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Are attentional instruction and feedback type affect on learning of postural and supra-postural tasks?

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Optimum postural control and balance is dependent on the individual, the environment, and the task limitations. Thus, the present study investigated the effect of attentional instruction and feedback type on postural and supra-postural tasks. The 96 participants aged 11–19 years with attention deficit hyperactivity disorder (ADHD) were randomly assigned to one of the eight groups such as attentional instruction (internal and external), feedback (external and internal), and task (postural and supra-postural). Following a pre-test, the participants underwent four training sessions. Each session included 20 trials of 30 s with 20 s of rest between trials. Twenty-four hours after the training session, they performed two trials of warm-up and then took part in a retention test. Twenty-four hours after the retention test, they again performed two trials of warm-up and then participated in the transfer test. The result showed that the external attentional feedback and external attentional instruction groups performed better on supra-postural and postural tasks than the other experimental groups (P > 0.05). The external attentional instruction group performed better on postural and supra-postural tasks in the delayed retention and transfer tests (P > 0.05). Also, the external feedback group scored highest on postural and supra-postural tasks in the delayed retention and transfer tests. The results suggest that external attentional feedback and instruction is more effective than internal attention when learning supra-postural tasks to maintain balance.

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  1. 1.

    Goetz M, Schwabova PJ, Hlavka Z, Ptacek R, Surman C (2017) Dynamic balance in children with attention-deficit hyperactivity disorder and its relationship with cognitive functions and cerebellum. Neuropsychiatric Disease & Treatment 13:873–880

  2. 2.

    Pakdaman F, Irani F, Tajikzadeh F, Jabalkandi SA (2018) The efficacy of Ritalin in ADHD children under neurofeedback training. Neurol Sci 39:2071–2078

  3. 3.

    Woollacott M, Shumway-Cook A (2002) Attention and the control of posture and gait: a review of an emerging area of research. Gait Post 16(1):1–14

  4. 4.

    McNevin NH, Shea CH, Wulf G (2003) Increasing the distance of an external focus of attention enhances learning. Psycho Research 67(1):22–29

  5. 5.

    Wulf G (2007) Attentional focus and motor learning: a review of 10 years of research. J Beweg Training 1(2–3):1–11

  6. 6.

    Wulf G, Prinz W (2001) Directing attention to movement effects enhances learning: a review. Psychon Bull Rev 8(4):648–660

  7. 7.

    Lajoie Y, Teasdale N, Bard C, Fleury M (1993) Attentional demands for static and dynamic equilibrium. Exp Brain Res 97(1):139–144

  8. 8.

    Cavanaugh JT, Mercer VS, Stergiou N (2007) Approximate entropy detects the effect of a secondary cognitive task on postural control in healthy young adults: a methodological report. J Neuroeng Rehab 4(42):1–7

  9. 9.

    Redfern MS, Müller ML, Jennings JR, Furman JM (2002) Attentional dynamics in postural control during perturbations in young and older adults. J Geront Series A: Biolo Sci Med Sci 57(8):298–303

  10. 10.

    Hwang S, Huang CT, Cherng RJ, Huang CC (2006) Postural fluctuations during pointing from a unilateral or bilateral stance. Hum Move Sci 25(2):275–291

  11. 11.

    Stoffregen TA, Pagulayan RJ, Bardy BG, Hettinger LJ (2000) Modulating postural control to facilitate visual performance. Hum Move Sci 19(2):203–220

  12. 12.

    Wulf G, McConnel N, Gärtner M, Schwarz A (2002) Enhancing the learning of sport skills through external-focus feedback. J Mot Behav 34(2):171–182

  13. 13.

    Cluff T, Gharib T, Balasubramaniam R (2010) Attentional influences on the performance of secondary physical tasks during posture control. Exp Brain Res 203(4):647–658

  14. 14.

    Saemi E, Porter J, Wulf G, Ghotbi-Varzaneh A, Bakhtiari S (2013) Adopting an external focus of attention facilitates motor learning in children with attention deficit hyperactivity disorder. Kinezio 45(2):179–185

  15. 15.

    Chiviacowsky S, Wulf G, Ávila L (2013) An external focus of attention enhances motor learning in children with intellectual disabilities. J Intellect Disabil Res 57(7):627–634

  16. 16.

    Wulf G, Weigelt M, Poulter D, McNevin N (2003) Attentional focus on suprapostural tasks affects balance learning. Quart J Exp Psych: Section A 56(7):1191–1211

  17. 17.

    McNevin NH, Wulf G (2002) Attentional focus on supra-postural tasks affects postural control. Hum Move Sci 21(2):187–202

  18. 18.

    Wulf G, Mercer J, McNevin N, Guadagnoli MA (2004) Reciprocal influences of attentional focus on postural and suprapostural task performance. J Mot Behav 36(2):189–199

  19. 19.

    Kal E, Van der Kamp J, Houdijk H (2013) External attentional focus enhances movement automatization: a comprehensive test of the constrained action hypothesis. Hum Move Sci 32(4):527–539

  20. 20.

    Landers M, Wulf G, Wallmann H, Guadagnoli M (2005) An external focus of attention attenuates balance impairment in patients with Parkinson’s disease who have a fall history. Physio 91(3):152–158

  21. 21.

    Wulf G, Höß M, Prinz W (1998) Instructions for motor learning: differential effects of internal versus external focus of attention. J Mot Behav 30(2):169–179

  22. 22.

    Wulf G (2008) Attentional focus effects in balance acrobats. Res Quart Exer Sport 79(3):319–325

  23. 23.

    Wulf G, Su J (2007) An external focus of attention enhances golf shot accuracy in beginners and experts. Res Quart Exer Sport 78(4):384–389

  24. 24.

    Stoffregen TA, Smart LJ, Bardy BG, Pagulayan RJ (1999) Postural stabilization of looking. J Exp Psycho: Hum Percep Perform 25(6):1641–1658

  25. 25.

    Morrison S, Newell KM (2000) Limb stiffness and postural tremor in the arm. Mot Control 4(3):293–315

  26. 26.

    Tokimura H, Di Lazzaro V, Tokimura Y, Oliviero A, Profice P, Insola A, Mazzone P, Tonali P, Rothwell JC (2000) Short latency inhibition of human hand motor cortex by somatosensory input from the hand. J Physiol 523(2):503–513

  27. 27.

    Bonnì S, Ponzo V, Di Lorenzo F, Caltagirone C, Koch G (2017) Real-time activation of central cholinergic circuits during recognition memory. Eur J Neurosci 45(11):1485–1489

  28. 28.

    Schirinzi T, Di Lorenzo F, Sancesario GM, Di Lazzaro G, Ponzo V, Pisani A, Mercuri NB, Koch G, Martorana A (2018) Amyloid-mediated cholinergic dysfunction in motor impairment related to Alzheimer’s disease. J Alzheimers Dis 64(2):525–532

  29. 29.

    Rochester L, Yarnall AJ, Baker MR, David RV, Lord S, Galna B, Burn DJ (2012) Cholinergic dysfunction contributes to gait disturbance in early Parkinson’s disease. Brain 135:2779–2788

  30. 30.

    Klinkenberg I, Sambeth A, Blokland A (2011) Acetylcholine and attention. Behav Brain Res 221:430–442

  31. 31.

    Pelosin E, Ogliastro C, Lagravinese G, Bonassi G, Mirelman A, Hausdorff JM, Abbruzzese G, Avanzino L (2016) Attentional control of gait and falls: is cholinergic dysfunction a common substrate in the elderly and Parkinson’s disease? Front Aging Neurosci 8:1–7

  32. 32.

    Sancesario GM, Di Lazzaro G, Ponzo V, Pisani A, Mercuri NB, Koch G, Martorana A (2018) Amyloid-mediated cholinergic dysfunction in motor impairment related to Alzheimer’s disease. J Alzheimers Dis 64(2):525–532

  33. 33.

    Triegaardt J, Han TS, Sada C et al. (2019). The role of virtual reality on outcomes in rehabilitation of Parkinson’s disease: meta-analysis and systematic review in 1031 participants. Neurol Sci; 1–8

  34. 34.

    Mitra S, Fraizer E (2004) Effects of explicit sway-minimization on postural–suprapostural dual-task performance. Hum Move Sci 23(1):1–20

  35. 35.

    Wulf G, Landers M, Lewthwaite R, Töllner T (2009) External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Therapy 89(2):162–168

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Correspondence to Amir Shams.

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Shams, A., Dehkordi, P.S., Tahmasbi, F. et al. Are attentional instruction and feedback type affect on learning of postural and supra-postural tasks?. Neurol Sci (2020). https://doi.org/10.1007/s10072-020-04278-9

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  • Supra-postural task
  • Postural task
  • Balance control
  • Attentional feedback
  • Attentional instruction
  • ADHD