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

Publication date: Available online 24 June 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Grace J. Kim, Jim Hinojosa, Ashwini K. Rao, Mitchell Batavia, Michael W. O'Dell
ObjectiveTo 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.SettingOutpatient clinic.Participants33 individuals with stroke and moderate-to-severe arm impairment living in the community (3 withdrawals).Interventions4-week arm training protocol on the InMotion ARM robot (12 sessions).Main Outcome MeasuresJoint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up.ResultsThere 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].ConclusionThere 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.



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