuing to explore the extent to which cognitive training can capitalise on near or mid-transfer effects for performance optimisation.

The functional role of visual information and fixation stillness in the quiet eye

The final fixation to a target in far-aiming tasks, known as the quiet eye, has been consistently identified as an important perceptual-cognitive variable for task execution. Yet, despite a number of proposed mechanisms it remains unclear whether the fixation itself is driving performance effects or is simply an emergent property of underpinning cognitions. Across two pre-registered studies, novice golfers (n = 127) completed a series of golf putts in a virtual reality simulation to examine the function of the quiet eye in the absence of visual information. In experiment 1 participants maintained a quiet eye fixation even when all visual information was occluded. Visual occlusion did significantly disrupt motor skill accuracy, but the effect was relatively small (89cm vs 105cm radial error, std. beta = 0.25). In experiment 2, a 'noisy eye' was induced using covertly moving fixation points, which disrupted skill execution (p = .04, BF = 318.07, std. beta = -0.25) even though visual input was equivalent across conditions. Overall, the results showed that performers persist with a long pre-shot fixation even in the absence of visual information, and that the stillness of this fixation confers a functional benefit that is not merely related to improved information extraction.

Movement kinematic and postural control differences when performing a visuomotor skill in real and virtual environments

Immersive technologies, like virtual and mixed reality, pose a novel challenge for our sensorimotor systems as they deliver simulated sensory inputs that may not match those of the natural environment. These include reduced fields of view, missing or inaccurate haptic information, and distortions of 3D space; differences that may impact the control of motor actions. For instance, reach-to-grasp movements without end-point haptic feedback are characterised by slower and more exaggerated movements. A general uncertainty about sensory input may also induce a more conscious form of movement control. We tested whether a more complex skill like golf putting was also characterized by more consciously controlled movement. In a repeated-measures design, kinematics of the putter swing and postural control were compared between (i) real-world putting, (ii) VR putting, and (iii) VR putting with haptic feedback from a real ball (i.e., mixed reality). Differences in putter swing were observed both between the real world and VR, and between VR conditions with and without haptic information. Further, clear differences in postural control emerged between real and virtual putting, with both VR conditions characterised by larger postural movements, which were more regular and less complex, suggesting a more conscious form of balance control. Conversely, participants actually reported less conscious awareness of their movements in VR. These findings highlight how fundamental movement differences may exist between virtual and natural environments, which may pose challenges for transfer of learning within applications to motor rehabilitation and sport.

An Active Inference Account of Skilled Anticipation in Sport: Using Computational Models to Formalise Theory and Generate New Hypotheses

Optimal performance in time-constrained and dynamically changing environments depends on making reliable predictions about future outcomes. In sporting tasks, performers have been found to employ multiple information sources to maximise the accuracy of their predictions, but questions remain about how different information sources are weighted and integrated to guide anticipation. In this paper, we outline how predictive processing approaches, and active inference in particular, provide a unifying account of perception and action that explains many of the prominent findings in the sports anticipation literature. Active inference proposes that perception and action are underpinned by the organism’s need to remain within certain stable states. To this end, decision making approximates Bayesian inference and actions are used to minimise future prediction errors during brain–body–environment interactions. Using a series of Bayesian neurocomputational models based on a partially observable Markov process, we demonstrate that key findings from the literature can be recreated from the first principles of active inference. In doing so, we formulate a number of novel and empirically falsifiable hypotheses about human anticipation capabilities that could guide future investigations in the field.

Radiographer Perspectives on current occurrence and management of claustrophobia in MRI

INTRODUCTION

Magnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice.

METHODS

Following ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support.

RESULTS

Responses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice.

CONCLUSION

The study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care.

IMPLICATIONS FOR PRACTICE

Ongoing support is needed for both patients and radiographers to improve experience within MRI.

Scoping review: How is virtual reality being used as a tool to support the experience of undergoing Magnetic resonance imaging?

OBJECTIVES

Undergoing a Magnetic Resonance Imaging (MRI) scan continues to be a source of anxiety and concern for many patients. Various interventions have been developed and are used in regular clinical practice to support patients through the procedure. A novel approach which is gaining traction is that of virtual reality (VR) as a tool to support patient experience in MRI. This scoping review considers how it is currently being used and developed and discusses how effective it may be.

KEY FINDINGS

The eight papers found show a range of approaches being used; as a preparatory tool, exposure therapy or distraction technique. All of which show general positive influence on patient anxiety, compliance, and acceptability. The more recent, but limited number of papers, show this to be a developing field.

CONCLUSION

The potential for the use of VR lies in its ability to closely replicate the real world as a preparatory and exposure technique for those likely to experience concerns over the MRI procedure itself. The reality of the virtual environment also provides opportunity to spend time coaching patients in advance without the need to take up actual scanner time, thereby providing a safe space in which preparation and support can be given.

IMPLICATIONS FOR PRACTICE

It is argued that a better understanding of the theoretical basis on which VR may be working would further help development and implementation in clinical practice. This could then support a truly patient-centred approach to management of claustrophobia and associated anxieties related to MRI.

A critical analysis of the functional parameters of the quiet eye using immersive virtual reality

Directing ocular fixations toward a target assists the planning and control of visually guided actions. In far aiming tasks, the quiet eye, an instance of premovement gaze anchoring, has been extensively studied as a key performance variable. However, theories of quiet eye are yet to establish the exact functional role of the location and duration of the fixation. The present work used immersive virtual reality to manipulate key parameters of the quiet eye-location (Experiment 1) and duration (Experiment 2)-to test competing theoretical predictions about their importance. Across two preregistered experiments, novice participants (n = 127) completed a series of golf putts while their eye movements, putting accuracy, and putting kinematics were recorded. In Experiment 1, participants' premovement fixation was cued to locations on the ball, near the ball, and far from the ball. In Experiment 2, long and short quiet eye durations were induced using auditory tones as cues to movement phases. Linear mixed effects models indicated that manipulations of location and duration had little effect on performance or movement kinematics. The findings suggest that, for novices, the spatial and temporal parameters of the final fixation may not be critical for movement preprogramming and may instead reflect attentional control or movement inhibition functions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In-task auditory performance-related feedback promotes cardiovascular markers of a challenge state during a pressurized task

Background and Objectives: Individuals evaluate the demands and resources associated with a pressurized situation, which leads to distinct patterns of cardiovascular responses. While it is accepted that cognitive evaluations are updated throughout a pressurized situation, to date, cardiovascular markers have only been recorded immediately before, or averaged across, these situations. Thus, this study examined the influence of in-task performance-related feedback on cardiovascular markers of challenge and threat to explore fluctuations in these markers. Methods and Design: Forty participants completed a pressurized visual search task while cardiovascular markers of challenge and threat were recorded. During the task, participants received either positive or negative feedback via distinct auditory tones to induce a challenge or threat state. Following task completion, cardiovascular markers were recorded during a recovery phase. Results: Participants' cardiovascular responses changed across the experimental protocol. Specifically, while participants displayed a cardiovascular response more reflective of a challenge state following in-task performance-related feedback, participants exhibited a response more akin to a threat state later during the recovery phase. Conclusions: In-task auditory performance-related feedback promoted cardiovascular markers of a challenge state. These markers fluctuated over the experiment, suggesting that they, and presumably underlying demand and resource evaluations, are relatively dynamic in nature.

Examining the roles of working memory and visual attention in multiple object tracking expertise

When tracking multiple moving targets among visually similar distractors, human observers are capable of distributing attention over several spatial locations. It is unclear, however, whether capacity limitations or perceptual-cognitive abilities are responsible for the development of expertise in multiple object tracking. Across two experiments, we examined the role of working memory and visual attention in tracking expertise. In Experiment 1, individuals who regularly engaged in object tracking sports (soccer and rugby) displayed improved tracking performance, relative to non-tracking sports (swimming, rowing, running) (p = 0.02, ηp2 = 0.163), but no differences in gaze strategy (ps > 0.31). In Experiment 2, participants trained on an adaptive object tracking task showed improved tracking performance (p = 0.005, d = 0.817), but no changes in gaze strategy (ps > 0.07). They did, however, show significant improvement in a working memory transfer task (p < 0.001, d = 0.970). These findings indicate that the development of tracking expertise is more closely linked to processing capacity limits than perceptual-cognitive strategies.

A Framework for the Testing and Validation of Simulated Environments in Experimentation and Training

New computer technologies, like virtual reality (VR), have created opportunities to study human behavior and train skills in novel ways. VR holds significant promise for maximizing the efficiency and effectiveness of skill learning in a variety of settings (e.g., sport, medicine, safety-critical industries) through immersive learning and augmentation of existing training methods. In many cases the adoption of VR for training has, however, preceded rigorous testing and validation of the simulation tool. In order for VR to be implemented successfully for both training and psychological experimentation it is necessary to first establish whether the simulation captures fundamental features of the real task and environment, and elicits realistic behaviors. Unfortunately evaluation of VR environments too often confuses presentation and function, and relies on superficial visual features that are not the key determinants of successful training outcomes. Therefore evidence-based methods of establishing the fidelity and validity of VR environments are required. To this end, we outline a taxonomy of the subtypes of fidelity and validity, and propose a variety of practical methods for testing and validating VR training simulations. Ultimately, a successful VR environment is one that enables transfer of learning to the real-world. We propose that key elements of psychological, affective and ergonomic fidelity, are the real determinants of successful transfer. By adopting an evidence-based approach to VR simulation design and testing it is possible to develop valid environments that allow the potential of VR training to be maximized.

Testing the Effects of 3D Multiple Object Tracking Training on Near, Mid and Far Transfer

Cognitive training (CT) aims to develop domain general mental abilities to support functions like decision making, multitasking, and performance under pressure. Research to date has indicated that CT likely aids performance on lab-based cognitive tests, but there has been little demonstration of transfer to tasks representative of real-world high performance environments. This study aimed to assess transfer from a CT intervention to near and mid-level transfer tasks, plus a far transfer test representative of real-world multitasking in a military environment. 84 participants were randomized to four independent training groups, using NeuroTracker, a CT task based on 3D object tracking. There was no evidence for near transfer (to another object tracking task) or for far transfer to a route monitoring task designed to replicate real-world multitasking. There may, however, have been some improvement in working memory performance as a result of training. These findings raise further questions about whether domain general CT will transfer to real-world performance. Effective uses of CT may require more task specific training targeting mid-level transfer effects.

Virtually the same? How impaired sensory information in virtual reality may disrupt vision for action

Virtual reality (VR) is a promising tool for expanding the possibilities of psychological experimentation and implementing immersive training applications. Despite a recent surge in interest, there remains an inadequate understanding of how VR impacts basic cognitive processes. Due to the artificial presentation of egocentric distance cues in virtual environments, a number of cues to depth in the optic array are impaired or placed in conflict with each other. Moreover, realistic haptic information is all but absent from current VR systems. The resulting conflicts could impact not only the execution of motor skills in VR but also raise deeper concerns about basic visual processing, and the extent to which virtual objects elicit neural and behavioural responses representative of real objects. In this brief review, we outline how the novel perceptual environment of VR may affect vision for action, by shifting users away from a dorsal mode of control. Fewer binocular cues to depth, conflicting depth information and limited haptic feedback may all impair the specialised, efficient, online control of action characteristic of the dorsal stream. A shift from dorsal to ventral control of action may create a fundamental disparity between virtual and real-world skills that has important consequences for how we understand perception and action in the virtual world.

Visual attention, EEG alpha power and T7-Fz connectivity are implicated in prosthetic hand control and can be optimized through gaze training

Background

Prosthetic hands impose a high cognitive burden on the user that often results in fatigue, frustration and prosthesis rejection. However, efforts to directly measure this burden are sparse and little is known about the mechanisms behind it. There is also a lack of evidence-based training interventions designed to improve prosthesis hand control and reduce the mental effort required to use them. In two experiments, we provide the first direct evaluation of this cognitive burden using measurements of EEG and eye-tracking (Experiment 1), and then explore how a novel visuomotor intervention (gaze training; GT) might alleviate it (Experiment 2).

Methods

In Experiment 1, able-bodied participants (n = 20) lifted and moved a jar, first using their anatomical hand and then using a myoelectric prosthetic hand simulator. In experiment 2, a GT group (n = 12) and a movement training (MT) group (n = 12) trained with the prosthetic hand simulator over three one hour sessions in a picking up coins task, before returning for retention, delayed retention and transfer tests. The GT group received instruction regarding how to use their eyes effectively, while the MT group received movement-related instruction typical in rehabilitation.

Results

Experiment 1 revealed that when using the prosthetic hand, participants performed worse, exhibited spatial and temporal disruptions to visual attention, and exhibited a global decrease in EEG alpha power (8-12 Hz), suggesting increased cognitive effort. Experiment 2 showed that GT was the more effective method for expediting prosthesis learning, optimising visual attention, and lowering conscious control – as indexed by reduced T7-Fz connectivity. Whilst the MT group improved performance, they did not reduce hand-focused visual attention and showed increased conscious movement control. The superior benefits of GT transferred to a more complex tea-making task.

Conclusions

These experiments quantify the visual and cortical mechanisms relating to the cognitive burden experienced during prosthetic hand control. They also evidence the efficacy of a GT intervention that alleviated this burden and promoted better learning and transfer, compared to typical rehabilitation instructions. These findings have theoretical and practical implications for prosthesis rehabilitation, the development of emerging prosthesis technologies and for the general understanding of human-tool interactions.

Electronic supplementary material

The online version of this article (10.1186/s12984-019-0524-x) contains supplementary material, which is available to authorized users.

Action observation for sensorimotor learning in surgery

Background

Acquiring new motor skills to learn complex movements and master the use of a diverse range of instruments is fundamental for developing expertise in surgery. Although aspects of skill development occur through trial and error, watching the performance of another individual (action observation) is an increasingly important adjunct for the acquisition of these complex skills before performing a procedure. The aim of this review was to examine the evidence in support of the use of action observation in surgery.

Methods

A narrative review of observational learning for surgical motor skills was undertaken. Searches of PubMed and PsycINFO databases were performed using the terms ‘observational learning’ OR ‘action observation’ AND ‘motor learning’ OR ‘skill learning’.

Results

Factors such as the structure of physical practice, the skill level of the demonstrator and the use of feedback were all found to be important moderators of the effectiveness of observational learning. In particular, observation of both expert and novice performance, cueing attention to key features of the task, and watching the eye movements of expert surgeons were all found to enhance the effectiveness of observation. It was unclear, however, whether repeated observations were beneficial for skill learning. The evidence suggests that these methods can be employed to enhance surgical training curricula.

Conclusion

Observational learning is an effective method for learning surgical skills. An improved understanding of observational learning may further inform the refinement and use of these methods in contemporary surgical training curricula.

A randomised trial of observational learning from 2D and 3D models in robotically assisted surgery

BACKGROUND

Advances in 3D technology mean that both robotic surgical devices and surgical simulators can now incorporate stereoscopic viewing capabilities. While depth information may benefit robotic surgical performance, it is unclear whether 3D viewing also aids skill acquisition when learning from observing others. As observational learning plays a major role in surgical skills training, this study aimed to evaluate whether 3D viewing provides learning benefits in a robotically assisted surgical task.

METHODS

90 medical students were assigned to either (1) 2D or (2) 3D observation of a consultant surgeon performing a training task on the daVinci S robotic system, or (3) a no observation control, in a randomised parallel design. Subsequent performance and instrument movement metrics were assessed immediately following observation and at one-week retention.

RESULTS

Both 2D and 3D groups outperformed no observation controls following the observation intervention (ps < 0.05), but there was no difference between 2D and 3D groups at any of the timepoints. There was also no difference in movement parameters between groups.

CONCLUSIONS

While 3D viewing systems may have beneficial effects for surgical performance, these results suggest that depth information has limited utility during observational learning of surgical skills in novices. The task constraints and end goals may provide more important information for learning than the relative motion of surgical instruments in 3D space.

A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport

Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.

The effect of observing novice and expert performance on acquisition of surgical skills on a robotic platform

BACKGROUND

Observational learning plays an important role in surgical skills training, following the traditional model of learning from expertise. Recent findings have, however, highlighted the benefit of observing not only expert performance but also error-strewn performance. The aim of this study was to determine which model (novice vs. expert) would lead to the greatest benefits when learning robotically assisted surgical skills.

METHODS

120 medical students with no prior experience of robotically-assisted surgery completed a ring-carrying training task on three occasions; baseline, post-intervention and at one-week follow-up. The observation intervention consisted of a video model performing the ring-carrying task, with participants randomly assigned to view an expert model, a novice model, a mixed expert/novice model or no observation (control group). Participants were assessed for task performance and surgical instrument control.

RESULTS

There were significant group differences post-intervention, with expert and novice observation groups outperforming the control group, but there were no clear group differences at a retention test one week later. There was no difference in performance between the expert-observing and error-observing groups.

CONCLUSIONS

Similar benefits were found when observing the traditional expert model or the error-strewn model, suggesting that viewing poor performance may be as beneficial as viewing expertise in the early acquisition of robotic surgical skills. Further work is required to understand, then inform, the optimal curriculum design when utilising observational learning in surgical training.

Aiming to Deceive: Examining the Role of the Quiet Eye During Deceptive Aiming Actions

In three experiments, we explored the use of deceptive gaze in soccer penalty takers using eye-tracking equipment. In Experiment 1, players competed against a goalkeeper while taking unconstrained shots. Results indicated that when players used deception (looking to the opposite side to which they shot), they extended the duration of their final aiming (quiet eye) fixation and maintained shooting accuracy. In Experiment 2, with no goalkeeper present, players still used extended quiet-eye durations when using a deceptive strategy, but this time, their accuracy suffered. In Experiment 3, we manipulated the goalkeeper's location while controlling for the use of peripheral vision and memory of goal size. Results indicated that increased quiet-eye durations were required when using deceptive aiming, and that accuracy was influenced by the position of the goalkeeper. We conclude that during deceptive aiming, soccer players maintain accuracy by covertly processing information related to the goalkeeper's location.

Examining the Spatiotemporal Disruption to Gaze When Using a Myoelectric Prosthetic Hand

The aim of this study was to provide a detailed account of the spatial and temporal disruptions to eye-hand coordination when using a prosthetic hand during a sequential fine motor skill. Twenty-one able-bodied participants performed 15 trials of the picking up coins task derived from the Southampton Hand Assessment Procedure with their anatomic hand and with a prosthesis simulator while wearing eye-tracking equipment. Gaze behavior results revealed that when using the prosthesis, performance detriments were accompanied by significantly greater hand-focused gaze and a significantly longer time to disengage gaze from manipulations to plan upcoming movements. The study findings highlight key metrics that distinguish disruptions to eye-hand coordination that may have implications for the training of prosthesis use.

Neurocognitive mechanisms of the flow state

While the experience of flow is often described in attentional terms-focused concentration or task absorption-specific cognitive mechanisms have received limited interest. We propose that an attentional explanation provides the best way to advance theoretical models and produce practical applications, as well as providing potential solutions to core issues such as how an objectively difficult task can be subjectively effortless. Recent research has begun to utilize brain-imaging techniques to investigate neurocognitive changes during flow, which enables attentional mechanisms to be understood in greater detail. Some tensions within flow research are discussed; including the dissociation between psychophysiological and experiential measures, and the equivocal neuroimaging findings supporting prominent accounts of hypofrontality. While flow has received only preliminary investigation from a neuroscientific perspective, findings already provide important insights into the crucial role played by higher-order attentional networks, and clear indications of reduced activity in brain regions linked to self-referential processing. The manner in which these processes may benefit sporting performance are discussed.

The effects of arousal reappraisal on stress responses, performance and attention

BACKGROUND AND OBJECTIVES

This study examined the effects of arousal reappraisal on cardiovascular responses, demand and resource evaluations, self-confidence, performance and attention under pressurized conditions. A recent study by Moore et al. [2015. Reappraising threat: How to optimize performance under pressure. Journal of Sport and Exercise Psychology, 37(3), 339-343. doi: 10.1123/jsep.2014-0186 ] suggested that arousal reappraisal is beneficial to the promotion of challenge states and leads to improvements in single-trial performance. This study aimed to further the work of Moore and colleagues (2015) by examining the effects of arousal reappraisal on cardiovascular responses, demand and resource evaluations, self-confidence, performance and attention in a multi-trial pressurized performance situation.

DESIGN AND METHODS

Participants were randomly assigned to either an arousal reappraisal intervention or control condition, and completed a pressurized dart throwing task. The intervention encouraged participants to view their physiological arousal as facilitative rather than debilitative to performance. Measures of cardiovascular reactivity, demand and resource evaluations, self-confidence, task performance and attention were recorded.

RESULTS

The reappraisal group displayed more favorable cardiovascular reactivity and reported higher resource evaluations and higher self-confidence than the control group but no task performance or attention effects were detected.

CONCLUSION

These findings demonstrate the strength of arousal reappraisal in promoting adaptive stress responses, perceptions of resources and self-confidence.

A randomized controlled trial of a group-based gaze training intervention for children with Developmental Coordination Disorder

The aim of this study was to integrate a gaze training intervention (i.e., quiet eye training; QET) that has been shown to improve the throwing and catching skill of children with Developmental Coordination Disorder (DCD), within an approach (i.e., group therapy) that might alleviate the negative psychosocial impact of these motor skill deficits. Twenty-one children with DCD were split into either QET (8 male 3 female, mean age of 8.6 years (SD = 1.04) or technical training (TT) groups (7 male 3 female, mean age of 8.6 years (SD = 1.84). The TT group were given movement-related instructions via video, relating to the throw and catch phases, while the QET group were also taught to fixate a target location on the wall prior to the throw (QE1) and to track the ball prior to the catch (QE2). Each group partook in a 4-week, group therapy intervention and measurements of QE duration and catching performance were taken before and after training, and at a 6-week delayed retention test. Parental feedback on psychosocial and motor skill outcomes was provided at delayed retention. Children improved their gaze control and catching coordination following QET, compared to TT. Mediation analysis showed that a longer QE aiming duration (QE1) predicted an earlier onset of tracking the ball prior to catching (QE2) which predicted catching success. Parents reported enhanced perceptions of their child’s catching ability and general coordination in the QET group compared to the TT group. All parents reported improvements in their child’s confidence, social skills and predilection for physical activity following the trial. The findings offer initial support for an intervention that practitioners could apply to address deficits in the motor and psychosocial skills of children with DCD.

Trial registration: ClinicalTrials.govNCT02904980

An Integrative Framework of Stress, Attention, and Visuomotor Performance

The aim of this article is to present an integrative conceptual framework that depicts the effect of acute stress on the performance of visually guided motor skills. We draw upon seminal theories highlighting the importance of subjective interpretations of stress on subsequent performance and outline how models of disrupted attentional control might explain this effect through impairments in visuomotor control. We first synthesize and critically discuss empirical support for theories examining these relationships in isolation. We then outline our integrative framework that seeks to provide a more complete picture of the interacting influences of stress responses (challenge and threat) and attention in explaining how elevated stress may lead to different visuomotor performance outcomes. We propose a number of mechanisms that explain why evaluations of stress are related to attentional control, and highlight the emotion of anxiety as the most likely candidate to explain why negative reactions to stress lead to disrupted attention and poor visuomotor skill performance. Finally, we propose a number of feedback loops that explain why stress responses are often self-perpetuating, as well as a number of proposed interventions that are designed to help improve or maintain performance in real world performance environments (e.g., sport, surgery, military, and aviation).

The Quiet Eye Provides Preplanning and Online Control Support for Interceptive Task Performance

Longer quiet eye (QE) periods are associated with better performance across a range of targeting and interceptive tasks. However, the direction of this relationship is still unclear. The two studies presented aimed to narrow this knowledge gap by experimentally manipulating QE duration-by delaying its onset or by truncating its offset-in an aiming interceptive task. In Experiment 1, the early trajectory was occluded, causing significantly shorter QE durations and worse subsequent performance. In Experiment 2, both early and/or late trajectory were occluded. Performance was degraded by the occlusion of either early or late information, and the worst performance occurred when both the early and late trajectory were occluded. Taken together, the results suggest that QE is not a by-product of performance but instead plays a causal role in supporting the interception of a moving target through a combination of preprogramming and online control processes.

An occlusion paradigm to assess the importance of the timing of the quiet eye fixation

The aim of the study was to explore the significance of the 'timing' of the quiet eye (QE), and the relative importance of late (online control) or early (pre-programming) visual information for accuracy. Twenty-seven skilled golfers completed a putting task using an occlusion paradigm with three conditions: early (prior to backswing), late (during putter stroke), and no (control) occlusion of vision. Performance, QE, and kinematic variables relating to the swing were measured. Results revealed that providing only early visual information (occluding late visual information) had a significant detrimental effect on performance and kinematic measures, compared to the control condition (no occlusion), despite QE durations being maintained. Conversely, providing only late visual information (occluding early visual information) was not significantly detrimental to performance or kinematics, with results similar to those in the control condition. These findings imply that the visual information extracted during movement execution - the late proportion of the QE - is critical when golf putting. The results challenge the predominant view that the QE serves only a pre-programming function. We propose that the different proportions of the QE (before and during movement) may serve different functions in supporting accuracy in golf putting.

Reappraising Threat: How to Optimize Performance Under Pressure

Competitive situations often hinge on one pressurized moment. In these situations, individuals' psychophysiological states determine performance, with a challenge state associated with better performance than a threat state. But what can be done if an individual experiences a threat state? This study examined one potential solution: arousal reappraisal. Fifty participants received either arousal reappraisal or control instructions before performing a pressurized, single-trial, motor task. Although both groups initially displayed cardiovascular responses consistent with a threat state, the reappraisal group displayed a cardiovascular response more reflective of a challenge state (relatively higher cardiac output and/or lower total peripheral resistance) after the reappraisal manipulation. Furthermore, despite performing similarly at baseline, the reappraisal group outperformed the control group during the pressurized task. The results demonstrate that encouraging individuals to interpret heightened physiological arousal as a tool that can help maximize performance can result in more adaptive cardiovascular responses and motor performance under pressure.

Quiet eye training facilitates visuomotor coordination in children with developmental coordination disorder

INTRODUCTION

Quiet eye training (QET) has been shown to be more effective than traditional training (TT) methods for teaching a throw and catch task to typically developing 8-10 yr old children. The current study aimed to apply the technique to children with developmental coordination disorder (DCD).

METHOD

30 children with DCD were randomly allocated into TT or QET intervention groups. The TT group were taught how to control their arm movements during the throw and catch phases, while the QET group were also taught to fixate a target location on the wall prior to the throw (quiet eye1; QE1), followed by tracking the ball prior to the catch (quiet eye2; QE2). Performance, gaze and motion analysis data were collected at pre/post-training and 6-week retention.

RESULTS

The QET group significantly increased QE durations from pre-training to delayed retention (QE1 = +247 ms, QE2 = +19%) whereas the TT group experienced a reduction (QE1 = -74 ms, QE2 = -4%). QET participants showed significant improvement in the quality of their catch attempts and increased elbow flexion at catch compared to the TT group (QET = -28°, TT = -1°).

CONCLUSION

QET changed DCD children's ability to focus on a target on the wall prior to the throw, followed by better anticipation and pursuit tracking on the ball, which in turn led to improved catching technique. QET may be an effective adjunct to traditional instructions, for therapists teaching visuomotor skills to children with DCD.

Robotic technology results in faster and more robust surgical skill acquisition than traditional laparoscopy

Technical surgical skills are said to be acquired quicker on a robotic rather than laparoscopic platform. However, research examining this proposition is scarce. Thus, this study aimed to compare the performance and learning curves of novices acquiring skills using a robotic or laparoscopic system, and to examine if any learning advantages were maintained over time and transferred to more difficult and stressful tasks. Forty novice participants were randomly assigned to either a robotic- or laparoscopic-trained group. Following one baseline trial on a ball pick-and-drop task, participants performed 50 learning trials. Participants then completed an immediate retention trial and a transfer trial on a two-instrument rope-threading task. One month later, participants performed a delayed retention trial and a stressful multi-tasking trial. The results revealed that the robotic-trained group completed the ball pick-and-drop task more quickly and accurately than the laparoscopic-trained group across baseline, immediate retention, and delayed retention trials. Furthermore, the robotic-trained group displayed a shorter learning curve for accuracy. The robotic-trained group also performed the more complex rope-threading and stressful multi-tasking transfer trials better. Finally, in the multi-tasking trial, the robotic-trained group made fewer tone counting errors. The results highlight the benefits of using robotic technology for the acquisition of technical surgical skills.

Individual reactions to stress predict performance during a critical aviation incident

BACKGROUND

Understanding the influence of stress on human performance is of theoretical and practical importance. An individual's reaction to stress predicts their subsequent performance; with a "challenge" response to stress leading to better performance than a "threat" response. However, this contention has not been tested in truly stressful environments with highly skilled individuals. Furthermore, the effect of challenge and threat responses on attentional control during visuomotor tasks is poorly understood.

DESIGN

Thus, this study aimed to examine individual reactions to stress and their influence on attentional control, among a cohort of commercial pilots performing a stressful flight assessment.

METHODS

Sixteen pilots performed an "engine failure on take-off" scenario, in a high-fidelity flight simulator. Reactions to stress were indexed via self-report; performance was assessed subjectively (flight instructor assessment) and objectively (simulator metrics); gaze behavior data were captured using a mobile eye tracker, and measures of attentional control were subsequently calculated (search rate, stimulus driven attention, and entropy).

RESULTS

Hierarchical regression analyses revealed that a threat response was associated with poorer performance and disrupted attentional control.

CONCLUSION

The findings add to previous research showing that individual reactions to stress influence performance and shed light on the processes through which stress influences performance.

Visual control strategies of surgeons: a novel method of establishing the construct validity of a transurethral resection of the prostate surgical simulator

OBJECTIVE

To examine novice and expert differences in visual control strategies while performing a virtual reality transurethral resection of the prostate (TURP) task and to determine if these differences could provide a novel method for assessing construct validity of the simulator.

SUBJECTS AND METHODS

A total of 11 novices (no TURP experience) and 7 experts (>200 TURPs) completed a virtual reality prostate resection task on the TURPsim (Simbionix USA Corp, Cleveland, OH) while wearing an eye tracker (ASL, Bedford, MA). Performance parameters and the surgeon's visual control strategy were measured and compared between the 2 groups.

RESULTS

Experts resected a greater percentage of prostate than novices (p < 0.01) and had less active diathermy time without tissue contact (p < 0.01). Experts adopted a target-locking visual strategy, employing fewer visual fixations (p < 0.05) with longer mean fixation duration (p < 0.005). With multiple learning trials, novices' performance improved and the adoption of a more expertlike gaze strategy was observed.

CONCLUSION

Significant differences between experts and novices in both performance and visual control strategy were observed. The study of visual control strategies may be a useful adjunct, alongside measurements of motor performance, providing a novel method of assessing the construct validity of surgical simulators.

Quiet eye distinguishes children of high and low motor coordination abilities

PURPOSE

This is the first study to use the quiet eye (QE) as an objective measure of visuomotor control underpinning proficiency differences in children's motor coordination.

METHODS

Fifty-seven, year 5 primary school children (9-10 yr old) completed the Movement Assessment Battery for Children, Second Edition (MABC-2), while wearing a gaze registration system. Participants were subsequently divided into one of three ability groups: high motor coordination (HMC), median motor coordination (MMC), and low motor coordination (LMC) based on these MABC-2 scores (mean % rank: HMC = 84%, MMC = 51%, LMC = 19%). QE analyses were performed for the fourth task of the MABC-2, which involved throwing a tennis ball against a wall and catching it on the return.

RESULTS

The HMC group was more successful in the catching task than both other groups (catching percentage: HMC = 92%, MMC = 62%, LMC = 35%) and demonstrated superior visuomotor control throughout the throwing and catching phases of the task. Compared with the other groups, the HMC group demonstrated longer targeting QE fixations before the release of the ball (HMC = 500 ms, MMC = 410 ms, LMC = 260 ms) and longer tracking QE durations before catching (HMC = 260 ms, MMC = 200 ms, LMC = 150 ms). There were no significant differences in ball flight time between the groups. Mediation analyses revealed that only the duration of the tracking QE predicted group differences in catching ability.

CONCLUSIONS

Findings suggest that the ability to predict and calibrate movements based on sensory feedback may be impaired in children with movement coordination difficulties and have implications for how they are taught fundamental movement skills.

Assessing visual control during simulated and live operations: gathering evidence for the content validity of simulation using eye movement metrics

BACKGROUND

Although virtual reality (VR) simulators serve an important role in the training and assessment of surgeons, they need to be evaluated for evidence of validity. Eye-tracking technology and measures of visual control have been used as an adjunct to the performance parameters produced by VR simulators to help in objectively establishing the construct validity (experts vs. novices) of VR simulators. However, determining the extent to which VR simulators represent the real procedure and environment (content validity) has largely been a subjective process undertaken by experienced surgeons. This study aimed to examine the content validity of a VR transurethral resection of the prostate (TURP) simulator by comparing visual control metrics taken during simulated and real TURP procedures.

METHODS

Eye-tracking data were collected from seven surgeons performing 14 simulated TURP operations and three surgeons performing 15 real TURP operations on live patients. The data were analyzed offline, and visual control metrics (number and duration of fixations, percentage of time the surgeons fixated on the screen) were calculated.

RESULTS

The surgeons displayed more fixations of a shorter duration and spent less time fixating on the video monitor during the real TURP than during the simulated TURP. This could have been due to (1) the increased complexity of the operating room (OR) environment (2) the decreased quality of the image of the urethra and associated anatomy (compared with the VR simulator), or (3) the impairment of visual attentional control due to the increased levels of stress likely experienced in the OR.

CONCLUSIONS

The findings suggest that the complexity of the environment surrounding VR simulators needs to be considered in the design of effective simulated training curricula. The study also provides support for the use of eye-tracking technology to assess the content validity of simulation and to examine psychomotor processes during live operations.

Champ or chump? Challenge and threat states during pressurized competition

The present research examined the immediate impact of challenge and threat states on golf performance in both real competition and a laboratory-based task. In Study 1, 199 experienced golfers reported their evaluations of competition demands and personal coping resources before a golf competition. Evaluating the competition as a challenge (i.e., sufficient resources to cope with demands) was associated with superior performance. In Study 2, 60 experienced golfers randomly received challenge or threat manipulation instructions and then performed a competitive golf-putting task. Challenge and threat states were successfully manipulated and the challenge group outperformed the threat group. Furthermore, the challenge group reported less anxiety, more facilitative interpretations of anxiety, less conscious processing, and displayed longer quiet eye durations. However, these variables failed to mediate the group-performance relationship. These studies demonstrate the importance of considering preperformance psychophysiological states when examining the influence of competitive pressure on motor performance.

Gaze training improves the retention and transfer of laparoscopic technical skills in novices

BACKGROUND

Gaze training is an effective way of training basic laparoscopic skills, resulting in faster acquisition periods and more robust subsequent performance under pressure. The current study is a randomized control trial which examines whether the performance benefits of gaze training stand the test of time (delayed retention) and transfer to more complex skills.

METHODS

Thirty-six medical students were trained to proficiency (50 trials) on a one-handed laparoscopic task (picking and dropping balls) in either a discovery learning (DL) or gaze training (GT) group. Both groups performed the one-handed task in baseline, retention and delayed retention (1 month) tests. They also performed baseline, retention and delayed retention tests of a two-handed task (grasping and cutting). Performance (completion time) and gaze control (target locking) were assessed throughout.

RESULTS

For the one-handed task, the GT group displayed superior performance at retention (p < .001), underpinned by more expert-like gaze control (p < .05). The GT group also displayed superior performance in the one-handed task at delayed retention (p < .005), underpinned by more expert-like gaze control strategies (p < .001). Although the DL group's performance fell to 84% of performance at retention, the GT group maintained performance at 100% of retention. There were no differences between the groups for the two-handed task at retention (p = .140); however, at delayed retention, the GT group outperformed the DL group (p < .005) and displayed more expert-like gaze control (p < .001).

CONCLUSIONS

Novices trained to adopt an expert-like gaze control strategy were able to attain higher levels of performance more quickly than novices who learned by discovery alone. Furthermore, these skills were more durable over time and were transferable to more complex skills. Gaze training is a beneficial intervention to aid the acquisition of the basic motor skills required for laparoscopy.

The effect of challenge and threat states on performance: an examination of potential mechanisms

Challenge and threat states predict future performance; however, no research has examined their immediate effect on motor task performance. The present study examined the effect of challenge and threat states on golf putting performance and several possible mechanisms. One hundred twenty-seven participants were assigned to a challenge or threat group and performed six putts during which emotions, gaze, putting kinematics, muscle activity, and performance were recorded. Challenge and threat states were successively manipulated via task instructions. The challenge group performed more accurately, reported more favorable emotions, and displayed more effective gaze, putting kinematics, and muscle activity than the threat group. Multiple putting kinematic variables mediated the relationship between group and performance, suggesting that challenge and threat states impact performance at a predominately kinematic level.

Quiet eye training: the acquisition, refinement and resilient performance of targeting skills

How we learn and refine motor skills in the most effective manner and how we prevent performance breakdown in pressurised or demanding circumstances are among the most important questions within the sport psychology and skill acquisition literature. The quiet eye (QE) has emerged as a characteristic of highly skilled perceptual and motor performance in visually guided motor tasks. Defined as the final fixation that occurs prior to a critical movement, over 70 articles have been published in the last 15 years probing the role that the QE plays in underpinning skilled performance. The aim of this review is to integrate research findings from studies examining the QE as a measure of visuomotor control in the specific domain of targeting skills; motor skills requiring an object to be propelled to a distant target. Previous reviews have focused primarily on the differences in QE between highly skilled performers and their less skilled counterparts. The current review aims to discuss contemporary findings relating to 1. The benefits of QE training for the acquisition and refinement of targeting skills; 2. The effects of anxiety upon the QE and subsequent targeting skill performance and 3. The benefits of QE training in supporting resilient performance under elevated anxiety. Finally, potential processes through which QE training proffers this advantage, including improved attentional control, response programming and external focus, will be discussed and directions for future research proposed.

Cheating experience: Guiding novices to adopt the gaze strategies of experts expedites the learning of technical laparoscopic skills

BACKGROUND

Previous research has demonstrated that trainees can be taught (via explicit verbal instruction) to adopt the gaze strategies of expert laparoscopic surgeons. The current study examined a software template designed to guide trainees to adopt expert gaze control strategies passively, without being provided with explicit instructions.

METHODS

We examined 27 novices (who had no laparoscopic training) performing 50 learning trials of a laparoscopic training task in either a discovery-learning (DL) group or a gaze-training (GT) group while wearing an eye tracker to assess gaze control. The GT group performed trials using a surgery-training template (STT); software that is designed to guide expert-like gaze strategies by highlighting the key locations on the monitor screen. The DL group had a normal, unrestricted view of the scene on the monitor screen. Both groups then took part in a nondelayed retention test (to assess learning) and a stress test (under social evaluative threat) with a normal view of the scene.

RESULTS

The STT was successful in guiding the GT group to adopt an expert-like gaze strategy (displaying more target-locking fixations). Adopting expert gaze strategies led to an improvement in performance for the GT group, which outperformed the DL group in both retention and stress tests (faster completion time and fewer errors).

CONCLUSION

The STT is a practical and cost-effective training interface that automatically promotes an optimal gaze strategy. Trainees who are trained to adopt the efficient target-locking gaze strategy of experts gain a performance advantage over trainees left to discover their own strategies for task completion.

Perceptual impairment and psychomotor control in virtual laparoscopic surgery

BACKGROUND

It is recognised that one of the major difficulties in performing laparoscopic surgery is the translation of two-dimensional video image information to a three-dimensional working area. However, research has tended to ignore the gaze and eye-hand coordination strategies employed by laparoscopic surgeons as they attempt to overcome these perceptual constraints. This study sought to examine if measures related to tool movements, gaze strategy, and eye-hand coordination (the quiet eye) differentiate between experienced and novice operators performing a two-handed manoeuvres task on a virtual reality laparoscopic surgical simulator (LAP Mentor™).

METHODS

Twenty-five right-handed surgeons were categorised as being either experienced (having led more than 60 laparoscopic procedures) or novice (having performed fewer than 10 procedures) operators. The 10 experienced and 15 novice surgeons completed the "two-hand manoeuvres" task from the LAP Mentor basic skills learning environment while wearing a gaze registration system. Performance, movement, gaze, and eye-hand coordination parameters were recorded and compared between groups.

RESULTS

The experienced surgeons completed the task significantly more quickly than the novices, used significantly fewer movements, and displayed shorter tool paths. Gaze analyses revealed that experienced surgeons spent significantly more time fixating the target locations than novices, who split their time between focusing on the targets and tracking the tools. A more detailed analysis of a difficult subcomponent of the task revealed that experienced operators used a significantly longer aiming fixation (the quiet eye period) to guide precision grasping movements and hence needed fewer grasp attempts.

CONCLUSION

The findings of the study provide further support for the utility of examining strategic gaze behaviour and eye-hand coordination measures to help further our understanding of how experienced surgeons attempt to overcome the perceptual difficulties inherent in the laparoscopic environment.

Gaze training enhances laparoscopic technical skill acquisition and multi-tasking performance: a randomized, controlled study

Background

The operating room environment is replete with stressors and distractions that increase the attention demands of what are already complex psychomotor procedures. Contemporary research in other fields (e.g., sport) has revealed that gaze training interventions may support the development of robust movement skills. This current study was designed to examine the utility of gaze training for technical laparoscopic skills and to test performance under multitasking conditions.

Methods

Thirty medical trainees with no laparoscopic experience were divided randomly into one of three treatment groups: gaze trained (GAZE), movement trained (MOVE), and discovery learning/control (DISCOVERY). Participants were fitted with a Mobile Eye gaze registration system, which measures eye-line of gaze at 25 Hz. Training consisted of ten repetitions of the “eye-hand coordination” task from the LAP Mentor VR laparoscopic surgical simulator while receiving instruction and video feedback (specific to each treatment condition). After training, all participants completed a control test (designed to assess learning) and a multitasking transfer test, in which they completed the procedure while performing a concurrent tone counting task.

Results

Not only did the GAZE group learn more quickly than the MOVE and DISCOVERY groups (faster completion times in the control test), but the performance difference was even more pronounced when multitasking. Differences in gaze control (target locking fixations), rather than tool movement measures (tool path length), underpinned this performance advantage for GAZE training.

Conclusions

These results suggest that although the GAZE intervention focused on training gaze behavior only, there were indirect benefits for movement behaviors and performance efficiency. Additionally, focusing on a single external target when learning, rather than on complex movement patterns, may have freed-up attentional resources that could be applied to concurrent cognitive tasks.