A new study by UNLV researchers found that those living with Parkinson’s disease may improve their stability and reduce the likelihood of falling if they change the focus of their attention during movement.

The study, which appears in the February 2009 issue of the scholarly journal Physical Therapy, found that postural stability improved significantly among a sample group of patients with Parkinson’s disease when they adopted an external rather than internal focus of attention.

An estimated one million Americans suffer from Parkinson’s disease, and two thirds of them reported falling within the last year.

In the study, a research team led by UNLV kinesiology professor Gabriele Wulf tested three groups of older adults with Parkinson’s disease by asking them to balance on an unstable surface (an inflated rubber disk).

One group was instructed to look straight ahead and focus on reducing movement in their feet (representing an internal focus); a second group was asked to look straight head but to focus on the disk (representing an external focus). A control group was not given attentional focus instructions.

The external focus exercise resulted in significantly greater postural stability than both the internal and control conditions.

“For those with a history of falls, it’s much more effective to focus attention on the effects that their movements have on the environment rather than to focus on the internal movements themselves,” Wulf says.

“These findings have the potential to improve efforts of caregivers and clinicians providing rehabilitation guidance to Parkinson’s patients,” she says. “They may also give the patients more control over their lives by providing them with a strategy to manage their posture and movement activities more safely and effectively.”

In patients with Parkinson’s disease, degeneration occurs in the basal ganglia, the part of the brain that controls motor function and learning. Wulf and her team contend that instructions directing attention to the effect, or outcome, of the movement support a more automatic form of motor control, consistent with that seen from expert performers.

“For example, beginning ice skaters focus all of their attention inward on their movements and adopt a stiff posture just to maintain balance,” Wulf notes. “For experts, the act of skating comes naturally, and they’re able to focus attention on the environment around them.

“Similarly in rehabilitation, we’ve found that directing attention externally – in this case, keeping the rubber disk as still as possible – allows automatic control processes to kick in and tasks are performed more effectively and efficiently.”

The study is available online at www.ptjournal.org.