Clinical trial NCT02890446: The Effects of Attentional Focus on Arm Training in Stroke
Official title: A Randomized Control Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Stroke
Keywords: attentional focus
upper extremity
hemiparesis
stroke
Lead sponsor: New York Presbyterian Hospital
Sponsor class: OTHER
Collaborators: name: New York University
First posted: 2016-09-07
Enrollment: 33
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: 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.

Detailed 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.

Eligibility criteria: 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

Primary outcomes:
measure: Change in coordination at the shoulder and elbow measured by joint independence after arm training assessed start of training, discharge and at follow up.
timeFrame: baseline, 4 weeks, 8 weeks
measure: Change in quality of arm motion measured by smoothness at the start of arm training, at 4week, and 8 weeks.
timeFrame: baseline, 4 weeks, 8 weeks
measure: Change in motor impairment of the arm measured by Fugl-Meyer Assessment (FMA) at the start of training, discharge, and follow up.
timeFrame: baseline, 4 weeks, 8 weeks
measure: 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.
timeFrame: baseline, 4 weeks, 8 weeks
Secondary outcomes:
Other outcomes:
Locations:
Study officials:
References:
citation: Kal EC, van der Kamp J, Houdijk H. External attentional focus enhances movement automatization: a comprehensive test of the constrained action hypothesis. Hum Mov Sci. 2013 Aug;32(4):527-39. doi: 10.1016/j.humov.2013.04.001. Epub 2013 Jun 30.
citation: Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010 Jan;44(1):75-84. doi: 10.1111/j.1365-2923.2009.03421.x.
citation: Fasoli SE, Trombly CA, Tickle-Degnen L, Verfaellie MH. Effect of instructions on functional reach in persons with and without cerebrovascular accident. Am J Occup Ther. 2002 Jul-Aug;56(4):380-90. doi: 10.5014/ajot.56.4.380.
citation: Durham KF, Sackley CM, Wright CC, Wing AM, Edwards MG, van Vliet P. Attentional focus of feedback for improving performance of reach-to-grasp after stroke: a randomised crossover study. Physiotherapy. 2014 Jun;100(2):108-15. doi: 10.1016/j.physio.2013.03.004. Epub 2013 Jun 21.
citation: Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A. 2001 Nov;54(4):1143-54. doi: 10.1080/713756012.
citation: Kim GJ, Hinojosa J, Rao AK, Batavia M, O'Dell MW. Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke. Arch Phys Med Rehabil. 2017 Oct;98(10):1924-1931. doi: 10.1016/j.apmr.2017.06.005. Epub 2017 Jun 24.