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Effects of Attentional Focus on Motor Training of the Upper Limb Using Robotics in Individuals After Chronic Stroke
Research Posters Participants: N/A. Interventions: N/A. Main Outcome Measure(s): Data Sources: Search of electronic data bases (Medline, Web of Science, Scopus, EBSCO, ProQuest), grey literature (OpenGrey, Google) from Jan 1, 2004 to Dec 31, 2014. Study Selection: Two investigators independently reviewed all titles, abstracts and full articles. Articles that reported on one the following criteria were included: 1) transdisciplinary research study outcomes; 2) factors influencing transdisciplinary research outcomes; 3) an evaluation model, framework, criteria for evaluating transdisciplinary research. Data Extraction: Two investigators independently reviewed the selected literature, extracted data into standardized data extraction forms, and identified themes. Results: Evidence suggests that adopting a transdisciplinary approach supports research productivity, involves better knowledge translation through broader dissemination of findings, enhances learning and training for students, and advances understanding of phenomena under investigation. However, implementing transdisciplinarity in practice is challenging. Barriers identified include: inefficient communications, established research hierarchies and practices, dealing with uncertainty, and lengthy research processes. Facilitators include: institutional support, heterogeneous team make-up, multi-directional communication, and collaborative leadership. To date, no evaluation criteria, model or framework has been advanced for measuring the quality and effectiveness of adopting transdisciplinarity in aging and technology. Conclusions: Despite evidence that transdisciplinarity can lead to more successful research and training processes, outcomes and impacts, it has received limited empirical exploration in the research and development of assistive technologies for older adults. Our review highlights a gap in knowledge on the impact of adopting transdisciplinary approaches in this research area, and an urgent need for development of quality frameworks to guide future implementation efforts. Key Words: Transdisciplinary, Technology, Research and Development Disclosures: None disclosed.
Research Poster 258 Effects of Attentional Focus on Motor Training of the Upper Limb Using Robotics in Individuals After Chronic Stroke Grace Kim (New York Presbyterian Hospital-Weill Cornell Medical Center), Jim Hinojosa, Mitch Batavia, Ashwini Rao Research Objectives: Compare the effects of an external focus versus an internal focus of attention on the performance and retention of arm reach after upper limb robotics training for individuals with moderate-to-severe arm impairment after stroke. Design: A randomized, repeated measures, mixed ANOVA design was used to compare the long term effects of an external focus versus internal focus of attention after a 4-week arm training protocol on the InMotion2 shoulder /elbow robot. Attentional focus and level of arm impairment were the between group factors, and time was the within group factor. Setting: Outpatient research lab at NewYork Presbyterian Hospital. Participants: Thirty participants with moderate-to-severe arm impairment were randomly assigned to either an external focus or internal focus group and matched for sample size, level of arm impairment, and training dosage. Interventions: Participants received proximal arm training on the InMotion 2 robot 3x/week for 4 weeks, each session was 40-90 minutes depending on motor ability of the participant. Main Outcome Measure(s): Smoothness and joint independence (kinematic outcomes on the InMotion 2, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and at a 4-week follow up. Results: Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4week follow up regardless of group assignment [smoothness, F(1.49, 38.61) Z 26.28, p<.001; joint independence, F(1.6,42.6) Z 17.20, p<.001; FMA, F(2, 52) Z 27.55, p<.001; WMFT, F(2, 52) Z14.05, p<.001]. There were no significant interaction effects for attentional focus.
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e35 Conclusions: This is one of the first inteventional studies investigating the long term effects of attentional focus for individuals with stroke. Contrary to the established literature on the healthy population (McNevin, Shea, & Wulf, 2003; Wulf, 2007), there were no differential effects of external focus or internal focus on the retention of motor skills after four weeks of arm training. The results suggest that individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus found in healthy individuals. The current theoretical model (Constrained Action Hypothesis) may need to be expanded and modified to account for individuals with moderate-to-severe motor impairments after stroke. Attentional focus is most likely not a primary active ingredient for retention of trained motor skills in individuals with moderate-to-severe arm impairment after stroke, whereas, dosage and intensity of practice appear to be pivotal. Key Words: Attentional focus, stroke, hemiparesis, upper extremity Disclosures: Grace Kim has served as a paid consultant for Interactive Motion Technologies (IMT) in the past. However, IMT provided no financial support or research design input into this study. The other listed authors have nothing to disclose. Research Poster 262 Validation of Frenchay Activity Index Among Older Veterans with Gait and Balance Deficits Pallavi Sood (University of Florida, Dept of Occupational Therapy), Sergio Romero Research Objectives: This study examines the validity of the Frenchay Activity index (FAI) when used to measure participation in a group of community dwelling older Veterans with gait and balance deficits. Design: Retrospective data analysis was conducted using EFA (Exploratory Factor Analysis), CFA (Confirmatory Factor Analysis), and Rasch partial credit model to determine factor structure and item-based psychometric properties of the FAI. Setting: Outpatient Gait and Balance Clinic (Malcom Randall VA Medical Center). Participants: 147 community dwelling older Veterans aged 55 to 91 (mean 77 5.73) with prior history of falls or at high risk for falling due to multiple risk factors. Interventions: Not Applicable. Main Outcome Measure(s): Not applicable. Results: CFA failed to confirm uni-dimensionality of the scale (Chi-Square value (X2 [df]) Z 222.240[91], p.95, TLI>.95, RMSEA >0.05, SRMR<1.0). The FAI 4-point rating scale did not meet Linacre’s 3 essential criteria and was collapsed into a 3-point rating scale to improve the response distribution. The domestic chores and work/leisure subscales showed satisfactory Rasch fit statistics (Outfit/Infit MnSq 0.6-1.4, zstd 0.70). Conclusions: An overarching goal of rehabilitation is to restore function, and to maximize social participation. Our findings suggest the FAI is a psychometrically acceptable IADL scale that measures complex everyday participation in Domestic chores and Work/Leisure activities for community dwelling older Veterans with gait and balance deficits. Key Words: Frenchay Activity Index, IADL, participation Disclosures: None disclosed. Research Poster 263 The Feasibility of Utilizing an EMG-triggered Hand Robot for Individuals After Chronic Stroke Grace Kim (New York Presbyterian Hospital-Weill Cornell Medical Center), Michael O’Dell, Joel Stein, Michael Taub, Carly Creelman, Christine Cahalan, Lisa Rivera Research Objectives: 1) Determine the feasibilty and safety of a new EMG-triggered hand device for individuals with chronic stroke. 2) Report intial effectiveness of the device after a 6-week protocol. Design: Case series (NZ6). Descriptive data related to feasibility (adverse responses, study completion, participant input, system set up) and study protocol (dosage, games used, clinical strategies implemented) of a new
Research Poster 258 Effects of Attentional Focus on Motor Training of the Upper Limb Using Robotics in Individuals After Chronic Stroke Grace Kim (New York Presbyterian Hospital-Weill Cornell Medical Center), Jim Hinojosa, Mitch Batavia, Ashwini Rao Research Objectives: Compare the effects of an external focus versus an internal focus of attention on the performance and retention of arm reach after upper limb robotics training for individuals with moderate-to-severe arm impairment after stroke. Design: A randomized, repeated measures, mixed ANOVA design was used to compare the long term effects of an external focus versus internal focus of attention after a 4-week arm training protocol on the InMotion2 shoulder /elbow robot. Attentional focus and level of arm impairment were the between group factors, and time was the within group factor. Setting: Outpatient research lab at NewYork Presbyterian Hospital. Participants: Thirty participants with moderate-to-severe arm impairment were randomly assigned to either an external focus or internal focus group and matched for sample size, level of arm impairment, and training dosage. Interventions: Participants received proximal arm training on the InMotion 2 robot 3x/week for 4 weeks, each session was 40-90 minutes depending on motor ability of the participant. Main Outcome Measure(s): Smoothness and joint independence (kinematic outcomes on the InMotion 2, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and at a 4-week follow up. Results: Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4week follow up regardless of group assignment [smoothness, F(1.49, 38.61) Z 26.28, p<.001; joint independence, F(1.6,42.6) Z 17.20, p<.001; FMA, F(2, 52) Z 27.55, p<.001; WMFT, F(2, 52) Z14.05, p<.001]. There were no significant interaction effects for attentional focus.
www.archives-pmr.org
e35 Conclusions: This is one of the first inteventional studies investigating the long term effects of attentional focus for individuals with stroke. Contrary to the established literature on the healthy population (McNevin, Shea, & Wulf, 2003; Wulf, 2007), there were no differential effects of external focus or internal focus on the retention of motor skills after four weeks of arm training. The results suggest that individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus found in healthy individuals. The current theoretical model (Constrained Action Hypothesis) may need to be expanded and modified to account for individuals with moderate-to-severe motor impairments after stroke. Attentional focus is most likely not a primary active ingredient for retention of trained motor skills in individuals with moderate-to-severe arm impairment after stroke, whereas, dosage and intensity of practice appear to be pivotal. Key Words: Attentional focus, stroke, hemiparesis, upper extremity Disclosures: Grace Kim has served as a paid consultant for Interactive Motion Technologies (IMT) in the past. However, IMT provided no financial support or research design input into this study. The other listed authors have nothing to disclose. Research Poster 262 Validation of Frenchay Activity Index Among Older Veterans with Gait and Balance Deficits Pallavi Sood (University of Florida, Dept of Occupational Therapy), Sergio Romero Research Objectives: This study examines the validity of the Frenchay Activity index (FAI) when used to measure participation in a group of community dwelling older Veterans with gait and balance deficits. Design: Retrospective data analysis was conducted using EFA (Exploratory Factor Analysis), CFA (Confirmatory Factor Analysis), and Rasch partial credit model to determine factor structure and item-based psychometric properties of the FAI. Setting: Outpatient Gait and Balance Clinic (Malcom Randall VA Medical Center). Participants: 147 community dwelling older Veterans aged 55 to 91 (mean 77 5.73) with prior history of falls or at high risk for falling due to multiple risk factors. Interventions: Not Applicable. Main Outcome Measure(s): Not applicable. Results: CFA failed to confirm uni-dimensionality of the scale (Chi-Square value (X2 [df]) Z 222.240[91], p.95, TLI>.95, RMSEA >0.05, SRMR<1.0). The FAI 4-point rating scale did not meet Linacre’s 3 essential criteria and was collapsed into a 3-point rating scale to improve the response distribution. The domestic chores and work/leisure subscales showed satisfactory Rasch fit statistics (Outfit/Infit MnSq 0.6-1.4, zstd 0.70). Conclusions: An overarching goal of rehabilitation is to restore function, and to maximize social participation. Our findings suggest the FAI is a psychometrically acceptable IADL scale that measures complex everyday participation in Domestic chores and Work/Leisure activities for community dwelling older Veterans with gait and balance deficits. Key Words: Frenchay Activity Index, IADL, participation Disclosures: None disclosed. Research Poster 263 The Feasibility of Utilizing an EMG-triggered Hand Robot for Individuals After Chronic Stroke Grace Kim (New York Presbyterian Hospital-Weill Cornell Medical Center), Michael O’Dell, Joel Stein, Michael Taub, Carly Creelman, Christine Cahalan, Lisa Rivera Research Objectives: 1) Determine the feasibilty and safety of a new EMG-triggered hand device for individuals with chronic stroke. 2) Report intial effectiveness of the device after a 6-week protocol. Design: Case series (NZ6). Descriptive data related to feasibility (adverse responses, study completion, participant input, system set up) and study protocol (dosage, games used, clinical strategies implemented) of a new