Focus and movement in stroke rehabilitation

This study aimed to see if internal or external focus affects dual performance in unilateral (one side of the body was affected) stroke patients. The study found no significant difference between which type of focus was used.

Performing two tasks at once – such as walking and texting – can be difficult for stroke patients. It can affect their balance and gait and lead to falling. Following stroke movement must be improved so that it becomes automatic and requires little focus.

In healthy adults, motor performance has been shown to be better when the person focuses on the outcome of the movement (external focus) rather than the movement itself (internal focus). Generally stroke patients use internal focus in rehabilitation. It is possible that using external focus might improve movement speed, fluency and automaticity, as well as dual task performance.

27 patients completed the trial. Single-task performance was measured with a seated, single leg stepping task. When asked to use external focus, patients would focus on moving their leg in front of or behind a line on the floor. Removing the line on the floor forced patients to have to concentrate on the actual movement (internal focus). Dual-task performance was measured by having patients perform this exercise at the same time as performing cognitive exercises using sounds and letters. 

There was no significant difference between internal and external focus in single-task performance. Movement speed was similar with both types of focus.

External focus reduced dual-task performance and reduced movement fluency (how automatically movement was performed), but these differences were not statistically significant.

The researchers concluded that an external focus did not improve movement or dual-task performance in stroke patients.

The study consisted mainly of people who had strokes several years ago. These people would be dependent on internal focus, which they learned in rehabilitation originally. It would be worthwhile to compare this subgroup of people to patients just beginning rehabilitation using both type of focus.