The Effects of Attentional Focus on Arm Training in Stroke

New York Presbyterian Hospital33 enrolled

Overview

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.

Participants were randomized to one of two treatment groups and received upper arm reaching training on the InMotion 2 shoulder robot (12 hourly sessions over four weeks). The external focus group received instructions specifically to pay attention to the task goal--hitting targets on the video game, while the internal focus group was instructed to pay attention to the movement of their arm motions (video game monitor was turned off). Both groups practiced the same arm reaching pattern and were matched for level of arm impairment and training dosage.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Stroke

Interventions

upper arm training on the InMotion 2 shoulder robotBEHAVIORAL

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

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 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 Exclusion Criteria: * 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

Outcomes

Primary Outcomes

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

Time frame: 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

Time frame: 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

Time frame: 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

Time frame: baseline, 4 weeks, 8 weeks

Data from ClinicalTrials.gov

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