Abstract
Design: Double-blind randomised controlled trial.
Setting: Inpatient stroke rehabilitation unit.
Subjects: Sixty-three stroke patients (Meanage = 59.6±10.7 years; Meandays since stroke = 28.5±16.6; MedianFunctional Ambulation Categories = 4).
Interventions: Patients were randomly assigned to an internal (N=31) or external (N=32) focus instruction group. Both groups practiced a balance board stabilization task, three times per week, for three weeks. Balance performance was assessed at baseline, and after one and three weeks of practice.
Main measures: Primary outcome was the threshold stiffness (Nm/radian) at which patients could stay balanced. Secondary outcomes were patient’s sway (root-mean-square error in degrees) at the baseline threshold stiffness under single- and dual-task conditions, and their performance on the Timed-up-and-Go and Utrecht Scale for Evaluation of Rehabilitation.
Results: Both groups achieved similar improvements in threshold stiffness (∆=27.1±21.1 Nm/radian), and single- (∆=1.8±2.3° root-mean-square error) and dual-task sway (∆=1.7±2.1° root-mean-square error) after three weeks of practice. No differences were found in improvements in clinical tests of balance and mobility. Patients with comparatively good balance and sensory function, and low attention capacity showed greatest improvements with external focus instructions.
Conclusions: External focus instructions did not result in greater improvement in balance skill in stroke patients compared to internal focus instructions. Results suggest that tailoring instructions to the individual stroke patient may result in optimal improvements in motor skill.
| Original language | English |
|---|---|
| Pages (from-to) | 207-221 |
| Number of pages | 15 |
| Journal | Clinical Rehabilitation |
| Volume | 33 |
| Issue number | 2 |
| Early online date | 31 Aug 2018 |
| DOIs | |
| Publication status | Published - 1 Feb 2019 |
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Keywords
- external focus of attention
- learning
- motor skill
- randomized controlled trial
- rehabilitation
- Stroke
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Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial. / Kal, Elmar; Houdijk, Han; van der Kamp, John; Verhoef, Manon; Prosée, Rens; Groet, Erny; Winters, Marinus; van Bennekom, Coen; Scherder, Erik.
In: Clinical Rehabilitation, Vol. 33, No. 2, 01.02.2019, p. 207-221.Research output: Contribution to Journal › Article › Academic › peer-review
TY - JOUR
T1 - Are the effects of internal focus instructions different from external focus instructions given during balance training in stroke patients? A double-blind randomized controlled trial
AU - Kal, Elmar
AU - Houdijk, Han
AU - van der Kamp, John
AU - Verhoef, Manon
AU - Prosée, Rens
AU - Groet, Erny
AU - Winters, Marinus
AU - van Bennekom, Coen
AU - Scherder, Erik
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Objective: This study aimed to assess if external focus instructions result in greater improvements in motor skill and automaticity compared to internal focus instructions in stroke patients. Design: Double-blind randomised controlled trial.Setting: Inpatient stroke rehabilitation unit.Subjects: Sixty-three stroke patients (Meanage = 59.6±10.7 years; Meandays since stroke = 28.5±16.6; MedianFunctional Ambulation Categories = 4).Interventions: Patients were randomly assigned to an internal (N=31) or external (N=32) focus instruction group. Both groups practiced a balance board stabilization task, three times per week, for three weeks. Balance performance was assessed at baseline, and after one and three weeks of practice.Main measures: Primary outcome was the threshold stiffness (Nm/radian) at which patients could stay balanced. Secondary outcomes were patient’s sway (root-mean-square error in degrees) at the baseline threshold stiffness under single- and dual-task conditions, and their performance on the Timed-up-and-Go and Utrecht Scale for Evaluation of Rehabilitation. Results: Both groups achieved similar improvements in threshold stiffness (∆=27.1±21.1 Nm/radian), and single- (∆=1.8±2.3° root-mean-square error) and dual-task sway (∆=1.7±2.1° root-mean-square error) after three weeks of practice. No differences were found in improvements in clinical tests of balance and mobility. Patients with comparatively good balance and sensory function, and low attention capacity showed greatest improvements with external focus instructions.Conclusions: External focus instructions did not result in greater improvement in balance skill in stroke patients compared to internal focus instructions. Results suggest that tailoring instructions to the individual stroke patient may result in optimal improvements in motor skill.
AB - Objective: This study aimed to assess if external focus instructions result in greater improvements in motor skill and automaticity compared to internal focus instructions in stroke patients. Design: Double-blind randomised controlled trial.Setting: Inpatient stroke rehabilitation unit.Subjects: Sixty-three stroke patients (Meanage = 59.6±10.7 years; Meandays since stroke = 28.5±16.6; MedianFunctional Ambulation Categories = 4).Interventions: Patients were randomly assigned to an internal (N=31) or external (N=32) focus instruction group. Both groups practiced a balance board stabilization task, three times per week, for three weeks. Balance performance was assessed at baseline, and after one and three weeks of practice.Main measures: Primary outcome was the threshold stiffness (Nm/radian) at which patients could stay balanced. Secondary outcomes were patient’s sway (root-mean-square error in degrees) at the baseline threshold stiffness under single- and dual-task conditions, and their performance on the Timed-up-and-Go and Utrecht Scale for Evaluation of Rehabilitation. Results: Both groups achieved similar improvements in threshold stiffness (∆=27.1±21.1 Nm/radian), and single- (∆=1.8±2.3° root-mean-square error) and dual-task sway (∆=1.7±2.1° root-mean-square error) after three weeks of practice. No differences were found in improvements in clinical tests of balance and mobility. Patients with comparatively good balance and sensory function, and low attention capacity showed greatest improvements with external focus instructions.Conclusions: External focus instructions did not result in greater improvement in balance skill in stroke patients compared to internal focus instructions. Results suggest that tailoring instructions to the individual stroke patient may result in optimal improvements in motor skill.
KW - external focus of attention
KW - learning
KW - motor skill
KW - randomized controlled trial
KW - rehabilitation
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85053377286&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053377286&partnerID=8YFLogxK
U2 - 10.1177/0269215518795243
DO - 10.1177/0269215518795243
M3 - Article
VL - 33
SP - 207
EP - 221
JO - Clinical Rehabilitation
JF - Clinical Rehabilitation
SN - 0269-2155
IS - 2
ER -