Comparison of Nonlinear Dynamics of Stepping in Educable Girls with Intellectual Disabilities under Internal and External Attention Focus Instructions

Document Type : Original Article

Authors

Department of Physical Education and Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran

Abstract

Purpose:
Alterations in gait patterns and asymmetry in gait cycle parameters among individuals with intellectual disabilities increase the risk of falls, reduce motor efficiency, and also increase coordination variability. The aim of the study was to investigate the effect of different types of attentional focus on the coordination variability of lower body segments in educable girls with intellectual disabilities.
Methods:
This applied, quasi-experimental study involved 23 girls aged 10–13 years with educable intellectual disabilities, selected through convenience sampling. Inertial sensors were attached to the pelvis, thigh, leg, and foot to assess gait kinematics under four attentional focus conditions: control (Ctrl), internal attention (IA), close external attention (CEA), and far external attention (FEA). Coordination variability (CV) was calculated using the angle-angle method between adjacent limb segments and the standard deviation index. Data were analyzed using repeated measures analysis of variance.
Results:
No significant differences were observed in the CV of the Hip-Thigh segment across the attentional focus conditions (Ctrl: 32.05 ± 9.71; IA: 32.75 ± 8.60; CEA: 32.94 ± 8.70; FEA: 34.00 ± 6.10) (p ≥ 0.05). However, the CV of the Thigh-Leg segment (Ctrl: 7.25 ± 1.33; IA: 7.37 ± 1.40; CEA: 7.43 ± 2.33; FEA: 7.80 ± 2.26) and the Leg-Ankle segment (Ctrl: 17.00 ± 2.90; IA: 17.45 ± 5.70; CEA: 18.73 ± 3.67; FEA: 19.31 ± 5.90) were significantly lower in the FEA condition compared to the IA condition (p ≤ 0.05).
Conclusion:
The findings suggest that adopting a far external focus of attention can effectively reduce coordination variability in lower body segments during gait in girls with intellectual disabilities.

Keywords

References

  1. Zolghadr H, Sedaghati P, Daneshmandi H. The effect of selected balance/corrective exercises on the balance performance of mentally-retarded students with developmental coordination disorder. Phys Treat Phys Ther J 2019; 9(1): 23–30.
  2. Samadi H, Hossein Nejad E, Sohbatiha M. Comparison of Effectiveness of Motor-Working Memory Training and Perceptual-Motor Exercises on Digit Span and Letter–Number Sequencing in Educable Children with Intellectual Disabilities. umsha 2022 ;29(1): 41–49.
  3. Cavanagh PR, Kram R. The efficiency of human movement--a statement of the problem. Med Sci Sports Exerc. 1985 Jun;17(3):304–8.
  4. Mon-Williams M, Tresilian JR, Bell VE, Coppard VL, Jobling A, Carson RG. The preparation of reach to grasp movements in adults with Down syndrome. Hum Mov Sci 2001; 20(4–5): 587–602.
  5. Taghadosi M, Afazel MR, Akbari H, Rahemi Z. Evaluation of the problems among the physical-mental disabled children under the coverage of Kashan rehabilitation centers. KAUMS 2012; 16(2):174–81.
  6. Samadi H, Mousav SH, Shirvani H. The effect of internal attentional focus instructions and various distances of external attention on the static and dynamic balance of the chemical veterans with movement impairment. Mil Med 2022; 21(6): 596–605.
  7. Luckasson R, Reeve A. Naming, defining, and classifying in mental retardation. Ment Retard 2001; 39(1): 47–52.
  8. Ghorbani M, Yaali R, Litafatkar A, Sadeghi H. The effect of nonlinear training on lower limb kinematics in walking motor skills in 3-5 year old children. Res Pap Sport Manag Mov Behav 2024;
  9. Siavoshi Hojjatollah, Seddighi Amirreza. The effect of a balance exercise program on improving stepping performance and temporal and spatial indicators of walking in adolescents with intellectual disabilities. Except Educ 2016; 138(16): 68–79.
  10. Banafsheh G, Shahzad TB, Shahbazi M, Arshi Ahmad Reza. Dynamic Evaluation of Motor Coordination and Variability in Children with and without Developmental Coordination Disorder. J Arak Univ Med Sci 2022; 24(6): 804–819.
  11. Nasri A, Abbasi A, Hadavi Z, Abbasi S, Svoboda Z. Lower-extremity inter-joint coordination variability in active individuals with transtibial amputation and healthy males during gait. Sci Rep 2024; 14(1): 11668.
  12. Tsuchida W, Inai T, Kudo S, Kobayashi Y, Fujimoto M. Effect of knee sleeves on joint angle variability during gait in older adults: a principal component analysis. Front Bioeng Biotechnol 2025; 13: 1525174.
  13. Fatemeh Sadat Ahmadneiri, Samadi H, Ahar S. Comparison of coordination and variability of gait coordination in elderly people with and without a history of falls during mental fatigue in single and dual task conditions. 2023.
  14. Bahramian M, Rafiei S. The effect of practice variability and freezing degrees of freedom on learning dart throwing skills. The Second National Conference on New Achievements in Physical Education and Sports. 2016.
  15. Baharlouei K, Wangwad VS. The effect of cognitive attentional focus instructions on Muscle Efficiency and Motor Performance of Skilled Individuals. Mot Behav [Internet] 2023; 15(54): 61–78.
  16. Meyer M, Sattler I, Schilling H, Lang UE, Schmidt A, Colledge F, et al. Mental Disorders in Individuals With Exercise Addiction—A Cross-Sectional Study. Front Psychiatry 2021; 12.
  17. Fardin Qeysari, Shahbazi M, Shahzad Tahmasebi Boroujeni Ali Sharifnejad. The Effect of External and Internal Focus of Attention on Electromyography of the Lower Extremity Muscles in Different Phases of Vertical Jump. Mot Behav 2020; 12(40): 87–102.
  18. Hadler R, Chiviacowsky S, Wulf G, Schild JFG. Children’s learning of tennis skills is facilitated by external focus instructions. Mot Rev Educ Física 2014; 20(4): 418–22.
  19. Abdollahipour R, Nieto MP, Psotta R, Wulf G. External focus of attention and autonomy support have additive benefits for motor performance in children. Psychol Sport Exerc 2017; 32: 17–24.
  20. Ducharme SW, Wu WFW, Lim K, Porter JM, Geraldo F. Standing long jump performance with an external focus of attention is improved as a result of a more effective projection angle. J Strength Cond Res 2016; 30(1): 276–81.
  21. Kearney PE. A distal focus of attention leads to superior performance on a golf putting task. Int J Sport Exerc Psychol 2015; 13(4): 371–81.
  22. Wulf G, Su J. An external focus of attention enhances golf shot accuracy in beginners and experts. Res Q Exerc Sport 2007; 78(4): 384–389.
  23. Wulf G, Prinz W. Directing attention to movement effects enhances learning: A review. Psychon Bull Rev 2001; 8(4) :648–660.
  24. Wulf G. Attentional focus and motor learning: a review of 15 years. Int Rev Sport Exerc Psychol 2013; 6(1): 77–104.
  25. Wulf G, Höß M, Prinz W. Instructions for Motor Learning: Differential Effects of Internal Versus External Focus of Attention. J Mot Behav 1998 ; 30(2): 169–79.
  26. Maxwell J, Applied RMIJ of, 2002‏ U. External versus internal focus instructions: Is the learner paying attention?‏. search.ebscohost.com ‏JP Maxwell, RSW Masters‏International J Appl Sport Sci 2002‏•search.ebscohost.com‏.
  27. Wulf G, Weigelt M, Poulter D, McNevin N. Attentional focus on suprapostural tasks affects balance learning. Q J Exp Psychol Sect A 2003; 56(7): 1191–211.
  28. Maryam Lotfi, Dehghanizade J, Hosseini FS. The Effect of Internal and External Focus of Attention on Acquisition, Retention and Transfer of Dart Throwing in Mentally Retarded Children. Sport Mot Dev Learn 2015 ;7(4): 511–27.
  29. Azadian E, Jabar Ali M. The Relationship between Executive Functions and Postural Control in Children with Mild Intellectual Disability and Comparison with Typically Developing Peers. iauh-biomech [Internet].2025; 10(4): 294–308.
  30. Prisco G, Pirozzi MA, Santone A, Esposito F, et al. Validity of wearable inertial sensors for gait analysis: a systematic review. Diagnostics 2024; 15(1): 36.
  31. Bagheri S. Processing, Converting, and Visualizing C3D File: A Free Web-based services.
  32. Grouvel G, Boutabla A, Corre J, Revol R, et al. Full-body kinematics and head stabilisation strategies during walking in patients with chronic unilateral and bilateral vestibulopathy. Sci Rep 2024; 14(1): 11757.
  33. Chang R, Van Emmerik R, Hamill J. Quantifying rearfoot–forefoot coordination in human walking. J Biomech. 2008; 41(14): 3101–3305.
  34. Chiviacowsky S, Wulf G, Wally R. An external focus of attention enhances balance learning in older adults. Gait Posture 2010 ; 32(4): 572–575.
  35. Chua LK, Jimenez-Diaz J, Lewthwaite R, Kim T, Wulf G. Superiority of external attentional focus for motor performance and learning: Systematic reviews and meta-analyses. Psychol Bull 2021; 147(6): 618.
  36. Chen CC, Ryuh Y, Luczak T, Lamberth J. The Effects of Attentional Focus and Skill Level on the Performance of Golf Putting. J Mot Learn Dev 2021; 9(3): 371–382.
  37. Kalron A, Achiron A, Menascu S. Gait variability, not walking speed, is related to cognition in adolescents with multiple sclerosis. J Child Neurol 2019; 34(1): 27–32.
  38. Grooms D, Appelbaum G, Onate J. Neuroplasticity following anterior cruciate ligament injury: a framework for visual-motor training approaches in rehabilitation. J Orthop Sport Phys Ther 2015; 45(5): 381–393.
  39. Vidal A, Wu W, Nakajima M, Becker J. Investigating the constrained action hypothesis: a movement coordination and coordination variability approach. J Mot Behav 2018; 50(5): 528–537.
  40. Hawkins TE, Alder DB, Bennett TB, Poolton JM. The Influence of External and Internal Focus of Attention Instructions on the Organization of Movement: A Systematic Review. J Mot Learn Dev 2025; 1(aop): 1–27.
  41. Poolton JM, Maxwell JP, Masters RSW, Raab M. Benefits of an external focus of attention: Common coding or conscious processing? J Sports Sci 2006; 24(1): 89–99.
  42. HATAMI F, Tahmasbi F, HADI H. The Effect of Internal and External Focus of Attention on EEG Changes in Darts Throwing Skill. Neuropsychology 2018; 3(11): 115–130.
  43. Parr JV V, Gallicchio G, Canales‐Johnson A, Uiga L, Wood G. Cortical, muscular, and kinetic activity underpinning attentional focus strategies during visuomotor control. Psychophysiology 2023; 60(6): e14249.
  44. Shahriyari M, Bazooband S, Shetab Booshehri SN. The Effects of Instructions Attention Focus Internal and External on Learning Protection Dynamic Balance in Children with Mental Retardation. Mot Behav 2016; 8(24): 95–110.
  45. Chiviacowsky S, Wulf G, Ávila LTG. An external focus of attention enhances motor learning in children with intellectual disabilities. J Intellect Disabil Res [Internet]. 2013 [cited 2025 Mar 25]; 57(7): 627–634.
  46. Mak TCT, Young WR, Chan DCL, Wong TWL. Gait Stability in Older Adults During Level-Ground Walking: The Attentional Focus Approach. J Gerontol B Psychol Sci Soc Sci 2020; 75(2): 274–281.
  47. Masters R, Maxwell JP. “Implicit motor learning, reinvestment and movement disruption: what you don’t know won’t hurt you?” Ski Acquis Sport Res Theory Pract 2004; 207–228.
  48. Zarei N, Asteri Z, Zeidabadi R. The effect of different types of attentional focus instructions on learning the gymnastic carousel skill. National Conference on Physical Education and Sports Sciences with restrictions on physical activities during the coronavirus outbreak. 2021.
  49. Zanone PG, Kelso JAS. The coordination dynamics of learning: Theoretical structure and experimental agenda. In: Interlimb coordination. Elsevier; 1994. 461–90.
  50. Perkins-Ceccato N, Passmore SR, Lee TD. Effects of focus of attention depend on golfers’ skill. J Sports Sci 2003; 21(8): 593–600.
Journal of Paramedical Sciences & Rehabilitation
Volume 14, Issue 3
November 2025
Pages 54-66

Files

Share

How to cite

Statistics