Adopting the correct focus during rehabilitation can help people with prosthetics

There are more than two million people living with an amputation in the United States, and about 400 are being added daily. For many of them, prosthetics or prosthetics are a part of their lives, and they need to re-learn how their bodies move with their new limbs again.

The trick to learning how to use a new limb — and regaining confidence in movement — has nothing to do with the prosthesis itself but with the brain, according to newly published research by UNLV physical therapy researcher Szu-Ping Lee. By adopting the right focus during rehabilitation, patients can learn new skills better and faster.

Vascular diseases and diabetes are becoming more common and one of the long-term consequences is amputation. It is important that clinicians such as prosthetists and physical therapists apply the latest science so that their patients can learn faster and better retain the skills they have learned.”

Szu-Ping Lee, researcher

The current standard of practice in rehabilitating millions of amputees in the country prioritizes internally focused instruction where patients are asked to move their joints or stretch their muscles in certain ways, a suboptimal mentality he tells me we should consider changing. This science builds on sports kinesiology research built by UNLV Associate Professor Gabriel Wolf.

Let’s play golf for a better understanding:

After getting close to the ball and reading the green, square your shoulders – align your shot. At this point, most of us focus on our form and measure every muscle movement like a pseudo-pro. This is the standard process of rehabilitation, Inner Focus.

But there is another way forward. Instead of prioritizing the movement of our bodies, focusing on the trajectory of the ball or simply the hole is easier and works better. That’s what Wolf and Lee are talking about – the focus is on the outcome, not the movement itself.

Professor Wolff’s research over the past 20 years has shown that extrinsic focus on motor tasks leads to faster learning and improved movement effectiveness and neuromuscular efficiency. Lee hopes this technology will help amputees master the use of prosthetics faster.

“With the wrong kind of focus or instructions used during physical therapy, the consequences can be dire – the prosthetic leg becomes paper-heavy in the closet,” he told me. “We want to advance clinical practice and that is the ultimate goal. We want physical therapy for patients to improve.”

Lower limb rehabilitation was monitored for 21 adults for this research, along with the oral instructions provided. The results showed that most verbal interactions were focused internally (normative) on the patient’s body movements and not externally on movement effects. More research is being done to evaluate how to improve motor learning outcomes such as balance and fall prevention with better instruction.


Journal reference:

Lee, SP. , et al. (2022) The direction of intentional focus in prosthetic training: current practice and potential for improving motor learning in individuals with lower limb loss. One Plus.