Durham K F, Sackley C M, Wright C C, Wing A M, Edwards M G, van Vliet P
School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham, UK; Faculty of Medicine and Health, University of East Anglia, Queens Building, Earlham Road, Norwich, Norfolk, NR4 7TJUK.
Physiotherapy. 2014 Jun;100(2):108-15. doi: 10.1016/j.physio.2013.03.004. Epub 2013 Jun 21.
To investigate whether feedback inducing an external focus (EF) of attention (about movement effects) was more effective for retraining reach-to-grasp after stroke compared with feedback inducing an internal focus (IF) of attention (about body movement). It was predicted that inducing an EF of attention would be more beneficial to motor performance.
Crossover trial where participants were assigned at random to two feedback order groups: IF followed by EF or EF followed by IF.
Research laboratory.
Forty-two people with upper limb impairment after stroke.
Participants performed three reaching tasks: (A) reaching to grasp a jar; (B) placing a jar forwards on to a table; and (C) placing a jar on to a shelf. Ninety-six reaches were performed in total over one training session.
Kinematic measures were collected using motion analysis. Primary outcome measures were movement duration, peak velocity of the wrist, size of peak aperture and peak elbow extension.
Feedback inducing an EF of attention produced shorter movement durations {first feedback order group: IF mean 2.53 seconds [standard deviation (SD) 1.85]; EF mean 2.12 seconds (SD 1.63), mean difference 0.41 seconds; 95% confidence interval -0.68 to 1.5; P=0.008}, an increased percentage time to peak deceleration (P=0.01) when performing Task B, and an increased percentage time to peak velocity (P=0.039) when performing Task A compared with feedback inducing an IF of attention. However, an order effect was present whereby performance was improved if an EF of attention was preceded by an IF of attention.
Feedback inducing an EF of attention may be of some benefit for improving motor performance of reaching in people with stroke in the short term; however, these results should be interpreted with caution. Further research using a randomised design is recommended to enable effects on motor learning to be assessed.
探讨与诱导关注内部焦点（关于身体动作）的反馈相比，诱导关注外部焦点（关于动作效果）的反馈对中风后抓握动作再训练是否更有效。据预测，诱导关注外部焦点对运动表现更有益。
交叉试验，参与者被随机分配到两个反馈顺序组：先进行关注内部焦点的反馈，再进行关注外部焦点的反馈；或先进行关注外部焦点的反馈，再进行关注内部焦点的反馈。
研究实验室。
42名中风后上肢功能受损的患者。
参与者进行三项伸手任务：（A）伸手去抓一个罐子；（B）将一个罐子向前放在桌子上；（C）将一个罐子放在架子上。在一次训练中总共进行96次伸手动作。
使用运动分析收集运动学指标。主要观察指标为动作持续时间、手腕峰值速度、最大孔径大小和肘部最大伸展度。
与诱导关注内部焦点的反馈相比，诱导关注外部焦点的反馈产生了更短的动作持续时间{第一个反馈顺序组：关注内部焦点的反馈平均为2.53秒[标准差（SD）1.85]；关注外部焦点的反馈平均为2.12秒（SD 1.63），平均差异为0.41秒；95%置信区间为-0.68至1.5；P = 0.008}，在执行任务B时达到峰值减速的时间百分比增加（P = 0.01），在执行任务A时达到峰值速度的时间百分比增加（P = 0.039）。然而，存在一种顺序效应，即如果在关注外部焦点的反馈之前先进行关注内部焦点的反馈，表现会得到改善。
诱导关注外部焦点的反馈可能在短期内对改善中风患者伸手动作的运动表现有一定益处；然而，这些结果应谨慎解读。建议采用随机设计进行进一步研究，以评估对运动学习的影响。
