An external focus of attention attenuates balance impairment in patients with Parkinson's disease who have a fall history

Landers, Merrill R.; Wulf, Gabriele; Wallmann, Harvey W.; Guadagnoli, Mark A.

doi:10.1016/j.physio.2004.11.010

Cited by 146 publications

(124 citation statements)

References 33 publications

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“…Furthermore, when the number of falls occurring during sway-referenced task performance was analyzed in this small group, four falls were recorded under no attentional focus instructions, three falls under IFA instructions, and no falls were found while following EFA instructions. 26 Similar results have been found in other studies. Chiviacowsky and colleagues 27 investigated the effects of inducing an EFA versus an IFA during a balance task in older adults (mean age = 69.4 years).…”

Section: External Focus Of Attentionsupporting

confidence: 89%

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The Impact of Attentional Focus on the Treatment of Musculoskeletal and Movement Disorders

Hunt

Páez

Folmar

2017

Intl J Sports Phys Ther

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Treatment plans employed by physical therapists involved in musculoskeletal rehabilitation may follow a conventional medical-model approach, isolating care at the tissue level but neglecting consideration for neurocognitive contributions to recovery. Understanding and integration of motor learning concepts into physical therapy practice is integral for influencing the human movement system in the most effective manner. One such motor learning concept is the use of verbal instruction to influence the attentional focus of the learner. Evidence suggests that encouraging an external focus of attention through verbal instruction promotes superior motor performance, and more lasting effects of a learning experience than an internal focus of attention. Utilizing an external focus of attention when instructing a patient on a motor task may facilitate improved motor performance and improved functional outcomes in treatment plans devised to address musculoskeletal injury and movement disorders. The purpose of this review is to summarize the basic principles of motor learning and available evidence on the influence an external focus of attention has on motor learning and performance, including the benefits of an external focus of attention over an internal focus of attention and how therapists may inadvertently encourage the latter. Furthermore, the benefits of possessing greater awareness of neurocognitive mechanisms are discussed to exhibit how implementing such concepts into musculoskeletal rehabilitation can maximize treatment outcomes. Level of Evidence: 5

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Section: External Focus Of Attentionsupporting

confidence: 89%

“…In one study, Landers and colleagues 26 investigated the use of an EFA to see how well it lessened balance impairment in individuals with Parkinson's disease, and a history of falls. The study focused on performance effects of EFA, and not on the effect it has on learning, or retention of skill.…”

Section: External Focus Of Attentionmentioning

confidence: 99%

The Impact of Attentional Focus on the Treatment of Musculoskeletal and Movement Disorders

Hunt

Páez

Folmar

2017

Intl J Sports Phys Ther

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“…An external focus has also been shown to yield more effective responses to perturbations (Ducharme & Wu, 2015). When control conditions without focus instructions were included (Landers, Wulf, Wallmann, & Guadagnoli, 2005;Wulf et al, 1998, Experiment 1;Wulf, Weigelt, Poulter, & McNevin, 2003, Experiment 2;Wulf, Landers, Lewthwaite, & Töllner, 2009), they yielded similar performances as internal focus instructions, and both led to inferior outcomes relative to external focus instructions.…”

Section: Balancementioning

confidence: 99%

Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning

2016

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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.Keywords Motivation . Attentional focus . Self-efficacy . Positive affect . Dopamine . Motor performance Skilled movement is fundamental to surviving and thriving in the world and the basis as well for many of the highest human endeavors and cultural achievements, from sport to art to music. How people learn and relearn movement skills has been addressed from a number of disparate scientific perspectives and levels of analysis, including behavioral, social cognitive, neurophysiological, and neurocomputational. In part, differences in assumptions, scientific terminology and philosophy, as well as methodological approaches have made scholarly rapprochement challenging, but we see the end goal of optimizing motor learning as important. We suggest that it may be valuable to bring recent insights from various approaches together to identify a coherent way forward that can result in optimized learning from humans' earliest encounters with new motor skills to the lifelong development of motoric expertise.It is typically considered time to look afresh at dominant theories in a field when the accumulating evidence suggests that old frameworks cannot account for substantial new insights an...

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“…According to this view, individuals who utilize an internal focus constrain or "freeze" their motor system during a conscious attempt to control it. This also seems to occur when individuals are not provided any attentional focus instructions (e.g., Landers, Wulf, Wallmann, & Guadagnoli, 2005;Wulf et al, 1998;Wulf, Weigelt, Poulter, & McNevin, 2003). Thus, the automaticity necessary for fluid, accurate movements is believed to be interrupted when employing an internal focus of attention, thereby producing a less effective and /or accurate result.…”

mentioning

confidence: 99%

Internal Versus External: Oral-Motor Performance as a Function of Attentional Focus

Freedman

Maas

Caligiuri

et al. 2007

J Speech Lang Hear Res

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external focus (focusing on the effect of the movement) versus an internal focus of attention (focusing on body parts such as the muscles of the hand). This study tested the hypothesis that the effects of attentional focus on limb performance would also occur in the oral-facial system. Method: Two groups of 23 participants were administered both hand and tongue impulse force control tasks in which each group was randomly assigned either an internal or an external focus of attention. Participants were required to exert rapid pressure bursts to achieve a target force level of 20% of their maximal strength. Results: Consistent with limb studies, findings revealed a significant advantage of an external focus (greater accuracy, less variability) for both the hand and tongue control tasks, as opposed to an internal focus of attention. Conclusions: Results are discussed relative to a constrained-action theory of motor control and future application to speech motor learning.

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An external focus of attention attenuates balance impairment in patients with Parkinson's disease who have a fall history

Cited by 146 publications

References 33 publications

The Impact of Attentional Focus on the Treatment of Musculoskeletal and Movement Disorders

The Impact of Attentional Focus on the Treatment of Musculoskeletal and Movement Disorders

Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning

Internal Versus External: Oral-Motor Performance as a Function of Attentional Focus

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