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The Effects of Attentional Focus on Arm Training in Stroke

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ClinicalTrials.gov Identifier: NCT02890446
Recruitment Status : Completed
First Posted : September 7, 2016
Last Update Posted : September 7, 2016
Sponsor:
Collaborator:
New York University
Information provided by (Responsible Party):
Grace Kim, 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.

Condition or disease Intervention/treatment Phase
Stroke Behavioral: upper arm training on the InMotion 2 shoulder robot Not Applicable

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 33 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
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 Start Date : May 2014
Actual Primary Completion Date : November 2015
Actual Study Completion Date : November 2015

Arm Intervention/treatment
Experimental: External Focus (EF)

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"

Behavioral: upper arm training on the InMotion 2 shoulder robot

Both groups practiced shoulder and elbow exercises on a robotic arm device under an external focus or internal focus practice condition.

Practiced arm reaching in a clock-like design to facilitate horizontal shoulder flexion, extension, abduction, adduction.

12 sessions--3 times a week for 4 weeks


Experimental: Internal Focus (IF)

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"

Behavioral: upper arm training on the InMotion 2 shoulder robot

Both groups practiced shoulder and elbow exercises on a robotic arm device under an external focus or internal focus practice condition.

Practiced arm reaching in a clock-like design to facilitate horizontal shoulder flexion, extension, abduction, adduction.

12 sessions--3 times a week for 4 weeks





Primary Outcome Measures :
  1. Change in coordination at the shoulder and elbow measured by joint independence after arm training assessed start of training, discharge and at follow up. [ Time Frame: baseline, 4 weeks, 8 weeks ]
    kinematic measure of coordination between the shoulder and elbow joint

  2. Change in quality of arm motion measured by smoothness at the start of arm training, at 4week, and 8 weeks. [ Time Frame: baseline, 4 weeks, 8 weeks ]
    kinematic assessment of arm motion measured by average velocity decided by maximum velocity

  3. Change in motor impairment of the arm measured by Fugl-Meyer Assessment (FMA) at the start of training, discharge, and follow up. [ Time Frame: baseline, 4 weeks, 8 weeks ]
    performance based assessment of underlying motor impairment of the affected shoulder, elbow, hand after stroke

  4. 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. [ Time Frame: baseline, 4 weeks, 8 weeks ]
    performance based assessment of underlying motor impairment and function of the affected arm after stroke



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
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
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Grace Kim, Assistant Professor, New York Presbyterian Hospital
ClinicalTrials.gov Identifier: NCT02890446    
Other Study ID Numbers: #1311014488
First Posted: September 7, 2016    Key Record Dates
Last Update Posted: September 7, 2016
Last Verified: August 2016
Keywords provided by Grace Kim, New York Presbyterian Hospital:
attentional focus
upper extremity
hemiparesis
stroke
Additional relevant MeSH terms:
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Stroke
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases