The impact of external and internal focus of attention on visual dependence and EEG alpha oscillations during postural control.
Lei Ma, Peter J Marshall, W Geoffrey Wright
PMID 35883085WHAT IT FOUND
In healthy young adults balancing on a rocker board with misleading visual cues, focusing attention on the board itself reduced sway and visual reliance.
Focusing on the feet did not improve balance compared to standard instructions.
Key findings
01External focus on the board resulted in significantly lower visual gain (reliance on misleading vision) compared to the control group.
02External focus led to better balance performance (lower sway velocity and path length) compared to internal focus on the feet.
03Internal focus on the feet did not reduce visual reliance more than the control condition.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Participants were healthy young adults (mean age ~26), so findings may not generalize to older adults or those with vestibular or neurological impairments. The study used a specific VR setup with a rocker board; it is unclear if these effects transfer to standard clinical balance tasks. EEG analysis was limited by low channel density and technical exclusions (3 participants excluded from EEG analysis). The control group received standard instructions which may have inadvertently included some internal focus strategies, potentially diluting the difference between control and internal focus groups.
Declared interests
Funded by Temple University’s College of Public Health Visionary Research Fund. No other conflicts declared.
The easy way to misread this
Do not assume that internal focus on the feet is ineffective for all balance tasks. This study specifically examined a visual-somatosensory conflict where vision was unreliable. Previous research suggests internal focus may help when vision is absent, so the context of the sensory conflict matters.