Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

Grace J. Kim, Jim Hinojosa, Ashwini K. Rao, Mitchell Batavia, Michael W. O'Dell

Research output: Contribution to journalArticle

Abstract

Objective: To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. Design: Randomized, repeated-measures, mixed analysis of variance. Setting: Outpatient clinic. Participants: Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). Interventions: Four-week arm training protocol on a robotic device (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 (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). Conclusions: There were no differences in retention of motor skills between EF and IF participants 4 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.

Original languageEnglish (US)
Pages (from-to)1924-1931
JournalArchives of Physical Medicine and Rehabilitation
DOIs
StatePublished - 2017

Fingerprint

Robotics
Upper Extremity
Arm
Stroke
Motor Skills
Joints
Outcome Assessment (Health Care)
Ambulatory Care Facilities
Analysis of Variance
Equipment and Supplies

Keywords

  • Attentional focus
  • Rehabilitation
  • Robotics
  • Stroke
  • Upper extremity
  • motor training
  • robotic therapy
  • post-stroke
  • chronic stroke

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{1ec3a8d13bdb48af9edac707e9db51d8,
title = "Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke",
abstract = "Objective: To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. Design: Randomized, repeated-measures, mixed analysis of variance. Setting: Outpatient clinic. Participants: Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). Interventions: Four-week arm training protocol on a robotic device (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 (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). Conclusions: There were no differences in retention of motor skills between EF and IF participants 4 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.",
keywords = "Attentional focus, Rehabilitation, Robotics, Stroke, Upper extremity, motor training, robotic therapy, post-stroke, chronic stroke",
author = "Kim, {Grace J.} and Jim Hinojosa and Rao, {Ashwini K.} and Mitchell Batavia and O'Dell, {Michael W.}",
year = "2017",
doi = "10.1016/j.apmr.2017.06.005",
language = "English (US)",
pages = "1924--1931",
journal = "Archives of Physical Medicine and Rehabilitation",
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TY - JOUR

T1 - Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

AU - Kim, Grace J.

AU - Hinojosa, Jim

AU - Rao, Ashwini K.

AU - Batavia, Mitchell

AU - O'Dell, Michael W.

PY - 2017

Y1 - 2017

N2 - Objective: To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. Design: Randomized, repeated-measures, mixed analysis of variance. Setting: Outpatient clinic. Participants: Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). Interventions: Four-week arm training protocol on a robotic device (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 (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). Conclusions: There were no differences in retention of motor skills between EF and IF participants 4 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.

AB - Objective: To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training. Design: Randomized, repeated-measures, mixed analysis of variance. Setting: Outpatient clinic. Participants: Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3). Interventions: Four-week arm training protocol on a robotic device (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 (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35). Conclusions: There were no differences in retention of motor skills between EF and IF participants 4 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.

KW - Attentional focus

KW - Rehabilitation

KW - Robotics

KW - Stroke

KW - Upper extremity

KW - motor training

KW - robotic therapy

KW - post-stroke

KW - chronic stroke

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