The Effects of Attentional Focus on Arm Training in Stroke

New York Presbyterian Hospital

Status: Completed

Conditions: Stroke

Treatments: Behavioral: upper arm training on the InMotion 2 shoulder robot

Study type: Interventional

Funder types: Other

Identifiers

NCT02890446

#1311014488

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 33 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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33 participants in 2 patient groups

External Focus (EF)

Experimental group

Description:

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"

Treatment:

Behavioral: upper arm training on the InMotion 2 shoulder robot

Internal Focus (IF)

Experimental group

Description:

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"

Treatment:

Behavioral: upper arm training on the InMotion 2 shoulder robot