Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss.
<h4>Objective</h4>Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we i...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0262977 |
| _version_ | 1818510419574128640 |
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| author | Szu-Ping Lee Alexander Bonczyk Maria Katrina Dimapilis Sarah Partridge Samantha Ruiz Lung-Chang Chien Andrew Sawers |
| author_facet | Szu-Ping Lee Alexander Bonczyk Maria Katrina Dimapilis Sarah Partridge Samantha Ruiz Lung-Chang Chien Andrew Sawers |
| author_sort | Szu-Ping Lee |
| collection | DOAJ |
| description | <h4>Objective</h4>Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.<h4>Methods</h4>Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 years, range = 4-21 years) during prosthetic training were recorded. Recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. We also explored whether LLP users' age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received.<h4>Results</h4>We recorded a total of 20 training sessions, yielding 904 statements of instruction from 338 minutes of training. Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 64% were internal, 9% external, 3% mixed, and 25% unfocused. Regression analysis revealed that female, older, and higher functioning LLP users were significantly more likely to receive internally-focused instructions (p = 0.006, 0.035, and 0.024, respectively).<h4>Conclusions</h4>Our results demonstrated that verbal instructions and feedback are frequently provided to LLP users during prosthetic training. Most verbal interactions are focused internally on the LLP users' body movements and not externally on the movement effects.<h4>Impact statement</h4>While more research is needed to explore how motor learning principles may be applied to improve LLP user outcomes, clinicians should consider adopting the best available scientific evidence during treatment. Overreliance on internally-focused instructions as observed in the current study may hinder prosthetic skill learning. |
| first_indexed | 2024-12-10T22:59:01Z |
| format | Article |
| id | doaj.art-eb1a001abc4f413884c91e2581f55fa9 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-10T22:59:01Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-eb1a001abc4f413884c91e2581f55fa92022-12-22T01:30:11ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01177e026297710.1371/journal.pone.0262977Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss.Szu-Ping LeeAlexander BonczykMaria Katrina DimapilisSarah PartridgeSamantha RuizLung-Chang ChienAndrew Sawers<h4>Objective</h4>Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.<h4>Methods</h4>Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age = 50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience = 10 years, range = 4-21 years) during prosthetic training were recorded. Recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. We also explored whether LLP users' age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received.<h4>Results</h4>We recorded a total of 20 training sessions, yielding 904 statements of instruction from 338 minutes of training. Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 64% were internal, 9% external, 3% mixed, and 25% unfocused. Regression analysis revealed that female, older, and higher functioning LLP users were significantly more likely to receive internally-focused instructions (p = 0.006, 0.035, and 0.024, respectively).<h4>Conclusions</h4>Our results demonstrated that verbal instructions and feedback are frequently provided to LLP users during prosthetic training. Most verbal interactions are focused internally on the LLP users' body movements and not externally on the movement effects.<h4>Impact statement</h4>While more research is needed to explore how motor learning principles may be applied to improve LLP user outcomes, clinicians should consider adopting the best available scientific evidence during treatment. Overreliance on internally-focused instructions as observed in the current study may hinder prosthetic skill learning.https://doi.org/10.1371/journal.pone.0262977 |
| spellingShingle | Szu-Ping Lee Alexander Bonczyk Maria Katrina Dimapilis Sarah Partridge Samantha Ruiz Lung-Chang Chien Andrew Sawers Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. PLoS ONE |
| title | Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. |
| title_full | Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. |
| title_fullStr | Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. |
| title_full_unstemmed | Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. |
| title_short | Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss. |
| title_sort | direction of attentional focus in prosthetic training current practice and potential for improving motor learning in individuals with lower limb loss |
| url | https://doi.org/10.1371/journal.pone.0262977 |
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