Skip to main content
Top
Published in: BMC Geriatrics 1/2009

Open Access 01-12-2009 | Research article

A randomised controlled trial investigating motor skill training as a function of attentional focus in old age

Authors: Eling D de Bruin, Jaap Swanenburg, Elsbeth Betschon, Kurt Murer

Published in: BMC Geriatrics | Issue 1/2009

Login to get access

Abstract

Background

Motor learning research has had little impact on clinical applications and rarely extended to research about how older adults learn motor skills. There is consistent evidence that motor skill performance and learning can be enhanced by giving learners instructions that direct their attention. The aim of this study was to test whether elderly individuals that receive an external focus instruction during training of dynamic balance skills would learn in a different manner compared to individuals that received an internal focus instruction.

Methods

This randomised trial included 26 older persons (81 ± 6 years) that were training functional balance twice a week for the duration of 5 weeks. Learning outcomes were recorded after every training session. Weight shifting score and dynamic balance parameters (Biodex Balance System), components of the Extended Timed-Get-Up-and-Go test, five chair rises, and falls efficacy (FES-I) was assessed at baseline and post-intervention.

Results

Participation for training sessions was 94%. No differences between groups were found following 5 weeks of training for weight shifting score, dynamic balance index and dynamic balance time (p < 0.95, p = 0.16, p < 0.50), implying no learning differences between training groups. Extended Timed-Get-Up-and-Go components Sit-to-stand, p = .036; Gait initiation, p = .039; Slow down, stop, turnaround, and sit down, p = 0.011 and the Fes-I (p = 0.014) showed improvements for the total group, indicating that function improved compared to baseline.

Conclusion

A 5-week balance training improved weight shifting scores and dynamic balance parameters as well as functional abilities. The observed improvements were independent from the type of attentional focus instructions. The findings provide support for the proposition of different motor learning principles in older adults compared to younger adults.

Trial Registration

ISRCTN44627088
Appendix
Available only for authorised users
Literature
1.
go back to reference Magill R: Motor learning and control; concepts and applications. 2004, New York, McGraw Hill, 7 Magill R: Motor learning and control; concepts and applications. 2004, New York, McGraw Hill, 7
2.
go back to reference Winstein CJ: Knowledge of results and motor learning–implications for physical therapy. Phys Ther. 1991, 71: 140-149.PubMed Winstein CJ: Knowledge of results and motor learning–implications for physical therapy. Phys Ther. 1991, 71: 140-149.PubMed
3.
go back to reference Marchant D: Staying focused: Additional questions and issues for future attentional focus research. Wulf on attentional focus and motor learning, E-Journal Bewegung und Training. Edited by: Hossner E-J, Wenderoth N. 2007, 1: 4-14. [http://www.ejournal-but.de] Marchant D: Staying focused: Additional questions and issues for future attentional focus research. Wulf on attentional focus and motor learning, E-Journal Bewegung und Training. Edited by: Hossner E-J, Wenderoth N. 2007, 1: 4-14. [http://​www.​ejournal-but.​de]
4.
go back to reference Daselaar SM, Rombouts SA, Veltman DJ, Raaijmakers JG, Jonker C: Similar network activated by young and old adults during the acquisition of a motor sequence. Neurobiol Aging. 2003, 24: 1013-1019. 10.1016/S0197-4580(03)00030-7.CrossRefPubMed Daselaar SM, Rombouts SA, Veltman DJ, Raaijmakers JG, Jonker C: Similar network activated by young and old adults during the acquisition of a motor sequence. Neurobiol Aging. 2003, 24: 1013-1019. 10.1016/S0197-4580(03)00030-7.CrossRefPubMed
5.
go back to reference Latash M, Levin M: Progress in motor control; effects of age, disorder, and rehabilitation. 2004, Human Kinetics, Champaign (IL), USA Latash M, Levin M: Progress in motor control; effects of age, disorder, and rehabilitation. 2004, Human Kinetics, Champaign (IL), USA
6.
go back to reference Thompson M: Education: The older learner. 2000, Alexandria, VA, APTA Thompson M: Education: The older learner. 2000, Alexandria, VA, APTA
7.
go back to reference Mulder T, Hochstenbach JBN: Motor control and learning: Implications for neurological rehabilitation. Handbook of neurological rehabilitation. Edited by: Greenwood RJ. 2003, New York, Psychology Press Mulder T, Hochstenbach JBN: Motor control and learning: Implications for neurological rehabilitation. Handbook of neurological rehabilitation. Edited by: Greenwood RJ. 2003, New York, Psychology Press
8.
go back to reference Stelmach GE, Worringham CJ: Sensorimotor deficits related to postural stability. Implications for falling in the elderly. Clin Geriatr Med. 1985, 1: 679-694.PubMed Stelmach GE, Worringham CJ: Sensorimotor deficits related to postural stability. Implications for falling in the elderly. Clin Geriatr Med. 1985, 1: 679-694.PubMed
9.
go back to reference Sturnieks DL, St George R, Lord SR: Balance disorders in the elderly. Neurophysiol Clin. 2008, 38: 467-478. 10.1016/j.neucli.2008.09.001.CrossRefPubMed Sturnieks DL, St George R, Lord SR: Balance disorders in the elderly. Neurophysiol Clin. 2008, 38: 467-478. 10.1016/j.neucli.2008.09.001.CrossRefPubMed
10.
go back to reference Teasdale N, Bard C, LaRue J, Fleury M: On the cognitive penetrability of posture control. Exp Aging Res. 1993, 19: 1-13. 10.1080/03610739308253919.CrossRefPubMed Teasdale N, Bard C, LaRue J, Fleury M: On the cognitive penetrability of posture control. Exp Aging Res. 1993, 19: 1-13. 10.1080/03610739308253919.CrossRefPubMed
11.
go back to reference Shumway-Cook A, Woollacott M: Attentional demands and postural control: The effect of sensory context. J Gerontol A Biol Sci Med Sci. 2000, 55: M10-16.CrossRefPubMed Shumway-Cook A, Woollacott M: Attentional demands and postural control: The effect of sensory context. J Gerontol A Biol Sci Med Sci. 2000, 55: M10-16.CrossRefPubMed
12.
go back to reference Wulf G, Prinz W: Directing attention to movement effects enhances learning: A review. Psychon Bull Rev. 2001, 8: 648-660.CrossRefPubMed Wulf G, Prinz W: Directing attention to movement effects enhances learning: A review. Psychon Bull Rev. 2001, 8: 648-660.CrossRefPubMed
13.
go back to reference Wulf G, Shea C, Park JH: Attention and motor performance: Preferences for and advantages of an external focus. Res Q Exerc Sport. 2001, 72: 335-344.CrossRefPubMed Wulf G, Shea C, Park JH: Attention and motor performance: Preferences for and advantages of an external focus. Res Q Exerc Sport. 2001, 72: 335-344.CrossRefPubMed
14.
go back to reference McNevin NH, Wulf G: Attentional focus on supra-postural tasks affects postural control. Hum Mov Sci. 2002, 21: 187-202. 10.1016/S0167-9457(02)00095-7.CrossRefPubMed McNevin NH, Wulf G: Attentional focus on supra-postural tasks affects postural control. Hum Mov Sci. 2002, 21: 187-202. 10.1016/S0167-9457(02)00095-7.CrossRefPubMed
15.
go back to reference Wulf G, Weigelt M, Poulter D, McNevin N: Attentional focus on suprapostural tasks affects balance learning. Q J Exp Psychol A. 2003, 56: 1191-1211.CrossRefPubMed Wulf G, Weigelt M, Poulter D, McNevin N: Attentional focus on suprapostural tasks affects balance learning. Q J Exp Psychol A. 2003, 56: 1191-1211.CrossRefPubMed
16.
go back to reference Nichols DS: Balance retraining after stroke using force platform biofeedback. Phys Ther. 1997, 77: 553-558.PubMed Nichols DS: Balance retraining after stroke using force platform biofeedback. Phys Ther. 1997, 77: 553-558.PubMed
17.
go back to reference Rose DJ, Clark S: Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls?. J Am Geriatr Soc. 2000, 48: 275-282.CrossRefPubMed Rose DJ, Clark S: Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls?. J Am Geriatr Soc. 2000, 48: 275-282.CrossRefPubMed
18.
go back to reference Lindemann U, Rupp K, Muche R, Nikolaus T, Becker C: Improving balance by improving motor skills. Z Gerontol Geriatr. 2004, 37: 20-26. 10.1007/s00391-004-0206-5.CrossRefPubMed Lindemann U, Rupp K, Muche R, Nikolaus T, Becker C: Improving balance by improving motor skills. Z Gerontol Geriatr. 2004, 37: 20-26. 10.1007/s00391-004-0206-5.CrossRefPubMed
19.
go back to reference Sihvonen SE, Sipila S, Era PA: Changes in postural balance in frail elderly women during a 4-week visual feedback training: A randomized controlled trial. Gerontology. 2004, 50: 87-95. 10.1159/000075559.CrossRefPubMed Sihvonen SE, Sipila S, Era PA: Changes in postural balance in frail elderly women during a 4-week visual feedback training: A randomized controlled trial. Gerontology. 2004, 50: 87-95. 10.1159/000075559.CrossRefPubMed
20.
go back to reference Sihvonen S, Sipila S, Taskinen S, Era P: Fall incidence in frail older women after individualized visual feedback-based balance training. Gerontology. 2004, 50: 411-416. 10.1159/000080180.CrossRefPubMed Sihvonen S, Sipila S, Taskinen S, Era P: Fall incidence in frail older women after individualized visual feedback-based balance training. Gerontology. 2004, 50: 411-416. 10.1159/000080180.CrossRefPubMed
21.
go back to reference Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
22.
go back to reference Portney L, Watkins M: Foundations of clinical research; applications to practice. 2000, New Jersey, Prentice Hall Portney L, Watkins M: Foundations of clinical research; applications to practice. 2000, New Jersey, Prentice Hall
23.
go back to reference de Bruin ED, Murer K: Effect of additional functional exercises on balance in elderly people. Clin Rehabil. 2007, 21: 112-121. 10.1177/0269215506070144.CrossRefPubMed de Bruin ED, Murer K: Effect of additional functional exercises on balance in elderly people. Clin Rehabil. 2007, 21: 112-121. 10.1177/0269215506070144.CrossRefPubMed
24.
go back to reference Pincivero D, Lephart S, Henry T: Learning effects and reliability of the biodex stability system. J Athl Train. 1995, 30: S48- Pincivero D, Lephart S, Henry T: Learning effects and reliability of the biodex stability system. J Athl Train. 1995, 30: S48-
25.
go back to reference Clark S, Rose DJ, Fujimoto K: Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults. Arch Phys Med Rehabil. 1997, 78: 1078-1084. 10.1016/S0003-9993(97)90131-3.CrossRefPubMed Clark S, Rose DJ, Fujimoto K: Generalizability of the limits of stability test in the evaluation of dynamic balance among older adults. Arch Phys Med Rehabil. 1997, 78: 1078-1084. 10.1016/S0003-9993(97)90131-3.CrossRefPubMed
26.
go back to reference Hinman M: Factors affecting reliability of the biodex balance system: A summary of four studies. J Sport Rehabil. 2000, 9: 240-252. Hinman M: Factors affecting reliability of the biodex balance system: A summary of four studies. J Sport Rehabil. 2000, 9: 240-252.
27.
go back to reference Schmitz R, Arnold B: Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system. J Sport Rehabil. 1998, 7: 95-101. Schmitz R, Arnold B: Intertester and intratester reliability of a dynamic balance protocol using the biodex stability system. J Sport Rehabil. 1998, 7: 95-101.
28.
go back to reference Wall JC, Bell C, Campbell S, Davis J: The timed get-up-and-go test revisited: Measurement of the component tasks. J Rehabil Res Dev. 2000, 37: 109-113.PubMed Wall JC, Bell C, Campbell S, Davis J: The timed get-up-and-go test revisited: Measurement of the component tasks. J Rehabil Res Dev. 2000, 37: 109-113.PubMed
29.
go back to reference Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49: M85-94.CrossRefPubMed Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: Association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49: M85-94.CrossRefPubMed
30.
go back to reference Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the falls efficacy scale-international (fes-i). Age Ageing. 2005, 34: 614-619. 10.1093/ageing/afi196.CrossRefPubMed Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the falls efficacy scale-international (fes-i). Age Ageing. 2005, 34: 614-619. 10.1093/ageing/afi196.CrossRefPubMed
31.
go back to reference Tabachnick B, Fidell L: Using multivariate statistics. 1996, New York, HarperCollins College Publishers, third Tabachnick B, Fidell L: Using multivariate statistics. 1996, New York, HarperCollins College Publishers, third
32.
go back to reference Olejnik S, Algina J: Generalized eta and omega squared statistics: Measures of effect size for some common research designs. Psychol Methods. 2003, 8: 434-447. 10.1037/1082-989X.8.4.434.CrossRefPubMed Olejnik S, Algina J: Generalized eta and omega squared statistics: Measures of effect size for some common research designs. Psychol Methods. 2003, 8: 434-447. 10.1037/1082-989X.8.4.434.CrossRefPubMed
33.
go back to reference Thomas JR, Nelson JK, Thomas KT: A generalized rank-order method for nonparametric analysis of data from exercise science: A tutorial. Res Q Exerc Sport. 1999, 70: 11-23.CrossRefPubMed Thomas JR, Nelson JK, Thomas KT: A generalized rank-order method for nonparametric analysis of data from exercise science: A tutorial. Res Q Exerc Sport. 1999, 70: 11-23.CrossRefPubMed
34.
go back to reference McNevin NH, Shea CH, Wulf G: Increasing the distance of an external focus of attention enhances learning. Psychol Res. 2003, 67: 22-29.PubMed McNevin NH, Shea CH, Wulf G: Increasing the distance of an external focus of attention enhances learning. Psychol Res. 2003, 67: 22-29.PubMed
35.
go back to reference Wulf G, McNevin N, Shea CH: The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A. 2001, 54: 1143-1154. 10.1080/02724980143000118.CrossRefPubMed Wulf G, McNevin N, Shea CH: The automaticity of complex motor skill learning as a function of attentional focus. Q J Exp Psychol A. 2001, 54: 1143-1154. 10.1080/02724980143000118.CrossRefPubMed
36.
go back to reference Shumway-Cook A, Woollacott M: Motor control; theory and practical applications. 2001, Philadelphia, Lippincott Williams & Wilkins, second Shumway-Cook A, Woollacott M: Motor control; theory and practical applications. 2001, Philadelphia, Lippincott Williams & Wilkins, second
37.
go back to reference Hass CJ, Gregor RJ, Waddell DE, Oliver A, Smith DW, Fleming RP, Wolf SL: The influence of tai chi training on the center of pressure trajectory during gait initiation in older adults. Arch Phys Med Rehabil. 2004, 85: 1593-1598. 10.1016/j.apmr.2004.01.020.CrossRefPubMed Hass CJ, Gregor RJ, Waddell DE, Oliver A, Smith DW, Fleming RP, Wolf SL: The influence of tai chi training on the center of pressure trajectory during gait initiation in older adults. Arch Phys Med Rehabil. 2004, 85: 1593-1598. 10.1016/j.apmr.2004.01.020.CrossRefPubMed
38.
go back to reference Steadman J, Donaldson N, Kalra L: A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. J Am Geriatr Soc. 2003, 51: 847-852. 10.1046/j.1365-2389.2003.51268.x.CrossRefPubMed Steadman J, Donaldson N, Kalra L: A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients. J Am Geriatr Soc. 2003, 51: 847-852. 10.1046/j.1365-2389.2003.51268.x.CrossRefPubMed
39.
go back to reference Graziano A, Raulin M: Research methods: A process of inquiry. 1989, New York, Harper Collins Graziano A, Raulin M: Research methods: A process of inquiry. 1989, New York, Harper Collins
Metadata
Title
A randomised controlled trial investigating motor skill training as a function of attentional focus in old age
Authors
Eling D de Bruin
Jaap Swanenburg
Elsbeth Betschon
Kurt Murer
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2009
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-9-15

Other articles of this Issue 1/2009

BMC Geriatrics 1/2009 Go to the issue