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Am J Occup Ther. 2002 Jul-Aug;56(4):380-90.

Effect of instructions on functional reach in persons with and without cerebrovascular accident.

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Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge 02139-4307, USA.



Verbal instructions comprise an important element of clinical practice, however, their effectiveness in promoting movement organization in persons with cerebrovascular accident (CVA) has not been well investigated.


A counterbalanced, repeated-measures design was used to examine the effects of externally focused (task-related) versus internally focused (movement-related) instructions on movement kinematics during three functional reaching tasks. Participants included 16 persons with stroke who were able to perform the tasks with their affected arm and 17 age-matched adults without neurological impairments.


Significantly shorter movement time and greater peak velocity were evident when reaching under the external-focus condition of all tasks than for the internal-focus condition.


One clinical implication is that internally focused instructions can contribute to slower and less forceful reach in adults with and without CVA. This research reinforces the need for therapists to consider their use of instruction during the evaluation and treatment of movement disorders.

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