FOA on Sit to Stand in Individuals Post Chronic Stroke

NCT07460804 | Recruiting

• 1 other identifier: 1799541
• Study Type: interventional
• Target: 20
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this study is to fill some gaps in the literature by examining the effects of focus of attention on motor learning and motor performance of sit to stand in individuals post chronic stroke. This study will investigate whether an internal or external focus of attention can lead to improved use of the affected lower extremity during the sit to stand transition, while maintaining an upright trunk position. More specifically, the study has two purposes. The first is to determine whether an external or internal focus of attention would lead to better motor learning of sit to stand. This is measured by retention testing and transfer of the task to changes in affected lower extremity weight bearing during gait. The second purpose of this study is to investigate whether an internal or external focus of attention affects the performance of sit to stands during training.

Conditions

Stroke

Keywords

Motor learning; Focus of attention; Sit to stand

Outcome Measures

Primary Outcomes (9)

• Center of pressure under their feet

  HR Pressure mat - Symmetry under the feet will be measured using a 61.26 X 58.72 cm pedobarograph with a 48.8 X 44.7 cm active sensing area during the sit to stand transition. The mat has 3.9 sensors/cm2 with a 185 Hz scanning rate. The mat will be calibrated prior to the start of the study.

  Baseline

• Center of pressure under their feet

  HR Pressure mat - Symmetry under the feet will be measured using a 61.26 X 58.72 cm pedobarograph with a 48.8 X 44.7 cm active sensing area during the sit to stand transition. The mat has 3.9 sensors/cm2 with a 185 Hz scanning rate. The mat will be calibrated prior to the start of the study.

  Acquisition (one 1 hour training)

• Center of pressure under their feet

  HR Pressure mat - Symmetry under the feet will be measured using a 61.26 X 58.72 cm pedobarograph with a 48.8 X 44.7 cm active sensing area during the sit to stand transition. The mat has 3.9 sensors/cm2 with a 185 Hz scanning rate. The mat will be calibrated prior to the start of the study.

  Immediate Post (5 minutes after acquisition training)

• Center of pressure under their feet

  HR Pressure mat - Symmetry under the feet will be measured using a 61.26 X 58.72 cm pedobarograph with a 48.8 X 44.7 cm active sensing area during the sit to stand transition. The mat has 3.9 sensors/cm2 with a 185 Hz scanning rate. The mat will be calibrated prior to the start of the study.

  Long term (one hour after acquisition/training)

• Trunk alignment

  IMU sensors -One Delsys inertial measurement units (IMUs) will be placed on the T1 spinous process to capture vertical trunk alignment throughout sit to stand.

  Baseline

• Trunk alignment

  IMU sensors -One Delsys inertial measurement units (IMUs) will be placed on the T1 spinous process to capture vertical trunk alignment throughout sit to stand.

  Acquisition (one 1 hour training)

• Trunk alignment

  IMU sensors -One Delsys inertial measurement units (IMUs) will be placed on the T1 spinous process to capture vertical trunk alignment throughout sit to stand.

  Immediate Post (5 minutes after acquisition training)

• Trunk alignment

  IMU sensors -One Delsys inertial measurement units (IMUs) will be placed on the T1 spinous process to capture vertical trunk alignment throughout sit to stand.

  Long term (one hour after training)

• Post Manipulation Questionnaire

  To establish whether participants were thinking about what they were instructed, all individuals were given a post manipulation questionnaire after the 1-hour post training retention testing for each condition. Participants were asked to rate how much they were thinking about "a target that is outside of your body," "how you move your body (e.g. shoulders, hips, trunk)," and about "something else." They responded on a Likert scale with 5 representing very much so and 1 to represent not at all.

  Long term (after all measures completed 1 hour after training)

Secondary Outcomes (6)

• % of Gait Cycle in Stance on Affected LE

  Baseline

• % of Gait Cycle in Stance on Affected LE

  Immediate Post (5 minutes after acquisition training)

• % of Gait Cycle in Stance on Affected LE

  Long term (one hour after acquisition/training)

• Step Length of Unaffected LE During Gait

  Baseline

• Step Length of Unaffected LE During Gait

  Immediate Post (5 minutes after acquisition)

Study Arms (2)

Internal focus of attention group

ACTIVE COMPARATOR

Participants were given instructions that make them think about their body's movements. Prior to training, a demonstration of the task was provided to the participants with emphasis to weight shift towards the affected side. For the internal focus condition, participants were told, "as you stand up and as you sit down bring your right/left (R/L) shoulder and R/L hip as far to the R/L as possible." Participants were asked to perform one repetition with the question "can you show me?" The demonstration was only provided before the first set, but the same verbal instructions were given prior to the start of each successive set during training. During training, individuals performed four sets of 10 sit to stand repetitions, yielding a total of 40 repetitions.

Other: Focus of Attention

External focus of attention group

EXPERIMENTAL

Participants were given instructions that make them think about an outside target/outcome. Prior to training, a demonstration of the task was provided to the participants with emphasis to weight shift towards the affected side. For the internal focus condition, participants were told, "as you stand up and as you sit down try to bring the targets together like this." Participants were asked to perform one repetition with the question "can you show me?" The demonstration was only provided before the first set, but the same verbal instructions were given prior to the start of each successive set during training. During training, individuals performed four sets of 10 sit to stand repetitions, yielding a total of 40 repetitions.

Other: Focus of Attention

Interventions

Focus of Attention OTHER

Focus of attention instruction and feedback. Focus of attention refers to what people are thinking about during motor tasks. An external focus refers to thinking about an outside outcome or target. An internal focus of attention refers to thinking about how someone is moving their body. During training, participants performed four sets of sit to stand transitions with the mat at progressively lower seat heights to increasingly challenge the participants, with instruction and feedback consistent with their condition allocation. The four sets occurred in the following sequences: 130% of the initial mat height determined at baseline assessment 120%, 110%, and 100%. Each set ended after the tenth repetition or when the participant reported an RPE rating of \>16/20. During training, one verbal correction was given during each set after the second, fourth, and seventh repetition.

External focus of attention group; Internal focus of attention group

Eligibility Criteria

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

You may qualify if:

• Stroke \>6 months
• Mild to moderate stroke (NIHSS scores 0-15)

You may not qualify if:

• Unable to perform sit to stand from a standard height 20" chair without physical assistance
• Unable to walk 20 feet with or without an assistive device at a contact guard to independent level
• Individuals with severe cognitive impairment (\<10/30 on the Montreal Cognitive assessment)
• Contraversive pushing (\> 1 on the Scale for Contraversive Pushing)
• Neglect as evidenced by \<44/54 on the star cancellation test
• Any orthopedic conditions that impact their ability to transition from sit to stand will be excluded from the study.
• Any other neurologic conditions that impact their ability to transition from sit to stand will be excluded from the study.
• Minors, prisoners, pregnant women will also be excluded.
• Non English speaking individuals due to lack of interpretation resources.

Sponsors & Collaborators

• Western Carolina University: lead

Study Sites (1)

Western Carolina University

Cullowhee, North Carolina, 28723, United States

RECRUITING

Related Publications (5)

• Cheng PT, Liaw MY, Wong MK, Tang FT, Lee MY, Lin PS. The sit-to-stand movement in stroke patients and its correlation with falling. Arch Phys Med Rehabil. 1998 Sep;79(9):1043-6. doi: 10.1016/s0003-9993(98)90168-x.

  PMID: 9749681 BACKGROUND

• Chua LK, Jimenez-Diaz J, Lewthwaite R, Kim T, Wulf G. Superiority of external attentional focus for motor performance and learning: Systematic reviews and meta-analyses. Psychol Bull. 2021 Jun;147(6):618-645. doi: 10.1037/bul0000335.

  PMID: 34843301 BACKGROUND

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

  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

• Wulf, G. (2013). Attentional focus and motor learning: A review of 15 years. International Review of Sport and Exercise Psychology, 6(1), 77-104. https://doi.org/10.1080/1750984X.2012.723728

  BACKGROUND

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

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

Central Study Contacts

Ashley Watamura, PT, DPT, PhD

CONTACT

717-682-9710; awhyatt@email.wcu.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: Participants will not be aware of their condition allocation compared to the other condition.
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: Randomized cross-over study. Participants will be randomized into the internal or external focus of attention condition and one week later they will complete the opposite protocol.

Study Record Dates

• First Submitted: July 17, 2025
• First Posted: March 10, 2026
• Study Start: March 26, 2025
• Primary Completion (Estimated): May 16, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: March 10, 2026

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)