外部注意焦点的康复策略对脑卒中后步行功能的影响

doi:10.3969/j.issn.1006-9771.2025.10.012

Abstract

Abstract:

Objective To explore the effect of external attentional focus strategy on walking function after stroke.
Methods From July to December 2024, 40 stroke patients admitted in Beijing Bo'ai Hospital were randomly divided into control group (n = 20) and experimental group (n = 20). Both groups underwent conventional rehabilitation. On this basis, the control group received conventional walking training, while the experimental group received walking training based on external attentional focus strategy, for three weeks. Before and after training, they were assessed with Gait Watch 3D gait analysis, Timed Up and Go Test (TUGT), Berg Balance Scale (BBS) and Fugl-Meyer Assessment-Lower Extremities (FMA-LE).
Results After training, the step speed, step frequency, walking cycle, time of TUGT, and the scores of BBS and FMA-LE improved in both groups (|t| > 3.098, P < 0.01), and the step speed, step frequency, walking cycle and the score of FMA-LE improved more in the experimental group than in the control group (|t| > 2.572, P < 0.05).
Conclusion External attentional focus strategy can improve the walking function of patients with stroke.

Key words: stroke, external attentional focus strategy, walking function, rehabilitation

CLC Number:

R743.3

WANG Yue, ZHANG Tong, LIU Huilin, LIU Jianhua, ZHU Xiaomin, ZHAO Jun. Effect of external attentional focus strategy on walking function after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(10): 1206-1213.

Figures/Tables 5

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References 38

[1]	BALABAN B, TOK F. Gait disturbances in patients with stroke[J]. PM R, 2014, 6(7): 635-642. doi: 10.1016/j.pmrj.2013.12.017
[2]	魏天祺, 罗家麒, 李紫娟, 等. 基于丰富环境的增强现实训练对脑卒中步行功能的影响[J]. 中国康复理论与实践, 2023, 29(12): 1439-1445. doi: 10.3969/j.issn.1006-9771.2023.12.008
	WEI T Q, LUO J Q, LI Z J, et al. Effect of augmented reality training based on enriched environment on walking function after stroke[J]. Chin J Rehabil Theory Pract, 2023, 29(12): 1439-1445.
[3]	THOMPSON E D, POHLIG R T, MCCARTNEY K M, et al. Increasing activity after stroke: a randomized controlled trial of high-intensity walking and step activity intervention[J]. Stroke, 2024, 55(1): 5-13. doi: 10.1161/STROKEAHA.123.044596 pmid: 38134254
[4]	RENDOS N K, ZAJAC-COX L, THOMAS R, et al. Verbal feedback enhances motor learning during post-stroke gait retraining[J]. Top Stroke Rehabil, 2021, 28(5): 362-377. doi: 10.1080/10749357.2020.1818480
[5]	KHALAJI Z, NEZAKAT A M, SAFAVI H S, et al. Optimizing motor learning in older adults[J]. J Gerontol B Psychol Sci Soc Sci, 2024, 79(1): gbad120.
[6]	CHUA L K, JIMENEZ-DIAZ J, LEWTHWAITE R, et al. Superiority of external attentional focus for motor performance and learning: systematic reviews and meta-analyses[J]. Psychol Bull, 2021, 147(6): 618-645. doi: 10.1037/bul0000335
[7]	STARZAK M, NINIKOWSKI T, BIEGAJO M, et al. Attentional focus strategies in racket sports: a systematic review[J]. PLoS One, 2024, 19(1): e0285239. doi: 10.1371/journal.pone.0285239
[8]	SAMADI Z, ABEDANZADEH R, NOROUZI E, et al. An external focus promotes motor learning of an aiming task in individuals with hearing impairments[J]. Eur J Sport Sci, 2024, 24(8): 1143-1151. doi: 10.1002/ejsc.12157 pmid: 38940066
[9]	AN J, WULF G. Golf skill learning: an external focus of attention enhances performance and motivation[J]. Psychol Sport Exerc, 2024, 70: 102563. doi: 10.1016/j.psychsport.2023.102563
[10]	JAZAERI S Z, AZAD A, MEHDIZADEH H, et al. The effects of anxiety and external attentional focus on postural control in patients with Parkinson's disease[J]. PLoS One, 2018, 13(2): e0192168. doi: 10.1371/journal.pone.0192168
[11]	裴子文, 朱元霄, 李贝, 等. 外在注意力焦点策略在脑卒中患者康复中的研究进展[J]. 中国康复理论与实践, 2020, 26(3): 315-318. doi: 10.3969/j.issn.1006-9771.2019.00.015
	PEI Z W, ZHU Y X, LI B, et al. Advances in external attentional focus strategy for stroke rehabilitation (review)[J]. Chin J Rehabil Theory Pract, 2020, 26(3): 315-318.
[12]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[13]	ZHANG H, LI X, GONG Y, et al. Three‐dimensional gait analysis and sEMG measures for robotic‐assisted gait training in subacute stroke: a randomized controlled trial[J]. Biomed Res Int, 2023, 2023: 7563802. doi: 10.1155/bmri.v2023.1
[14]	NAL B, KSE N, NAL E N, et al. Validity and reliability of the Berg Balance Scale in different tele-assessment methods in patients with stroke[J]. J Eval Clin Pract, 2025, 31(4): e70141. doi: 10.1111/jep.v31.4
[15]	HERNANDEZ E D, FORERO S M, GALEANO C P, et al. Intra-and inter-rater reliability of Fugl-Meyer Assessment of Lower Extremity early after stroke[J]. Braz J Phys Ther, 2021, 25(6): 709-718. doi: 10.1016/j.bjpt.2020.12.002
[16]	GOMES C L A, CACHO R O, NOBREGA V T B, et al. Effects of attentional focus on upper extremity motor performance in post stroke patients: a randomized pilot study[J]. Medicine (Baltimore), 2021, 100(9): e24656. doi: 10.1097/MD.0000000000024656
[17]	POLLOK F, COOK DA, SHAIKH N, et al. Autonomy and focus of attention in medical motor skills learning: a randomized experiment[J]. BMC Med Educ, 2022, 22(1): 1-9. doi: 10.1186/s12909-021-03037-4
[18]	SHOOLI M, SAEMI E, BOUSHEHRI N S, et al. Effects of self-controlled practice and focus of attention on free throw accuracy: exploring optimal theory among skilled basketball players[J]. Hum Mov Sci, 2024, 94: 103187. doi: 10.1016/j.humov.2024.103187
[19]	YOU Y, WENG W C, SUPRIANTO G B, et al. The effects of conscious movement investment on inhibiting a simple response[J]. Front Psychol, 2024, 15: 1365420. doi: 10.3389/fpsyg.2024.1365420
[20]	JOHNSON L, BURRIDGE J, DEMAIN S. Development of lower limb training interventions that promote an external focus of attention in people with stroke: a modified Delphi survey[J]. Physiother Theory Pract, 2022, 38(13): 2998-3009. doi: 10.1080/09593985.2021.1972501
[21]	JIE L J, MELANIE K, KENNETH M, et al. Implicit and explicit motor learning interventions have similar effects on walking speed in people after stroke: a randomized controlled trial[J]. Phys Ther, 2021, 101(5): pzab017.
[22]	WANG Z, MENG L, LU M, et al. Effects of attentional focus strategies in drop landing biomechanics of individuals with unilateral functional ankle instability[J]. Front Physiol, 2024, 15: 1444782. doi: 10.3389/fphys.2024.1444782
[23]	HAO Q H, QIU M M, WANG J, et al. The effect of lower limb rehabilitation robot on lower limb-motor function in stroke patients: a systematic review and meta-analysis[J]. Syst Rev, 2025, 14(1): 70. doi: 10.1186/s13643-025-02759-6
[24]	NISHIMOTO R, INOKUCHI H, FUJIWARA S, et al. Implicit learning provides advantage over explicit learning for gait-cognitive dual-task interference[J]. Sci Rep, 2024, 14(1): 18336. doi: 10.1038/s41598-024-68284-z pmid: 39112521
[25]	JIE L J, KLEYNEN M, ROTHUIZEN G, et al. Overview of effects of motor learning strategies in neurologic and geriatric populations: a systematic mapping review[J]. Arch Rehabil Res Clin Transl, 2024, 6(4): 100379.
[26]	KAL E, VAN DEN BRINK H, HOUDIJK H, et al. How physical therapists instruct patients with stroke: an observational study on attentional focus during gait rehabilitation after stroke[J]. Disabil Rehabil, 2018, 40(10): 1154-1165. doi: 10.1080/09638288.2017.1290697 pmid: 28637152
[27]	KUHN Y A, TAUBE W. Changes in the brain with an external focus of attention: neural correlates[J]. Exerc Sport Sci Rev, 2024, 53(2): 49-59. doi: 10.1249/JES.0000000000000354
[28]	KAL E C, YOUNG W R, ELLMERS T J. Balance capacity influences the effects of conscious movement processing on postural control in older adults[J]. Hum Mov Sci, 2022, 82: 102933. doi: 10.1016/j.humov.2022.102933
[29]	LI D K T, MAK T C T, WONG T W L. Does an externally focused dual-task mitigate real-time conscious postural control in older adults?[J]. Exp Aging res, 2022, 48(3): 259-310.
[30]	PARR J V V, MILLS R, KAL E, et al. A "conscious" loss of balance: Directing attention to movement can impair the cortical response to postural perturbations[J]. J Neurosci, 2024, 44(48): e0810242024. doi: 10.1523/JNEUROSCI.0810-24.2024
[31]	STRICK A J, MARKWELL L T, MAKARUK H, et al. The location of an internal focus of attention differentially affects motor performance[J]. PLoS One, 2023, 18(11): e0294246. doi: 10.1371/journal.pone.0294246
[32]	LAW J C L, WONG T W L. Internal focus instruction increases psychological stress with conscious motor processing and deteriorates motor performance in dart throwing[J]. Cogn Proc, 2021, 22(1): 57-64. doi: 10.1007/s10339-020-00991-7
[33]	谭嘉辉, 刘涛, 周兴生, 等. 注意焦点的追加反馈对模拟足球接球任务反应时影响的实验研究[J]. 广州体育学院学报, 2021, 41(2): 48-52.
	TAN J H, LIU T, ZHOU X S, et al. An experimental study of effects of augmented feedback of attentional focus on reaction time in a simulated soccer ball catching task[J]. J Guangzhou Sport Univ, 2021, 41(2): 48-52.
[34]	张剑桥. 基于外部注意焦点策略下的网球技术教学优化设计与实证研究[D]. 济南: 山东体育学院, 2022.
	ZHANG J Q. Tennis technique teaching optimization design and empirical research based on external focus of attention strategy[D]. Ji'nan: Shandong Sport University, 2022.
[35]	陈皆播, 赵星, 宋文静, 等. 注意焦点对学龄前儿童基本动作技能练习效果的影响:以立定跳远动作为例[J]. 中国体育科技, 2023, 59(8): 40-46.
	CHEN J B, ZHAO X, SONG W J, et al. Influence of attentional focus on the practice effect for preschoolers' fundamental motor skills: take the standing long jump as an example[J]. Chin Sport Sci Technol, 2023, 59(8): 40-46.
[36]	李小英. 言语绩效反馈频率和注意焦点对儿童羽毛球正手击高远球技能学习的影响研究[D]. 武汉: 华中师范大学, 2023.
	LI X Y. A study on the effects of verbal performance feedback frequency and attentional focus on children's forehand hitting in badminton skill learning[D]. Wuhan: Central China Normal University, 2023.
[37]	MATSUMOTO A, UEDA H, OGAWA A, et al. External and internal focus of attention differentially modulate corticospinal excitability in anticipatory postural adjustments[J]. Sci Rep, 2022, 12(1): 22385. doi: 10.1038/s41598-022-26987-1 pmid: 36572719
[38]	AIKEN C A, BECKER K A. Utilising an internal focus of attention during preparation and an external focus during execution may facilitate motor learning[J]. Eur J Sport Sci, 2023, 23(2): 259-266. doi: 10.1080/17461391.2022.2042604

项目	对照组(n = 20)	试验组(n = 20)	χ²/t值	P值
性别/n			2.667	0.102
男	15	10
女	5	10
年龄/岁	51.55±13.94	55.55±12.47	0.956	0.345
卒中类型/n
脑出血	10	12
脑梗死	10	8	0.404	0.525
偏瘫侧/n			2.667	0.102
左	10	5
右	10	15
平均病程/月	4.10±4.59	4.10±4.72	0.000	1.000

变量	组别	n	测试	$\bar{x}±s$	t值	P值
步速/cm·s^-1	对照组	20	前测	77.95±26.37	-7.594	< 0.001
			后测	107.00±28.29
	试验组	20	前测	87.70±21.48	-14.633	< 0.001
			后测	169.00±36.08
	训练前两组均值差			9.75±7.61	1.282	0.208
	训练后两组均值差			62.00±10.25	6.048	< 0.001
步频/min^-1	对照组	20	前测	66.85±12.05	-9.253	< 0.001
			后测	87.05±11.47
	试验组	20	前测	67.70±8.06	-11.619	< 0.001
			后测	97.90±12.85
	训练前两组均值差			0.85±3.24	0.262	0.795
	训练后两组均值差			10.85±3.85	2.817	0.008
步行周期/s	对照组	20	前测	1.85±0.34	8.283	< 0.001
			后测	1.40±0.19
	试验组	20	前测	1.80±0.23	10.574	< 0.001
			后测	1.25±0.19
	训练前两组均值差			-0.05±0.09	-0.537	0.594
	训练后两组均值差			-0.16±0.06	-2.572	0.014

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	20	前测	31.15±20.37	3.712	0.001
		后测	22.87±10.78
试验组	20	前测	25.21±13.83	3.098	0.006
		后测	19.08±5.42
训练前两组均值差			5.94±5.51	-1.079	0.287
训练后两组均值差			-3.80±2.70	-1.408	0.167

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	20	前测	42.20±4.86	-7.464	< 0.001
		后测	48.30±3.18
试验组	20	前测	44.65±5.48	-8.788	< 0.001
		后测	49.95±4.06
训练前两组均值差			2.45±1.64	1.496	0.143
训练后两组均值差			1.65±1.15	1.431	0.161

组别	n	测试	$\bar{x}±s$	t值	P值
对照组	20	前测	18.25±1.07	-46.917	< 0.001
		后测	26.50±0.95
试验组	20	前测	17.90±1.21	-42.236	< 0.001
		后测	30.90±1.55
训练前两组均值差			-0.35±0.36	-0.969	0.339
训练后两组均值差			4.40±0.41	10.823	< 0.001

Effect of external attentional focus strategy on walking function after stroke

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