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Article Title

EFFICACY OF INCORPORATING ANEXTERNAL ATTENTIONAL FOCUS STRATEGY WHEN TEACHING NEW BALANCE TASKS: A META-ANALYSIS

Abstract

Jonathan C. Swain1, Lauren G. Killen2, James M. Green2 & Eric K. O’Neal2 1Univeristy of Arkansas, Fayetteville, Arkansas; 2University of North Alabama, Florence, Alabama

An external focus of attention (EF), where subjects focus on the goals of their movements, has been shown advantageous in balance motor learning and task performance, especially vs.an internal focus of attention (IF), where subjects focus solely on movement performance. However, task difficulty level and the presence of any conditions inhibiting balance control may have an impact on the efficacy of an EF when learning novel balance tasks. PURPOSE: This study used meta-analytic procedures to examine the impact of task difficulty and clinical conditions on the efficacy of an EF strategy when learning a novel balance task. METHODS: After a thorough literature search using Google Scholar and PubMed data bases, seven studies with a combined total of 178 participants met inclusion criteria. Twenty-two separate comparisons were drawn from these studies and were analyzed by two moderators: population type and task difficulty. Comparisons utilizing participants with visual, vestibular, or somatosensory impairments (VVSI) were compared against participants with no impairments (NIMP), and tasks were categorized as easy (Level 1), moderate (Level 2), or hard (Level 3). RESULTS: Overall, EF approached significance (p = 0.08; d =-0.12, 95% CI = -0.26 to 0.01). Level 3 task difficulty neared significance (p = 0.09, d = -0.24, 95% CI = -0.52 to 0.04), but only the NIMP moderator level reached significance (p = 0.04; d = -0.18, 95% CI = -0.35 to -0.01). CONCLUSION: An EF may offer learners of a novel static balance task modest advantages during initial phases of skill acquisition. Results indicate subjects without VVSI conditions or subjects attempting higher level tasks will receive the most benefit from an EF strategy. Future research should focus on how the efficacy of an EF strategy during multiple balance task practice sessions and balance task retention tests is affected by balance-impairing conditions and task difficulty.

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