External Focus Strategy on Visuomotor Control in Older Adults

Investigating Visual Search Strategies and the Role of Attentional Focus During Psychomotor Gait Re-education in Older Adults at Risk of Falling: Implication for Fall Rehabilitation

Only a few studies have adopted external focus strategy as an intervention to mitigate the negative effects of heightened conscious movement processing in older adults. The goal was to investigate whether a single-session intervention (SSI) using external focus strategy could improve gait stability and visual search behaviors during adaptive locomotion among the older population.

Participants were randomly allocated to either an external focus (EXT) or a control group (CON). All participants performed an obstacle circumvention walking task along an 8-m walkway for five trials at pre-intervention (T0), post-intervention (T1), and retention (T2). The training phase included 20 walking trials. EXT focused on digits displayed on monitors at their path destinations, while CON walked naturally without any manipulation.

Study Overview

• Status: Completed
• Conditions: Gait; Older Adults; Fall Risk
• Intervention / Treatment: Behavioral: External focus; Behavioral: Control

• Study Type: Interventional
• Enrollment (Actual): 112
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong, 000
    • The Hong Kong Polytechnic University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• aged 65 or above
• were able to walk independently indoors without walking aids

Exclusion Criteria:

• a total score of less than 24 on the Chinese version of the Mini-Mental State Examination
• a static visual acuity poorer than 20/40 vision
• the presence of any untreated cerebral vascular disease, Parkinson's disease, or any other major neurological deficit

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: EXT	Behavioral: External focus; The training phase consisted of 20 consecutive training trials, with a rest interval of at least 30 seconds between trials. All participants had to circumvent an obstacle during each trial on the 8-m level-ground walkway. During each trial, the general instruction was to focus on a random series of digits ranging from 0 to 9 displayed on monitors placed at the immediate and future destinations of the walkway. Each number was displayed for at least 2 seconds to allow participants to have sufficient time to read them.
Active Comparator: CON	Behavioral: Control; The training phase consisted of 20 consecutive training trials, with a rest interval of at least 30 seconds between trials. All participants had to circumvent an obstacle during each trial on the 8-m level-ground walkway. During each trial, the general instruction was to walk to the end of the walkway at your natural pace.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait stability	Measured by a 3-D motion-capture system. Indicated by the variabilities of temporal and spatial gait parameters	pre-test, post-test (the same day, immediately after the single-session intervention), 1 week after post-test (retention)
Visual search behavior	Measured by eye tracker. Indicated by: number of fixation (%) on ground number of fixation (%) on destination number of fixation (%) on obstacle number of fixation (%) on random areas fixation duration (%) on ground fixation duration (%) on destination fixation duration (%) on obstacle fixation duration (%) on random areas	pre-test, post-test (the same day, immediately after the single-session intervention), 1 week after post-test (retention)

Collaborators and Investigators

• Sponsor: The Hong Kong Polytechnic University

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2021
• Primary Completion (Actual): June 30, 2023
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: August 21, 2024
• First Submitted That Met QC Criteria: August 23, 2024
• First Posted (Actual): August 26, 2024

Study Record Updates

• Last Update Posted (Actual): August 26, 2024
• Last Update Submitted That Met QC Criteria: August 23, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: gait; older adults; visual search; attentional focus
• Other Study ID Numbers: HSEARS20210525002

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No