Effects of attentional focus on improving upper limb motor performance on post-stroke patients

Abstract

Background: Rehabilitation is an important process in the recovery of upper limb motor function after stroke. In addition, studies show that therapist verbal instruction during treatment is an effective strategy in this process. One way for the therapist to facilitate the command to be given to the learner is to use verbal cues for guidance. They are called focus of attention: internal focus - IF (own body) and external focus - EF (consequence of movement in the environment). For this, it is necessary to evaluate the reach and grasp movements of these individuals, this analysis can be performed using conventional clinical instruments or by high cost kinematic analysis devices. Objective: To evaluate the effects of attention focus types on upper extremity motor performance after stroke by means of a kinematic assessment instrument developed by the authors (Temporal Data Acquisition Instrument (TDAI) as a low cost alternative and simple application. Methods: This study recruited twelve subjects, randomly assigned on two groups by simple draw, where they were asked to perform two motor tasks with the affected limb (16 repetitions), using verbal commands directed by a trained therapist. In the first phase, group 1 received commands with internal focus, while group 2 was instructed with commands with external focus. After one week, the command type changed between groups. To obtain the variables (time of movement, average speed and number of speed peaks), a device developed by the authors (Temporal Data Acquisition Instrument - TDAI) and free kinematic software - CVMob version 4.0 were used. Results: Both attentional focus (internal and external focus) promoted significant differences in time and speed of movement, however, only internal focus provided significant results in both tasks. Discussion: The benefits of one focus of attention over another are not fully confirmed. However, not receiving any kind of attention guidance induces the patient to adopt their own strategies, compromising motor performance. It is pertinent that during the rehabilitation the therapist is aware of the importance of choosing the verbal commands that will be oriented to the patients. Conclusion: Both focuses provided similar motor enhancements and the results support the hypothesis that the benefits of external focus are enhanced when preceded by internal focus.