The Effects of Attentional Focus Instructions on Simulated Upper Extremity Amputees’ Movement Kinematics When Learning a Novel Functional Task

Abstract

An important question in motor learning concerns where attention should be focused when learning a new task. The majority of the literature dealing with this subject suggests that an external (visual, or task-related) focus of attention produces better results than an internal (proprioceptive, or movement-related) focus of attention. While many studies have explored the effect of attentional focus instructions on motor learning in healthy participants, none have dealt with upper extremity amputees. Furthermore, although occupational and physical therapists teach motor skills on a daily basis, there has been little research exploring the best way to teach these skills to patients. This study examined the effects of attentional focus instructions on 30 healthy, college-aged males and females who used a simulated transradial upper extremity prosthesis to learn a novel functional movement task. The experimental task required participants to use the prosthesis to pick up a cup of cereal, pour the cereal into a bowl, move the bowl full of cereal to a plate, and then pick up and transport the bowl of cereal on the plate to a new location. The experiment took place over three sessions and allowed ten trials per session. Sessions one and two were skill acquisition sessions, and session three was a retention session. Participants were randomly assigned to one of three groups: external focus, internal focus, or control. On session one, all groups were shown a video that briefly explained how to use the simulated transradial prosthesis. External and internal focus groups were shown an additional video that instructed them to attend either externally or internally. On session two, internal and external focus groups again viewed the attentional focus video. No videos were shown on session three. The following variables were measured: movement time, movement units, plate pitch and plate roll, and amount of cereal spilled. No significant differences (p < .05) were found between groups during acquisition or retention for the following variables: movement time, movement units, plate pitch and plate roll. However, there was a statistically significant difference between groups for the amount of cereal spilled. While moving as quickly as the other groups, the external focus group spilled significantly less cereal during both skill acquisition and skill retention sessions. Furthermore, in the absence of attentional focus instructions, nine out of 10 control group participants reported using an external focus approach in post-experiment interviews. These findings suggest that occupational and physical therapists may help their patients learn how to use an upper extremity prosthesis more effectively by using instructions that encourage an external focus of attention.