Response From the Authors

We appreciate the reader's interest and feedback on our recent publication. Research must be transparent and straightforward about study methodology, results, and conclusions. In our article, we explain how we came to our study conclusions because the results were not consistent with the existing understanding of attentional focus and the retention of motor skills. We wanted to address the reader's specific concerns by highlighting the results of the Manipulation Check Questionnaire and discussing the selection of robotics training. Participants in the external focus (EF) group had significantly more EF-related thoughts than the internal focus (IF) group, and the IF group had significantly more IF-related thoughts than the EF group. To a much lesser extent, both groups thought about unrelated things at a similar frequency. Rather than discounting the study conclusions, the Manipulation Check Questionnaire results demonstrated that participants were compliant with their assigned attentional focus instructions. Data on participants having unrelated thoughts provided insight about the difficulty of adhering to the designated attentional focus instructions continuously over an average of 909 repetitions. As stated in the methods section, we selected robotics because it allows individuals with moderate-to-severe aim impairment to participate in a safe and intensive arm therapy intervention. Additionally, the InMotion ARM (Bionik Labs) delivered the same standardized arm training to both treatment groups, which increased the internal validity of our study.