Based on Optimal Feedback Control Theory in motor control, this study interpreted physical misalignment as the cumulative result of the nervous system repeatedly selecting low-cost movement strategies. Accordingly, an intervention program informed by Referent Control Theory was designed to reduce degrees of freedom in movement selection through verbal instructions that explicitly presented segment-specific target positions, enabling correct alignment to be repeatedly learned at lower control costs. This learning-based exercise intervention was applied to five children with genu valgum over 12 sessions across four weeks. Data from Sessions 1, 3, 6, 9, and 12 were analyzed to examine time-series changes in immediate effects, cumulative effects, efficiency, and stabilization. The results showed that physical alignment indices shifted toward normalized alignment, while postural control indices demonstrated an overall improvement trend. In addition, prefrontal cortex activity exhibited a time-series pattern characterized by an initial increase followed by a subsequent decrease, suggesting a neurophysiological adaptation associated with control strategy learning. In conclusion, this pilot study suggests that the proposed learning-based exercise intervention may serve as a therapeutic approach to physical alignment based on motor learning, rather than solely on muscle strength enhancement.
Go et al. (Thu,) studied this question.