New research says adopting an attentional mindset during physical therapy and rehabilitation can help people learn to use prostheses better and faster. The current standard of practice in post-amputation rehabilitation prioritizes internally focused instructions where patients are told to move their joints or contract their muscles in certain ways, but an external focus of attention has been shown to benefit motor performance and learning in sports kinesiology and may translate to prosthetics rehabilitation.
The latest study by Szu-Ping Lee, PT, PhD, a physical therapy researcher at the University of Nevada, Las Vegas (UNLV), and his colleagues is grounded in sports kinesiology research by fellow UNLV professor Gabriele Wulf, PhD. Wulf’s research over the last 20 years has shown that external focus for motor tasks leads to faster learning and improved movement effectiveness and neuromuscular efficiency.
The researchers compared the standard prosthetics rehabilitation method to preparing to golf: approaching the ball, squaring the shoulders, and lining up the putt. Instead of this concentration on form and muscle movement, the researchers say the focus should be on the outcome—the path of the ball—which they found to be more intuitive and effective.
For the study, participants included 21 adults with lower-limb amputations (8 females, 13 males; 85 percent at K3 level; mean age = 50.5) and their prosthetists (mean experience = 10 years, range = 4-21 years) in a clinical prosthetic training setting. The researchers monitored and recorded the verbal instructions and analyzed the frequency and direction of attentional focus. The recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. Twenty training sessions, yielding 904 statements of instruction from 338 minutes of training were recorded.
The research team also explored whether the participants’ age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received.
The results demonstrated that verbal instructions and feedback were frequently provided during prosthetic training. Most verbal interactions were focused internally on the body movements and not externally on the movement effects.
Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 64 percent were internal, 9 percent external, 3 percent mixed, and 25 percent unfocused. Regression analysis revealed that female, older, and higher functioning participants were significantly more likely to receive internally focused instructions.
More research is being done to evaluate how motor learning outcomes such as balance and fall prevention may be improved with better instructions.
“With the wrong kind of focus or instruction being used during physical therapy, the consequences can be catastrophic—the artificial leg becomes a paperweight in a closet,” said Lee. “We want to advance clinical practice and that’s the ultimate goal. We want physical therapy to get better and better for the patients.”
The study, “Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss,” was published in PLOS One.
Editor’s note: This story was adapted from materials provided by UNLV.