Instructions and feedback that direct the learner’s focus of attention (FOA) toward the effect or outcome of the movement (i.e., external) are more advantageous than those that direct the FOA to the learner’s own body (i.e., internal). Such knowledge could be critical for telehealth practice, where challenges had been associated with a heightened emphasis on verbal instructions and feedback. To facilitate knowledge translation, we need to know how practitioners utilise FOA in their practice. This study aims to examine physiotherapists’ use of FOA for instructions and feedback during telehealth sessions for children with NDDs.
Using a non-participatory observational design, 24 telehealth sessions delivered by 6 physiotherapists for 12 children with NDDs were recorded (2 sessions per child). Physiotherapists’ statements were transcribed verbatim and analysed following a structured matrix of the following parameters: type, attentional focus, modality, and recipient. Relative focus scores were calculated to estimate the physiotherapists’ preference for external or internal FOA. The clinicians’ rating form of the Developmental Profile-4th edition was used to assess the children’s developmental stage.
The analysis revealed a mean of 159 (SD 67) transcribed statements within sessions that averaged 46 (SD 7) minutes. The majority of statements were directed toward the child (83% SD 12), while the remainder addressed the caregiver. The statements consisted of 44% (SD 11) instructions, 50% (SD 10) feedback, and 5% (SD 4) general chatter. Most of the statements focused on strategy (46% SD 10) and reinforcements (37% SD 8). FOA was utilised in 18% (SD 4) of the statements, with a trend toward a preference for external FOA in instructions (e.g., jump to the red stone) and internal FOA in feedback (e.g., move your left leg). There was a greater tendency for using internal FOA when the patients were older and had higher physical and cognitive development levels.
Paediatric physiotherapists tend to prefer external FOA when providing instructions during telehealth sessions, while internal FOA is favoured for feedback. Internal FOA appears to be preferred for children who are older and have better physical and cognitive development levels, suggesting that they are believed to have the cognitive capacity to process internal FOA instructions and feedback.
Previous related research of physiotherapists in the Philippines revealed a self-reported overall preference for internal FOA. The findings of this current research provide a more nuanced understanding of physiotherapists’ use of internal and external FOA in paediatric telehealth contexts. It appears that knowledge translation efforts could build on identifying the suitability of either internal or external FOA based on relevant considerations, rather than solely disseminating evidence supporting external FOA.
focus of attention
neurodevelopmental disorder
