Focus of Attention in Individuals With Stroke
Condition: Cerebrovascular Accident
MeSH terms: Stroke
Study type: Interventional

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.
    

Detailed description: 
      This was a two phase feasibility study exploring appropriate management, setting,
      participants including inclusion and exclusion criteria, attrition rates, protocol, and
      retention. Outcome data for each stage were collected during baseline, acquisition,
      short-term, and long-term retention.

      There were two primary objectives of this two phase feasibility study. The first was to
      uncover some potential short comings in research designs used in this area. The second was to
      explore the feasibility of a study in both the chronic and acute stroke populations in a
      rural community. Topics of feasibility include recruitment, retention, and specific inclusion
      and exclusion criteria. Extending the work by Muckel and Merholz, this feasibility study
      examined performance of individuals post stroke during a seated lateral weight shifting task
      and incorporated retention trials, quality of movement exploration, and bilateral weight
      shifting.

      During Phase I, individuals in both groups sat unsupported on a hi-lo mat table which was
      adjusted so participants were sitting at 90 degrees hip and knee flexion with feet shoulder
      width apart. Tape marks were used to mark initial set up ensuring standardized positioning
      for each trial. Following baseline trials, all participants watched the same instructional
      video describing lateral weight shifting. The instructions included correct mechanics that
      should be used when weight shifting laterally with focus on correct form needed for the
      movement.

      Testing included baseline, acquisition, short term retention (5 minutes later), and long-term
      retention (7-10 days later). Participants performed three trials of seated weight shifting to
      each side at all timepoints. During acquisition, the internal focus group was instructed to
      "shift your weight as much as possible towards your right or left hip without using your
      arms". The external focus group sat with targets one arm length away at shoulder height and
      were instructed to "shift your body weight as much as possible towards the blue/orange target
      without using your arms." During baseline and retention trials, adults were instructed to
      "lean as far as you can to the right/left without using your arms." During Phase II, the
      protocol was similar except 6 trials were performed for acquisition to potentially improve
      motor learning, which was not significant in Phase I per retention data. Other changes to the
      protocol included allowing participants to move their feet when weight-shifting. Instructions
      were also revised. The external focus group was told to "move your shoulder as close to the
      blue/orange target as possible", while the internal focus group was told to "shift your body
      weight as much as possible towards your right/left hip without using your arms."
    

Intervention name(s): Focus of attention
Intervention type(s): Behavioral
Intervention description(s): Individuals were asked to laterally weight shift while seated with either internal focus or external focus instructions.
Other intervention name(s): Seated lateral weight shifting
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two independent groups measured at 4 timepoints, baseline, acquisition, short-term, and long-term retention.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Focus of attention; Motor learning; Seated weight shifting