Cueing to Enhance Motor Learning and Transferability to Activities

Nicklaas Winkelman

LEARNING OBJECTIVES

After reading this chapter, you should be able to:

Understand why the attentional focus of external cues improves motor skill learning.
Understand how the constrained action hypothesis explains the effectiveness of external versus internal cues.
Understand the effect of attentional focus on the neuromuscular system in terms of velocity, strength, endurance, and force production accuracy.
Understand how to effectively cue a motor skill.

“How can you think and hit at the same time?

–YOGI BERRA

Introduction: Learning

Consider the following scenario. A patient comes into a physical therapy clinic to be seen for insidious knee pain. After an initial consultation, the therapist identifies that the patient consistently falls into a valgus knee position when walking and running, which is likely one of the root causes of the lingering knee pain. The therapist decides to spend the remaining sessions focused on correcting unwanted hip and knee motion. To remedy the faulty mechanics, the therapist emphasizes single-leg squatting control and improved running technique. Thus, each session comprises exercises designed to improve hip and knee control in the context of single-leg squatting and running. Over time, the therapist notices an interesting and troublesome trend. Although the patient makes progress during the therapy session, the improvements never seem to stick. For example, the therapist would provide cues such as “keep your knee aligned over your toe” or “keep your hip behind your heel” as the patient performs a single-leg squat. Although the patient fully understood the cues, and in fact seemed to benefit from the corrective feedback during the session, any improvements gained during the session seemingly dissolved, at least to some degree, between the time the patient left the clinic and returned for their next session. This discontinuity left the therapist puzzled, because they did not understand how an apparently stable improvement in technique could regress in a matter of days.

This scenario is one that coaches and therapists face on a consistent basis. However, the reasons underpinning this discontinuity between practice performance and the relative stability of performance over time are not always well understood. Often, if there are no observable improvements over time, especially as it relates to technique, then practitioners will seek to identify new exercises or drills that may be better suited to correct or enhance the movement of interest. Although the selection and variation of drills can be considered a viable option for the longterm development of a robust movement system, it does not address the root problem identified in the fictional scenario described above. Specifically, the scenario begs the question: “Why is it that an acute improvement in practice performance does not necessarily ensure the maintenance of this performance over time?”

To answer this question, it is important to discern the difference between practice performance and the stable expression of performance over time or learning. Soderstrom and Bjork^1(p176) describe this relationship by noting the following in a recent review:

Instruction should endeavor to facilitate learning, which refers to the relatively permanent changes in behavior or knowledge that support long-term retention and transfer. Such learning needs to be distinguished from performance, which refers to the temporary fluctuations in behavior or knowledge that can be observed and measured during or immediately after the acquisition process.

Thus, methods leading to acute performance improvement during practice may not lead to lasting improvements over time. For example, in a classic study by Shea and Morgan,² the researchers found that a blocked practice schedule (i.e., practicing a single motor skill repetitively for a number of trials) resulted in superior performance during acquisition compared with a random practice schedule (i.e., practicing multiple, related motor skills for a number of trials using an interwoven structure); however, the random practice schedule resulted in superior learning when assessed 10 days later. Thus, practice that is desirably difficult, although not always the best solution for acute performance, can lead to a form of learning that is both stable and transferable to related tasks.³ In describing one of the proposed hypotheses meant to explain this phenomenon, Kantak and Winstein^4(p225) state the following:

Random-order practice, characterized by the interspersing of the to-be-learned tasks, provides the learner with an opportunity to compare and contrast the tasks during the inter-trial interval. In contrast, when the same task is repeated as it is in blocked practice, the learner has limited opportunity for inter-task comparison. The inter-task comparison during random-order practice allows the learner to encode critical task-related information, and leads to a stronger and more elaborate memory representation.

Thus, by using a random practice schedule, the learner is forced to invest more cognitive resources in the to-be-learned skill, which results in stable learning at the expense of short-term performance.⁴ Moreover, from a practical context, very rarely in life or in sport are we given the option to repetitively express a skill; rather, skill expression is often random through the lens that movement emerges in relation to task demands and the environment with which the task is meant to be executed (e.g., a father having to pick up
a bag of groceries while holding his 6-month-old son or an athlete having to make a quick decision to pass or shoot when faced with a two-versus-one scenario in soccer). Therefore, a learning environment that is both desirably difficult and contextually relevant will lead to better residual performance when it counts.

Similar to practice design (i.e., blocked vs. random), instruction, feedback, and cueing have all been shown to differentially influence practice performance and long-term learning. For example, Wulf, Hoss, and Prinz (experiment 2)⁵ evaluated the effects of instruction on balance in a group of novices. An internal focus group (i.e., instruction directed toward the body) was asked to “keep their feet at the same height,” whereas an external focus group (i.e., instruction directed at the environment) was asked to “keep the red markers (on the balance platform) at the same height.” The results showed no difference between groups during practice; however, the external focus group outperformed the internal focus group during a delayed retention test where no instruction was provided. Thus, instruction that directs attention toward the environment or movement outcome (i.e., focus on the balance board itself), although no better than instruction that directs attention toward the body (i.e., focus on the feet) during practice, does result in a significant learning advantage when no additional instruction is given during a delayed retention test. Similar results have since been reported elsewhere.⁶^,⁷

The red thread connecting both of these examples (i.e., practice design and instructional design) is the differential use of attention. Specifically, Soderstrom and Bjork^1(p193) state the following about practice design:

As unintuitive as it may seem, the active cognitive processes engendered by confronting and resolving difficulties during acquisition serves to effectively link or entrench new information with knowledge that already exists in memory.

Thus, random practice design leads to an improved ability to direct attention toward task-relevant cues, because there is greater attentional demand required to retrieve the correct motor memory during random compared with blocked practice conditions. Although this process is implicitly driven, because there is no explicit instruction coming from a coach, for example, it still provides evidence that attention needs to be directed—by chance or by choice—at the most relevant cues that will lead to a stable expression of performance over time (i.e., learning).

Similarly, explicitly focusing attention externally, as opposed to internally, leads to improved practice performance and learning across a diversity of skills.⁸ Thus, Wulf, McNevin, and Shea^9(p1144) suggest that an internal focus “constrains the motor system by interfering with automatic motor control processes that would ‘normally’ regulate the movement.” Conversely, an external focus allows the “motor system to more naturally self-organize, unconstrained by the interference caused by conscious control attempts.” Therefore, focusing on the movement outcome allows the implicit motor system to control the movement process while being guided by the learner’s explicit intention or attentional focus.

In summary, there is a discontinuity between methods that lead to acute performance and those that lead to the stable expression of performance over time. This methodological disconnect is perpetuated by the fact that coaches, therapists, and athletes alike are often drawn toward intuitively selecting the wrong skill learning strategies (i.e., blocked practice and internal cues).¹^,¹⁰^,¹¹ Thus, it is important for those engaged in pedagogical pursuits (i.e., teaching, coaching, and therapy) to have a pragmatic understanding of methods associated with the optimization of motor skill learning. Because it is beyond the scope of this chapter to cover every motor learning method, the remaining sections will specifically expand upon the role of instruction and cueing as an explicit motor learning strategy.

Attentional Focus: Internal Versus External Cues

Had the therapist in the fictional scenario noted above been privy to the information shared thus far, they would now understand that their choice to use internal cues, as opposed to external cues, was likely one underpinning reason why the patient wasn’t retaining the apparent gains observed within each therapy session. However, they would also require more background information concerning the dissociable effects that emerge from internal and external focus cues, and they would likely want further practical insights into the effective application of external cues. Therefore, it is necessary to start at the beginning and discuss the role of attention, or attentional focus, and understand how the manipulation of attention can lead to vastly different outcomes from a motor skill performance standpoint.

The role of attention in motor skill learning¹²^,¹³ is a concept that has interested psychologists¹⁴ and motor
learning theorists¹⁵ for over a century. In his seminal book, William^14(p402) ruminated, stating that: “My experience is what I agree to attend to. Only those items which I notice shape my mind—without selective interest, experience is utter chaos.” These words emphasize the importance of attention to human experience, because humans are unaware of that which they do not attend to. Moreover, Kahneman^16(p23) stated the humans “dispose of a limited budget of attention that you can allocate to activities, and if you try to go beyond your budget, you will fail.”¹⁷ Thus, although the capacity to attend exists, this capacity is limited and requires individuals to selectively attend to the information that is deemed most relevant for a given context. Therefore, the role of attention in influencing motor skill learning has emerged as an important concept for researchers, coaches, and therapists alike.¹⁸

From a motor learning standpoint, attention is the “perceptual, cognitive, and motor activities that establish limits to our performance of motor skills.”^19(p195) Moreover, attentional focus relates to how attention is directed toward specific features of the performance environment and where attention is directed during action-preparation of a motor skill.¹⁹ From a coaching and teaching perspective, instructions and cues are used to focus a learner’s attention on the most important characteristics of the motor skill being learned. This process directs the “attentional spotlight” toward the most relevant features of the motor skill being learned while encouraging the learner to disregard task-irrelevant features. Specifically, a learner can be encouraged to adopt an external focus on the intended movement effect or outcome (e.g., “explode off the ground” or “jump as high as you can”), adopt an internal focus on body movements (e.g., “explode through your hips” or “rapidly extend your legs”),⁵^,⁸^,²⁰ or in the case of no instruction being provided, adopt what can otherwise be considered a normal focus, which is likely going to result in internally or externally directed thoughts.¹¹

Attentional focus has emerged as an important mediator of performance and learning.⁸ Wulf et al (experiment 1)⁵ were the first to evaluate how attentional focus direction mediates performance and skill learning. The researchers found that instruction encouraging an external focus, rather than an internal focus of attention, led to better performance and learning on a ski-simulator task in novice participants. Specifically, the internal focus group was “instructed to exert force on the outer foot” and the external focus group was “instructed to exert force on the outer wheels,” whereas a control group received no additional instruction. The results showed that the external focus group was significantly more effective than the internal focus group during practice (i.e., greater amplitude and frequency of movement). More importantly, the external focus group was significantly more effective than the internal focus and control groups during a delayed retention test—where no instruction was provided, which provides evidence that an external focus leads to superior skill learning than an internal focus or a normal focus (i.e., control condition) within a novice population. There has since been extensive research confirming the various performance and learning benefits of an external focus of attention for balance and suprapostural tasks,⁵^,²¹^,²²^,²³^,²⁴ neuromuscular expression of force and velocity,²⁵^,²⁶^,²⁷^,²⁸ discrete sport skills with an implement (e.g., golf, tennis, and soccer),²⁹^,³⁰^,³¹ discrete sport skills without an implement (e.g., vertical and horizontal jumping),³²^,³³^,³⁴^,³⁵ and continuous sport skills (e.g., swimming, running, and sprinting).³⁶^,³⁷^,³⁸

Attentional Focus: Constrained Action Hypothesis

The “constrained action hypothesis” has been proposed as a theoretical explanation for the learning and performance advantage associated with an external focus, while providing reasoning for the performance and learning deterioration commonly associated with an internal focus.⁹^,²² Wulf and Lewthwaite³⁹ suppose that an internal focus of attention causes a “self-invoking trigger,” which leads to overt control over movements that would otherwise be controlled automatically, causing a series of ongoing “microchoking” episodes. To provide evidence for this line of reasoning, research has evaluated a diversity of neuromuscular control and neurocognitive factors that could provide insights into the efficacy of the “constrained action hypothesis.”

Wulf et al²² were the first to directly assess the “constrained action hypothesis” by assessing the influence of attentional focus on balance while measuring probe reaction times (i.e., reaction to a light), which can be considered an assessment of attentional or working memory load. Using the same instructional conditions as earlier (experiment 2),⁵ Wulf et al²² had participants either adopt an internal focus or an external focus while balancing on a stabilometer. As in previous studies, the external focus group exhibited fewer balance errors and had higher frequency adjustments, “indicating higher confluence between voluntary and
reflexive mechanisms.”^22(p1143) What’s more, the external focus group had significantly faster reaction times than those in the internal focus group. Thus, an external focus of attention promotes a more automatic or implicit control mechanism, thereby freeing up attentional resources to effectively perform a secondary task like reacting to a light. Since this seminal study, additional research has shown that adopting an external focus of attention results in faster reaction times during sprinting³⁶ and frees up attentional resources so that they can be directed at secondary tasks.⁴⁰

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