External focus instructions reduce postural instability in individuals with Parkinson disease.

Wulf G, Landers M, Lewthwaite R, Töllner T

This study examined the generalizability of the attentional focus effect to balance in older adults with PD. Fourteen participants diagnosed with idiopathic PD (Hoehn and Yahr stages II and III) 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). The 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.

The results show that 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.

Physical Therapy, 2009, 89(2),162-8

Link to Abstract