The role of attentional focus on walking efficiency among older fallers and non-fallers

Abstract

BackgroundThis study evaluated the effect of attentional focus instructions on movement efficiency during a level-ground walking task in older adults with and without a history of falls.MethodsOne hundred and thirty-four community-dwelling older adults were categorised into older fallers (OF) (n = 37) and older non-fallers (ONF) (n = 97). Each participant was instructed to walk at a self-selected pace along a 6 m walkway under three attentional focus conditions (i.e. internal, goal-directed and control) for a total of nine trials. Average muscle activity indices of lower limb co-contractions were measured using surface electromyography.ResultsBoth shank and thigh muscle co-contractions were higher in OF than in ONF in all three conditions. OF also demonstrated higher shank muscle co-contraction under the internal relative to the goal-directed condition, with no such change observed in ONF.ConclusionDespite no significant between-group differences in functional balance and balance confidence, relative walking inefficiencies were observed in OF compared with ONF. This finding demonstrates the debilitating consequences of falling that can occur with relative independence from various physiological or psychological factors that are commonly associated with falling and used to rationalise behavioural change. We also provide evidence that OF are more susceptible to conditions that provoke them to allocate attention internally. Therefore, in clinical contexts (e.g. gait rehabilitation), verbal instructions that refer to body movements (internal focus) might serve to compromise movement efficiency in older adults with a history of falls. Such changes will, theoretically, lessen the ability to react efficiently to changing environments experienced in daily life.

Children With Developmental Coordination Disorder Exhibit Greater Stepping Error Despite Similar Gaze Patterns and State Anxiety Levels to Their Typically Developing Peers

“…However, it is worth acknowledging that, in the absence of any differences in overt attention (spatial location of gaze), differences may still exist in covert attention. Recent evidence has shown increased gait instability to be associated with an internal focus of attention (focusing on one’s own movements) relative to an external focus of attention (focusing on the impact of the movement on the environment; Mak et al, 2019 , 2020 ). Future work should therefore elucidate the covert attentional processes that underpin adaptive gait performance in children with DCD and its relative impact on stepping accuracy.…”

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

“…The following gait variables were extracted from the GAITRite: Velocity (cm/s), step length (cm), base of support (cm) and double-limb support (% of gait cycle). These variables were selected due to their associations with experimentally-induced CMP [10,11]. Due to the single trial protocol used in the present research, it was not possible to calculate reliable measures of gait variability.…”

“…Consciously processing gait can occur in a variety of contexts, particularly when balance is threatened, but also manifests following injury or disease (e.g., Parkinson's or Stroke) [8,9]. This motor control strategy has been shown to directly influence locomotion, resulting in slower, less-efficient (e.g., shorter steps and increased muscular activation) and more unstable patterns of gait [10,11]. Conscious movement processing (CMP) also leads to impaired motor planning [12,13], reduced retention of visual spatial information [9], reduced attentional processing efficiency [8] and greater stepping errors [13].…”

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

“…Another suggestion for the lack of comparable (to young adults) Baseline-Internal focus change in older adults relates to the potential between-group differences in how these instructions were interpreted and subsequently utilized to regulate posture. For example, Mak and colleagues (35, 36) have found evidence to suggest that the manner with which older adults alter their behavior following the adoption of an internal focus was dependent on previous experiences with falling—with these experiences resulting in different interpretations of the internal focus instructions. For example, fallers might instinctively think about significant and problematic factors that jeopardize their balance on a daily basis, whereas their non-falling counterparts may be more inclined to focus attention on more generic movement rules.…”