LAS VEGAS - January 22, 2009 - A new study by UNLV researchers found that for the estimated one million Americans living with Parkinson's disease - two thirds of whom reported falling within the last year - improved stability, and ultimately fewer falls, can be achieved by simply changing their focus of attention.
The study, which appears in the February 2009 issue of the journal Physical Therapy, found that postural stability improved significantly among a sample group of patients with Parkinson's disease when they adopted an external rather than internal focus of attention.
A research team led by UNLV Kinesiology Professor Gabriele Wulf tested a group of 14 older adults with diagnosed Parkinson's disease by asking them to balance on an unstable surface (inflated rubber disk). All participants were instructed to look straight ahead and focus on reducing movements of their feet (internal focus) or the disk (external focus), or they were not given attentional focus instructions. The external focus exercise resulted in significantly greater postural stability than both the internal and control conditions.
"For those with a history of falls, it's much more effective to focus attention on the effects their movements have on the environment rather than focusing internally on the movements themselves," said Wulf.
"These findings have the potential to not only improve rehabilitation efforts of caregivers and clinicians working with Parkinson's patients, but may also give the patients more control over their lives by providing them with a strategy to more safely and effectively manage their posture and movement activities," she said.
In patients with Parkinson's disease, there is disease or degeneration of the basal ganglia, the part of the brain that controls motor function and learning. Wulf and her team contend that instructions directing attention to the effect, or outcome, of the movement support a more automatic form of motor control, consistent with that seen from expert performers.
"For example, beginning ice skaters focus all of their attention inward on their movements and adopt a stiff posture just to maintain balance. For experts, the act of skating comes naturally and they're able to focus attention on the environment around them," said Wulf. "Similarly in rehabilitation, we've found that directing attention externally, in this case keeping the rubber disk they're standing on as still as possible, allows automatic control processes to kick in and tasks are performed more effectively and efficiently."
Study participants were tested in their homes one hour after their medication was taken. Each participant performed four, 15-second trials of each condition.
Wulf has conducted numerous studies on the effectiveness of external focus on a variety of motor skills, leading improved performance in golf, tennis, volleyball and soccer, as well practical applications in physical and occupational therapy.
Co-authors with Wulf on the study were Merrill Landers, associate professor of physical therapy at UNLV; Rebecca Lewthwaite, director of research and education in physical therapy for Rancho Los Amigos National Rehabilitation Center; and Thomas T?llner, assistant professor of neurocognitive psychology at Ludwig-Maximilians University in Munich, Germany. The study is available online at
