Passive movements for treatment and prevention of contractures—what is the evidence? A cochrane systematic review

Abstract

focusing on body movements) and External focus of attention wherein instructions are given to the learner to focus externally (e.g. focusing on the task to be performed). Purpose: The purpose of this study was to investigate the influence of different types of instructions on motor skills among older adults. Methods: In this Randomized controlled trial 60 healthy elderly participants were recruited from community dwelling old age home after obtaining ethical and informed consent. Participants were randomly assigned using block randomization to one of the three groups an Internal focus group (IF), an External focus group (EF) or a control group. All the participants were unfamiliar with the task. The task was to throw vacuum ball into the center of a circular wooden board (similar to dart throwing). The tasks were divided into three phases to capture the acquisition, retention and transfer during motor learning. All the phases were performed in blocks of ten throws each. Each participant came for 2 consecutive days. On the first day, during the acquisition phase, participants threw the ball 50 times in 5 trial blocks (10 throws per block). One day after the acquisition phase, both retention and transfer phases were conducted. In the retention phase, participants threw 20 times (2 blocks of 10 throws each) from the same distance as in the acquisition phase. Several minutes later, the transfer phase will be conducted, in which participants threw 20 times (2 blocks of 10 throws each) from a further distance. Instructions for the IF group were directed at movements of the shoulder, arm, and fingers. Instructions for the EF group were directed at the target and the ball’s trajectory. Outcome measures used were Mean Radial Error [MRE] for accuracy of throwing and bivariate variable error [BE] for variability of throwing. The outcome assessor was blinded to the group allocation. Results: Repeated measures ANOVA for within and between group comparisons were done. Significant improvements in throwing accuracy and variability were seen within all the three groups. However there was significantly more improvement in throwing accuracy and reduced throwing variability in EF group compared to the IF and control group. Conclusion(s): This study shows that older adults may benefit more from external focus of instructions for motor learning compared with internal focus of instructions. Future studies are recommended to analyze the way older adults learn motor skills. Implications: External focus of instructions may be beneficial and improve motor learning among older adults.