Revisiting the Relationship Between Internal Focus and Balance Control in Young and Older Adults

Abstract

Research highlights the detrimental effect that directing too much conscious attention toward movement can have on postural control. While this concept has received support from many studies, recent evidence demonstrates that this principle does not always translate to aging clinical populations. Given the increasing clinical interest in this topic, the current study evaluated if the original notion (that an internal focus results in compromised balance performance) is upheld in young and older adults during a challenging balance task where we are able to objectively corroborate changes in attentional focus; using an electroencephalography (EEG) method previously identified as an objective indicator of conscious movement control. This method assesses the neural coherence, or “communication,” between T3 (verbal-analytical) and Fz (motor-planning) regions of the brain. Thirty-nine young and 40 older adults performed a challenging balance task while holding a 2-meter pole under two randomized conditions: Baseline and Internal focus of attention (directing attention internally toward movement production). Results showed that young adults demonstrated increased EEG T3-Fz coherence in conjunction with increased sway path during the Internal focus condition. However, no significant differences were observed in older adults between conditions for any measure. The current study provides supporting evidence for the detrimental effect that adopting an Internal focus can have on postural control—especially in populations able to govern these processes in a relatively “automatic” manner (e.g., young adults). However, this work illustrates that such observations may not readily translate between populations and are not robust to age-related changes. Further work is necessary to examine mechanisms underlying this clear translational issue.

Re-evaluating the measurement and influence of conscious movement processing on gait performance in older adults: Development of the Gait-Specific Attentional Profile

“…This evidence is largely accrued from studies experimentally manipulating anxiety and/or attentional focus. However, in apparent contradiction, results from cross-sectional studies provide very little supporting evidence for CMP-related differences [14,15]. One potential explanation for this discrepancy may relate to the measure commonly used to assess a walker's propensity to consciously monitor and/or control their movements: the generic (non-gait-specific) Movement Specific Reinvestment Scale (MSRS) [16].…”

Balance Control and Muscles Activity of An Elderly Retired Man During Different Focus of Attention Instructions

“…Vestibular function is age-dependent as above one-third of persons over 70 have an abnormal vestibular system. Vestibular nerve fibers decrease by ~5% per decade between the ages of 40 and 90, and one-third of afferents are lost after 70 [35]. However, as our studied samples had no history of vestibular dysfunction and they were below six decades, so it could be assumed that their balance control was less affected by vestibular systems dysfunction.…”

The role of conscious processing of movements during balance by young and older adults

“…For example, Wulf et al (2001) demonstrated that following training young adults who had adopted an external focus of attention (i.e., keep the markers besides your feet horizontal) generated smaller balance errors than young adults who had adopted an internal focus of attention (i.e., keep your feet horizontal). Chow, Ellmers, Young, Mak, and Wong (2019) have recently compared balance performance between young adults who received internal focus instructions and young adults who received no instructions. The authors confirmed the disadvantages of adopting an internal focus of attention by showing increased body sway in young adults who were instructed to focus internally compared to participants who received no instructions.…”

“…The authors confirmed the disadvantages of adopting an internal focus of attention by showing increased body sway in young adults who were instructed to focus internally compared to participants who received no instructions. It has been argued that adopting an internal focus of attention promotes conscious movement processing, which interferes with automatic control mechanisms and, therefore, reduces fluency of movement (Wulf et al, 2001;Chow et al, 2019). Indeed, Chow et al (2019) provided objective evidence of this by demonstrating that participants who were instructed to focus internally displayed increased cortical communication between the verbal-analytical (T3) and motor planning (Fz) areas of the brain (indicative of conscious processing of the motor task; see Zhu, Poolton, Wilson, Maxwell, & Masters, 2011) compared to participants who received no instructions.…”

“…It has been argued that adopting an internal focus of attention promotes conscious movement processing, which interferes with automatic control mechanisms and, therefore, reduces fluency of movement (Wulf et al, 2001;Chow et al, 2019). Indeed, Chow et al (2019) provided objective evidence of this by demonstrating that participants who were instructed to focus internally displayed increased cortical communication between the verbal-analytical (T3) and motor planning (Fz) areas of the brain (indicative of conscious processing of the motor task; see Zhu, Poolton, Wilson, Maxwell, & Masters, 2011) compared to participants who received no instructions. In line with these results, Wulf et al (2001) showed that participants instructed to focus externally exhibited lower probe reaction times 1 than participants instructed to focus internally, for whom balancing seemed to require more conscious effort.…”