CoChat
Sign Up
Cited by 132Stroke Rehabilitation and RecoverySport Psychology and PerformanceSports and Physical Education Research

The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index.

Internal and External Focus of Attention During Gait Re-Education: An Observational Study of Physical Therapist Practice in Stroke Rehabilitation

Johnson, Louise, Burridge, Jane H., Demain, Sara H.·2013·Physical Therapy
DOI 10.2522/ptj.20120300
Open this paper in CoChat — free account

Abstract

Background: Focus of attention is known to play an important role in motor skill learning, yet little is known about how attention is directed within the context of stroke rehabilitation. Objective: The aims of this study were: (1) to identify physical therapists' use of internal and external focus of attention during gait rehabilitation for individuals with hemiplegia following stroke and (2) to use the findings to design an experimental study examining the impact of focus of attention on learning poststroke. Design: The study design involved direct nonparticipation observation of physical therapy treatment sessions. Methods: Eight physical therapy treatment sessions, in which gait rehabilitation was taking place, were video recorded. Patients were aged between 36 and 85 years, and ranged from 7 to 216 days poststroke; physical therapists had between 3 and 12 years of experience in stroke rehabilitation. Data analysis took 2 forms: (1) clear definitions of internal and external focus of attention were agreed on via a consensus group and used to develop an analysis matrix through which incidences of instruction and feedback were identified, categorized, and counted; and (2) verbal dialogue was transcribed verbatim and transcripts were thematically analyzed to provide a detailed description of how instructions and feedback were used, illustrated by examples. Results: The use of instructions and feedback (internal and external focus) was high; an average of one verbal instruction or feedback statement was delivered every 14 seconds. Sixty-seven percent of the statements were internally focused, 22% were externally focused, and 11% were of mixed focus. Unfocused statements (eg, “good”) also were used regularly. Patients were frequently encouraged to “think about” their performance. Limitations: Observational data collection methods may result in changes in the behavior of those observed, which is a potential source of bias. The small sample size also was a limitation of the study. Conclusion: Physical therapists frequently encouraged patients to be aware of their movements and their performance (internal focus). This approach may reduce automaticity and hinder learning and retention.

Overview

Integrity signals

Registry

Crossref · 10.2522/ptj.20120300

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Verification

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Citations

Cites

Show all 52 references

Cited by

Sorted by citations

Related

See all

Metadata

Authors
Johnson, L., Burridge, J. H., & Demain, S. H.
Affiliations
  • Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust (GB)
  • University of Southampton (GB)
Corresponding author
Johnson, Louise
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2013-07-01
Volume
93
Issue
7
Pages
957-966
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.2522/ptj.20120300
OpenAlex
W2113547133
Cited by
132
References
52
Citations by year
2026: 3 · 2025: 10 · 2024: 16 · 2023: 13 · 2022: 9 · 2021: 18 · 2020: 12 · 2019: 13 · 2018: 11 · 2017: 9 · 2016: 13 · 2015: 3 · 2014: 2
FWCI
6.40
Type
journal article
Language
en
Open access
closed
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
Funders
National Institute for Health and Care Research (PDF-2011-04-016)
Topics
  • Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
  • Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Sports and Physical Education Research
Keywords
internal focus, external attention, gait rehabilitation, stroke rehabilitation, hemiplegia, verbal feedback, motor skill learning, automaticity
MeSH terms
Stroke Rehabilitation, Adult, Aged, Aged, 80 and over, Attention, Feedback, Female, Hemiplegia, Humans, Male, Middle Aged, Nonverbal Communication, Professional-Patient Relations, Teaching, Verbal Behavior, Video Recording, Observation, Gait Disorders, Neurologic, Stroke, Physical Therapy Modalities

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review