Attentional Focus and Gait Stability: Implication for Fall Rehabilitation

Abstract

The aim of the present study is to investigate the potential effect of different attentional focus instructions on gait stability during levelground walking in elderly fallers. Forty community-dwelling elderly fallers (mean age=70.6 years, SD=4.9 years) were recruited randomly from different elderly community centres in Hong Kong. The entire experiment included baseline assessments and walking trials. The baseline assessments included Berg Balance Scale, Time Up & Go Test, Fall Efficacy Scale and Mini-Mental State Examination. During the walking trials, each participant was invited to walk at natural pace along a 6-metre walkway for a total of 9 trials. Either internal focus instructions, external focus instructions or no instruction (control condition) were given in 3 of the 9 walking trials in randomized order. Spatial and temporal gait parameters were measured by a Qualisys 3-D motion-capture system. Results suggested significantly higher swing time variability under internal focus condition relative to external and control condition, which suggested that internal focus instructions can deteriorate gait stability in elderly fallers. In addition, slower speed and shorter steps were observed under internal condition when compared to external and control condition. Logical explanation could be related to postural adjustment mechanisms in which fallers tended to adopt a more conservative gait pattern in an attempt to increase gait stability but failed as illustrated in our present findings. Results implicate that instructions that related to own body movements (e.g., internal focus instructions) may not be suitable to be implemented in clinical settings during gait rehabilitation for elderly fallers.