Concurrent Augmented Feedback Research Articles

Computerized Virtual Reality Simulation in Preclinical Dentistry: Can a Computerized Simulator Replace the Conventional Phantom Heads and Human Instruction?

In preclinical dental education, the acquisition of clinical, technical skills, and the transfer of these skills to the clinic are paramount. Phantom heads provide an efficient way to teach preclinical students dental procedures safely while increasing their dexterity skills considerably. Modern computerized phantom head training units incorporate features of virtual reality technology and the ability to offer concurrent augmented feedback. The aims of this review were to examine and evaluate the dental literature for evidence supporting their use and to discuss the role of augmented feedback versus the facilitator's instruction. Adjunctive training in these units seems to enhance student's learning and skill acquisition and reduce the required faculty supervision time. However, the virtual augmented feedback cannot be used as the sole method of feedback, and the facilitator's input is still critical. Well-powered longitudinal randomized trials exploring the impact of these units on student's clinical performance and issues of cost-effectiveness are warranted.

Can augmented feedback facilitate learning a reactive balance task among older adults?

While concurrent augmented visual feedback of the center of pressure (COP) or center of gravity (COG) can improve quiet standing balance control, it is not known whether such feedback improves reactive balance control. Additionally, it is not known whether feedback of the COP or COG is superior. This study aimed to determine whether (1) concurrent augmented feedback can improve reactive balance control, and (2) feedback of the COP or COG is more effective. Forty-eight healthy older adults (60-75years old) were randomly allocated to one of three groups: feedback of the COP, feedback of the COG, or no feedback. The task was to maintain standing while experiencing 30s of continuous pseudo-random perturbations delivered by a moving platform. Participants completed 25 trials with or without feedback (acquisition), immediately followed by 5 trials without feedback (immediate transfer); 5 trials without feedback were completed after a 24-h delay (delayed transfer). The root mean square error (RMSE) of COP-COG, electrodermal level, and co-contraction index were compared between the groups and over time. All three groups reduced RMSE and co-contraction index from the start of the acquisition to the transfer tests, and there were no significant between-group differences in RMSE or co-contraction on the transfer tests. Therefore, all three groups learned the task equally well, and improved balance was achieved with practice via a more efficient control strategy. The two feedback groups reduced electrodermal level with practice, but the no-feedback group did not, suggesting that feedback may help to reduce anxiety.

Transposing musical skill: sonification of movement as concurrent augmented feedback enhances learning in a bimanual task

Concurrent feedback provided during acquisition can enhance performance of novel tasks. The ‘guidance hypothesis’ predicts that feedback provision leads to dependence and poor performance in its absence. However, appropriately structured feedback information provided through sound (‘sonification’) may not be subject to this effect. We test this directly using a rhythmic bimanual shape-tracing task in which participants learned to move at a 4:3 timing ratio. Sonification of movement and demonstration was compared to two other learning conditions: (1) Sonification of task demonstration alone and (2) completely silent practice (control). Sonification of movement emerged as the most effective form of practice, reaching significantly lower error scores than control. Sonification of solely the demonstration, which was expected to benefit participants by perceptually unifying task requirements, did not lead to better performance than control. Good performance was maintained by participants in the Sonification condition in an immediate retention test without feedback, indicating that the use of this feedback can overcome the guidance effect. On a 24-h retention test, performance had declined and was equal between groups. We argue that this and similar findings in the feedback literature are best explained by an ecological approach to motor skill learning which places available perceptual information at the highest level of importance.

Bimanual Coordination Learning with Different Augmented Feedback Modalities and Information Types.

Previous studies have shown that bimanual coordination learning is more resistant to the removal of augmented feedback when acquired with auditory than with visual channel. However, it is unclear whether this differential “guidance effect” between feedback modalities is due to enhanced sensorimotor integration via the non-dominant auditory channel or strengthened linkage to kinesthetic information under rhythmic input. The current study aimed to examine how modalities (visual vs. auditory) and information types (continuous visuospatial vs. discrete rhythmic) of concurrent augmented feedback influence bimanual coordination learning. Participants either learned a 90°-out-of-phase pattern for three consecutive days with Lissajous feedback indicating the integrated position of both arms, or with visual or auditory rhythmic feedback reflecting the relative timing of the movement. The results showed diverse performance change after practice when the feedback was removed between Lissajous and the other two rhythmic groups, indicating that the guidance effect may be modulated by the type of information provided during practice. Moreover, significant performance improvement in the dual-task condition where the irregular rhythm counting task was applied as a secondary task also suggested that lower involvement of conscious control may result in better performance in bimanual coordination.

Benefits of Crank Moment Sonification in Cycling

In sports, the provision of augmented feedback is an important means to accelerate learning of new movements. Traditionally, concurrent augmented feedback has been provided verbally or visually. However, more recent studies have shown sonification of data during the movement, i.e. the mapping of a measured variable to parameter of sound, can be very effective to learn temporal aspects of a movement or movement patterns. In this pilot study, it was investigated if learning of complex pushing-pulling action applied to clipless pedals of a cycling ergometer can be enhanced by sonification of the crank moment. Three novice and three experienced cyclists were invited to train a reference crank moment pattern for two consecutive days (a total of twelve training sessions of 60 s each). However, in contrast to the results found in studies on rowing, the applied sonification did not enhance learning compared to visual and verbal instruction only. The lack of learning might be due to an inappropriate sonification design, short training sessions or the high task complexity. Extended studies are needed to draw more significant conclusions.

Sonification as Concurrent Augmented Feedback for Motor Skill Learning and the Importance of Mapping Design

There is a whole body of research that provides evidence that the motor system plays a crucial role in controlling as well as perceiving movements. So far a lot of evidence for the interaction of action and perception derives from studies in the visual domain. However, up to now not much is known about the role of acoustic information. The focus of this review is to provide an overview regarding the role of the motor system and auditory sense during action perception and motor control. Recent theories and studies that discuss the interaction of perception and action will be reviewed with an emphasis on the use of acoustic information. Empirical evidence derived from behavioral as well as neuroscience research using simple as well as whole-body movements will be provided. Additionally, we will provide perspectives regarding future research questions to bring forward our understanding of the role of acoustic information in the control and perception of actions and its underlying mechanisms.

Sonification and haptic feedback in addition to visual feedback enhances complex motor task learning.

Concurrent augmented feedback has been shown to be less effective for learning simple motor tasks than for complex tasks. However, as mostly artificial tasks have been investigated, transfer of results to tasks in sports and rehabilitation remains unknown. Therefore, in this study, the effect of different concurrent feedback was evaluated in trunk-arm rowing. It was then investigated whether multimodal audiovisual and visuohaptic feedback are more effective for learning than visual feedback only. Naïve subjects (N = 24) trained in three groups on a highly realistic virtual reality-based rowing simulator. In the visual feedback group, the subject's oar was superimposed to the target oar, which continuously became more transparent when the deviation between the oars decreased. Moreover, a trace of the subject's trajectory emerged if deviations exceeded a threshold. The audiovisual feedback group trained with oar movement sonification in addition to visual feedback to facilitate learning of the velocity profile. In the visuohaptic group, the oar movement was inhibited by path deviation-dependent braking forces to enhance learning of spatial aspects. All groups significantly decreased the spatial error (tendency in visual group) and velocity error from baseline to the retention tests. Audiovisual feedback fostered learning of the velocity profile significantly more than visuohaptic feedback. The study revealed that well-designed concurrent feedback fosters complex task learning, especially if the advantages of different modalities are exploited. Further studies should analyze the impact of within-feedback design parameters and the transferability of the results to other tasks in sports and rehabilitation.

Training Femoral Neck Screw Insertion Skills to Surgical Trainees

: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.

Visual and Auditory Augmented Concurrent Feedback in a Complex Motor Task

In general, concurrent augmented feedback has been shown to effectively enhance learning in complex motor tasks. However, to optimize technical systems that are intended to reinforce motor learning, a systematic evaluation of different augmented feedback designs is required. Until now, mainly visual augmented feedback has been applied to enhance learning of complex motor tasks. Since most complex motor tasks are mastered in response to information visually perceived, providing augmented concurrent feedback in a visual manner may overload the capacities of visual perception and cognitive processing. Thus, the aim of this work was to evaluate the practicability of auditory feedback designs supporting a three-dimensional rowing-type movement in comparison with visual feedback designs. We term a feedback design practical if the provided information can easily be perceived and interpreted, and immediately be used to support the movement. In a first experiment, it became evident that participants could interpret three-dimensional auditory feedback designs based on stereo balance, pitch, timbre, and/or volume. Eleven of 12 participants were able to follow the different target movements using auditory feedback designs as accurately as with a very abstract visual feedback design. Visual designs based on superposition of actual and target oar orientation led to the most accurate performance. Considering the first experimental results, the feedback designs were further developed and again evaluated. It became evident that a permanent visual display of the target trajectories could further enhance movement accuracy. Moreover, results indicated that the practicability of the auditory designs depends on the polarity of the mapping functions. In general, both visual and auditory concurrent feedback designs were practical to immediately support multidimensional movement. In a next step, the effectiveness to enhance motor learning will be systematically evaluated.

Visual and auditory augmented concurrent feedback in a complex motor task

In general, concurrent augmented feedback has been shown to effectively enhance learning in complex motor tasks. However, to optimize technical systems that are intended to reinforce motor learning...

A virtual trainer concept for robot-assisted human motor learning in rowing

Keeping the attention level and observing multiple physiological and biomechanical variables at the same time at high precision is very challenging for human trainers. Concurrent augmented feedback, which is suggested to enhance motor learning in complex motor tasks, can also hardly be provided by a human trainer. Thus, in this paper, a concept for a virtual trainer is presented that may overcome the limits of a human trainer. The intended virtual trainer will be implemented in a CAVE providing auditory, visual and haptic cues. As a first application, the virtual trainer will be used in a realistic scenario for sweep rowing. To provide individual feedback to each rower, the virtual trainer quantifies errors and provides concurrent auditory, visual, and haptic feedback. The concurrent feedback will be adapted according to the actual performance, individual maximal rowing velocity, and the athlete’s individual perception.

The Effect of Computer Navigation on Trainee Learning of Surgical Skills

While computer-assisted orthopaedic surgery technology may facilitate performance and learning in the expert, its effects on the trainee are unclear. Motor learning theory suggests that, while the real-time feedback provided by computer-assisted orthopaedic surgery should improve performance, it may be detrimental to learning. The purpose of this study was to assess the effects of computer-assisted orthopaedic surgery on the learning of surgical skills by trainees. Forty-five participants were randomized to one of three training groups-conventional training, computer navigation, or knowledge of results-in which they learned technical skills related to total hip replacement. Outcomes were assessed in a pretest session and in ten-minute and six-week retention and transfer tests. All groups demonstrated improved accuracy and precision in the determination of the abduction angle and the version angle of the acetabular cups during training (p < 0.001). The computer navigation group demonstrated significantly better accuracy and precision in early training (p < 0.05) and better precision throughout training (p < 0.05). No significant degradation in performance was observed between the immediate and the delayed testing for any group, suggesting that there was task learning in all groups with no negative effects of the tested training modalities on learning. In this study, the concurrent augmented feedback provided by computer-assisted orthopaedic surgery resulted in improved early performance and equivalent learning. While we did not observe a compromise in learning, further investigation is required to ensure that computer-assisted orthopaedic surgery does not compromise trainee learning in more complex tasks.

25 Effects of concurrent augmented feedback and discovery learning on novice rowers

25 Effects of concurrent augmented feedback and discovery learning on novice rowers

Concurrent Augmented Feedback and Isometric Force Generation during Familiar and Unfamiliar Muscle Movements

To evaluate the effect of concurrent augmented feedback on isometric force output during familiar and unfamiliar muscle movements, 18 men and 21 women, 18 to 23 years of age, completed two isometric exercises: flexion of the thumb (a familiar muscle movement) and abduction of the fifth digit (an unfamiliar movement). The exercises consisted of 10 maximum voluntary isometric contractions lasting 10 s each and separated by 10-s intertrial rest intervals. Concurrent visual feedback was provided during alternate contractions. The order of exercises and trials for feedback was randomly assigned and balanced over subjects. Peak force output during abduction of the fifth digit was significantly (p less than or equal to .01) greater with (4.4 +/- 0.29 kg) than without feedback (4.1 +/- 0.26 kg). Feedback did not influence (p greater than .05) peak force output during thumb flexion (23.2 +/- 1.09 kg vs 22.5 +/- 1.05 kg). Muscular fatigue was more pronounced during thumb flexion without feedback (18.4 +/- 1.17%) than when feedback was provided (11.8 +/- 1.36%). These data suggest that fatigue may increase the effect of feedback on force generation during familiar muscular movements. To obtain maximal isometric force measures during strength testing, augmented feedback should be provided.