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5 Improving Motor Skills Many strategies can be employed to enhance human motor performance. The Army has already incorporated into military instruction many proven psychological techniques, such as demonstration or modeling, feedback, and reinforcement. The research basis for some of the newer techniques, however, has not been clearly established, although the sponsors of these techniques make claims of extraordinary improvements in performance. Three strategies are discussed in this chapter: mental practice, visual concentration, and biofeedback. Of the three, mental practice appears to be the most promising. It has been shown to produce impressive gains in performance, gains that are even larger when combined with physical practice. The evidence on visual training exercises is less impressive. While improving vision in general, the exercises have not been shown to enhance performance; however, these results are based on a relatively small research literature, and further investigation may reveal a relation. A larger research literature exists with regard to biofeedback. While the promise of enhancement remains, research on biofeedback to date has largely failed to demonstrate clear effects. MENTAL PRACTICE According to Richardson (1967), ''mental practice refers to the symbolic rehearsal of a physical activity in the absence of any gross muscular movements" (p. 95~. In real life, mental practice is evident, for example, when a golfer closes his eyes and in imagination goes through the motions of putting (Richardson, 1967~. In research studies, to create similar 61

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62 ENHANCING HUMAN PERFORMANCE conditions, demonstration of a skill to subjects (or having subjects perform the skill a few times) is usually followed by asking students to mentally practice the skill a specified number of times or as many times as possible within an allotted period. Beyond this, the type of symbolic activity is largely unspecified. Some subjects may therefore employ visual imagery of the skill, others may talk their way through the skill, and still others may use a combination of both strategies. The diffuse nature of this construct not only makes it difficult to control experimentally, but also results in the same topics being investigated under a variety of other names-for example, symbolic rehearsal, imaginary practice, implicit practice, mental rehearsal, conceptualizing practice, and mental prepa- ration. Most experiments on skill acquisition have been variants of a research design that employs four groups of subjects randomly selected from a homogeneous population or equated on initial levels of performance. These groups are (l) mental practice, (2) physical practice, (3) combined physical and mental practice, and (4) no physical or mental practice (control). Most studies have compared the performances (before and after) of subjects who had previous mental practice to a control group that had not received instructions on mental practice. In the mental practice group, the subjects rehearse the skill in imagination for a set amount of time. Subjects in the control group are instructed not to practice the skill physically or mentally during the interval. A more appropriate control would require subjects in the no-practice group to participate in the same number of practice sessions as the mental and physical practice groups, but with activity that was irrelevant to the task. In many studies, mental practice and control groups are contrasted to a physical practice group and a group receiving combined mental and physical practice. The practice period instituted varies considerably in the number of trials in each practice session and in the total number and spacing of trials. In the combined mental and physical practice groups, practice periods usually involve having subjects either alternate mental and physical practice trials, mentally practice a number of trials and then physically practice, or physically practice a number of trials and then mentally practice. Following this practice period, the subjects' skills were tested under standard conditions to determine whether their performance scores differed as a result of the practice condition administered. PREVIOUS REVIEWS Several people have reviewed research examining the effects of mental practice on motor learning and skilled performance on a selective basis. The reviews by Richardson (1967) and Corbin (1972) included 22 to 56

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IMPROVING MOTOR SKILLS 63 studies and provided contradictory conclusions. Richardson (1967) re- viewed studies of three types: (1) those that focused on how mental practice could facilitate the initial acquisition of a perceptual motor skill, (2) those that focused on aiding the continued retention of a motor skill, and (3) those that focused on improving the immediate performance of a skill. He concluded that in a majority of the studies reviewed, mental practice facilitated the acquisition of a motor skill. At that time there were not enough studies to draw any conclusions regarding the effect of mental practice on retention or immediate performance of a task. Five years later, Corbin (1972) reviewed many other factors that could affect mental practice and was much more cautious in his interpretation of the effects of mental practice on acquisition and retention of skilled motor behavior. In fact, he maintained that the studies were inconclusive and that a host of individual, task, and methodological factors used with mental practice produced different results. In a 1982 review of `' mental preparation," Weinberg reviewed 27 studies dealing with mental practice. Although Weinberg noted the . . , ~ . . - . -. . . equivocal nature of this literature, he maintained that the following consistencies were apparent: (1) physical practice is better than mental practice; (2) a minimum skill proficiency is needed in order for mental practice to be effective; and (3) mental practice combined and alternated with physical practice is more effective than either physical or mental practice alone. The latter conclusion is similar to Richardson's (1967) cautious inference that the combined practice group is as good as or better than the physical practice trials only. The most comprehensive review of the mental practice literature to date is that of Feltz and Landers (19831. This study used meta-analysis techniques proposed by Glass (19771. (For a review of these techniques see the paper prepared for the committee by Deborah L. Feltz, Daniel M. Landers, and Betsy J. Becker, Appendix B.) A search of published and unpublished literature yielded 60 studies in which mental practice was contrasted to a simple or placebo control. Collectively, mental practice effects were examined across SO different tasks, ranging from dart throwing to maze learning. Analysis of the resulting 146 effect sizes yielded an overall average effect size for mental practice of 0.48. Except for the conclusion reached by Corbin (1972), Feltz and Landers's overall findings supported the conclusions of other reviewers that '`mentally practicing a motor skill influences performance somewhat better than no practice at all'' (Feltz and Landers, 1983:251. Feltz and Landers also examined several variables believed to moderate the effects of mental practice. Results from these comparisons indicated that larger effect sizes were found: ~ I ~ in published compared with unpublished studies; (2) when the posttest was given a longer time after

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64 ENHANCING HUMAN PERFORMANCE mental practice rather than immediately after; and (3) in studies employing cognitive tasks as opposed to motor and strength tasks. Subsequent polynomial regression analysis revealed that this latter, highly robust finding was dependent on the time or number of trials subjects were allowed to mentally practice. Motor tasks having a substantial cognitive component (i.e., card sorting, pegboard test, maze learning, symbol digit test) benefited from only a few trials or a few minutes' engagement in mental practice. By contrast, when tasks that primarily involved strength or motor components were examined, larger effects were evident only when subjects mentally practiced for 10 or more minutes or 20 or more trials. The results also showed no differences in effect sizes for sex, age, self-paced versus reactive tasks, and type of research design. Based on their comprehensive review, Feltz and Landers concluded that ''mental practice effects are primarily associated with cognitive- symbolic rather than motor elements of the task" and that these effects "are not just limited to early learning-they are found in early and later stages of learning and may be task specific" (1983:45-461. This latter conclusion does not support Weinberg's (1982) conclusion that for mental practice to be effective individuals must achieve a minimal skill profi clency. The most recent review of the mental practice literature is the paper by Feltz, Landers, and Becker. The majority of the studies (69 percent) reviewed were the same as in the 1983 review, with 14 additional studies. They examined: (1) learning effects by means of effect sizes for pretest- to-posttest differences, (2) mental practice effects compared with no practice, physical practice, and mental and physical practice, and (3) effect sizes using more modern meta-analytic procedures recommended by Hedges and Olkin (1985~. Only studies containing complete data for pretest and pastiest comparisons were included in the review: as a result, 48 studies for 223 separate samples were reviewed. The results revealed that the average difference in effect size from pretest to pastiest across all types of practice treatments was 0.43 standard deviations and that this differed significantly from zero ~ p < .051. The mean change for all practice conditions was significantly greater than zero, with physical practice showing the greatest change effects (0.79), followed by the combined physical and mental practice group (0.62), and the control group showing the smallest change effects (0.22~. The average weighted pretest-posttest effect size for mental practice groups (0.47) was very close to the 0.48 unweighted effect size reported by Feltz and Landers (1983~. Contrary to what has been previously theorized in the literature (Corbin, 1972; Weinberg, 1982), combined mental and physical practice does not appear to be more effective than either mental or physical practice alone.

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IMPROVING MOTOR SKILLS 65 When the overall effects were broken down to examine the moderating variables of task type and type of dependent measure, most of the variation was found in dependent measures of accuracy and time-on- target or time-in-balance and in tasks that were essentially motor (versus cognitive or strength). The failure to find differences for cognitive tasks as well as for speed, distance, and form-dependent measures was due to the insufficient number of samples (N ~ 3) having these characteristics. Although the physical practice group generally had the highest effect sizes, those of the combined physical and mental practice group were relatively close. For task measures of time-on-target or time-in-balance, the combined practice group actually had a larger difference score effect size than either the physical or mental practice groups. However, this finding is of questionable significance due to the relatively small number of samples and a much larger standard error of measurement. The fact that many of the tasks in the studies reviewed were gross motor tasks involving accuracy of dart throwing, basketball foul shooting, ball striking, golf chip shots, bowling, and so on lends greater assurance that these findings would generalize to tasks of significance to military performance (e.g., marksmanship). The merging of mental practice with varying combinations of physical practice may lend itself to military applications. For some tasks for which actual physical practice may either be expensive, time-consuming, or physically or mentally fatiguing, the combined practice may be advantageous, since the effects are nearly as good as physical practice with only half the number of physical practice trials. It might be useful in future research to find out whether the gap between physical and combined physical and mental practice could be decreased by increasing physical practice relative to mental practice trials (e.g., a 60:40 or 70:30 ratio of physical to mental practice trials3. THEORETICAL EXPLANATIONS FOR MENTAL PRACTICE There are two main theories to explain the effects of mental practice. The first explanation, termed symbolic learning (Sackett, 1934), posits that mental practice gives a performer the opportunity to rehearse the sequence of movements as symbolic components of the task. Most real- life tasks include components of symbolic (verbalizable) and nonsymbolic (perceptual-motor) activity. Given an opportunity for mental practice, covert rehearsal of the symbolic components of the task can occur, and overt practice can strengthen these activities. Thus, according to this theory, mental practice facilitates performance only to the extent that symbolically encoded components are relatively important. A second type of theory, termed the neuromuscular theory (Jacobson, 1932), posits that it is possible to inhibit peripheral motor activity. This

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66 ENHANCING HUMAN PERFORMANCE theory suggests that minimal, or low-gain, neuromuscular efferent patterns during imagined movement should be identical (in timing and in muscles used) to those patterns generated during overt movement, but reduced in magnitude. Although no overt movement takes place, this minute innervation, as indicated by electromyography (EMG), is presumed to transfer to the physical practice situation. According to the theory, only a small, localized efferent from imagery is required for visual and kinesthetic feedback to the motor cortex and thus for the motor schema to be further improved (Hale, 1981) or for the corresponding muscle movement nodes to be primed (Mackay, 1981~. Conceivably, then, mental practice involves virtually all the neural activity of the overt performance. There are a number of problems with the neuromuscular theory. The evidence provided in support of it (see Feltz and Landers, 1983, for a reviews does not demonstrate that the low-gain EMG activity during mental practice is similar (i.e., in timing and in muscles used) to the EMG associated with overt performance of the skill, and it does not indicate that the presence of low-gain muscle activity during mental practice is related to subsequent task performance. In essence, investi- gators testing this theory to date have not measured EMG activity during overt task performance and have not measured performance following assessments of EMG activity during mental practice trials (e.g., Harris and Robinson, 19861. Furthermore, the idea that mental practice involves "virtually all of the neural activity" related to the overt performance is called into question by studies examining regional cerebral blood flow (rCBF) during overt and covert finger movements (Roland, Larsen, et al., 1980; Roland, Skinhoj, et al., 19801. With the assumption that rCBF indicates which part of the brain is being activated, Roland et al. found that, compared with the rCBF associated with programming and control during the actual execution of finger movements, mental practice of the same sequence resulted in some brain regions' not being activated (i.e., primary senso- rimotor hand area), and the rCBF in the supplementary motor areas being only 60 percent of the increase observed during actual execution. Thus, it appears that the programming during mental practice is qualita- tively and quantitatively different from the programming that takes place during physical practice. Perhaps the low-gain muscle activity that is commonly observed during mental practice may have nothing to do with programming. It may simply be an artifact associated with "priming'' for the upcoming activity (e.g., arousal-attention set, Schmidt, 1982) or-the idiosyncratic tendency through imagination of movement for some subjects to produce muscular impulses that correspond to the overtly produced motion (so-called Carpenter effect, Cratty, 1973~.

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IMPROVING MOTOR SKILLS 67 Finally, examination of key experiments (Johnson, 1982; Kohl and Roenker, 1983; Mackay, 1981; Ryan and Simons, 1983) has led reviewers to conclude that the locus of mental practice effects are cognitive- symbolic rasher then motor(Annett, 1985; Feltz and Landers, 1983~. As summarized by Annett (1985:1941: What seems to be emerging is that the representations which are most effective in mental practice are of a rather abstract kind, such as spatial context in Johnson~s experiments, core meaning in Mackay's experiments, and control rules rather than specific movements in the tracing experiment. If each of these rather different skills is thought of as being controlled by a motor plan then it would appear that rehearsal of critical and invariant elements of the plan which may be represented in imagery is the source of mental practice effects. The executive details of the plan, which may in any case have to be varied from time to time to meet variable conditions, probably contribute little and may not be laid down in a permanent store. The idea that mental practice effects derive from "rehearsal of critical and invariant elements of the plan" is not the only cognitive explanation for mental practice. Other investigators (Tversky and Kahneman, 1973) suggest an '`availability idea," that is, that well-rehearsed images are stored in easily retrievable places in the brain. Greater rehears-al would then allow the image to "spring to mind more quickly" and produce the belief that the image is more likely to occur as a consequence. This latter idea is similar to the idea of "images of achievement," which is currently being promoted as a central concept in a marketed self-improvement program dealing with the "neuropsychology of achievement." This self- help program has been singled out for discussion since it is the most highly developed and influential mental practice program currently being marketed, and it purports to provide a breakthrough in scientific under- standing of how and why mental practice and imagery occurs. The general achievement program as well as videotape programs for a variety of sport skills are products of SyberVision~ Systems, Inc., Newark, California. A description and evaluation of the scientific bases for these products are presented in the next section. SYBERVISION On August 29, 1986, two committee members visited SyberVision~ Systems headquarters and interviewed Stephen DeVore, founder and president, and Karl Pribram, head of Stanford University's Neuropsy- chology Research Laboratory and director of research for SyberVision~ Systems. The discussion centered on a series of audiotapes called ``The Neuropsychology of Achievement" (1986) and a set of videotapes (1981)

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68 ENHANCING HUMAN PERFORMANCE that concentrates on such sport skills as golf (men's, women's, putting, and driving), skiing (downhill and cross-country), tennis, bowling, rac- quetball, and baseball batting. The videotape packages include a 60- minute videotape of a well-known professional athlete (e.g., Stan Smith, Al Geiberger, Rod Carew), a personal training guide designed to accelerate learning, and four companion audiotapes: (1) an explanation of how SyberVision~ works, (2) teaching tips from the professional athlete, (3) psychological characteristics of winners, and (4) the musical score from the videotape for use in imagery recall. The tapes are of professional quality, showing a performer repeating the skill over and over. The viewing angle and speed (regular and slow motion) repeatedly change so as to reduce habituation. Occasionally the fundamental movement is amplified and simplified through computer graphics, illustrating the biomechanics of the movement. '~Synchronized high performance music" is played throughout the tape; the tempo, rhythm, and timing of the music accentuate the ideal tempo, rhythm, and timing associated with optimal performance of the skill. The videotapes are designed for three levels of use: (1) casual, recreational viewing, (2) biomechanical reinforcement, and (3) neuro- muscular programming. Of particular relevance is their use in neuromus- cular programming- a "scientifically formulated" procedure for trans- ferring the high performance skills modeled on the tape into the nervous system of the observer. To do this, the instructional manual recommends: (1) relaxing by using breathing and imagery techniques; (2) watching the tape while emphasizing a whole-body, lower, upper, then whole-body focus; (3) upon completion of the tape, turning it off and with eyes closed imagining each motion about ten times in slow motion or in the comput- erized graphics mode; and (4) reinforcing the learning by repeated viewing of the fundamental skill. Following this sequence of steps is supposed to facilitate the development of "a fluid and graceful rhythm" in synchrony with the skilled movement on the tape. The "simple physics of neuromuscular programming'' is presented in an appendix to the instruction manual, and there is a more complete description on the first audiotape of ''The Neuropsychology of Achieve- ment" program, entitled "Your Holographic Brain: The Power of Three- Dimensional Visualization." According to the audiotape, Karl Pribram has proposed that the hologram "provides the long sought after model of how visual sensory information is received, distributed, stored and recalled by the brain." The tape goes on to say that ''there is enough lo, laboratory evidence available to demonstrate physiological, biological and mathematical bases for the model." The evidence presented points to similar parallels between the holo- graphic model and brain function: (1) memory is distributed throughout

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IMPROVING MOTOR SKILLS 69 the brain in a way similar to a holographic image that is spread over the entire surface of a film plate; (2) a single holographic plate comes closest to matching the storage capacity of the human brain (I cubic centimeter holds 10 billion bytes of information); and (3) both holograms and the brain can construct three-dimensional images. According to Pribram's theory of brain functioning, the brain and the nervous system act as a holographic processor by having an equivalent object beam (i.e., the eye, since it represents 95 percent of object reality) and reference beam (i.e., the remaining senses) that interact and create interference patterns (waveforms) of nerve impulses. These nerve im- pulses are transformed by the brain into electromagnetic waveforms with a unique frequency that represents the exact movement specifications. The decomposition of what is seen and sensorily experienced is accom- plished mathematically by the brain's ability to perform a Fourier transform (Instruction Manual, 19811. Once the transformation is com- pleted, the electrical frequency (timing, rhythm, and tempo) associated with the movement is distributed and stored throughout the brain. To recall this stored information, the particular reference beam associated with the object beam is needed to trigger the stored motion frequency, ''bring it to the surface of memory and neurally reconstruct the stored memory event" (Instruction Manual, 1981, p. 17~. Thus, activities such as looking at old photographs may trigger certain emotions that can act as sensory reference beams to evoke vivid three-dimensional images. Also included in Pribram~s analysis of imagery are principles derived from quantum physics and electromagnetic energy. According to the law of quantum physics, images exist in reality because they are waveforms that possess energy and matter. Thus, the more one visualizes the image along with sensory detail and emotion, the greater the electromagnetic force will be, and the more it will mimic concrete reality. During the interview, DeVore and Pribram confirmed what a search of the literature had already revealed: that no research could be found testing the efficacy of the SyberVision~ tapes. Thus, the sole basis for the relationship of tapes to performance is anecdotal accounts and personal testimony of satisfied customers. Although both DeVore and Pribram wished to encourage research into the use of the tapes for neuromuscular programming, this type of research was not compatible with Pribram's research program, and DeVore was not willing to provide much funding for research. On the basis of the extensive research literature on mental practice, it is conceivable that programs like SyberVision~ could improve perform- ance. However, SyberVision~ is a broad-based package that includes elements of modeling and imagery, a training guide, tips from professional athletes, and common psychological characteristics of winners. If per

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70 ENHANCING HUMAN PERFORMANCE formance gains were observed, they could not be attributed to mental practice. The available research literature on mental practice is consistent enough to support a recommendation for the Army to conduct evaluation studies on operational military tasks. However, packages like SyberVision~ should not be evaluated apart from the types of mental practice training that already have an established research base. They should be evaluated only within the traditional mental practice paradigm so their pre-post performance effects can be directly compared with physical, mental, combined physical and mental, and placebo-control practice conditions. Research evidence for neuromuscular programming via holograms and Fourier transforms is elusive. Other than the claims in the SyberVision~ videotapes and audiotapes, no direct scientific evidence was found that the brain acts like a holographic processor or performs Fourier transforms. The research to which Pribram referred us (Pribram, Sharafat, and Beekman, 1984) discusses the possible interpretation of research results in light of the holographic model, but the data did not provide any direct support for the model. At the present time, therefore, the cognitive- symbolic theory still remains the most viable explanation for mental practice effects. CONCLUSIONS The research generally indicates that mental practice accounts for about half a standard deviation in performance gain over what is observed for controls. When mental practice is examined for motor tasks having significant cognitive components or when it is combine,d with physical practice, the performance gains are much greater. The explanation for mental practice effects appears to be related to symbolic rehearsal of critical and invariant elements (i.e., control rules) of the motor plan. The research does not indicate support for either Jacobson's neuromuscular theory or Pribram's holographic model as explanations for mental practice. The overall effectiveness of mental practice supports future research in at least two directions: one is evaluation studies by the Army on operational military tasks; the other is research designed to determine which combinations of mental and physical practice (e.g., 60:40 or 70:30 ratios of physical to mental practice) would best enhance skill acquisition and maintenance, taking into account time, efficiency, and cost. VISUAL CONCENTRATION Many military tasks would be enhanced if concentration were improved. Although there are numerous experimental techniques to assess concen

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IMPROVING MOTOR SKILLS 71 tration (e.g., the dual-task paradigm and the probe technique), there are so far no concentration- and attention-training techniques derived from experimental research. The training programs designed to develop con- centration fall into two categories: (1) cognitive-behavioral techniques (Meichenbaum, 1977) to focus attention better and (2) visual training to develop the eye muscles. COGNITIVE-B EHAVIORAL TECHN PIQUES According to Schmid and Peper (1986), concentration is '`the ability to focus one's attention on the task and thereby not be disturbed or affected by irrelevant external or internal stimuli." Within a cognitive- behavioral framework, Nideffer (1976, 1979, 1981, 1985, 1986) has de- veloped what he has called attentional control training. The training consists of cognitive-behavioral techniques such as breathing-muscle relaxation (to control arousal) and mental rehearsal-positive self-talk (to shut out negative self-thoughts). In this literature (Nideffer, 1985, 1986), attention is conceived as requiring at least two dimensions: width (broad or narrow) and direction of focus (internal or external). Table 1 illustrates four types of activities that would be performed best with a given attentional style. The idea is that, by knowing the types of attentional focus required by the task, attention can be trained and performance improved (Zaichkowsky, 1984~. There are two major problems with this approach: (1) research or evaluation studies comparing the performances of subjects receiving attentional control training and subjects not receiving training have not been conducted, and (2) other than for the broad-narrow dimension (Reds and Bird, 1982), the questionnaire used to distinguish types of attentional focus (i.e., the Test of Attentional and Interpersonal Style, TAIS) has poor validity both with respect to factorial validity (Dewey, Brawley, and Allard, in press; Rubl, 1983; Vallerand, 1983; Van Schoyck and Grasha, 1981) and construct validity (Aronson, 1981; Jackson, 1980; TABLE l Activities as a Function of Attentional Style Width of Direction Focus Internal External Broad Used to analyze and plan Narrow Used to systematically mentally rehearse a performance situation or to monitor and/or control physical arousal Used to rapidly assess a situation Used to focus in a nondistractible way on one or two external cues

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IMPROVI1VG MOTOR SKILLS 91 Engel, ]985; Perski and Engel, 1980; Perski, Tzankoff, and Engel, 1985). Furthermore, studies indicate that attention (Perski and Dureman, 1979) and instructions (Lo and Johnston, 1984) can be ruled out as factors mediating the HR training effect. The evidence for HR attenuation during static muscular work, compared with that during dynamic exercise, is not as consistent. Although subjects trained to increase HR while encaged in varying levels of muscular work . . .. . ~ ~ _ have consistently oeen successful in increasing it above exercise-only levels (Carroll and McGovern, 1983; Clemens and Shattock, 1979; Magnusson, 1976; Moses, Clemens, and Brener, 1986), attempts to train subjects to decrease HR have produced equivocal results. For example, Clemens and Shattock (1979) found that subjects trained in HR biofeed- back were also able to decrease HR while engaged in static handgrip exercise at 10, 30, and 50 percent of maximal isometric contraction. Moses, Clemens, and Brener (1986) used the same levels of exercise but did not find that subjects were able to modulate the tachycardia of exercise. In their study, HR control (particularly decreases) was pro- gressively impaired as the exercise demands increased. A point of current debate concerns whether the above-mentioned static and dynamic exercise findings can be interpreted as evidence for cardio- specific control. With the exception of the Goldstein, Ross, and Brady (1977) study, studies examining dynamic exercise have found that blood pressure does not change; the only apparent training effect appeared to be specific to the target response (HR) of the training (Fredrikson and Engel, 19851. Aside from blood pressure, however, the studies examining ventilation have supported the interpretation that the cardiac changes imposed on exercise were largely nonspecific, involving parallel changes in oxygen consumption and respiratory patterns. Moses et al. (1986) maintain that none of the experiments on static and dynamic exercise supports '`the inference that individuals may learn to modify the normal tissue-perfusion functions of the heart" (p. 5191. Instead, in most of the studies HR has been closely associated with metabolic rate. RESPIRATION As pointed out in the previous section, respiratory factors parallel the HR attenuation that is believed to result from HR feedback during exercise. Although the major research emphasis has been on cardiac significance of respiration biofeedback for econ feedback, the potential omy of effort in exercise is just beginning to be understood. In fact, it has been suggested by B.D. Hatfield (personal communication, December 16, 1986) that subjects may be able to modulate respiration more easily than HR during exercise.

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93 ._ C~ s~ x y: D a C) cr. . _ - x - r3 - V,~ -C) ~L :r :~: ~4 C ~ ._ ._ 3 - D V C z ~ C;: ~ _ Ct - C ~ ~ O Y ~ e ~ 0 L~ - G - o 5 Ct CJ ~ - o V) ~ _ ._ _ _ ~ - C)< :~ ~ ~ ~ _ 5~ 3 0.1) LL O ~ :1: '= C) 3, .' '"G., - C) C; X ,= s~ C} Ct ~ = o ._ 04 ~ C =; ._ ~ =: ~ - _ 3 u:: o tV - 3 ~ o C ~ y ce D C ~V C _ ~ e ~ c,, ~ 3 e _ D LL ~ D ~ D U) O ~: t~ ~,~ o~ - -O ~C4 ~ ~ ~ ~ ~ ' O (~] ~ ~ _ ~ O - V) C O ~ ._ _ ~ 3 ~ _ cn ~ - o _ CC ~ a y a ~ a y.~, a a ,~, ~ a ct D ct D ~ 5 t ~eD ct D i~ ~C ~, C ~ ~ '~ ~ O ~ ~ . C ~ _ ._ G) - 00 O - ~ ~ o ~ L} ~ O O _ O ~OG - O _ ~ cr ~0 _ oo X - C _ _ ~ _ - ~C Ct ~ - tV . ~`~ - ~ ~ ~3

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94 ENHA NC1NG H UMA N PERFORMA NCE The efficacy of respiration feedback was recently investigated by Hatfield et al. (19861. In this study, 12 aerobically trained athletes were provided with ventilatory feedback on a digital display updated every 15 seconds. With regard to the HR biofeedback studies, the exercise was of greater intensity (i.e., just below calculated ventilatory threshold). A within-subjects design was employed, with subjects receiving, in random order, three conditions (feedback, control, and distraction) during a 36- minute rum The distraction condition consisted of a coincident (antici- pation) timing task with timing feedback given every 3 to 4 seconds. During the control condition, subjects were instructed not to attend to feedback of any kind. The results revealed that the metabolic cost of the run was undiffer- entiated across conditions. However, minute volume and ventilatory equivalent were significantly reduced with feedback compared with the control and distraction, which were not differentiated. Similar results were found for pressure of end tidal 0' and CO' inhaled by producing relatively more CO' with each expiration. Although this is only a single study, the results are consistent with the running economy results found for HR feedback. Taken together, these results demonstrate that feedback procedures can alter metabolic effi- ciency during intensive activity in trained athletes. These results are particularly impressive considering the near maximal intensity of the work performed. Considering the magnitude of the effects at high levels of exercise intensity, it would be useful in future research to compare HR and respiratory feedback in modulating a number of physiological and biochemical parameters associated with exercise. THERMAL SELF-REGULATION Although many clinicians have found thermal training useful as an aid in treating migraine headaches, frostbite or frostnip, and Raynaud~s and other vasoconstrictive disorders, thermal self-regulation with biofeedback may have other cold-weather applications as well (Kappes and Mills, 1985; Taub, 19771. For instance, it is known that extrinsic warming of the hands improves manual efficiency and reduces pain in conditions of extreme cold stress (Lockhart, 19681. In order to perform effectively in cold environments, it is necessary to preserve surface finger temperature to prevent a loss of both tactile sensitivity and dexterity. With obvious implications for the military, Kitching, Bentley, and Page (1942) have examined the usefulness of insulation in increasing hand temperature. Unfortunately, such attempts have often been counterproductive for performance, since heavy insulation often obstructs movement and decreases hand efficiency. Thus, it would be advantageous if hand warming

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IMPROVING MOTOR SKILLS 95 in operational environments could be achieved by other means. One alternative that has gained attention recently is the use of biofeedback to increase hand temperature. Research on the self-regulation of hand temperature in cold environ- ments (see Table 5) has shown, with few exceptions, that feedback training of digital skin temperature can slow a loss of peripheral skin C7 , , ~ '= ~ ~ t 1 ^^ ~ temperature. In the three studies examining performance tHayOuK, lYbU, 1982: Kanoes. Chanman, and Sullivan, 1986), the ability to maintain hand temperature resulted in increased performance. For example, Hayduk (1980) was able to train six subjects to increase skin temperature by 7 ~ rem ~ ' 5.64F, and this increase was found to be related to decreased pain as well as improved performance on measures of manual and finger dexterity, hand strength, and tactile sensitivity. A one-year follow-up (Hayduk, 1982) confirmed that these same subjects maintained their learned ability to self-regulate hand temperature. Unfortunately, the interpretation of feedback effects in the Hayduk studies is confounded by training consisting of both classical conditioning and biofeedback components. However, other researchers have achieved the same temperature (Kappes and Chapman, 1984; Kappes, Chapman, and Sullivan, 1986) and performance (Kappes, Chapman, and Sullivan, 1986) results as Hayduk, even when training had been restricted to biofeedback practice accompanied by a relaxation audiotape. With the exception of the Donald and Hovland (1981) study, the studies listed in Table 5 trained and tested subjects' thermoregulatory abilities inside controlled temperature chambers with total body exposure. Training of this type has led to much better transfer of temperature self-regulation to cold environments than studies that have trained subjects in warm environments with only their hands exposed to cold stress (Donald and Hovland, 1981; Simkins and Funk, 1979; Stoffer, Jensen, and Nessett, 19771. Comparisons of indoor and outdoor environments have shown that skin temperatures of subjects trained outdoors increased, while ~ A_ +~ AI ~ ~_c~ -~31~ ~1~7 maintain their ~.mneratures when tested in an outdoor environment (Kappes and Chapman, 19841. By contrast, the temperatures of the control subjects continued to go down in the cold environment. Although the results of this study suggest a . ~UOI~ t1 Wilily lilUQ~1 ~ ~V~1~ Allay IlA~AA4~^ ~44~ __- thermal specificity of the training environment, subsequent work has failed to confirm this finding (Kappes, Chapman, and Sullivan, 19861. It has yet to be determined if the impressive performance gains achieved with hand warming can generalize beyond the resting state. Future research needs to determine if self-regulation of hand temperatures can be of operational use in situations in which subjects are more physically active, have greater cognitive load, or are exposed to additional forms of stress (i.e., competition, combat, and so on). It would also appear that IT

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96 C) so Blob so G V) o . _ Ct s:: Cd U. so - La o it: o - C) i. V, 4- - Cal on it: ._ ._ Ct so EM m _' Ct C) Lo - Ct it; V, U. - - w ~ ~ Cal W W U) ~ 00 0 O Ct - ' so e. Ct Ct O W W E-. ~ > ~ ~ I ~ o Ct 00 _ ~ W w 04 - C: ~ He W Ct _ W - id Ct - w U) Cal w a W ~ _ ._ Ct ~ ~._ 00 ^ Ct ~ ~ W _ ~ cn W ~ W _ ._ 5 ~ CC u ~e~ -0 w e 3 1I E 0, ~ .= ~ ~ II A ~ 3 ~ ~ :, E ~ ~ ~ ~ ~ ~ ~ ~, ' ~ E c) .- _ ~ E~ ' ~ W ~ . W ') + _ . ~ . _ W _ ._ W ~ _ x o w ~ + ~o o W oo =: o - - -w ~o 0 ~' ~Q Ct Ct o ~o :: o oo _ _ Ct _ o ^ + ~ ._ o s~ ~ ~,L4 ~ G o o C) Ct + + Ct ~ - ~ cr~ C: _ . _ _ Ct _ oo ct cr `: _ o -

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98 ENHANCING [IUMAN PERFORMANCE biofeedback research on performance in cold environments (mountain- eering and skiing, as well as operational tasks important to the military) should examine subjects' accuracy in recognizing hand temperature. The protocols used in the studies in Table 5 did not call for subjects to be trained in the specific skill of temperature estimation; instead, they were trained to increase temperatures by relaxing. Thus, when asked to estimate their peripheral skin temperature, subjects were uniformly inaccurate (Kappes and Chapman, 19841. Perhaps discrimination could be improved by having subjects, as part of the training protocol, report subjective changes in skin temperature. MULTIPLE AUTONOMIC RESPONSES There are a few examples in the research literature of biofeedback for which more than one autonomic response has been given. One study examined the combined effects of feedback and open-focus attention training (a cognitive relaxation procedure) on economy of effort in bicycle ergometer work (Powers, 19804. The four subjects in this study were given 20 sessions of EMG and temperature feedback-open-focus attention training following baseline sessions to determine oxygen consumption, heart rate, and systolic blood pressure. To demonstrate acquisition of skill, subjects had to reduce mean EMG levels as well as finger and toe temperature to preestablished criteria. The Powers results indicated that all but one subject had significantly improved efficiency of pedaling the bicycle ergometer. For all subjects, the percentage reductions from pretest to posttest were as follows: heart rate 8.35 percent: oxvaen consumption, 11.75 percent; and systolic blood , ,.._, ~ - - r _A ~ ~ _, _~ =_ pressure, 9.35 percent. Although the magnitude of these findings is impressive, the failure to employ a placebo control group and the confounding of biofeedback with open-focus training limits a strictly biofeedback interpretation for the findings. Despite these limitations, Powers suggested that the mechanism for the biofeedback self-regulation process . . . may be an organization by means of attentional cortical open focusing leading to bilateral brain hemisphere synchrony; this, in turn, promotes trophotropic processes of the limbic and midbrain area, normalizing the regulatory centers of the hypothalmus, autonomic nervous system, and reticular activating system. ( 1980:3928-B) According to Powers, the end result is a state of homeostasis that facilitates optimal functioning. In an interesting series of studies by Cowings and associates (sowings, 1977; Cowings, Billingham, and Toscano, 1977; Cowings and Toscano,

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IMPRO VINC MOTOR SKILLS 99 1977, 1982), a training method involving biofeedback, autogenic therapy (Schultz and Luthe, 1969), and distraction from symptoms was employed to deal with problems associated with the onset of motion sickness. Cowings ( 1977) found that, compared with either biofeedback or autogenic therapy alone, the combination produced larger magnitude, less variable response changes that were more stable over time. The 12-day training method, called "autogenic feedback training'' (AFT), also accounts for individual response stereotypy (Lacey et al., 1963) by often presenting up to four simultaneous sources of autonomic feedback (heart rate, respiration rate, blood-volume pulse, galvanic skin response, or intercostal muscle activity). The subjects could choose the feedback (auditory or visual) for the given autonomic variable most relevant to their own autonomic response to the motion sickness experienced before testing. The AFT method is believed to deal directly with the final common path of autonomic manifestations of motion sickness, and thus it should work equally well when the underlying mechanisms are different (e.g., Coriolis acceleration affecting the semicircular canals and linear acceleration affecting the otolith organs). To create nausegenic stimulation by means of Coriolis acceleration, Cowings employed a rotating chair (6 to 30 revolutions per minute) combined with 45 head movements. Experimental subjects given AFT training were able to withstand the stress of Coriolis acceleration signif- icantly longer than control subjects (sowings, Billingham, and Toscano, 19771. The findings were the same whether subjects were initially found to be moderately or highly susceptible to Coriolis acceleration (sowings and Toscano, 19824. Symptoms of motion sickness were alleviated for subjects given AFT training only when compared with subjects performing a distracting task (Black Jack task) or no task at all (Toscano and Cowings, 1982~. In this latter study, five of the six subjects undergoing AFT training either significantly reduced or totally suppressed symptoms. A recent study by Dobie et al. ( 1986) showed that a treatment combining biofeedback (EMG and temperature) and cognitive-behavioral therapy (confidence building and desensitization) was effective in increasing tolerance to stimulation-eliciting motion sickness. However, when the separate effects due to biofeedback versus cognitive-behavior therapy were examined, only the cognitive-behavior group increased tolerance to stimulation and reported less symptomatology than the biofeedback and control groups. This could suggest that biofeedback may have little to do with Cowings's findings. However, Dobie et al. (1986) interpreted their findings as perhaps due to (1) the minimal stimulation experienced in their study; (2) not basing feedback on the unique type of autonomic distress experienced by subjects during pretest acceleration tests; and (3) not exposing the feedback and control groups to similar adaptive exposures

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100 ENHANCING HUMAN PERFORMANCE of visually induced motion' as given to the combined and cognitive- behavior groups. Considering these ' is difficult to conclude much from the Dobie et al. Innings. tt may oe that biofeedback is only efficacious if the symptoms are severe or if the relevant autonomic response system is known and then specifically trained in each individual. CONCLUSIONS . . . .. . - ~ design ano procedural varlallo~lv' lr Two major problems appear repeatedly throughout the research on biofeedback and performance. One problem' which limits any clear interpretation of biofeedback effects, is the use of biofeedback as part of broader therapeutic techniques, for example, biofeedback plus classical conditioning (Hayduk, 1980, 1982) or autogenic therapy (sowings, Bil- lingham, and Toscano, 19771. The other problem, primarily evident in studies examining training in EMG, EEG (alpha or theta), and HR while subjects are performing tasks, is that no prior knowledge is available concerning what the most desirable levels of EMG, EEG, or HR should be to produce optimal performance on the tasks of interest. In other words, the training criteria were not based on EMG, EEG, or HR levels known to be important for effective task performance. In the areas in which biofeedback has shown more consistent perform- ance benefits, the relations between, for example, ERP and various thresholds, slow wave potentials and readiness to respond to various tasks, HR or respiration and running economy, and hand warmth and finger dexterity, have been established by previous research. Thus, the direction and magnitude of the physiological parameter to be trained could be more clearly established. Provided subjects could be trained on the particular physiological measure, a performance enhancement was generally found. Until more is learned about the most effective EMG, EEG (alpha or theta), and HR levels for the execution of particular tasks, biofeedback research in these areas should not be pursued. Although the biofeedback research on event-related and slow wave potentials, HR slowing during exercise, and hand warming has been more consistently related to performance enhancement, specific problems must be addressed before these techniques can be implemented into military training programs. For instance, more research needs to be conducted an th`~ mart e.ffi~.io~ training programs for producing a greater per- centage of subjects who can be trained. In addition, the generality of the laboratory-generated relations needs to be tested in operational environ- ments important to the military. It needs to be determined if the fairly robust effects found in the laboratory can extend to performance of more complex tasks having greater cognitive load or while physically active ~ ~ & % ~ ~ _ ~ ~ ~ v ~O 1 ~

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IMPROVING MOTOR SKILLS 101 subjects are exposed to additional forms of stress (e.g., competition or combat). Further research is also needed to train subjects to determine when BEG, HR, and temperature levels are inappropriate for task performance so the self-regulation process can be initiated. Finally, the performance effects of biofeedback need to be compared with other performance-enhancing techniques (e.g., autogenic training, relaxation, imagery, knowledge of performance or results). In reviews comparing biofeedback with relaxation training, Silver and Blanchard (1978) concluded that there was no consistent advantage of one form of treatment over the other across all of the psychophysiological disorders examined. Even though certain types of biofeedback have been shown to improve performance, biofeedback has not been shown to work better than some other, less costly techniques. In addition to determining what technique is most efficacious and cost-effective, future research also should consider what technique is most efficient (works faster), durable (beneficial effects hold up longer), generalizable (benefits a larger pro- portion of people), and convenient (easier to administer and easier to perform) (Silver and Blanchard, 1978~. SOURCES OF lNFORMATlON Our conclusions are based on several sources of information that were made available to the subcommittee. The literature on mental practice was reviewed according to meta-analysis procedures in the Feltz, Landers, and Becker paper prepared for the committee. In addition, the subcom- mittee received briefings from practitioners involved in the development of visual training exercises. Useful information was also conveyed by product developers during site visits. These visits enabled subcommittee members to better understand how training programs are developed from certain assumptions about psychological processes, some of which may have a basis in the research literature.