External Focus Instructions Reduce Postural Instability in Individuals With Parkinson Disease

2009 ◽  
Vol 89 (2) ◽  
pp. 162-168 ◽  
Author(s):  
Gabriele Wulf ◽  
Merrill Landers ◽  
Rebecca Lewthwaite ◽  
Thomas Toöllner
Keyword(s):  
Parkinson Disease ◽  
Postural Sway ◽  
Attentional Focus ◽  
Postural Instability ◽  
External Focus ◽  
Unstable Surface ◽  
Related Risk ◽  
Internal Focus ◽  
Potential Benefits ◽  
And Control

BackgroundPostural instability while standing, walking, and interacting with objects or the environment places individuals with Parkinson disease (PD) at risk for falls, injuries, and self-imposed restrictions in activity. Recent research with motor skills, including those demanding postural stability, has demonstrated performance and learning advantages when performers are instructed to adopt an external rather than an internal focus of attention. Despite the potential benefits in stability-related risk reduction and enhanced movement effectiveness, attentional focus research in individuals challenged with postural instability is limited.ObjectiveThe present translational research study examined the generalizability of the attentional focus effect to balance in older adults with PD.DesignA within-participant design was used to account for potentially substantial individual variations in balancing capabilities.MethodsFourteen participants diagnosed with idiopathic PD (Hoehn and Yahr stages II and III) participated in the experiment. They were asked to balance on an unstable surface (inflated rubber disk). In counterbalanced orders, they were instructed to focus on reducing movements of their feet (internal focus) or the disk (external focus), or they were not given attentional focus instructions (control).ResultsThe adoption of an external focus resulted in less postural sway relative to both internal focus and control conditions. There was no difference between the internal focus and control conditions.LimitationsMental functioning was not formally assessed, and comprehensive clinical profiles of participants were not obtained.ConclusionsThe results are consistent with previous findings on attentional focus in samples of patients and people without disabilities. Subtle wording distinctions that direct attention to movement effects external to the mover reduce postural instability during standing for individuals with PD relative to an internal focus. The findings have potentially important implications for instructions given by clinicians and the reduction of fall risk.

Adopting an External Focus of Attention Enhances Musical Performance

2018 ◽  
Vol 66 (4) ◽  
pp. 375-391 ◽  
Author(s):  
Adina Mornell ◽  
Gabriele Wulf
Keyword(s):  
Music Teachers ◽  
Evaluation Criteria ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Musical Expression ◽  
External Focus ◽  
Internal Focus ◽  
Focus Condition ◽  
And Performance ◽  
And Control

Two experiments are reported in which skilled musicians playing different instruments performed a piece of their choice under various attentional focus conditions. In the external focus condition, they were asked to focus on playing for the audience and the expressive sound of the music. In the internal focus condition, they were asked to focus on the precision of their finger movements (or lip movements for singers) and correct notes. In the control condition, they were asked to play the way they normally did. Expert raters evaluated the musicians’ performances for both musical expression and technical precision. In Experiment 1, external focus instructions enhanced musical expression relative to both internal focus and control conditions. There was no effect on technical precision. In Experiment 2, raters were given more detailed evaluation criteria. An external focus again led to superior musical expression compared with internal focus and control conditions. In addition, technical precision was higher within the external relative to the internal focus condition. The findings show that the advantages of focusing on the intended movement effect (i.e., externally) generalize to experienced musicians. Music teachers could offer their students specific recommendations for focus of attention during training and in concert situations to optimize learning and performance.

scholarly journals The Effect of Different Attentional Focus Instructions during Finger Movement Tasks in Healthy Subjects: An Exploratory Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Giacomo Rossettini ◽  
Marco Testa ◽  
Marco Vicentini ◽  
Paolo Manganotti
Keyword(s):  
Healthy Subjects ◽  
Motor Performance ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Control Group ◽  
Finger Movement ◽  
External Focus ◽  
Internal Focus ◽  
And Control

External focus of attention (EFA) and internal focus of attention (IFA) represent commonly used strategies to instruct subjects during exercise. Several studies showed EFA to be more effective than IFA to improve motor performance and learning. To date the role of these strategies on motor performance during finger movement was less studied. The objective of the study was to investigate motor performance, patient’s preference induced by IFA and EFA, and the focus during control condition. Ten healthy right-handed participants performed a finger movement task in control, EFA, and IFA conditions (counterbalanced). Errors, patient’s preference, and type of attentional focus spontaneously adopted during the control condition were recorded. EFA determined less error (p<0.01) compared to control and IFA. Participants preferred EFA against IFA and control condition. In the control group 10% of subjects adopted a purely EFA, 70% of subjects adopted a purely IFA, and 20% of subjects adopted a mixture of the two foci. Our results confirm that EFA is more effective than IFA and control in finger movement task. Due its clinical relevance, the interaction between attention and finger movement should be further investigated.

Increases in Jump-and-Reach Height through an External Focus of Attention

2007 ◽  
Vol 2 (3) ◽  
pp. 275-284 ◽  
Author(s):  
Gabriele Wulf ◽  
Tiffany Zachry ◽  
Carolina Granados ◽  
Janet S. Dufek
Keyword(s):  
Vertical Jump ◽  
Center Of Mass ◽  
Force Production ◽  
Vertical Displacement ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
External Focus ◽  
Internal Focus ◽  
Focus Condition ◽  
And Control

The present study examined whether the previously observed benefits of an external focus of attention (i.e., focusing on the movement effect), relative to an internal focus (i.e., focusing on one's body movements) and control conditions, would generalize to tasks requiring maximum force production, such as jumping. In two experiments, participants performed a vertical jump-and-reach task. A Vertec™ measurement device was used to determine jump-and-reach height. Participants performed under three conditions in a within-participant design: External focus (i.e., focus on the rungs of the Vertec that were to be touched), internal focus (i.e., focus on the finger, with which the rungs were to be touched), and control conditions (i.e., focus on jumping as high as possible). Experiment 1 showed that participants' jump-and-reach height was greatest with an external focus. Those results were replicated in Experiment 2. In addition, it was observed that the vertical displacement of the center of mass was greater under the external focus condition, compared to the other two conditions. This suggests that participants jumped higher by producing greater forces when they adopted an external focus. These findings indicate that the previously shown benefits of an external attentional focus generalize to tasks requiring maximal force production

scholarly journals Is an external focus of attention more beneficial than an internal focus to ball catching in children?

Kinesiology ◽  
2017 ◽  
Vol 49 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Reza Abdollahipour ◽  
Rudolf Psotta
Keyword(s):  
Repeated Measures ◽  
Frontal Plane ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Tennis Ball ◽  
External Focus ◽  
Internal Focus ◽  
Yellow Line ◽  
Tennis Balls ◽  
And Control

The performance benefits of adopting an external relative to an internal focus of attention have been demonstrated for many different targeting and balance tasks. No study has examined attentional focus effects for interceptive motor skills. Also, the majority of studies have used adult participants. In this study, children (mean age: 8.75 years, SD=0.79; 15 girls, 9 boys) were required to catch tennis balls in the frontal plane under the external focus (EF), internal focus (IF), and control (Cont) conditions. Participants were asked to stand behind a yellow line (2 × 100 cm), 15 m apart from a tennis ball throwing machine. In a within-participant design, participants performed 10 trials under each IF (“concentrate on your hands”), EF (“concentrate on the ball”), or Cont (no focus instructions) conditions. The order of conditions was counterbalanced. Performance data were analyzed using a one-way analysis of variance (ANOVA) with repeated measures on attentional focus conditions (internal, external, and control) (alpha=.05). Catching performance was significantly different&nbsp;and more effective in the EF (M=1.53, SD=0.25) than in the IF (M=1.39, SD=0.35) condition, while both EF and IF were not significantly different from the Cont (M=1.49, SD=0.28) condition. The current findings suggest that the external focus of attention is more beneficial, compared to the internal focus, to motor performance of an interceptive skill in children.

Verbal Cues and Attentional Focus: A Simulated Target-Shooting Experiment

2017 ◽  
Vol 5 (1) ◽  
pp. 148-159 ◽  
Author(s):  
Louisa D. Raisbeck ◽  
Jed A. Diekfuss
Keyword(s):  
Attentional Focus ◽  
Focus Of Attention ◽  
Verbal Cues ◽  
Task Load ◽  
External Focus ◽  
Gun Barrel ◽  
Internal Focus ◽  
And Performance ◽  
Nasa Task Load Index ◽  
Learning And Performance

Performance benefits exist for an external focus of attention compared with an internal focus of attention for performance and learning (Wulf, 2013). It is unknown, however, if varying the number of verbal cues affects learning and performance. Focus of attention and the number of verbal cues were manipulated during a simulated handgun-shooting task. For the internal focus conditions, participants were told to focus on their hand, arm, and wrist, whereas the external focus instructions were to focus on the gun, gun barrel, and gun stock. To manipulate the number of verbal cues, participants received instruction to focus on a single verbal cue or multiple verbal cues. Shooting performance was assessed at baseline, acquisition, and at two separate retention phases (immediate, delayed) that included transfer tests. Participants completed the NASA—Task Load Index to assess workload following all trials. Participants who received one verbal cue performed significantly better during immediate retention than those who received three verbal cues. Participants who used external focus of attention instructions had higher performance and reported less workload at delayed retention compared to those who used internal focus instructions. This research provides further support for the benefits of an external focus and highlights the importance of minimizing the number of verbal cues.

scholarly journals Do Children Benefit External Focus of Attention as Much as Adults? A Motor Learning Study

2017 ◽  
Vol 11 (7) ◽  
pp. 85 ◽  
Author(s):  
Somaye Roshandel ◽  
Hamidreza Taheri ◽  
Amir Moghadam
Keyword(s):  
Motor Skills ◽  
Retention Test ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Learning Study ◽  
Test Results ◽  
Future Studies ◽  
External Focus ◽  
Internal Focus ◽  
And Task

Recent evidence supports advantages of an external focus of attention on learning motor skills, however, there is a need to retest these finding for children and comparing them with adults. Thus, the purpose of current study was to determine the effect of different attentional focus on learning a motor skill in children and adults. Thirty children (8-12 year) and thirty adults (25-42 years) were randomly assigned to one of four groups: (1) Children external focus of attention (EFA), (2) Children- internal focus of attention (IFA), (3) Adults- External focus of attention (EFA), (4) Adults- internal focus of attention (IFA). Following initial instructions and task demonstration, participants performed 60 darts throwing in six blocks and 24 hours later performed 10 additional throws for retention test. Results revealed that children benefited from EFA and IFA instruction in the same manner, however, adults benefited from EFA more than IFA instruction. Future studies should continue to examine effects of different attentional focus on other skills.

Effects of Internal and External Attentional Focus on Postural Response to a Sliding Stance Surface

2019 ◽  
Vol 126 (3) ◽  
pp. 446-461 ◽  
Author(s):  
Hiroshi Kunimura ◽  
Masakazu Matsuoka ◽  
Naoki Hamada ◽  
Koichi Hiraoka
Keyword(s):  
Cognitive Activity ◽  
Attentional Focus ◽  
Upper Body ◽  
Body Sway ◽  
Support Surface ◽  
Postural Response ◽  
Postural Perturbation ◽  
Forward Displacement ◽  
External Focus ◽  
Internal Focus

The present study examined whether an internal or external attentional focus would affect participants’ feet-in-place balance response to postural stance perturbations. A movable platform automatically slid forward or backward while healthy participants stood on it and (a) performed no cognitive activity (control), (b) focused on the pelvis or upper body sway (internal focus), (c) memorized a number displayed immediately before the platform slid (external focus), or (d) kept the equilibrium of an unstable cylinder over the arm (external focus). The forward displacement of the pelvis induced by the platform sliding forward was smaller when participants focused on their pelvic sway, although such effect was absent when they focused on their upper body sway, indicating that the internal focus was effective for the postural response when attention was paid to the pelvic sway. Regarding an external attention focus, the forward displacement of the pelvis induced by the platform sliding forward was smaller when participants focused on the equilibrium of an unstable object over the arm, but this effect was absent when they focused on the number, indicating that an external focus was only effective when the unstable object focused upon was relevant to the equilibrium of one’s own body. No attentional intervention was effective during backward sliding of the support surface, indicating that central set for responding to postural perturbation depends on the direction of the postural perturbation.

The automaticity of complex motor skill learning as a function of attentional focus

2001 ◽  
Vol 54 (4) ◽  
pp. 1143-1154 ◽  
Author(s):  
Gabriele Wulf ◽  
Nancy McNevin ◽  
Charles H. Shea
Keyword(s):  
Focus Group ◽  
Dynamic Balance ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Skill Learning ◽  
External Focus ◽  
Control Processes ◽  
Attention Focus ◽  
Balance Task ◽  
Internal Focus

The present experiment was designed to test the predictions of the constrained-action hypothesis. This hypothesis proposes that when performers utilize an internal focus of attention (focus on their movements) they may actually constrain or interfere with automatic control processes that would normally regulate the movement, whereas an external focus of attention (focus on the movement effect) allows the motor system to more naturally self-organize. To test this hypothesis, a dynamic balance task (stabilometer) was used with participants instructed to adopt either an internal or external focus of attention. Consistent with earlier experiments, the external focus group produced generally smaller balance errors than did the internal focus group and responded at a higher frequency indicating higher confluence between voluntary and reflexive mechanisms. In addition, probe reaction times (RTs) were taken as a measure of the attention demands required under the two attentional focus conditions. Consistent with the hypothesis, the external focus participants demonstrated lower probe RTs than did the internal focus participants, indicating a higher degree of automaticity and less conscious interference in the control processes associated with the balance task.

Attentional Focus in Motor Skill Learning: Do Females Benefit from an External Focus?

2003 ◽  
Vol 12 (1) ◽  
pp. 37-52 ◽  
Author(s):  
Gabriele Wulf ◽  
Sebastian Wächter ◽  
Stefan Wortmann
Keyword(s):  
High School Students ◽  
Attentional Focus ◽  
Skill Learning ◽  
Female Group ◽  
School Students ◽  
External Focus ◽  
Internal Focus ◽  
Male High School ◽  
Instep Kick ◽  
Directing Attention

Recently, researchers in the motor learning area have shown that instructions to direct the learner’s attention to their body movements (i.e., induce an internal focus) – such as those typically used in applied settings – are less effective than instructions directing attention to the movement effects (i.e., inducing an external focus). Under the assumption that females tend to be more concerned about performing a movement correctly than males, who might be more inclined to focus on the outcome of their actions, the purpose of the present study was to examine whether females would benefit more from external-focus instructions than males. Female and male high-school students practiced a soccer instep kick with instructions that either induced an internal or external focus of attention. Subsequent retention (stationary ball) and transfer (moving ball) tests without instructions were performed to assess learning. The female group that was given internal-focus instructions during practice showed a greater performance decrement from retention to transfer than all other groups. This provides support for the view that the type of attentional focus induced by instructions might be particularly relevant for females, and that females might show greater learning advantages when provided with external-focus instructions.

scholarly journals Verbal Instruction Reduces Patellofemoral Joint Loading During Bodyweight Squatting

2020 ◽  
Vol 29 (4) ◽  
pp. 463-468
Author(s):  
Thomas G. Almonroeder ◽  
Emily Watkins ◽  
Tricia Widenhoefer
Keyword(s):  
Patellofemoral Joint ◽  
Attentional Focus ◽  
Focus Of Attention ◽  
Verbal Instruction ◽  
Joint Loading ◽  
Common Component ◽  
External Focus ◽  
Verbal Instructions ◽  
Joint Forces ◽  
Internal Focus

Context: The bodyweight squat exercise is a common component for treatment and prevention of patellofemoral pain; however, it can also place a high load on the patellofemoral joint. Restricting anterior motion of the knees relative to the toes during squatting appears to reduce patellofemoral loading. However, exercise professionals typically rely on verbal instructions to alter squat technique. Objective: To evaluate the influence of verbal instructions regarding squat technique on patellofemoral joint loading. Design: Cross-sectional study. Setting: Motion analysis laboratory. Participants: Eleven uninjured females. Intervention: Participants performed bodyweight squats before (baseline) and after receiving verbal instructions to limit anterior knee motion. Two different types of verbal instruction were used, one intended to promote an internal focus of attention and the other intended to promote an external focus of attention. Three-dimensional kinematics and kinetics were recorded using a multicamera system and force plate. Main Outcome Measures: Sagittal plane patellofemoral joint forces and stress were estimated using a musculoskeletal model. Results: Participants demonstrated a reduction in patellofemoral joint forces (35.4 vs 31.3 N/kg; P = .01) and stress (10.7 vs 9.2 mPa; P = .002) after receiving instructions promoting an internal focus of attention, compared with their baseline trials. Participants also demonstrated a reduction in patellofemoral joint forces (35.4 vs 32.3 N/kg; P = .03) and stress (10.7 vs 9.6 mPa; P = .04) after receiving instructions promoting an external focus of attention (vs baseline). However, there were no significant differences in patellofemoral forces (P = .84) or stress (P = .41) for trials performed with an internal versus external attentional focus. Conclusion: It appears that verbal instruction regarding knee position influences patellofemoral joint loading during squatting.

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