Sensory information is critical to correct performance errors online during the execution of complex tasks and can be complemented by augmented feedback (FB). Here, 2 groups of participants acquired a new bimanual coordination pattern under different augmented FB conditions: 1) visual input reflecting coordination between the 2 hands and 2) auditory pacing integrating the timing of both hands into a single temporal structure. Behavioral findings revealed that the visual group became dependent on this augmented FB for performance, whereas the auditory group performed equally well with or without augmented FB by the end of practice. Functional magnetic resonance imaging (fMRI) results corroborated these behavioral findings: the visual group showed neural activity increases in sensory-specific areas during practice, supporting increased reliance on augmented FB. Conversely, the auditory group showed a neural activity decrease, specifically in areas associated with cognitive/sensory monitoring of motor task performance, supporting the development of a control mode that was less reliant on augmented FB sources. Finally, some remnants of brain activity in sensory-specific areas in the absence of augmented FB were found for the visual group only, illustrating ongoing reliance on these areas. These findings provide the first neural account for the "guidance hypothesis of information FB," extensively supported by behavioral research.

Little is known about activation changes reflecting overlearning, i.e., extensive motor training beyond asymptotic performance. Here we used functional magnetic resonance imaging to trace the neural shifts from an initial to a skilled (learning) and finally overlearned stage (automatization). Scanning occurred before training (PRE) and after 1 (MID) and 2 weeks (POST) of intensive practice on a new bimanual coordination task (Ͼ10,500 cycles). Kinematics revealed major improvements between PRE and MID sessions, whereas MID to POST session performance leveled off, indicative of learning and automatization, respectively. Imaging findings showed that activation decreased in bilateral opercular areas, bilateral ventrolateral prefrontal cortex, the right ventral premotor and supramarginal gyrus, and the anterior cingulate sulcus during the learning stage and in the supplementary motor area during the automatization stage. These changes are hypothesized to reflect decreases in attention-demanding sensory processing, as well as suppression of preferred coordination tendencies as a prelude to acquiring new coordination modes. Conversely, learning-related increases were observed in the primary motor cortex (M1), posterior cingulate zone (PCZ), putamen, and right anterior cerebellum. Importantly, both M1 and PCZ activation decreased again to initial level (PRE) during automated performance (POST). Only the putamen and anterior cerebellum remained more activated across both learning and automatization stages, supporting their crucial role in long-term motor memory formation for coordination tasks.

Little research has been published about the impact of simulation technology on the learning process of novel motor skills. Especially the role of augmented feedback (FB) on the quality of performance and the transfer of the acquired behaviour to a no-augmented FB condition require further investigation. Therefore, novice dental students were randomly assigned to one of three groups and given the task of drilling a geometrical class 1 cavity. The FB group trained under augmented visual FB conditions, provided by the virtual reality (VR) system (DentSim). The no-FB group practised under normal vision conditions, in the absence of augmented FB. A control group performed the test sessions without participating in any training programme. All preparations were evaluated by the VR grading system according to four traditional (outline shape, floor depth, floor smoothness and wall inclination), and two critical, criteria (pulp exposure and damage to adjacent teeth). Performance analyses revealed an overall trend towards significant improvement with training for the experimental groups. The FB group obtained the highest scores. It scored better for floor depth (P < 0.001), whilst the no-FB group was best for floor smoothness (P < 0.005). However, at the retention tests, the FB group demonstrated inferior performance in comparison with the no-FB group. The transfer test on a traditional unit revealed no significant differences between the training groups. Consequently, drilling experience on a VR system under the condition of frequently provided FB and lack of any tutorial input was considered to be not beneficial to learning. The present data are discussed in view of the guidance hypothesis of FB, which refers to the apprentice's dependence on FB.

Virtual reality (VR) simulators can be used as tools in manual dexterity training. The visual feedback guides the subject towards proper performance but creates, at the same time, some dependency on this feedback. To overcome this drawback, the effect of adjunct tutorial input on motor learning behaviour was examined. Novice dental students were randomly assigned to one of two training groups or to a non-training control group, given the task of preparing a geometrical class 1 cavity in phantom teeth. The feedback (FB) group trained under augmented visual feedback conditions, provided by the VR system (DentSim). The feedback-plus (FB+) group received, in addition, standardised expert input to enrich the augmented feedback information. The control group, consisting of same year students, did not participate in any training programme. All preparations were evaluated by the VR scoring system. Performance analyses revealed an overall trend towards significant improvement with practice for the training groups. Performance of the FB+ group was most accurate across training. After 1 day and 3 weeks of no practice, both training groups outperformed the control group. After 4 months, however, only the FB+ condition was significantly more accurate than the control group. The same tendency was noted for the transfer tests. Consequently, cavity preparation experience on a VR system under the condition of frequently provided feedback supplemented with expert input was most beneficial to long time learning.

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