The Effects of Inaccessible Visual Feedback Used Concurrently or Terminally
Identifieur interne : 003066 ( Ncbi/Merge ); précédent : 003065; suivant : 003067The Effects of Inaccessible Visual Feedback Used Concurrently or Terminally
Auteurs : Ryohei Yamamoto ; Yukari OhashiSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2014.
Abstract
[Purpose] Concurrent feedback is more detrimental for long-term retention of motor skills because learners depend on accessible visual information provided in parallel with movements. However, visual information is not always accessible. Furthermore, the effects of concurrent feedback vary with aspects of the task being performed. We investigated the effects of inaccessible visual feedback used concurrently or terminally, focusing on aspects of movement. [Subjects and Methods] Fourteen subjects were quasi-randomly assigned to either a concurrent feedback group or a terminal feedback group. They practiced a task that involved right shoulder flexion with a specific acceleration. Learning achievements were assessed by measurement of errors in movement duration, peak timing, and strength. [Results] Regarding errors in movement duration, the concurrent feedback group was superior to the terminal feedback group during the midterm and final sessions. Regarding errors in peak timing, learning occurred in the concurrent feedback group, but not in the terminal feedback group because the improvement in performance during practice was inadequate. Regarding errors in peak strength, learning occurred in both groups. [Conclusion] Concurrent visual feedback that is used inaccessibly has learning effects that either equal or surpass those of terminal feedback that is used with inaccessible visual information for all parameters.
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DOI: 10.1589/jpts.26.731
PubMed: 24926140
PubMed Central: 4047240
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Effects of Inaccessible Visual Feedback Used Concurrently or
Terminally</title><author><name sortKey="Yamamoto, Ryohei" sort="Yamamoto, Ryohei" uniqKey="Yamamoto R" first="Ryohei" last="Yamamoto">Ryohei Yamamoto</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Ohashi, Yukari" sort="Ohashi, Yukari" uniqKey="Ohashi Y" first="Yukari" last="Ohashi">Yukari Ohashi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24926140</idno><idno type="pmc">4047240</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047240</idno><idno type="RBID">PMC:4047240</idno><idno type="doi">10.1589/jpts.26.731</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002066</idno><idno type="wicri:Area/Pmc/Curation">002066</idno><idno type="wicri:Area/Pmc/Checkpoint">000903</idno><idno type="wicri:Area/Ncbi/Merge">003066</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Effects of Inaccessible Visual Feedback Used Concurrently or
Terminally</title><author><name sortKey="Yamamoto, Ryohei" sort="Yamamoto, Ryohei" uniqKey="Yamamoto R" first="Ryohei" last="Yamamoto">Ryohei Yamamoto</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Ohashi, Yukari" sort="Ohashi, Yukari" uniqKey="Ohashi Y" first="Yukari" last="Ohashi">Yukari Ohashi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p> [Purpose] Concurrent feedback is more detrimental for long-term retention of motor
skills because learners depend on accessible visual information provided in parallel with
movements. However, visual information is not always accessible. Furthermore, the effects
of concurrent feedback vary with aspects of the task being performed. We investigated the
effects of inaccessible visual feedback used concurrently or terminally, focusing on
aspects of movement. [Subjects and Methods] Fourteen subjects were quasi-randomly assigned
to either a concurrent feedback group or a terminal feedback group. They practiced a task
that involved right shoulder flexion with a specific acceleration. Learning achievements
were assessed by measurement of errors in movement duration, peak timing, and strength.
[Results] Regarding errors in movement duration, the concurrent feedback group was
superior to the terminal feedback group during the midterm and final sessions. Regarding
errors in peak timing, learning occurred in the concurrent feedback group, but not in the
terminal feedback group because the improvement in performance during practice was
inadequate. Regarding errors in peak strength, learning occurred in both groups.
[Conclusion] Concurrent visual feedback that is used inaccessibly has learning effects
that either equal or surpass those of terminal feedback that is used with inaccessible
visual information for all parameters.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Smyth, Mm" uniqKey="Smyth M">MM Smyth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Holding, Dh" uniqKey="Holding D">DH Holding</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Annett, J" uniqKey="Annett J">J Annett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vander Linden, Dw" uniqKey="Vander Linden D">DW Vander Linden</name></author><author><name sortKey="Cauraugh, Jh" uniqKey="Cauraugh J">JH Cauraugh</name></author><author><name sortKey="Greene, Ta" uniqKey="Greene T">TA Greene</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schmidt, Ra" uniqKey="Schmidt R">RA Schmidt</name></author><author><name sortKey="Wulf, G" uniqKey="Wulf G">G Wulf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fox, Pw" uniqKey="Fox P">PW Fox</name></author><author><name sortKey="Michael Levy, C" uniqKey="Michael Levy C">C Michael Levy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Park, Jh" uniqKey="Park J">JH Park</name></author><author><name sortKey="Shea, Ch" uniqKey="Shea C">CH Shea</name></author><author><name sortKey="Wright, Dl" uniqKey="Wright D">DL Wright</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morford, Wr" uniqKey="Morford W">WR Morford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Robb, M" uniqKey="Robb M">M Robb</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccloskey, Di" uniqKey="Mccloskey D">DI McCloskey</name></author><author><name sortKey="Cross, Mj" uniqKey="Cross M">MJ Cross</name></author><author><name sortKey="Honner, R" uniqKey="Honner R">R Honner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hirata, C" uniqKey="Hirata C">C Hirata</name></author><author><name sortKey="Yoshida, S" uniqKey="Yoshida S">S Yoshida</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lavery, Jj" uniqKey="Lavery J">JJ Lavery</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24926140</article-id><article-id pub-id-type="pmc">4047240</article-id><article-id pub-id-type="publisher-id">jpts-2013-479</article-id><article-id pub-id-type="doi">10.1589/jpts.26.731</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original</subject></subj-group></article-categories><title-group><article-title>The Effects of Inaccessible Visual Feedback Used Concurrently or
Terminally</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Yamamoto</surname><given-names>Ryohei</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ohashi</surname><given-names>Yukari</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><aff id="aff1"><label>1)</label> Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394, Japan</aff><aff id="aff2"><label>2)</label> Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Ryohei Yamamoto, Graduate School of Health Sciences, Ibaraki Prefectural
University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki-gun, Ibaraki 300-0394,
Japan. (E-mail: <email xlink:href="45040054@ipu.ac.jp">45040054@ipu.ac.jp</email>)</corresp></author-notes><pub-date pub-type="epub"><day>29</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2014</year></pub-date><volume>26</volume><issue>5</issue><fpage>731</fpage><lpage>735</lpage><history><date date-type="received"><day>17</day><month>10</month><year>2013</year></date><date date-type="accepted"><day>14</day><month>12</month><year>2013</year></date></history><permissions><copyright-statement>2014©by the Society of Physical Therapy Science</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p> [Purpose] Concurrent feedback is more detrimental for long-term retention of motor
skills because learners depend on accessible visual information provided in parallel with
movements. However, visual information is not always accessible. Furthermore, the effects
of concurrent feedback vary with aspects of the task being performed. We investigated the
effects of inaccessible visual feedback used concurrently or terminally, focusing on
aspects of movement. [Subjects and Methods] Fourteen subjects were quasi-randomly assigned
to either a concurrent feedback group or a terminal feedback group. They practiced a task
that involved right shoulder flexion with a specific acceleration. Learning achievements
were assessed by measurement of errors in movement duration, peak timing, and strength.
[Results] Regarding errors in movement duration, the concurrent feedback group was
superior to the terminal feedback group during the midterm and final sessions. Regarding
errors in peak timing, learning occurred in the concurrent feedback group, but not in the
terminal feedback group because the improvement in performance during practice was
inadequate. Regarding errors in peak strength, learning occurred in both groups.
[Conclusion] Concurrent visual feedback that is used inaccessibly has learning effects
that either equal or surpass those of terminal feedback that is used with inaccessible
visual information for all parameters.</p></abstract><kwd-group><title>Key words</title><kwd>Motor learning</kwd><kwd>Feedback timing</kwd><kwd>Inaccessible visual feedback</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Patients who undergo physical therapy may have difficulty in walking and performing
movements such as roll over because of some type of disorder. In many cases, patients cannot
perform a target movement in a manner similar to that before onset of the disorder. In such
cases, physical therapists determine the optimal movement for the patient and instruct them
regarding the movement. Physical therapists then train the patients until they are capable
of performing the movement. Extrinsic feedback is a technique that physical therapists use
to teach patients motor skills. Physical therapists improve the movement of patients by
giving visual, verbal, or haptic information about the results of a movement and by guiding
the patients to appropriate movement.</p><p>Physical therapists provide feedback to patients either during (concurrent feedback) or
after task execution (terminal feedback). In concurrent feedback, information is provided in
parallel with movement, and the movement is regulated by extrinsic information. Therefore,
almost all responses are repeated accurately during a practice session. In the clinical
setting, there are practices with concurrent feedback such as practice of partial weight
bearing using a weight scale, adjusting the power of muscles using electromyography,
balancing with a stabilometer, and walking using a mirror image. In contrast, a number of
errant responses occur during a practice session guided by terminal feedback because
learners cannot gain information in parallel with their movement<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>. In previous studies, concurrent feedback has been more
beneficial for immediate performance, but more detrimental for the long-term retention of
motor skills compared with terminal feedback<xref rid="r1" ref-type="bibr">1</xref>, <xref rid="r3" ref-type="bibr">3</xref>,<xref rid="r4" ref-type="bibr">4</xref>,<xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>. However, Fox<xref rid="r6" ref-type="bibr">6</xref><sup>)</sup> examined the effects of feedback timing, feedback frequency, and
methods of decreasing frequency using a 100% concurrent feedback group, 100% terminal
feedback group, 50% concurrent feedback group that participated in every single trial and
50% feedback group that participated in the second half of each block. The 100% concurrent
feedback group showed decreased performance compared with the 100% terminal feedback group,
and both 50% concurrent feedback groups showed performances equivalent to that shown by the
100% terminal feedback group in the retention phase. Similarly, Park<xref rid="r7" ref-type="bibr">7</xref><sup>)</sup> reported that motor learning occurs effectively by gradually
decreasing the frequency of concurrent feedback.</p><p>These results showed that the level of performance during practice can be maintained by
adequate adjustment of the frequency of visual information provided in parallel with
movement but that the learning achievement degrades when excessive visual information is
provided in parallel with movement. Such a phenomenon was attributed to the fact that
comparatively accessible visual information supersedes other kinesthetic information. In
practice, utilizing concurrent feedback with electromyography, a stabilometer, or a mirror
image enables learners to evaluate how they should move easily. Therefore, they tend to
depend on visual information, which means there is no effective motor learning, as observed
previously. In such cases, therapists should decrease the frequency of feedback, but they
may be unable to decrease the frequency in the practice of a continuous skill such as
walking. In this situation, dependency on visual information can be decreased by making
visual feedback inaccessible. However, the learning effect of feedback used as inaccessible
information is still incompletely understood. Furthermore, some previous studies showed
similar results; however, the effects vary within parameters, as exemplified by force
adjustment, movement timing, and position adjustment<xref rid="r1" ref-type="bibr">1</xref>,
<xref rid="r8" ref-type="bibr">8</xref>, <xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>. The purpose of this study was to test the learning effects of
inaccessible visual feedback used concurrently or terminally, focusing on aspects of
movement.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><sec><title>Subjects</title><p>Fourteen healthy young adults (8 men, 6 women) participated in this study. Their mean age
was 21.4 ± 0.6 years. All subjects were right-hand dominant, had no history of
neurological or musculoskeletal pathology, and had never performed the task. We explained
the procedures to the subjects and obtained their written informed consent to participate
in this study before testing began.</p></sec><sec><title>Methods</title><p>The subjects were quasi-randomly assigned to one of two feedback groups such that the
male to female ratio was 4:3 for each group. They practiced the same task under different
feedback conditions. The learning task involved shoulder flexion to move the right wrist
with a specified acceleration and timing. The concurrent and terminal feedback groups were
seated in front of an oscilloscope and a monitor, with an acceleration meter attached to
their right wrists. The starting position had the subjects seated on a chair with their
right arm pulled down by the side of their bodies. The examiner instructed the subjects to
confirm the start time, the timing and strength of the acceleration peak, and the time at
which movement was stopped with the target acceleration waveform. They started performing
the task on hearing a specific set of sounds, which comprised a percussive tone and a
starting tone played with a specific timing. The percussive tone was played before
starting the task, while the starting tone was played 1 s after the percussive tone.</p><p>In this study, visual feedback was made inaccessible, compared with feedback relevant to
muscular strength and position of limbs commonly used in previous studies, by visualizing
acceleration of the right wrist. The concurrent feedback group was provided feedback in
parallel with their movement by looking at the screen of an oscilloscope that was fitted
with the target acceleration waveform. Furthermore, the subjects were tasked with reading
aloud between each block so that they could not practice mentally. The terminal feedback
group was provided with feedback after each block of attempts. Their feedback was an image
of the oscilloscope recorded during task execution. We set up a partition made of cloth to
prevent subjects from watching their right arms during task execution.</p><p>The experimental protocol included a pretest, an acquisition session, and a retention
test. During the pretest, participants performed 5 trials without feedback. The
acquisition session consisted of 10 blocks of 6 trials each, with a 1-min break between
each block. Participants in the concurrent feedback group practiced the task while
receiving concurrent feedback, whereas the terminal feedback group practiced the task and
received feedback after every 6 trials. The retention test took place 24 h after the
acquisition session. During the retention test, participants executed the task under the
same conditions used during pretest. Acceleration data and a signal synchronized with the
percussive tone from the electrical stimulator were printed on thermal paper with a
thermal array recorder. In this study, learning achievement was determined by errors of
movement duration, peak timing, and peak strength. Movement duration was defined as the
time between the point at which the acceleration waveform began rising and the point at
which it returned to baseline (<xref ref-type="fig" rid="fig_001">Fig. 1</xref><fig orientation="portrait" fig-type="figure" id="fig_001" position="float"><label>Fig. 1.</label><caption><p> Movement duration. Solid line: the target waveform, Dotted line: the waveform of
executed movement. (Duration1− Duration2)= the error of movement duration</p></caption><graphic xlink:href="jpts-26-731-g001"></graphic></fig>). The target movement duration was 0.8 s. The error in peak timing was derived from
the difference on the horizontal axis between the peak of the target acceleration waveform
and the peak of the measured waveform (<xref ref-type="fig" rid="fig_002">Fig.
2</xref><fig orientation="portrait" fig-type="figure" id="fig_002" position="float"><label>Fig. 2.</label><caption><p> Peak timing and strength. Solid line: the target waveform, Dotted line: the
waveform of executed movement. x1+x2= the error of peak strength. y1+y2= the error
of peak timing</p></caption><graphic xlink:href="jpts-26-731-g002"></graphic></fig>). The error in peak strength was the difference in length on the vertical axis
between the peak of the target acceleration waveform and the peak of the measured waveform
(<xref ref-type="fig" rid="fig_002">Fig. 2</xref>).</p><p>In this research, the motion of the task was fast, and it was comparatively difficult to
understand the feedback; therefore, modification of movement during each trial may have
been too difficult in the concurrent feedback group. In this group, no discontinuous
waveforms were modified in any trial; therefore, modification of movement on the basis of
feedback information may have practically occurred after the 2nd trial of each block.
Therefore, the second, third, fourth, fifth, and sixth trials of each block were analyzed.
In addition, the results from block 1 were excluded from the analysis because the terminal
feedback group only received the effect of feedback beginning with block 2. Blocks 2 to 10
were divided into 3 sessions. Statistical analyses were conducted using the SPSS ver. 20
software (SPSS Statistics, IBM Corp., Armonk, NY, USA) for Windows. The design for the
analysis of the test and acquisition data was a 2 × 5 (feedback × test and session) ANOVA
with repeated measures on the last factor. Post-ANOVA comparisons were performed using the
Tukey procedure for the factors of test and session and an independent samples t-test for
the factor of feedback.</p></sec></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>With regard to errors in movement duration, a significant main effect was found for test
and session and for feedback. A significant feedback × test and session interaction was also
found (<xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title> Errors in movement duration</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Pretest</th><th align="center" rowspan="1" colspan="1">First session</th><th align="center" rowspan="1" colspan="1">Midterm session*</th><th align="center" rowspan="1" colspan="1">Last session*</th><th align="center" rowspan="1" colspan="1">Retention test</th></tr></thead><tbody><tr><td align="left" valign="bottom" rowspan="1" colspan="1">Concurrent feedback</td><td align="center" rowspan="1" colspan="1">1.0 ± 0.3</td><td align="center" rowspan="1" colspan="1">0.5 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.3 ± 0.1</td><td align="center" rowspan="1" colspan="1">0.3 ± 0.1</td><td align="center" rowspan="1" colspan="1">0.5 ± 0.1</td></tr><tr><td align="left" valign="bottom" rowspan="1" colspan="1">Terminal feedback</td><td align="center" rowspan="1" colspan="1">1.0 ± 0.3</td><td align="center" rowspan="1" colspan="1">0.7 ± 0.3</td><td align="center" rowspan="1" colspan="1">0.6 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.6 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.5 ± 0.2</td></tr></tbody></table><table-wrap-foot><p>Unit: Seconds. Mean ± SD. *Significant difference between concurrent feedback and
terminal feedback (p < 0.05)</p></table-wrap-foot></table-wrap>). In the terminal feedback group, the Tukey procedure indicated that the
errors in movement duration committed during the midterm session, final session, and
retention test were significantly smaller than those committed during the pretest. In the
concurrent feedback group, the Tukey procedure indicated that the errors in movement
duration committed during the first session, midterm session, final session, and retention
test were significantly smaller than those committed during the pretest. Furthermore, an
independent samples t-test indicated that the errors in movement duration committed by the
concurrent feedback group were smaller than those committed by the terminal feedback group
during the midterm session and final session.</p><p>In terms of errors in peak timing, a significant main effect was found for test and session
and for feedback (<xref rid="tbl_002" ref-type="table">Table 2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title> Errors in peak timing</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Pretest</th><th align="center" rowspan="1" colspan="1">First session</th><th align="center" rowspan="1" colspan="1">Midterm session*</th><th align="center" rowspan="1" colspan="1">Last session</th><th align="center" rowspan="1" colspan="1">Retention test</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Concurrent feedback</td><td align="center" rowspan="1" colspan="1">0.8 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.3 ± 0.1</td><td align="center" rowspan="1" colspan="1">0.2 ± 0.1</td><td align="center" rowspan="1" colspan="1">0.2 ± 0.0</td><td align="center" rowspan="1" colspan="1">0.4 ± 0.2</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Terminal feedback</td><td align="center" rowspan="1" colspan="1">0.7 ± 0.4</td><td align="center" rowspan="1" colspan="1">0.6 ± 0.3</td><td align="center" rowspan="1" colspan="1">0.4 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.3 ± 0.2</td><td align="center" rowspan="1" colspan="1">0.4 ± 0.2</td></tr></tbody></table><table-wrap-foot><p>Unit: seconds. Mean ± SD. *Significant difference between concurrent feedback and
terminal feedback (p < 0.05)</p></table-wrap-foot></table-wrap>). In the concurrent feedback group, the Tukey procedure indicated that errors
in peak timing committed during the first session, midterm session, final session, and
retention test were significantly smaller than those committed during the pretest. In the
terminal feedback group, these differences were not significant. Furthermore, an independent
samples t-test indicated that the errors in peak timing committed by the concurrent feedback
group were smaller than those committed by the terminal feedback group during the midterm
session.</p><p>In terms of errors in peak strength, a significant main effect for test and session was
found (<xref rid="tbl_003" ref-type="table">Table 3</xref><table-wrap id="tbl_003" orientation="portrait" position="float"><label>Table 3.</label><caption><title> Errors in peak strength</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Pretest</th><th align="center" rowspan="1" colspan="1">First session</th><th align="center" rowspan="1" colspan="1">Midterm session</th><th align="center" rowspan="1" colspan="1">Last session</th><th align="center" rowspan="1" colspan="1">Retention test</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Concurrent feedback</td><td align="center" rowspan="1" colspan="1">28.3 ± 6.3</td><td align="center" rowspan="1" colspan="1">17.7 ± 2.3</td><td align="center" rowspan="1" colspan="1">12.8 ± 8</td><td align="center" rowspan="1" colspan="1">9.3 ± 4.1</td><td align="center" rowspan="1" colspan="1">13.1 ± 6.9</td></tr><tr><td align="left" rowspan="1" colspan="1">Terminal feedback</td><td align="center" rowspan="1" colspan="1">26.7 ± 7.3</td><td align="center" rowspan="1" colspan="1">20.8 ± 8.4</td><td align="center" rowspan="1" colspan="1">18.8 ± 9.0</td><td align="center" rowspan="1" colspan="1">14.5 ± 6.6</td><td align="center" rowspan="1" colspan="1">14.4 ± 9.3</td></tr></tbody></table><table-wrap-foot><p>Unit: mm. Mean ± SD.</p></table-wrap-foot></table-wrap>). The Tukey procedure indicated that errors in peak strength committed during
the first session, midterm session, final session, and retention test were significantly
smaller than those committed during the pretest.</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>The purpose of this study was to test the learning effects of inaccessible visual feedback
used either concurrently or terminally, focusing on aspects of movement. We focused
attention on aspects of the acceleration waveform. Furthermore, we made visual feedback
inaccessible, compared with muscular strength and position of the limbs commonly used in
previous studies, by visualizing acceleration of the right wrist. It is commonly believed
that no proprioceptive organ for the acceleration of limb motion exists. McCloskey<xref rid="r10" ref-type="bibr">10</xref><sup>)</sup> reported that intramuscular
mechanoreceptors receive sensation of positions, spindles of muscles, passive and voluntary
motion. Acceleration is most likely derived from these sensations, complemented by
sensations from the joints and skin. Therefore, the concurrent feedback used in this study
may be more inaccessible than that used in a number of previous studies.</p><p>The results of our study on the error in movement duration showed that changes in the
performance of the terminal feedback group during the acquisition sessions occurred later
than changes in the performance of the concurrent feedback group. This is similar to results
reported in a number of previous studies. However, in terms of motor learning, the
concurrent feedback group showed a learning achievement equivalent to that shown by the
terminal feedback group, a result different from that in a number of previous studies. With
regard to the results of our study on the errors in peak timing, there was no change in
performance; therefore, motor learning did not occur. Finally, the results of our study on
the error in peak strength showed that the change in performance during the acquisition
sessions and motor learning occurred equally in both groups. However, contrary to previous
studies, the performance of the concurrent feedback group did not change immediately during
the acquisition sessions.</p><p>These results indicate that the change in performance of the concurrent feedback group
during the acquisition sessions either equaled or surpassed the change in performance of the
terminal feedback group and that the motor learning of the concurrent feedback group equaled
that of the terminal feedback group. Furthermore, the concurrent feedback group improved its
performance at a stage in which the performance of the terminal feedback group was not
adequately improved. In addition, contrary to previous studies, motor learning occurred in
the concurrent feedback group.</p><p>The differences in outcome between this study and previous studies are thought to be due to
the fact that the feedback used in this study was information about acceleration of
movement. Hirata<xref rid="r11" ref-type="bibr">11</xref><sup>)</sup> performed an
experiment relevant to concurrent feedback using a computer program having the function of a
prism. A prism is a lens modifying visual information with a regularity that reverses
front–back or horizontal direction. The results suggested that the effects of the prism
remained during the retention test, even if feedback was not provided. In terms of this
study, it is thought that the acceleration of limb movement is information that is more
inaccessible than other sensations of movement, such as muscular strength and position of
the limbs. Therefore, probing the relationships between target acceleration and movement may
well achieve the same effect as a prism. Additionally, for the procedure, the concurrent
feedback group and the terminal feedback group have effects of 100% and summary feedback
respectively. One hundred percent feedback is what was provided to a learner after each
trial. On the other hand, summary feedback is what was provided to a learner in the block
after each set of practice. In the previous study comparing 100% to terminal feedback,
summary feedback was more detrimental for immediate performance, but more beneficial for the
long-term retention of motor skills compared with 100% terminal feedback<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup>. A factor other than feedback timing may
have effects on the results of this research, but the concurrent feedback having effects of
100% feedback showed learning achievement equivalent to that of the terminal feedback group
having effects of summary feedback. Thus, the learning achievement of the concurrent
feedback group might be an improvement.</p><p>The present study tested the effects of inaccessible feedback on motor learning. Each
parameter reflected a different aspect of movement. The effect of concurrent feedback that
immediately improves performance during practice is strong and remains relatively intact.
Furthermore, concurrent feedback works effectively for motor learning. The results suggest
that concurrent feedback comprised of inaccessible visual information works effectively for
motor learning as well as performance during practice. In the clinical setting, during the
practice of continuous skills such as walking, where it is difficult to decrease the
frequency of feedback, therapists can occasionally ask the patient to probe the relationship
between feedback and motion using visual concurrent feedback and systematic modification of
the visual information. In doing so, dependency on patient feedback may decrease and
effective motor learning may take place. In this way, it is necessary to adjust
accessibility according to the skill level of patients when concurrent feedback is used. The
advantages of guidance that improves performance immediately during practice are obtained,
the negative effects of dependency on visual information are suppressed, and motor learning
occurs effectively in a short period of time.</p><p>However, the limitation of this research is that the optimal degree of accessibility
remains uncertain. Visual information in this research was supposedly more inaccessible than
that in previous studies; however, there is no method of determining the degree of
accessibility of the visual feedback used in this research. Therefore, further experiments
are necessary to quantify the degree of accessibility of visual feedback.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group><name><surname>Smyth</surname><given-names>MM</given-names></name></person-group>: <article-title>Attention to visual feedback in motor
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