Deans' stroke musings: How physical therapists instruct patients with stroke: An observational study on attentional focus during gait rehabilitation after stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, May 14, 2020

How physical therapists instruct patients with stroke: An observational study on attentional focus during gait rehabilitation after stroke

Survivors would be incredibly focused if you had EXACT STROKE PROTOCOLS, movements and repetition numbers. You could require 10 million movements and they would start counting. GET THERE!

How physical therapists instruct patients with stroke: An observational study on attentional focus during gait rehabilitation after stroke

Elmar Kal, Henrieke van den Brink, Han Houdijk, John van der Kamp, Paulien Helena Goossens, Coen van Bennekom & Erik Scherder
To cite this article: Elmar Kal, Henrieke van den Brink, Han Houdijk, John van der Kamp, Paulien Helena Goossens, Coen van Bennekom & Erik Scherder (2017): How physical therapists instruct patients with stroke: an observational study on attentional focus during gait rehabilitation after stroke, Disability and Rehabilitation, DOI: 10.1080/09638288.2017.1290697 To link to this article: http://dx.doi.org/10.1080/09638288.2017.1290697
Elmar Kala,b,c, Henrieke van den Brinka, Han Houdijka,c, John van der Kampc,d, Paulien Helena Goossense,f, Coen van Bennekoma,g and Erik Scherderb aResearch and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, The Netherlands; bDepartment of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; cResearch Institute MOVE, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; dInstitute of Human Performance, University of Hong Kong, Hong Kong; eRijnlands Rehabilitation Centre, Leiden, The Netherlands; fSophia Rehabilitation Centre, The Hague, The Netherlands; gCoronel Institute for Occupational and Environmental Health, Academic Medical Centre, Amsterdam, The Netherlands

ABSTRACT

Purpose:

People without neurological impairments show superior motor learning when they focus on movement effects (external focus) rather than on movement execution itself (internal focus). Despite its potential for neurorehabilitation, it remains unclear to what extent external focus strategies are currently incorporated in rehabilitation post-stroke. Therefore, we observed how physical therapists use attentional focus when treating gait of rehabilitating patients with stroke.

Methods:

Twenty physical therapist-patient couples from six rehabilitation centers participated. Per couple, one regular gait-training session was video-recorded. Therapists’ statements were classified using a standardized scoring method to determine the relative proportion of internally and externally focused instructions/feedback. Also, we explored associations between therapists’ use of external/internal focus strategies and patients’ focus preference, length of stay, mobility, and cognition.

Results:

Therapists’ instructions were generally more external while feedback was more internal. Therapists used relatively more externally focused statements for patients with a longer length of stay (B¼0.239, p¼0.013) and for patients who had a stronger internal focus preference (B¼0.930, p¼0.035). Conclusions:

Physical therapists used more external focus instructions, but more internally focused feedback. Also, they seem to adapt their attentional focus use to patients’ focus preference and rehabilitation phase. Future research may determine how these factors influence the effectiveness of different attentional foci for motor learning post-stroke.
IMPLICATIONS FOR REHABILITATION Physical therapists use a balanced mix of internal focus and external focus instructions and feedback when treating gait of stroke patients. Therapists predominantly used an external focus for patients in later rehabilitation phases, and for patients with stronger internal focus preferences, possibly in an attempt to stimulate more automatic control of movement in these patients. Future research should further explore how a patients’ focus preference and rehabilitation phase influence the effectiveness of different focus strategies. Awaiting further research, we recommend that therapists use both attentional focus strategies, and explore per patient which focus works best on a trial-and-error basis.(Nope, nope, nope; a PROTOCOL not trial and error.)