Effects of attentional focus on walking stability in elderly.

Introduction: Balance performance in the elderly is related to psychological factors such as attentional focus. We investigated the effects of internal vs. external focus of attention and fall history on walking stability in healthy older adults.

Method: Walking stability of twenty-eight healthy older adults was assessed by applying random unilateral decelerations on a split-belt treadmill and analysing the resulting balance recovery movements. The internal focus instruction was: concentrate on the movement of your legs, whereas the external focus instruction was: concentrate on the movement of the treadmill. In both conditions participants were asked to look ahead at a screen. Outcome measures were coefficient of variation of step length and step width, and characteristics of the centre of mass velocity time-series as analysed using statistical parametric mapping. Fall history was assessed using a questionnaire.

Results: After each perturbation participants required two to three strides to regain a normal gait pattern, as determined by the centre of mass velocity response. No effects were found of internal and external focus of attention instructions and fall history on any of the outcome measures.

Discussion: We conclude that, compared to an internal focus of attention instruction, external focus to the walking surface does not lead to improved balance recovery responses to gait perturbations in the elderly.