Practice Difficulty Research Articles

Robotic task specific training for upper limb neurorehabilitation: a mixed methods feasibility trial reporting achievable dose.

Robotic devices for upper-limb neurorehabilitation allow an increase in intensity of practice, often relying on video game-based training strategies with limited capacity to individualise training and integrate functional training. This study shows the development of a robotic Task Specific Training (TST) protocol and evaluate the achieved dose. Mixed-method study. A 3D robotic device for the upper limb, was made available to therapists for use during neurorehabilitation sessions. A first phase allowed clinicians to define a dedicated session protocol for TST. In a second phase the protocol was applied and the achieved dose was measured. First phase (N = 5): a specific protocol, using deweighting for assessment, followed by customised passive movements and then active movement practice was developed. Second phase: the protocol was successfully applied with all participants (N = 10). Intervention duration: 4.5 ± 0.8 weeks, session frequency: 1.4 ± 0.2sessions/week, session length: 42 ± 9mins, session density: 39 ± 13%, intensity: 214 ± 84 movements/session, difficulty: dn = 0.77 ± 0.1 (normalised reaching distance) and Ɵ = 6.3 ± 23° (transverse reaching angle). Sessions' density and intensity were consistent across participants but clear differences of difficulty were observed. No changes in metrics were observed over the intervention. Robotic systems can support TST with high therapy intensity by modulating the practice difficulty to participants' needs and capabilities.

ESP Students’ Self-Reflection on English Speaking Anxiety: An Investigation on Gender’s Perspectives

Speaking in a foreign language becomes a challenge for many students, including ESP students. In ESP class, the students learn English for specific context related to the professional fields. Thus, having anxiety in the English class could affect their future performance in their future job. The current study seeks for insight on identifying speaking anxiety awareness among ESP students through self-reflection. The students are required to describe on of the tourist attraction in front of the class and have a self-reflection on their performance. With the total of 15 male and 15 female students, the study applied a qualitative study with case study design. The data were collected through classroom observation, questionnaires, and interview. The data were triangulated and analyzed through data condensation, data display, and conclusion drawing. As a result, the male students tend to have speaking anxiety than the female students. Based on the male students’ perceptions, pronunciation difficulty, lack of grammar comprehension, lack of vocabulary mastery, and lack of confidence become the cause of the speaking anxiety, while the female students have lack of practice, nervousness, and pronunciation difficulty as the problem. Thus, it is suggested the English lecturer to provide more practice on language system, such as grammar, vocabulary, and pronunciation to shape students’ comprehensibility on English. Also, the ESP students need to have extensive speaking practice to boost their confidence in speaking in front of the class.

Development and psychometric testing of the nursing practice difficulty scale for nurses caring for patients with dementia in general hospitals

ObjectiveAs aging in the Chinese population increases, the hospitalization rates of patients with dementia have also risen. Research on the difficulties of nurses who care for patients with dementia in Chinese general hospitals is limited. This study aimed to develop a scale to measure the difficulties nurses face in nursing patients with dementia in Chinese general hospitals and to verify its reliability and validity. MethodsGuided by the biopsychosocial theory, an initial scale was created through a literature review, qualitative interviews, and expert consultation. A web-based survey for psychometric testing was conducted with 394 nurses from 11 general hospitals during September to November 2021. Validity was verified using content validity, exploratory factor analysis, the known-groups method, and concurrent validity. Cronbach’s α coefficient and split-half reliability were used to assess reliability. ResultsThe Item-level Content Validity Index was 0.833–1.000. The Scale-level Content Validity Index was 0.929. Twenty-one items with four factors were extracted from the item analysis and exploratory factor analysis. According to the known-groups method, the difficulty of the experienced group and the group with training experience was significantly lower than that of the less experienced group and the group without training experience. Based on external standards, the correlation coefficient was 0.387 with the Nursing Job Stress Scale and −0.239 with the Dementia Care Attitude Scale. Cronbach’s α coefficient for each factor ranged from 0.889 to 0.905, and the total was 0.959. The split-half reliability for each factor ranged from 0.814 to 0.894, and the total was 0.911. ConclusionThis study discovered a four-factor structure related to the difficulty scale of dementia nursing practice, and the scale’s reliability and validity were confirmed. The scale can be utilized to assess the difficulty of dementia nursing practice in general hospitals and may be employed in future research to improve dementia nursing practices.

Research on teaching reform and practice of architectural design courses in colleges and universities based on big data analysis

Abstract In this paper, we carry out an innovative reform of architectural design professional courses in colleges and universities, focusing on improving the effect of practical teaching by combining knowledge maps and new technological means. Aiming at the problems of long practice cycle, high cost and difficulty verifying the effect in traditional teaching, it promotes the transformation of teaching mode to immersion, interaction and autonomy. The article discusses the application of knowledge maps in optimizing the course content, improving the effect of teaching organization, such as the association model of knowledge elements and learning resources, and calculating the ontological conceptual similarity of knowledge nodes. Meanwhile, the introduction of augmented reality technology and the Analysis of the correlation between learning styles and academic performance highlight the critical role of technology in enhancing the efficiency and quality of learning. The difference in average grades before and after the teaching reform in the experimental class was significant, with the most enormous difference of 10.76 points in the second round of test results. The most significant improvement was observed in the knowledge part of the course, with an increase of 0.72, and in the practical part, with an increase of 0.39. The students’ architectural design and practice skills were significantly improved in all dimensions. The teaching reform program proposed in this paper effectively enhances the architectural design program’s teaching quality and students’ practical ability.

Teaching vulval anatomy in the twenty-first century: The Australian experience.

Anatomy has often been regarded as an immutable discipline where everything that needs to be known is known. This article focuses on the teaching of vulval anatomy, the diversification of gender in contemporary society, and the increasing popularity of the Female Genital Cosmetic Surgery (FGCS) industry. The binary language and singular structural arrangements contained in lectures and chapters on "female genital anatomy" are nowadays rendered exclusive and incomplete. A series of 31 semi-structured interviews with Australian anatomy teachers identified barriers and facilitators for teaching vulval anatomy to contemporary student cohorts. Barriers included lack of connection to contemporary clinical practice, time and technical difficulty involved in regularly updating online presentations, the crowded curriculum, personal sensitivity to teaching vulval anatomy, and reluctance to introduce inclusive terminology. Facilitators included lived experience, regular use of social media, and institutional initiatives toward inclusivity including the support of queer colleagues.

운동기술 학습 및 동기 수준에 있어 혼합된 자기통제 연습의 효과

The purpose of this study is to determine whether a mixed design method of task related(amount of practice and task difficulty) and indirectly-related(color) factors using self-controlled practice affects the acquisition and learning motor skills and to analyze the participation motivation on task between group. In Experiment 1, the sport stacking task was used, and APCO, AP, CO, and C groups were used as a mixture of the amount of practice and choice of color. Performance time was used as the dependent variable. As a result, the APCO group showed a better learning effect than the C group and the AP group. In Experiment 2, the baseball throwing task was used, and the DICO, CO, DI, and C groups were used as a mixture of distance difficulty and choice of color. Performance score was used as the dependent variable. As a result, the DICO group showed a better learning effect than the CO, DI, and C groups. The participation motivation on task test used to measure psychological variables through self-control practice did not show a valid difference in Experiment 1 and Experiment 2. The effect of the mixed design method through self-control practice in the autonomy support environment was found to be applicable to various motor skills.

Prediction of binge-eating disorder based on symptoms of depression, emotion regulation, and psychological flexibility in women with type 2 diabetes

Introduction: Type 2 diabetes affects more than 90% of diabetic patients, which in addition to physical complications, is associated with psychological problems, such as binge-eating disorder. Diagnosing and treating binge-eating disorder can improve many comorbidities and type 2 diabetes. Therefore, this study aims to predict binge-eating disorder in women with type 2 diabetes based on symptoms of depression, emotion regulation, and psychological flexibility. Methods: The present descriptive-correlational study was conducted on 102 people with type 2 diabetes through the cooperation of centers related to diabetes and using social media in a targeted manner. Research tools included the Gormally et al. (1982) binge-eating, the Beck et al. (1996) depression, the Bond et al. (2011) acceptance and the practice, and Graz and Roemer (2004) difficulty in regulation of emotion questionnaires. The data were analyzed by SPSS software version 22 using Pearson correlation coefficient and multiple regression. Results: The results show that the symptoms of depression, emotion regulation, and psychological flexibility could significantly (p <0.001) predict binge-eating disorder. Among the predictor variables, depression symptoms with a prediction of 33% of the variance of binge-eating disorder, was the best predictor of the disorder in people with type 2 diabetes (p <0.001). Conclusion: It can be concluded that early detection and treatment of depression symptoms in people with type 2 diabetes, can reduce binge-eating disorder in these people.

Continuous and Intermittent Artificial Gravity as a Countermeasure to the Cognitive Effects of 60 Days of Head-Down Tilt Bed Rest.

Environmental and psychological stressors can adversely affect astronaut cognitive performance in space. This study used a 6° head-down tilt bed rest (HDBR) paradigm to simulate some of the physiologic changes induced by microgravity. Twenty-four participants (mean ± SD age 33.3 ± 9.2 years, N = 16 men) spent 60 consecutive days in strict HDBR. They were studied in three groups of eight subjects each. One group served as Control, whereas the other two groups received either a continuous or intermittent artificial gravity (AG) countermeasure of 30 min centrifugation daily (1 g acceleration at the center of mass and 2 g at the feet). Participants performed all 10 tests of NASA’s Cognition battery and a brief alertness and mood survey repeatedly before, during, and after the HDBR period. Test scores were adjusted for practice and stimulus set difficulty effects. A modest but statistically significant slowing across a range of cognitive domains was found in all three groups during HDBR compared to baseline, most consistently for sensorimotor speed, whereas accuracy was unaffected. These changes were observed early during HDBR and did not further worsen or improve with increasing time in HDBR, except for emotion recognition performance. With increasing time spent in HDBR, participants required longer time to decide which facial emotion was expressed. They were also more likely to select categories with negative valence over categories with neutral or positive valence. Except for workload, which was rated lower in the Control group, continuous or intermittent AG did not modify the effect of HDBR on cognitive performance or subjective responses. Participants expressed several negative survey responses during HDBR relative to baseline, and some of the responses further deteriorated during recovery, which highlights the importance of adequate medical and psychological support during extended duration HDBR studies. In conclusion, 60 days of HDBR were associated with moderate cognitive slowing and changes in emotion recognition performance, but these effects were not mitigated by either continuous or intermittent exposure to AG for 30 min daily.

Native language inhibition predicts more successful second language learning: Evidence of two ERP pathways during learning

How some individuals succeed in learning a second language as adults is still an unsolved question in cognitive neuroscience. At the brain level, adults' electrophysiological responses to input in a second language may differ after completing different types of training. However, there is limited understanding of what neural pathways are activated as learning unfolds, and which patterns of activation lead to successful learning. Using brain event-related potentials, this study explored whether individual brain responses to practice difficulty during second language learning predict learning outcomes. English-speaking learners of Spanish practiced completing newly learned phrases in their second language. For some learners, all the choices presented during practice were “easy” because non-target choices were unrelated distractors. In the more “difficult” practice mode, however, learners had to avoid choosing a competing word that would be acceptable based on their native language, but not in the second language being learned. Performance during practice was similar in both groups of learners. Critically, divergence in event-related potentials indicated alternative strategies to practice, based on the level of difficulty. At the group level, learners completing the easier practice revealed increased monitoring when making responses; in the difficult condition, learners showed inhibition of their native language (i.e., an N400 for phrases congruent with the native language) to avoid interference during word selection. Individual brain responses indexing the degree of native language inhibition predicted learning rates in tests.

Computer-assisted challenge point intervention for residual speech errors.

This preliminary case series investigated the effects of biofeedback intervention for residual rhotic errors delivered within a modified challenge point framework. In the challenge point framework, practice difficulty is adaptively adjusted with the goal of enhancing generalization learning. This study more specifically evaluated the feasibility of a computer-mediated implementation of challenge point treatment for rhotic errors using a custom open-source software, the Challenge Point Program (CPP). Participants were five native English speakers, ages 7;3-15;5, who had established but not generalized correct rhotic production in previous treatment; overall treatment duration was flexible. Treatment incorporated either electropalatographic or visual-acoustic biofeedback and was structured by challenge point principles implemented using the CPP software. Participants were highly variable in the magnitude of generalization gains attained. However, the median overall effect size was 4.24, suggesting that participants' response in treatment tended to exceed the minimum value considered clinically significant. These findings provide preliminary evidence that computer-mediated implementation of the challenge point framework can be effective in producing generalization in some participants.

Coordination in a composite green-product supply chain under different power structures

PurposeThe purpose of this paper is to find the optimal power structure that drives green practices in the supply chain and coordinate the costs and benefits of green practices in supply chain under different power structures.Design/methodology/approachThis paper developed a supply chain of one supplier and one manufacturer, in which the supplier and the manufacturer are responsible for the “greening” of products. Then, the game theory modeling method is used to explore the influence of different power structures on green practices in the supply chain. Finally, the authors developed a green cost-sharing contract made by the leader; regarding optimal supply chain profits and green performance, the proposed contracts and the non-coordination situation are compared and tested by a numerical simulation.FindingsThe increase of the green practice difficulty of any member in the supply chain will not only reduce the greenness of products at that stage but will also reduce the green investment of the supply chain partner. Becoming a channel leader does not necessarily mean being more profitable than being a follower, and when the green practice difficulty of the leader is less than a certain threshold, ceding dominant power to the follower may benefit both sides. A green cost-sharing contract made by the leader is not necessarily beneficial to all enterprises.Originality/valueThis paper helps to better understand the role of the power relation in realizing the industry's green goals and helps decision-makers to achieve win-win cooperation by adjusting power relations and optimizing green cost-sharing contracts.

Learner-Controlled Practice Difficulty and Task Exploration in an Active-Learning Gaming Environment

Background. With the use of computer-based simulations and games becoming increasingly common in education and organizational contexts for delivering training and instruction, learners are being granted unprecedented control over their learning. This increase in learner control leaves large differences in how learners challenge themselves and explore their learning environments. Learners can benefit from task difficulty, an aspect of challenge, when they are neither overwhelmed nor underwhelmed. The purpose of the present lab study was to test a model of how encouraging learners to challenge themselves with greater task difficulty when practicing a video game could be a “double-edged sword” in terms of their skill-based learning. Method. Using a first-person shooter computer game as the criterion task, 120 undergraduate males were randomly assigned to one of two groups. Half of the participants were encouraged to practice at a difficulty level that matched their skill level, while the other half were encouraged to practice at a difficulty that greatly exceeded their skill. Exploratory behavior was reflected in the variety of weapons used. Results. Findings supported a model of inconsistent mediation predicting that difficulty encouragement instructions would lead to higher selected practice difficulty, which in turn would have positive direct effects on skill transfer yet negative indirect effects through exploratory behavior. Discussion. The present study demonstrated that encouraging learners to practice at high levels of task difficulty is a “double-edged sword.” Although high levels of task difficulty can help in the preparation for future difficulties, it can also undermine exploratory behavior which is an important aspect of the learning process. This research speaks to the potential of encouraging learners to practice under difficult conditions without undermining their learning.

P17 Participation in the Child and Adult Care Food Program (CACFP) Influences Nutrition-Related Practices of Child Care Settings in Nebraska

Background Federal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children. Objective Determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. Study Design, Settings, Participants Cross-sectional surveys were distributed to 3,014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2-5 years. Measureable Outcome/Analysis Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). Results The sample included 1,345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P Conclusion While participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommending mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding USDA.

Participation in the Child and Adult Care Food Program Influences Nutrition-Related Practices of Child Care Settings in Nebraska (P04-172-19)

ObjectivesFederal food assistance programs such as the Child and Adult Care Food program (CACFP) are designed to promote healthy dietary habits for young children; the present study will aim to determine how CACFP participation influences implementation of nutrition-related best practices and barriers in childcare settings. MethodsCross-sectional surveys were distributed to 3014 licensed childcare facilities in Nebraska in 2017 to collect provider-reported information on facility demographics, CACFP participation, and practices implemented in childcare settings serving children aged 2–5 years. Chi-square analysis was performed in SPSS to determine differences in best practice implementation, barriers, and difficulty level between those who do versus do not participate in the CACFP, stratified by childcare context (center-based versus family childcare home-based). ResultsThe sample included 1345 childcare programs (54.6% response rate); 86.8% participated in the CACFP, 21.7% were center-based, and 78.3% were home-based. Childcare programs who participated in the CACFP were more likely to serve foods and beverages according to best practices across both contexts; practices included serving fruit at least one time, serving vegetables at least one time, and serving skim or 1% milk (P < 0.05 for all). In family childcare homes only, those who participated in the CACFP were more likely to role model eating healthy foods and serve meals family style (P < 0.05 for both). Across both contexts, those who participated in the CACFP were more likely to receive professional development on child nutrition (P < 0.01). ConclusionsWhile participation in the CACFP was related to higher prevalence of serving healthier food and beverages, few mealtime practices were affected. This could be attributed to CACFP regulations requiring participating childcare programs to serve nutritious food and beverages to children, but only recommend mealtime-related best practices. These findings could suggest that CACFP-related trainings should emphasize the importance of these practices with consideration of known provider-reported barriers. Funding SourcesThis work was supported by the US Department of Agriculture National Institute of Food and Agriculture and the Nebraska Agricultural Experiment Station.

Evidence-Based Practice: a survey of Brazilian physical therapists from the dermatology subdiscipline

BackgroundDermatology is a relatively new subdiscipline of physical therapy with growth potential. Therefore, it is important to identify whether professionals from this area have the knowledge and skills required to offer the best available service based on evidence-based practice. ObjectivesTo describe the self-reported behavior, knowledge, skills, opinion, and barriers related to the evidence-based practice of Brazilian physical therapists from the dermatology subdiscipline. MethodsAn adapted electronic questionnaire was sent by the Brazilian Association of Dermatology Physical Therapy via email to all registered members. The data were analyzed descriptively. ResultsThe response rate was 40.4% (101/250). Brazilian physical therapists from the dermatology subdiscipline reported that they update themselves equally through scientific papers and courses, and access preferentially databases that offer scientific papers in the Portuguese language. Respondents believe they have sufficient knowledge to use evidence-based practice, inform patients about treatment options and consider their choices in the decision-making process. However, there were inconsistencies in responses regarding the experience with evidence-based practice during undergraduate or postgraduate degree, as well as having discussions about evidence-based practice in the workplace. The barriers most frequently reported were difficulty to obtain full-text papers, lack of quality of the scientific papers, applicability of the findings into clinical practice, lack of evidence-based practice training and difficulty to understand the statistics. ConclusionBrazilian physical therapists from the dermatology subdiscipline have positive perceived behavior, believe that they have sufficient knowledge and skills, and have favorable opinion related to evidence-based practice. However, there are inconsistencies related to some aspects of knowledge and skills set.

Ergonomics in dentistry: experiences of the practice by dental students.

The aim of this study was to qualitatively evaluate the experiences of students enrolled in the last year of dentistry school with ergonomic practice. This is a qualitative, observational and cross-sectional study, with a non-probabilistic sample design. The sample comprised students enrolled in the last year of dentistry in Araraquara-UNESP (n = 29). The data were collected by means of open semi-structured and individual interviews, captured by a digital voice recorder. The students were interviewed in their own university at a time that was previously scheduled, and care was taken to provide a private and welcoming environment to carry out the interviews. A script containing questions related to practices in ergonomics was prepared at the university. Data analysis was carried out using the qualitative-quantitative Collective Subject Discourse technique with the aid of Qualiquantisoft® software program. It was found that more than half of the students (58.6%) believe that adopting an ergonomic posture is important to prevent future problems, pain and occupational diseases, and 62.1% of the students confirm having difficulties in adopting ergonomic postures due to the types of treatment required and the regions of the mouth being treated. The main reasons stated for the fact that their colleagues do not adopt ergonomic postures are lack of attention, practice and forgetfulness (44.8%) and difficulty in visualising the operatory field or the procedure performed (27.6%). It is possible to conclude that the students interviewed know ergonomic principles and their importance in occupational health. However, they found it difficult to put these principles into practice.

A method for automated control of belt velocity changes with an instrumented treadmill

Increased practice difficulty during asymmetrical split-belt treadmill rehabilitation has been shown to improve gait outcomes during retention and transfer tests. However, research in this area has been limited by manual treadmill operation. In the case of variable practice, which requires stride-by-stride changes to treadmill belt velocities, the treadmill control must be automated. This paper presents a method for automation of asymmetrical split-belt treadmill walking, and evaluates how well this method performs with regards to timing of gait events. One participant walked asymmetrically for 100 strides, where the non-dominant limb was driven at their self-selected walking speed, while the other limb was driven randomly on a stride-by-stride basis. In the control loop, the key factors to insure that the treadmill belt had accelerated to its new velocity safely during the swing phase were the sampling rate of the A/D converter, processing time within the controller software, and acceleration of the treadmill belt. The combination of these three factors resulted in a total control loop time during each swing phase that satisfied these requirements with a factor of safety that was greater than 4. Further, a polynomial fit indicated that belt acceleration was the largest contributor to changes in this total time. This approach appears to be safe and reliable for stride-by-stride adjustment of treadmill belt speed, making it suitable for future asymmetrical split-belt walking studies. Further, it can be incorporated into virtual reality rehabilitation paradigms that utilize split-belt treadmill walking.

Gradual training reduces practice difficulty while preserving motor learning of a novel locomotor task

Motor learning strategies that increase practice difficulty and the size of movement errors are thought to facilitate motor learning. In contrast to this, gradual training minimizes movement errors and reduces practice difficulty by incrementally introducing task requirements, yet remains as effective as sudden training and its large movement errors for learning novel reaching tasks. While attractive as a locomotor rehabilitation strategy, it remains unknown whether the efficacy of gradual training extends to learning locomotor tasks and their unique requirements. The influence of gradual vs. sudden training on learning a locomotor task, asymmetric split belt treadmill walking, was examined by assessing whole body sagittal plane kinematics during 24hour retention and transfer performance following either gradual or sudden training. Despite less difficult and less specific practice for the gradual cohort on day 1, gradual training resulted in equivalent motor learning of the novel locomotor task as sudden training when assessed by retention and transfer a day later. This suggests that large movement errors and increased practice difficulty may not be necessary for learning novel locomotor tasks. Further, gradual training may present a viable locomotor rehabilitation strategy avoiding large movement errors that could limit or impair improvements in locomotor performance.

Repeated retrieval practice and item difficulty: Does criterion learning eliminate item difficulty effects?

A wealth of previous research has established that retrieval practice promotes memory, particularly when retrieval is successful. Although successful retrieval promotes memory, it remains unclear whether successful retrieval promotes memory equally well for items of varying difficulty. Will easy items still outperform difficult items on a final test if all items have been correctly recalled equal numbers of times during practice? In two experiments, normatively difficult and easy Lithuanian-English word pairs were learned via test-restudy practice until each item had been correctly recalled a preassigned number of times (from 1 to 11 correct recalls). Despite equating the numbers of successful recalls during practice, performance on a delayed final cued-recall test was lower for difficult than for easy items. Experiment 2 was designed to diagnose whether the disadvantage for difficult items was due to deficits in cue memory, target memory, and/or associative memory. The results revealed a disadvantage for the difficult versus the easy items only on the associative recognition test, with no differences on cue recognition, and even an advantage on target recognition. Although successful retrieval enhanced memory for both difficult and easy items, equating retrieval success during practice did not eliminate normative item difficulty differences.

Learner-controlled practice difficulty in the training of a complex task: Cognitive and motivational mechanisms.

An inherent aspect of learner-controlled instructional environments is the ability of learners to affect the degree of difficulty faced during training. However, research has yet to examine how learner-controlled practice difficulty affects learning. Based on the notion of desirable difficulties (Bjork, 1994), this study examined the cognitive and motivational antecedents and outcomes of learner-controlled practice difficulty in relation to learning a complex task. Using a complex videogame involving both strong cognitive and psychomotor demands, 112 young adult males were given control over their practice difficulty, which was reflected in the complexity of the training task. Results show that general mental ability, prior experience, pre-training self-efficacy, and error encouragement were positively related to learner-controlled practice difficulty. In turn, practice difficulty was directly related to task knowledge and post-training performance, and it was related to adaptive performance through the mediating influences of task knowledge and post-training performance. In general, this study supports the notion that training difficulty operationalized in terms of task complexity is positively related to both knowledge and performance outcomes. Results are discussed with respect to the need for more research examining how task complexity and other forms of difficulty could be leveraged to advance learner-controlled instructional practices.