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© 2022 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Impact statement

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.

Details

Title
Direction of attentional focus in prosthetic training: Current practice and potential for improving motor learning in individuals with lower limb loss
Author
Szu-Ping, Lee; Contributed equally to this work with: Szu-Ping Lee; Bonczyk, Alexander; Dimapilis, Maria Katrina; Partridge, Sarah; Ruiz, Samantha; Lung-Chang, Chien; Sawers, Andrew  VIAFID ORCID Logo  ; Andrew Sawers Maria Katrina Dimapilis; Andrew Sawers Sarah Partridge; Andrew Sawers Samantha Ruiz; Andrew Sawers Lung-Chang Chien; Andrew Sawers Andrew Sawers Contributed equally to this work with: Szu-Ping Lee
First page
e0262977
Section
Research Article
Publication year
2022
Publication date
Jul 2022
Publisher
Public Library of Science
e-ISSN
19326203
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2686270127
Copyright
© 2022 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.