The Effects of Attentional Focus on Arm Training in Stroke

A Randomized Control Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

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.

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