Eli's Rehab Report

External focus instructions reduce postural instability in individuals with Parkinson disease. Wulf G, Landers M, Lewthwaite R, Töllner T; Phys Ther. 2009 Feb;89(2):169- 70; author reply 170-2.

Patients with Parkinson disease may be able to improve their postural stability by directing their attention to the external effects of their movements, rather than to the movements of their own body, according to researchers in the University of Nevadas department of Kinesiology and nutrition sciences.

Researchers had 14 people diagnosed with idiopathic PD (Hoehn and Yahr stages II and III) to balance on an unstable surface (an inflated rubber disk). In counterbalanced orders, researchers instructed them to focus on reducing movements of their feet (internal focus) or the disk (external focus), or they were not given attentional focus instructions (control).

Findings: Subjects asked to take an external focus experienced less postural sway relative to both internal focus and control conditions. In fact, there was no difference between the internal focus and control conditions.

In the past 12 years or so, numerous studies have been done -- many of them involving healthy adults learning sport skills -- and it has consistently been found that individuals perform and learn motor skills more effectively when they are instructed to adopt an external focus, said lead researcher Gabriele Wulf, PhD. Other studies have shown that those advantages generalize to people after stroke as well as to the rehabilitation of ankle sprains, for example. This is a very reliable effect, and the current study demonstrates that persons with Parkinson disease benefit from an external attentional focus as well.