[Abstract] A Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics with Individuals after Chronic Stroke 

 

Highlights

  • Individuals with moderate-to-severe arm impairment after stroke improved motor control after engaging in high-repetition training
  • There were no differences between external focus or internal focus of attention on retention of motor skills after four weeks of arm training for individuals with stroke
  • Individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus during motor training found in healthy individuals
  • Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment

Abstract

Objective

To compare the long-term effects of external focus (EF) versus internal focus (IF) of attention after 4-weeks of arm training. Design: Randomized, repeated measure, mixed ANOVA.

Setting

Outpatient clinic.

Participants

33 individuals with stroke and moderate-to-severe arm impairment living in the community (3 withdrawals).

Interventions

4-week arm training protocol on the InMotion ARM robot (12 sessions).

Main Outcome Measures

Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up.

Results

There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment [Jt indep-EF, F(1.6, 45.4) = 17.74, p<.0005, partial η2=.39; Jt indep-IF, F(2, 56)= 18.66, p<.0005, partial η2=.40; FMA, F(2, 56) = 27.83, p<.0005, partial η2=.50 ; WMFT, F(2, 56) =14.05, p<.0005, partial η2=.35].

Conclusion

There were no differences in retention of motor skills between EF and IF participants four weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

Source: A Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics with Individuals after Chronic Stroke – Archives of Physical Medicine and Rehabilitation

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