Observational Learning During Simulation-Based Training in Arthroscopy: Is It Useful to Novices?

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.OBJECTIVE: Observing experts constitutes an important and common learning experience for surgical residents before operating under direct guidance. However, studies suggest that exclusively observing experts may induce suboptimal motor learning, and watching errors from non-experts performing simple motor tasks may generate better performance. We investigated whether observational learning is transferrable to arthroscopy learning using virtual reality (VR) simulation. SETTING/DESIGN: In our surgical simulation laboratory, we compared students learning basic skills on a VR arthroscopy simulator after watching an expert video demonstration of VR arthroscopy tasks or a non-expert video demonstration of the same tasks to a Control group without video demonstration. Ninety students in 3 observing groups (expert, non-expert, and Control) subsequently completed the same procedure on a VR arthroscopy simulator. We hypothesized the non-expert-watching group would outperform the expert-watching group, and both groups to outperform the Control group. We examined performance pretest, posttest, and 1 week later. PARTICIPANTS: Participants were recruited from the final year of medical school and the very early first year of surgical residency training programs (orthopaedic surgery, urology, plastic surgery, and general surgery) at Western University (Ontario, Canada). RESULTS: All participants improved their overall performance from pretest to retention (p < 0.001). At initial retention testing, non-expert-watching group outperformed the other groups in camera path length p < 0.05 and time to completion, p < 0.05, and both the expert/non-expert groups surpassed the Control group in camera path length (p < 0.05). CONCLUSION: We suggest that error-observation may contribute to skills improvement in the non-expert-watching group. Allowing novices to observe techniques/errors of other novices may assist internalization of specific movements/skills required for effective motor performances. This study highlights the potential effect of observational learning on surgical skills acquisition and offers preliminary evidence for peer-based practice (combined non-experts and experts) as a complementary surgical motor skills training strategy.This project was supported by a Physicians׳ Services Incorporated (PSI) Foundation, Canada grant. Funds were used to pay for salary and employee benefits (LvE). The PSI Foundation did not play a role in the investigation

Observing object lifting errors modulates cortico-spinal excitability and improves object lifting performance.

PublishedJournal ArticleObserving the actions of others has been shown to modulate cortico-spinal excitability and affect behaviour. However, the sensorimotor consequences of observing errors are not well understood. Here, participants watched actors lift identically weighted large and small cubes which typically elicit expectation-based fingertip force errors. One group of participants observed the standard overestimation and underestimation-style errors that characterise early lifts with these cubes (Error video--EV). Another group watched the same actors performing the well-adapted error-free lifts that characterise later, well-practiced lifts with these cubes (No error video--NEV). We then examined actual object lifting performance in the subjects who watched the EV and NEV. Despite having similar cognitive expectations and perceptions of heaviness, the group that watched novice lifters making errors themselves made fewer overestimation-style errors than those who watched the expert lifts. To determine how the observation of errors alters cortico-spinal excitability, we measured motor evoked potentials in separate group of participants while they passively observed these EV and NEV. Here, we noted a novel size-based modulation of cortico-spinal excitability when observing the expert lifts, which was eradicated when watching errors. Together, these findings suggest that individuals' sensorimotor systems are sensitive to the subtle visual differences between observing novice and expert performance.G. Buckingham was supported with a Banting Postdoctoral Fellowship, awarded by the Natural Sciences and Engineering Council of Canada (NSERC

A Role for the Somatosensory System in Motor Learning by Observing

An influential idea in neuroscience is that action observation activates an observer’s sensory-motor system. This idea has recently been extended to motor learning; observing another individual undergoing motor learning can promote sensory-motor plasticity as well as behavioural changes in both the motor and somatosensory domains. While previous research has suggested a role for the motor system in motor learning by observing, this thesis presents a series of experiments testing the hypothesis that the somatosensory system is also involved in motor learning by observing. The experiments included in this thesis used force field (FF) adaptation as a model of motor learning, a task in which subjects adapt their reaches to a robot-imposed FF. Subjects observed a video showing another individual adapting his or her reaches to a FF, and motor learning by observing was assessed behaviourally following observation. First, we used functional magnetic resonance imaging (fMRI) to assess changes in resting-state functional connectivity (FC) associated with motor learning by observing. We identified a functional network consisting of visual area V5/MT, cerebellum, primary motor cortex (M1), and primary somatosensory cortex (S1) in which post- observation FC changes were correlated with subsequent behavioural measures of motor learning achieved through observation. We then investigated if pre-observation measures of brain function or structure could predict subsequent motor learning by observing. We found that individual differences in pre-observation resting-state FC predicted observation-related gains in motor learning. Subjects who exhibited greater FC between bilateral S1, M1, dorsal premotor cortex (PMd), and left superior parietal lobule (SPL) prior to observation achieved greater motor learning by observing on the following day. In a subsequent experiment, we tested the involvement of the somatosensory system in motor learning by observing using median nerve stimulation and electroencephalogra- phy (EEG). In experiment 1, we showed that interfering with somatosensory cortical processing throughout observation (by delivering median nerve stimulation) can disrupt motor learning by observing. In a follow-up experiment, we assessed pre- to post- observation changes in S1 excitability by acquiring somatosensory evoked potentials (SEPs) using EEG. We showed that SEP amplitudes increased after observing motor learning. Post-observtion SEP increases were correlated with subsequent behavioural measures of motor learning achieved through observation. In a final experiment, we tested if improving subjects’ somatosensory function would enhance subsequent motor learning by observing. Subjects underwent perceptual training to improve their proprioceptive acuity prior to observation. We found that improving proprioceptive acuity prior to observation enhanced the extent to which subjects benefitted from observing motor learning (compared to subjects who had not undergone perceptual training). We further found that post-training increases in proprioceptive acuity were correlated with subsequent observation-related gains in motor performance. Collectively, these studies suggest that motor learning by observing is supported by a fronto-parieto-occipital network in which the somatosensory system is an active element. We have shown that observing motor learning changes somatosensory activity in a behaviourally-relevant manner. Observing motor learning resulted in S1 plasticity that corresponded to the extent of learning achieved through observation. Moreover, manipulating somatosensory activity influenced motor learning by observing. Interfering with somatosensory processing throughout observation disrupted motor learning by observing whereas improving somatosensory function prior to observation enhanced motor learning by observing. These experiments therefore suggest that the somatosensory system is indeed involved in motor learning by observing

The affordance-matching hypothesis: how objects guide action understanding and prediction

PubMed ID: 24860468 ESRC ES/J019178/1 One step ahead: prediction of other people’s behavior in healthy and autistic individual

Principles of sensorimotor learning.

The exploits of Martina Navratilova and Roger Federer represent the pinnacle of motor learning. However, when considering the range and complexity of the processes that are involved in motor learning, even the mere mortals among us exhibit abilities that are impressive. We exercise these abilities when taking up new activities - whether it is snowboarding or ballroom dancing - but also engage in substantial motor learning on a daily basis as we adapt to changes in our environment, manipulate new objects and refine existing skills. Here we review recent research in human motor learning with an emphasis on the computational mechanisms that are involved

Durability of Motor Learning by Observation

Recent evidence suggests that neural representations of novel movement dynamics can be acquired by observing someone else experiencing them first-hand. Visual information about another person’s movement kinematics can be transformed into an adaptation of feedforward limb control for the observer; however, little is known about the durability of this adaptation. Despite the longevity of changes in the motor system being a defining characteristic of motor learning, studies to date have only examined observation-related effects shortly after observation has occurred, leaving unknown whether such effects are transient phenomena or products of learned, durable changes in neural systems. We measured human participants’ force generation patterns before and at various time points (1 minute – 24 hours) after they had either performed or observed movements that were perturbed by novel, robot-generated forces (i.e., a velocity-dependent force field). Like participants who had physically practiced, observers learned to predictively generate directionally- and temporally-specific compensatory forces during reaching. Although retention generally decayed with time, we found no evidence of an interaction between the effects of the passage of time and whether participants had performed or observed reaches in a force field, suggesting that the adaptation decayed similarly regardless of whether it was induced by observing someone else’s physical force field learning or feeling the force field for oneself. Notably, the adaptation of predictive limb control induced by observation was still detectable 24 hours later, demonstrating that visually-acquired representations of movement dynamics can be retained, and continue to influence behaviour, long after the initial training period is over. Our results suggest that observing can have lasting effects on the brain that are similar to those seen for physical practice

The Effect of Sensory Experience and Movement Observation on Motor Adaptation to Novel Force Perturbations

On a daily basis, humans capably and effortlessly interact with their surrounding environment through the performance of accurate movements. Movements are often perturbed through the physical influence of the surrounding environment, interaction with objects, or injury, yet adaptation is both rapid and flexible. When adapting, humans are informed by their direct trial-and-error movement experience, incrementally updating predictive control on the next movement; how the brain processes sensed errors into adaptation is not fully known. We may also learn to move through the observation of the movements of others, as visually observed movement information may be transformed into motor memories that influence subsequent motor command; the neural computations underlying such a learning process are not well understood. In this thesis, I aimed to further understand how people incrementally update their predictive motor control in novel haptic environments as a function of sensation during action and during observation. Theories of motor learning suggest that adaptation scales with the size of experienced error. Previous studies have indicated the relationship between adaptation and sensed error can be modulated by statistics of the perturbing environment. In Chapter 2, we considered how the duration of experienced force perturbations might modulate adaptive strategy and found that people becomes increasingly sensitive to kinematic and dynamic sensory signals when experiencing perturbations of decreasing duration. We further found that subjects experiencing pulsatile forces adapted their steady-state feedforward prediction of dynamics with a persistently mismatched breadth when compared to the duration of experienced forces, but learned to closely match the experienced duration of full-movement forces. In the next two sections, we considered the learning effects of movement observation. In Chapter 3, we newly designed and implemented an experimental paradigm in which movement and observation were interleaved, varying the strength of perturbations and associated kinematics from trial-to-trial. Based on previous descriptions of long-term learning by observing, we hypothesized that incremental adaptation would be corrective with respect to observed errors but more modest in magnitude than gains from physical practice. Instead, we found that the incremental adaptive response of movement observation generally countered the direction of experienced forces and was similar in magnitude to the response following action, but was not error-corrective with respect to real-valued signals. Previous research had established an initial advantage when adapting to novel dynamics following observation but the learning processes influencing this effect were unknown. In Chapter 4, we newly demonstrated that the long-term movement observation resulted in adaptive changes in feedforward predictive dynamics. We found that observation generated a small, but significant, compensatory change in reach dynamics that could be characterized by a learned scaling of perturbation-appropriate kinematic signals, suggesting a transformation of visual inputs into a neural representation of environment dynamics

Cortical Mechanisms of Visual Target Memory and Movement Planning and Execution for Reaches and Saccades in Humans

The cortical mechanisms for reach have been studied extensively, but directionally selective mechanisms for visuospatial target memory, movement planning, and movement execution have not been clearly differentiated in the human. It is also unclear how effector-specificity evolves in the human brain across these three phases for reaches and saccades. To study these phenomenon, an event-related fMRI design with three key phases was used to break apart a movement into target memory, movement planning and movement execution phases. In the first experimental chapter (chapter 2) directionally selective mechanisms were studied in a memory-guided reach task that informed the subject to perform a pro- or anti-reach after the target memory phase. Using the pro/anti instruction to differentiate visual and motor directional selectivity during planning, we found that one occipital area showed contralateral visual selectivity, whereas a broad constellation of left hemisphere occipital, parietal, and frontal areas showed contralateral movement selectivity. Temporal analysis of these areas through the entire memory-planning sequence revealed early visual selectivity in most areas, followed by movement selectivity in most areas, with all areas showing a stereotypical visuo-movement transition. Cross-correlation of these spatial parameters through time revealed separate spatiotemporally correlated modules for visual input, motor output, and visuo-movement transformations that spanned occipital, parietal, and frontal cortex. In the second experimental chapter (Chapter 3), effector-specific activation for reaches and saccades was studied using a similar design that informed subjects of the effector after the target memory phase. Our analysis revealed more medial (pIPS, mIPS, M1, and PMd) activity during both reach planning and execution, and more lateral (mIPS, AG, and FEF) activity only during saccade execution. These motor activations were bilateral, with a left (contralateral) preference for reach. Apart from right FEF, effector-specific contrasts comparing reach and saccade activation revealed significantly more parietofrontal activation for reaches than saccades during both planning and execution. Cross-correlation of reach, saccade, and reach-saccade activation through time revealed spatiotemporally correlated activation both within and across effectors in each hemisphere, but with higher correlations in the right hemisphere. Taken together, these results demonstrate highly distributed, coordinated occipital-parietal-frontal networks for both reach and saccade, with effector-specific activation

Perception meets action: fMRI and behavioural investigations of human tool use

Tool use is essential and culturally universal to human life, common to hunter-gatherer and modern advanced societies alike. Although the neuroscience of simpler visuomotor behaviors like reaching and grasping have been studied extensively, relatively little is known about the brain mechanisms underlying learned tool use. With learned tool use, stored knowledge of object function and use supervene requirements for action programming based on physical object properties. Contemporary models of tool use based primarily on evidence from the study of brain damaged individuals implicate a set of specialized brain areas underlying the planning and control of learned actions with objects, distinct from areas devoted to more basic aspects of visuomotor control. The findings from the current thesis build on these existing theoretical models and provide new insights into the neural and behavioural mechanisms of learned tool use. In Project 1, I used fMRI to visualize brain activity in response to viewing tool use grasping. Grasping actions typical of how tools are normally grasped during use were found to preferentially activate occipitotemporal areas, including areas specialized for visual object recognition. The findings revealed sensitivity within this network to learned contextual associations tied to stored knowledge of tool-specific actions. The effects were seen to arise implicitly, in the absence of concurrent effects in visuomotor areas of parietofrontal cortex. These findings were taken to reflect the tuning of higher-order visual areas of occipitotemporal cortex to learned statistical regularities of the visual world, including the way in which tools are typically seen to be grasped and used. These areas are likely to represent an important source of inputs to visuomotor areas as to learned conceptual knowledge of tool use. In Project 2, behavioural priming and the kinematics of real tool use grasping was explored. Behavioural priming provides an index into the planning stages of actions. Participants grasped tools to either move them, grasp-to-move (GTM), or to demonstrate their common use, grasp-to-use (GTU), and grasping actions were preceded by a visual preview (prime) of either the same (congruent) or different (incongruent) tool as that which was then acted with. Behavioural priming was revealed as a reaction time advantage for congruent trial types, thought to reflect the triggering of learned use-based motor plans by the viewing of tools at prime events. The findings from two separate experiments revealed differential sensitivity to priming according to task and task setting. When GTU and GTM tasks were presented separately, priming was specific to the GTU task. In contrast, when GTU and GTM tasks were presented in the same block of trials, in a mixed task setting, priming was evident for both tasks. Together the findings indicate the importance of both task and task setting in shaping effects of action priming, likely driven by differences in the allocation of attentional resources. Differences in attention to particular object features, in this case tool identity, modulate affordances driven by those features which in turn determines priming. Beyond the physical properties of objects, knowledge and intention of use provide a mechanism for which affordances and the priming of actions may operate. Project 3 comprised a neuroimaging variant of the behavioural priming paradigm used in Project 2, with tools and tool use actions specially tailored for the fMRI environment. Preceding tool use with a visual preview of the tool to be used gave rise to reliable neural priming, measured as reduced BOLD activity. Neural priming of tool use was taken to reflect increased metabolic efficiency in the retrieval and implementation of stored tool use plans. To demonstrate specificity of priming for familiar tool use, a control task was used whereby actions with tools were determined not by tool identity but by arbitrarily learned associations with handle color. The findings revealed specificity for familiar tool-use priming in four distinct parietofrontal areas, including left inferior parietal cortex previously implicated in the storage of learned tool use plans. Specificity of priming for tool-action and not color-action associations provides compelling evidence for tool-use-experience-dependent plasticity within parietofrontal areas