Award Date


Degree Type

Doctoral Project

Degree Name

Doctor of Physical Therapy (DPT)


Physical Therapy

First Committee Member

Daniel Young

Second Committee Member

Szu-Ping Lee

Third Committee Member

Merrill Landers

Number of Pages



Objective: Adopting an external focus of attention has been shown to benefit motor performance and learning. However, the potential of optimizing attentional focus for improving prosthetic motor skills in lower limb prosthesis (LLP) users has not been examined. In this study, we investigated the frequency and direction of attentional focus embedded in the verbal instructions in a clinical prosthetic training setting.

Methods: Twenty-one adult LLP users (8 female, 13 male; 85% at K3 level; mean age=50.5) were recruited from prosthetic clinics in the Southern Nevada region. Verbal interactions between LLP users and their prosthetists (mean experience=10 years, range=4-21 years) during prosthetic training were recorded. Recordings were analyzed to categorize the direction of attentional focus embedded in the instructional and feedback statements as internal, external, mixed, or unfocused. We also explored whether LLP users’ age, time since amputation, and perceived mobility were associated with the proportion of attentional focus statements they received.

Results: We recorded a total of 20 training sessions, yielding 904 statements of instruction from 338 minutes of training. Overall, one verbal interaction occurred every 22.1 seconds. Among the statements, 63% were internal, 9% external, 3% mixed, and 25% unfocused. Regression analysis revealed that female, older, and higher functioning LLP users were significantly more likely to receive internally-focused instructions (p=0.006, 0.035, and 0.024, respectively).

Conclusions: Our results demonstrate that verbal instructions and feedback are frequently provided to LLP users during prosthetic training. Most verbal interactions are focused internally on the LLP users’ body movements and not externally on the intended movement effects.

Impact Statement: While more research is needed to explore how motor learning principles may be applied to improve LLP user outcomes, clinicians should consider adopting the best available scientific evidence during treatment. Overreliance on internally-focused instructions as observed in the current study may hinder prosthetic skill learning.


Motor learning; Prosthesis; Amputees; Amputation; Amputees--Rehabilitation; Rehabilitation; Attention


Motor Control | Physical Therapy

File Format


File Size

812 KB

Degree Grantor

University of Nevada, Las Vegas




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