The effect of focus of attention on motor performance and learning during a sit to stand task in individuals post acute stroke



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Individuals post stroke have reduced ability to stand up with symmetrical weight bearing, while maintaining a midline trunk position. The reduction in the ability to stand up can affect their independence, fall risk, and quality of life. Rehabilitation and the type of instruction provided can impact these outcomes. Multiple studies completed in the healthy adult and sports populations have suggested that focusing on a target or outcome, an external focus, can lead to more success in performance and learning of a motor skill than focusing on body movement, an internal focus of attention. The purpose of this study was to explore the effects of focus of attention on motor performance and learning of sit to stand in individuals post-acute stroke. This randomized cross over study included 13 participants who had a stroke less than 6 months prior and could stand and walk without physical assistance. Individuals were provided internal or external focus instruction and feedback during 4 progressively more challenging sets of sit to stands. Task performance was quantified using force through the affected lower extremity and trunk position during the sit to stand transitions. Motor learning was assessed by a retention test 5 minutes and 1 hour after training, as well as a transfer test by the exploring the effects on gait kinematics. Results of the study suggested there was no effect of focus of attention on the increased use of the paretic lower extremity during sit to stand or gait, but when individuals post-acute stroke were in the external focus condition, they had decreased trunk movement throughout training. All individuals showed improvement of the use of the affected lower extremity and increased unaffected step length, and gait velocity, regardless of which focus of attention was provided. Manipulation check revealed that participants adopted internal focus during practice despite the instructions. This study suggests that individuals post stroke may respond differently than healthy adults to attentional focus cues, especially during sit to stand, but the external focus may impact quality of movement during training. Further studies should explore what factors post stroke can affect their response to focus of attention.