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      Physiotherapists' Use of Attentional Focus Instructions and Feedback in the Philippines: A Survey Study

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          ABSTRACT

          Background and Purpose

          Verbal instructions and feedback are critical motor learning elements within physiotherapy practice. With evident advantages associated with instructions and feedback that direct learner attention externally, it has been recommended that knowledge about the focus of attention (FOA) be translated into physiotherapy practice. However, most existing information on this topic comes from non‐Asian and high‐resourced settings. This study aims to fill the knowledge gap regarding context‐specific practice patterns by examining the preferences of physiotherapists in the Philippines for external or internal FOA when delivering instructions and feedback across various practice areas. We also explored how professional characteristics relate to these preferences and considerations for delivering instructions and feedback.

          Methods

          This study employed a cross‐sectional survey design. A total of 223 physiotherapists completed an online survey, of which 182 answered questions on their preferences for external or internal FOA based on clinical scenarios. The survey also collected information on participants' professional and practice backgrounds, conscious planning in delivering instructions and feedback, and considerations for varying instructions and feedback.

          Results

          The participants tended to prefer internal FOA for delivering instructions and feedback, which was not associated with educational background, years of experience, specialisation, geographic region, practice setting, or FOA familiarity. While only approximately half of the respondents were familiar with the concept of FOA, the majority tended to consciously plan the delivery of instructions and feedback based on clients' cognitive and impairment levels.

          Discussion

          There is an overall preference for internal FOA for delivering instructions and feedback among physiotherapists in the Philippines. Work is needed to enhance practitioners' knowledge of the evidence related to FOA and to facilitate knowledge translation that enables the utilisation of research in physiotherapy practice.

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          Most cited references47

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          Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.

          This paper reviews 10 principles of experience-dependent neural plasticity and considerations in applying them to the damaged brain. Neuroscience research using a variety of models of learning, neurological disease, and trauma are reviewed from the perspective of basic neuroscientists but in a manner intended to be useful for the development of more effective clinical rehabilitation interventions. Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage. The qualities and constraints of experience-dependent neural plasticity are likely to be of major relevance to rehabilitation efforts in humans with brain damage. However, some research topics need much more attention in order to enhance the translation of this area of neuroscience to clinical research and practice. The growing understanding of the nature of brain plasticity raises optimism that this knowledge can be capitalized upon to improve rehabilitation efforts and to optimize functional outcome.
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            Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning.

            Effective motor performance is important for surviving and thriving, and skilled movement is critical in many activities. Much theorizing over the past few decades has focused on how certain practice conditions affect the processing of task-related information to affect learning. Yet, existing theoretical perspectives do not accommodate significant recent lines of evidence demonstrating motivational and attentional effects on performance and learning. These include research on (a) conditions that enhance expectancies for future performance, (b) variables that influence learners' autonomy, and (c) an external focus of attention on the intended movement effect. We propose the OPTIMAL (Optimizing Performance through Intrinsic Motivation and Attention for Learning) theory of motor learning. We suggest that motivational and attentional factors contribute to performance and learning by strengthening the coupling of goals to actions. We provide explanations for the performance and learning advantages of these variables on psychological and neuroscientific grounds. We describe a plausible mechanism for expectancy effects rooted in responses of dopamine to the anticipation of positive experience and temporally associated with skill practice. Learner autonomy acts perhaps largely through an enhanced expectancy pathway. Furthermore, we consider the influence of an external focus for the establishment of efficient functional connections across brain networks that subserve skilled movement. We speculate that enhanced expectancies and an external focus propel performers' cognitive and motor systems in productive "forward" directions and prevent "backsliding" into self- and non-task focused states. Expected success presumably breeds further success and helps consolidate memories. We discuss practical implications and future research directions.
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              Attentional focus and motor learning: a review of 15 years

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                Author and article information

                Contributors
                thomson.wong@polyu.edu.hk
                Journal
                Physiother Res Int
                Physiother Res Int
                10.1002/(ISSN)1471-2865
                PRI
                Physiotherapy Research International
                John Wiley and Sons Inc. (Hoboken )
                1358-2267
                1471-2865
                07 February 2025
                April 2025
                : 30
                : 2 ( doiID: 10.1002/pri.v30.2 )
                : e70035
                Affiliations
                [ 1 ] Department of Rehabilitation Sciences The Hong Kong Polytechnic University Kowloon Hong Kong
                Author notes
                [*] [* ] Correspondence: Thomson W. L. Wong

                ( thomson.wong@ 123456polyu.edu.hk )

                Author information
                https://orcid.org/0000-0002-5479-5342
                Article
                PRI70035
                10.1002/pri.70035
                11806208
                39921235
                da97406a-889f-4f3e-88c3-68299f329f51
                © 2025 The Author(s). Physiotherapy Research International published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 13 January 2025
                : 21 August 2024
                : 29 January 2025
                Page count
                Figures: 2, Tables: 3, Pages: 11, Words: 7471
                Categories
                Research Article
                Research Article
                Custom metadata
                2.0
                April 2025
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.5.3 mode:remove_FC converted:08.02.2025

                focus of attention,instructions and feedback,knowledge translation,physiotherapy

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