Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke
Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rath...
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| Format: | Online |
| Language: | English |
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Public Library of Science
2015
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| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552655/ |
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pubmed-4552655 |
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pubmed-45526552015-09-10 Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke Kal, E. C. van der Kamp, J. Houdijk, H. Groet, E. van Bennekom, C. A. M. Scherder, E. J. A. Research Article Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p’s ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients’ attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients’ strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor control after stroke. Public Library of Science 2015-08-28 /pmc/articles/PMC4552655/ /pubmed/26317437 http://dx.doi.org/10.1371/journal.pone.0136917 Text en © 2015 Kal et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
| repository_type |
Open Access Journal |
| institution_category |
Foreign Institution |
| institution |
US National Center for Biotechnology Information |
| building |
NCBI PubMed |
| collection |
Online Access |
| language |
English |
| format |
Online |
| author |
Kal, E. C. van der Kamp, J. Houdijk, H. Groet, E. van Bennekom, C. A. M. Scherder, E. J. A. |
| spellingShingle |
Kal, E. C. van der Kamp, J. Houdijk, H. Groet, E. van Bennekom, C. A. M. Scherder, E. J. A. Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| author_facet |
Kal, E. C. van der Kamp, J. Houdijk, H. Groet, E. van Bennekom, C. A. M. Scherder, E. J. A. |
| author_sort |
Kal, E. C. |
| title |
Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| title_short |
Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| title_full |
Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| title_fullStr |
Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| title_full_unstemmed |
Stay Focused! The Effects of Internal and External Focus of Attention on Movement Automaticity in Patients with Stroke |
| title_sort |
stay focused! the effects of internal and external focus of attention on movement automaticity in patients with stroke |
| description |
Dual-task performance is often impaired after stroke. This may be resolved by enhancing patients’ automaticity of movement. This study sets out to test the constrained action hypothesis, which holds that automaticity of movement is enhanced by triggering an external focus (on movement effects), rather than an internal focus (on movement execution). Thirty-nine individuals with chronic, unilateral stroke performed a one-leg-stepping task with both legs in single- and dual-task conditions. Attentional focus was manipulated with instructions. Motor performance (movement speed), movement automaticity (fluency of movement), and dual-task performance (dual-task costs) were assessed. The effects of focus on movement speed, single- and dual-task movement fluency, and dual-task costs were analysed with generalized estimating equations. Results showed that, overall, single-task performance was unaffected by focus (p = .341). Regarding movement fluency, no main effects of focus were found in single- or dual-task conditions (p’s ≥ .13). However, focus by leg interactions suggested that an external focus reduced movement fluency of the paretic leg compared to an internal focus (single-task conditions: p = .068; dual-task conditions: p = .084). An external focus also tended to result in inferior dual-task performance (β = -2.38, p = .065). Finally, a near-significant interaction (β = 2.36, p = .055) suggested that dual-task performance was more constrained by patients’ attentional capacity in external focus conditions. We conclude that, compared to an internal focus, an external focus did not result in more automated movements in chronic stroke patients. Contrary to expectations, trends were found for enhanced automaticity with an internal focus. These findings might be due to patients’ strong preference to use an internal focus in daily life. Future work needs to establish the more permanent effects of learning with different attentional foci on re-automating motor control after stroke. |
| publisher |
Public Library of Science |
| publishDate |
2015 |
| url |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552655/ |
| _version_ |
1613470128319496192 |