Effect of focus of attention on transfer of a postural control task following an ankle sprain.

STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To examine the effect of attentional focus instructions during training on the transfer of a learned balance capability to a more challenging condition among subjects with ankle ligament injury. BACKGROUND: Current evidence suggests that instructions inducing an external focus of attention may be more effective at promoting learning than instructions inducing an internal focus of attention. The effect of attentional direction on transfer has not been tested in populations following a disease or injury, such as lateral ankle sprain, in which postural control is impaired. METHODS AND MEASURES: Participants were 36 male volunteers (mean age, 20.9 years; range, 19-33 years) who were referred to physical therapy following a grade 1 or 2 ankle sprain. The patients were randomly allocated to 1 of 2 groups, which were instructed to focus attention either internally or externally during postural control training. Three training sessions were conducted on consecutive days and consisted of ten 20-second trials at 2 stability levels, using the Biodex Stability System. Postural control at an untrained, less stable level was assessed before the initial training session and 48 hours following the last session using the Biodex Stability System. Three measures of stability were used: (1) overall stability, as indicated by the variance in platform displacement in all directions, (2) anterior/posterior variance of platform displacement, and (3) medial/lateral variance of platform displacement. RESULTS: Participants utilizing an external focus of attention improved significantly over the study period in all 3 stability indices, while those utilizing internal focus of attention did not improve significantly. CONCLUSIONS: Our results suggest that an external focus of attention is advantageous for the transfer of learning of a postural control task following an ankle injury. Furthermore, they indicate that using an external focus of attention when training under moderately unstable conditions can significantly improve postural control under less stable conditions.