Article written by Chloé Van Hede, Physiotherapist.
Let's start at the beginning, by going back for a moment to the definition of cognitive functions?
We all know that these are the capacities of our brain that allow us to interact with our environment. They help us, among other things, to perceive, concentrate, acquire knowledge, adapt, reason and interact with others. According to the literature, they can be grouped into different categories: attention, language, memory, executive functions, visual-spatial functions and social cognition.
In order to increase the performance of our sports patients, we tend to focus on motor functions.
What if the key to sports performance was also to work on cognitive functions?
Every good sportsperson knows that it is not enough to train only muscle strength or proprioception to become a top athlete. Many disciplines require a multitude of skills such as adaptation, organisation, planning and anticipation to position oneself correctly on the field in reaction to actions taking place in real time. Decisions must be made very quickly to anticipate the reactions of opponents, changes in the terrain and more generally anything that disrupts the course of the action.
All this requires sustained concentration and attention.
The team of Lucia et al. has taken an interest in this subject. Their study shows that training that combines a motor task with cognitive work improves the sports performance of players. [1] Here, two groups of basketball players were compared. One group underwent classic sports training (participation in games and field training) for 5 weeks. The other group followed the same programme with the addition of two 30-minute sessions of cognitive-motor training. This training consisted of adding a cognitive task while the player performed dribbling.
The second group showed a 17% increase in the results of sport-specific tests.
A review of the literature on the effects of dual-task training concludes that it promotes the development of working memory and thus improves the motor and cognitive abilities of athletes over the long term.
[2] Duchène et al (2016) studied two groups of hockey players. The results are as follows: perceptual-cognitive training reduces the cognitive load on motor performance by allowing faster movement without altering it.
[3] All this research tends to prove that improving our cognitive abilities is an equally interesting way of improving our sporting abilities and performance. Although this research is not recent (some of it was funded by NASA in 1998 [4]), and is increasingly numerous, it does not yet make it possible to define the optimal training methods.
It is clear that the human brain has not yet revealed all its secrets...
One interesting way to implement this winning cognitive-motor combination in a rehabilitation protocol would be to use Virtual Reality (VR).
The basis of VR is that it works by stimulating attention and concentration. Feedback from practitioners already equipped with VR systems shows that it increases people's engagement in the exercises, their motivation [5] and the intensity of the session.
A 2019 study conducted on karatekas also showed that integrating VR into the athlete's daily practice was useful in improving recognition of the opponent's attack type, so athletes could anticipate and improve their response time and decision making. Where other studies only assumed an increase in motivation, Petri et al. (2019) statistically proved this motivational increase. The excitement came from the fact that the fighters could try out new movements and reactions in a safe environment [6].
In addition to the immersive dimension, which is perceived as fun by the patients, VR makes it possible to work on the dual task or inhibition while carrying out motor work.
A study on elderly subjects showed that VR training was more effective than conventional training. [7] The IADL, a questionnaire for assessing activities of daily living, was significantly improved in the VR group compared to the control group. The control group trained in a more traditional manner, performing squats, sit/stand, walking, muscle strengthening and adding a dual task, changing the instructions or adding memory work.
In addition to functional work, the various possible settings of VR software allow real time adaptation of the patient's exercise conditions [8]. The multitude of environments and exercises makes it a tool that offers almost unlimited possibilities for working on the different aspects of rehabilitation or sports training. The fields of application are vast and still to be discovered.
In summary, adding cognitive work, carried out in VR, to the rehabilitation protocol should make it possible to improve patients' motor skills as well as their sports performance.
[1] https://pubmed.ncbi.nlm.nih.gov/35053809/ Brain Sci. 2021 Dec 31;12(1):68. doi: 10.3390/brainsci12010068.
[2] https://www.mdpi.com/1660-4601/18/4/1732. The Acute and Chronic Effects of Dual-Task on the Motor and Cognitive Performances in Athletes: A Systematic Review .Int. J. Environ. Res. Public Health 2021, 18(4), 1732; https://doi.org/10.3390/ijerph18041732
[3] Duchêne, S. (2016). Design and validation of a training protocol to reduce the impact of a perceptual-cognitive task on motor performance. (Unpublished Master's thesis) Montreal: École de technologie supérieure. 4] Dennis K. A. & Harris, D. (1998). Computer based simulation as an adjunct to Ab Initio flight training. The International Journal of Aviation Psychology, 8(3): 261-277.[5]Petri, K., Masik, S., Danneberg, M., Emmermacher, P. & Witte, K. Possibilities to use a virtual opponent for enhancements of reactions and perception of young karate athletes. Int. J. Comput. Sci. Sport 18, 20-33 (2019)[6] Press article published in l'Indépendant 21/01/21 : La réalité Virtuelle au service de la Rééducation à Port-La-Nouvelle (https://bit.ly/3dpI4Mq)
[7] Ying-Yi Liao 1, Han-Yun Tseng 1, Yi-Jia Lin 2, Chung-Jen Wang 3, Wei-Chun Hsu 4 Eur J Phys Rehabil Med ; Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment , 2020 Feb;56(1):47-57. doi: 10.23736/S1973-9087.19.05899-4
[8] Article published in the Républicain 19/10/21 - At the hospital, virtual reality at the service of patient rehabilitation (https ://bit.ly/3mQVPaI)
