The Effects of Attentional Focus on Arm Training in Stroke

NCT02890446 | Completed

• 1 other identifier: #1311014488
• Study Type: interventional
• Target: 33
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study compares the effects of an internal versus an external focus of attention on motor training of the affected arm for individuals with stroke. Participants were randomly assigned to either the internal or external focus treatment groups and received 12 sessions of arm training.

Conditions

Stroke

Keywords

attentional focus; upper extremity; hemiparesis; stroke

Outcome Measures

Primary Outcomes (4)

• Change in coordination at the shoulder and elbow measured by joint independence after arm training assessed start of training, discharge and at follow up.

  kinematic measure of coordination between the shoulder and elbow joint

  baseline, 4 weeks, 8 weeks

• Change in quality of arm motion measured by smoothness at the start of arm training, at 4week, and 8 weeks.

  kinematic assessment of arm motion measured by average velocity decided by maximum velocity

  baseline, 4 weeks, 8 weeks

• Change in motor impairment of the arm measured by Fugl-Meyer Assessment (FMA) at the start of training, discharge, and follow up.

  performance based assessment of underlying motor impairment of the affected shoulder, elbow, hand after stroke

  baseline, 4 weeks, 8 weeks

• Change in motor impairment and functional ability of the arm measured by the Wolf Motor Function Test (WMFT) at start of training, discharge, and follow up.

  performance based assessment of underlying motor impairment and function of the affected arm after stroke

  baseline, 4 weeks, 8 weeks

Study Arms (2)

External Focus (EF)

EXPERIMENTAL

Participants received arm training using the InMotion2 robot under external focus practice conditions and instructions. Participants practiced arm reaching by playing a simple video game. EF instructions: "Focus on moving the yellow ball on the screen in a smooth, straight line at a constant speed"; "Move the yellow ball toward the blinking red/orange light"; and "Hit the center of the target and try not to overshoot the target"

Behavioral: upper arm training on the InMotion 2 shoulder robot

Internal Focus (IF)

EXPERIMENTAL

Participants received arm training using the InMotion2 robot without the video game interface. Participants were instructed to think about how they were moving their arm while completing the arm training tasks. IF instructions: "think about how you're moving your arm"; "push your arm away from you"; "pull your arm toward you"; "move your arm to the right/left"

Behavioral: upper arm training on the InMotion 2 shoulder robot

Interventions

upper arm training on the InMotion 2 shoulder robot BEHAVIORAL

Both groups practiced shoulder and elbow exercises on a robotic arm device under an external focus or internal focus practice condition. Practiced arm reaching in a clock-like design to facilitate horizontal shoulder flexion, extension, abduction, adduction. 12 sessions--3 times a week for 4 weeks

External Focus (EF); Internal Focus (IF)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• diagnosis of stroke \> 6 months
• moderate to severe arm impairment
• intact visual scanning and spatial orientation of the affected arm
• functional cognitive status
• medically stable

You may not qualify if:

• concurrent occupational or physical therapy for the arm
• joint contractures at the wrist, forearm, elbow, or shoulder
• moderate to severe spasticity at the elbow or shoulder
• presence of other neurological conditions
• botulinum toxin injection in the affected arm \< 3 months prior
• score of 0/5 on manual muscle test at the elbow or shoulder

Sponsors & Collaborators

• New York Presbyterian Hospital: lead
• New York University: collaborator

Related Publications (6)

• Kal EC, van der Kamp J, Houdijk H. External attentional focus enhances movement automatization: a comprehensive test of the constrained action hypothesis. Hum Mov Sci. 2013 Aug;32(4):527-39. doi: 10.1016/j.humov.2013.04.001. Epub 2013 Jun 30.

  PMID: 24054892 BACKGROUND

• Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010 Jan;44(1):75-84. doi: 10.1111/j.1365-2923.2009.03421.x.

  PMID: 20078758 BACKGROUND

• Fasoli SE, Trombly CA, Tickle-Degnen L, Verfaellie MH. Effect of instructions on functional reach in persons with and without cerebrovascular accident. Am J Occup Ther. 2002 Jul-Aug;56(4):380-90. doi: 10.5014/ajot.56.4.380.

  PMID: 12125827 BACKGROUND

• Durham KF, Sackley CM, Wright CC, Wing AM, Edwards MG, van Vliet P. Attentional focus of feedback for improving performance of reach-to-grasp after stroke: a randomised crossover study. Physiotherapy. 2014 Jun;100(2):108-15. doi: 10.1016/j.physio.2013.03.004. Epub 2013 Jun 21.

  PMID: 23796803 BACKGROUND

• Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A. 2001 Nov;54(4):1143-54. doi: 10.1080/713756012.

  PMID: 11765737 BACKGROUND

• Kim GJ, Hinojosa J, Rao AK, Batavia M, O'Dell MW. Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke. Arch Phys Med Rehabil. 2017 Oct;98(10):1924-1931. doi: 10.1016/j.apmr.2017.06.005. Epub 2017 Jun 24.

  PMID: 28652064 DERIVED

MeSH Terms

Conditions

Stroke; Paresis

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: August 26, 2016
• First Posted: September 7, 2016
• Study Start: May 1, 2014
• Primary Completion: November 1, 2015
• Study Completion: November 1, 2015
• Last Updated: September 7, 2016

Record last verified: 2016-08