Focus of Attention in Individuals With Stroke

NCT04696302 | Completed

• 1 other identifier: 949671-4
• Study Type: interventional
• Target: 38
• Locations: 1 country
• Sites: 1

Brief Summary

This two phase feasibility study looked at the feasibility of conducting a clinical trial in the outpatient and inpatient rehab setting exploring how individuals post stroke respond to different focus of attention cues. Focus of attention refers to whether individuals in are thinking about how their body is moving, internal focus, or on the effect their body has on the environment, external focus, during motor task. This trial will specifically look at the effect focus of attention has on motor performance and learning in individuals post stroke during lateral seated weight shifting task.

Conditions

Cerebrovascular Accident

Keywords

Focus of attention; Motor learning; Seated weight shifting

Outcome Measures

Primary Outcomes (2)

• Recruitment

  Percentage of participants recruited out of the estimated number needed by power analysis. Power analyses revealed 42 participants were needed for 2X4 mixed model ANOVA 193 analysis, a=.05, power=.8, with a medium effect size, f=.2.

  One year for each arm of the study.

• Retention

  Percentage of participants that completed all 4 timepoints, baseline, acquisition, short term, and long term retention out of those that completed baseline trials.

  One year for each arm of the study.

Secondary Outcomes (16)

• Shoulder alignment during baseline to affected side

  baseline (prior to training)

• Shoulder alignment during baseline to unaffected side

  baseline (prior to training)

• Shoulder alignment during acquisition or training to affected side

  acquisition (30 minutes) through study completion, average of one year.

• Shoulder alignment during acquisition or training to unaffected side

  acquisition (30 minutes) through study completion, average of one year.

• Shoulder alignment during short term retention to affected side

  short-term (5 minutes after training)

Study Arms (2)

Focus of attention in individuals post chronic stroke during seated lateral weight shifting

EXPERIMENTAL

Feasibility study

Behavioral: Focus of attention

Focus of attention in individuals post acute stroke during seated lateral weight shifting

EXPERIMENTAL

Feasibility study

Behavioral: Focus of attention

Interventions

Focus of attention BEHAVIORAL

Individuals were asked to laterally weight shift while seated with either internal focus or external focus instructions.

Also known as: Seated lateral weight shifting

Focus of attention in individuals post acute stroke during seated lateral weight shifting; Focus of attention in individuals post chronic stroke during seated lateral weight shifting

Eligibility Criteria

• Age: 18 Years - 100 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• participants with history of stroke
• ability to sit statically without physical assistance

You may not qualify if:

• severe hemineglect (star cancellation test \<44/54)
• inability to follow multistep commands
• orthopedic issues that limited their ability to weight shift including severe hip or back pain
• individuals with other neurologic conditions such as dementia
• individuals with contraversive pushing.
• During the first arm (phase) of the study there were age matched healthy controls.

Sponsors & Collaborators

• Western Carolina University: lead
• Mission Health System, Asheville, NC: collaborator

Study Sites (1)

Western Carolina University

Cullowhee, North Carolina, 28723, United States

Location

Related Publications (25)

• Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020 Mar 3;141(9):e139-e596. doi: 10.1161/CIR.0000000000000757. Epub 2020 Jan 29.

  PMID: 31992061 BACKGROUND

• Wulf G. Attentional focus and motor learning: A review of 15 years. Int Rev Sport Exerc Psychol. 2013;6(1):77-104. doi:10.1080/1750984X.2012.723728

  BACKGROUND

• 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

• Kakebeeke T, Knols R, de Bruin E. Should rehabilitation specialists use external focus instructions when motor learning is fostered? A systematic review. Sports. 2013;1(2):37-54. doi:10.3390/sports1020037

  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

• Sturmberg C, Marquez J, Heneghan N, Snodgrass S, van Vliet P. Attentional focus of feedback and instructions in the treatment of musculoskeletal dysfunction: a systematic review. Man Ther. 2013 Dec;18(6):458-67. doi: 10.1016/j.math.2013.07.002. Epub 2013 Sep 3.

  PMID: 24008053 BACKGROUND

• McNevin NH, Wulf G, Carlson C. Effects of attentional focus, self-control, and dyad training on motor learning: implications for physical rehabilitation. Phys Ther. 2000 Apr;80(4):373-85. doi: 10.1093/ptj/80.4.373.

  PMID: 10758522 BACKGROUND

• Masters RSW. Knowledge, knerves and know-how: The role of explicit versus implicit knowledge in the breakdown of a complex motor skill under pressure. Br J Psychol. 1992;83:343-358.

  BACKGROUND

• Kal EC, van der Kamp J, Houdijk H, Groet E, van Bennekom CA, Scherder EJ. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke. PLoS One. 2015 Aug 28;10(8):e0136917. doi: 10.1371/journal.pone.0136917. eCollection 2015.

  PMID: 26317437 BACKGROUND

• Kal E, Houdijk H, van der Kamp J, Verhoef M, Prosee R, Groet E, Winters M, van Bennekom C, Scherder E. Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial. Clin Rehabil. 2019 Feb;33(2):207-221. doi: 10.1177/0269215518795243. Epub 2018 Aug 31.

  PMID: 30168348 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 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

• 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

• Muckel S, Mehrholz J. Immediate effects of two attention strategies on trunk control on patients after stroke. A randomized controlled pilot trial. Clin Rehabil. 2014 Jul;28(7):632-6. doi: 10.1177/0269215513513963. Epub 2014 Jan 22.

  PMID: 24452700 BACKGROUND

• Ziv G, Lidor R. Attentional focus and motor learning in clinical settings and in older age: A review. J Mot Learn Dev. 2015;3(2):123-139. doi:10.1123/jmld.2015-0014

  BACKGROUND

• Perennou DA, Mazibrada G, Chauvineau V, Greenwood R, Rothwell J, Gresty MA, Bronstein AM. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain. 2008 Sep;131(Pt 9):2401-13. doi: 10.1093/brain/awn170. Epub 2008 Aug 4.

  PMID: 18678565 BACKGROUND

• Becker K, Smith PJ. Age, task complexity, and sex as potential moderators of attentional focus effects. Percept Mot Skills. 2013 Aug;117(1):1172-86. doi: 10.2466/23.25.pms.117x14z3.

  PMID: 24422344 BACKGROUND

• Johnson L, Burridge JH, Demain SH. Internal and external focus of attention during gait re-education: an observational study of physical therapist practice in stroke rehabilitation. Phys Ther. 2013 Jul;93(7):957-66. doi: 10.2522/ptj.20120300. Epub 2013 Apr 4.

  PMID: 23559523 BACKGROUND

• Shafizadeh M, Platt GK, Mohammadi B. Effects of different focus of attention rehabilitative training on gait performance in Multiple Sclerosis patients. J Bodyw Mov Ther. 2013 Jan;17(1):28-34. doi: 10.1016/j.jbmt.2012.04.005. Epub 2012 May 10.

  PMID: 23294680 BACKGROUND

• McKay B, Wulf G. A distal external focus enhances novice dart throwing performance. Int J Sport Exerc Psychol. 2012;10(2):149-156. doi:10.1080/1612197X.2012.682356

  BACKGROUND

• McNevin NH, Shea CH, Wulf G. Increasing the distance of an external focus of attention enhances learning. Psychol Res. 2003 Feb;67(1):22-9. doi: 10.1007/s00426-002-0093-6. Epub 2002 Oct 30.

  PMID: 12589447 BACKGROUND

• Kal E, van den Brink H, Houdijk H, van der Kamp J, Goossens PH, van Bennekom C, Scherder E. How physical therapists instruct patients with stroke: an observational study on attentional focus during gait rehabilitation after stroke. Disabil Rehabil. 2018 May;40(10):1154-1165. doi: 10.1080/09638288.2017.1290697. Epub 2017 Feb 24.

  PMID: 28637152 BACKGROUND

• Lam JM, Globas C, Hosp JA, Karnath HO, Wachter T, Luft AR. Impaired implicit learning and feedback processing after stroke. Neuroscience. 2016 Feb 9;314:116-24. doi: 10.1016/j.neuroscience.2015.11.051. Epub 2015 Nov 27.

  PMID: 26633264 BACKGROUND

• Chiviacowsky S, Wulf G, Wally R. An external focus of attention enhances balance learning in older adults. Gait Posture. 2010 Oct;32(4):572-5. doi: 10.1016/j.gaitpost.2010.08.004. Epub 2010 Sep 17.

  PMID: 20850325 BACKGROUND

• McNevin N, Weir P, Quinn T. Effects of attentional focus and age on suprapostural task performance and postural control. Res Q Exerc Sport. 2013 Mar;84(1):96-103. doi: 10.1080/02701367.2013.762321.

  PMID: 23611013 BACKGROUND

Related Links

• Founder letter : Is the 8 % payment cut the wake-up call rehab therapists need? WebPT

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Ashley W Hyatt, DPT

  Western Carolina University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Participants were blinded from whether they were in control or experimental group and statistician was blinded.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Physical Therapy

Model Details: Two independent groups measured at 4 timepoints, baseline, acquisition, short-term, and long-term retention.

Study Record Dates

• First Submitted: December 16, 2020
• First Posted: January 6, 2021
• Study Start: March 23, 2015
• Primary Completion: May 1, 2019
• Study Completion: May 1, 2019
• Last Updated: January 6, 2021

Record last verified: 2021-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)