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The Effects of Attentional Focus on Arm Training in Stroke

Not Applicable
Completed
Conditions
Stroke
Interventions
Behavioral: upper arm training on the InMotion 2 shoulder robot
Registration Number
NCT02890446
Lead Sponsor
New York Presbyterian Hospital
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.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
33
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

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
External Focus (EF)upper arm training on the InMotion 2 shoulder robotParticipants 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"
Internal Focus (IF)upper arm training on the InMotion 2 shoulder robotParticipants 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"
Primary Outcome Measures
NameTimeMethod
Change in quality of arm motion measured by smoothness at the start of arm training, at 4week, and 8 weeks.baseline, 4 weeks, 8 weeks

kinematic assessment of arm motion measured by average velocity decided by maximum velocity

Change in coordination at the shoulder and elbow measured by joint independence after arm training assessed start of training, discharge and at follow up.baseline, 4 weeks, 8 weeks

kinematic measure of coordination between the shoulder and elbow joint

Change in motor impairment of the arm measured by Fugl-Meyer Assessment (FMA) at the start of training, discharge, and follow up.baseline, 4 weeks, 8 weeks

performance based assessment of underlying motor impairment of the affected shoulder, elbow, hand after stroke

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.baseline, 4 weeks, 8 weeks

performance based assessment of underlying motor impairment and function of the affected arm after stroke

Secondary Outcome Measures
NameTimeMethod
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