title: Influence of focus of attention, reinvestment and fall history on elderly gait stability.
abstract: Falls represent a substantial risk in the elderly. Previous studies have found that a focus on the outcome or effect of the movement (external focus of attention) leads to improved balance performance, whereas a focus on the movement execution itself (internal focus of attention) impairs balance performance in elderly. A shift toward more conscious, explicit forms of motor control occurs when existing declarative knowledge is recruited in motor control, a phenomenon called reinvestment. We investigated the effects of attentional focus and reinvestment on gait stability in elderly fallers and nonfallers. Full body kinematics was collected from twenty-eight healthy older adults walking on a treadmill, while focus of attention was manipulated through instruction. Participants also filled out the Movement Specific Reinvestment Scale (MSRS) and the Falls Efficacy Scale International (FES-I), and provided details about their fall history. Coefficients of Variation (CV) of spatiotemporal gait parameters and Local Divergence Exponents (LDE) were calculated as measures of gait variability and gait stability, respectively. Larger stance time CV and LDE (decreased gait stability) were found for fallers compared to nonfallers. No significant effect of attentional focus was found for the gait parameters, and no significant relation between MSRS score (reinvestment) and fall history was found. We conclude that external attention to the walking surface does not lead to improved gait stability in elderly. Potential benefits of an external focus of attention might not apply to gait, because walking movements are not geared toward achieving a distinct environmental effect.
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam MOVE Research Institute Amsterdam, Amsterdam, the Netherlands j.f.stins@vu.nl.|Cognitive Motor Function research group, School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.
authors.forename: Jonathan L A
authors.initials: JL
authors.lastname: de Melker Worms
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam MOVE Research Institute Amsterdam, Amsterdam, the Netherlands.
authors.forename: John F
authors.initials: JF
authors.lastname: Stins
authors.affiliation: Department of Rehabilitation Medicine, VU University Medical Center MOVE Research Institute Amsterdam, Amsterdam, the Netherlands.
authors.forename: Erwin E H
authors.initials: EE
authors.lastname: van Wegen
authors.affiliation: Cognitive Motor Function research group, School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Loram
authors.affiliation: Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam MOVE Research Institute Amsterdam, Amsterdam, the Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Beek
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D001288:Attention / Q000502:physiology*; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D009068:Movement / Q000502:physiology; D004856:Postural Balance / Q000502:physiology; D012307:Risk Factors; D016138:Walking / Q000502:physiology
keywords: Attentional focus; elderly; falls; gait; motion capture