The influence of attentional focus on neuroplasticity following a seven-day balance training intervention

It is well established that focusing on the external effect of one’s movement (an external focus of attention) results in enhanced motor learning and produces superior motor performance compared to focusing inward on the body’s own physical execution of the motor movement (an internal focus). While the benefits of an external focus in motor learning, and the detriments of an inward or ‘internal’ focus have been highly replicated, there is still little mechanistic understanding pertaining to the brain-related changes that may result from these two different foci of attention during motor training. Since the brain is highly malleable and has been shown to adapt in response to motor training (i.e., neuroplasticity), it is postulated that attentional focus may change the brain’s structure and function. However, no direct examination exploring the influence of attentional focus on neuroplasticity (structural or functional) exists. The primary objective of this study was to determine the effects of balance training with different attentional foci on brain-related neuroplasticity in a young healthy population. Participants (n = 33) were randomly assigned to a control, internal focus, or external focus condition. Functional and structural brain connectivity analyses was conducted using neuroimaging data collected through functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) prior to (baseline) and following a seven-day balance training intervention (retention). Between baseline and retention data collection, participants in the internal and external focus training groups practiced a dynamic balance task for one hour per day, each day for seven consecutive days (acquisition). For the internal focus trials, participants were asked to, ‘focus on keeping their feet level;’ whereas, for the external focus trials participants were asked to, ‘focus on keeping the board level.’ The control group did not complete any balance training, but completed baseline and retention balance measurements. An inertial measurement unit was attached to the center of the balance board to assess the performance and learning of the balance task. Resting-state brain connectivity analyses were performed on the fMRI data to contrast connectivity differences for each group at retention relative to baseline, and, for the diffusion data (DTI), fractional anisotropy analyses (a metric to quantify water diffusion within a voxel of white-matter) was performed to quantify the relationship between changes in balance and water diffusivity within white-matter tracts. Classical attentional focus effects were observed for acquisition, with those in the external focus condition producing significantly less mean and standard deviation velocity compared to the internal focus group (both p .05). These results suggest that a seven-day balance training program with attentional focus in a young healthy population influences brain function (specifically correlated activity at rest), but longer training programs or more rest may be needed to influence brain structure (as measured by fractional anisotropy). These findings have important implications for a variety of clinical populations who show altered resting-sate connectivity and deteriorations in balance control (e.g., Alzheimer’s disease, stroke survivors). Seven days of balance training with an external focus may be useful in improving balance control and may influence correlated brain activity at rest, but longer training programs or more rest may be needed to influence brain structure. We discuss these findings in the context of the constrained-action hypothesis and OPTIMAL theory

Influence of practice schedules and attentional focus on skill development and retention

Focus of attention during dual-tasks and practice schedules are important components of motor skill performance and learning; often studied in isolation. The current study required participants to complete a simple key-pressing task under a blocked or random practice schedule. To manipulate attention, participants reported their finger position (i.e., skill-focused attention) or the pitch of an auditory tone (i.e., extraneous attention) while performing two variations of a dual-task key-pressing task. Analyses were conducted at baseline, 10 min and 24 h after acquisition. The results revealed that participants in a blocked schedule, extraneous focus condition had significantly faster movement times during retention compared to a blocked schedule, skill focus condition. Furthermore, greatest improvements from baseline to immediate and delayed retention were evident for an extraneous attention compared to the skill-focused attention, regardless of practice schedule. A discussion of the unique benefits an extraneous focus of attention may have on the learning process during dual-task conditions is presented