Maintain your mind, maintain your focus: Effects of focused attention and intensity in experienced runners

The intensity that people choose for their endurance activities has a major influence on their affective experience. Furthermore, the direction of attention (e.g., internal or external) during endurance activities may significantly influence performance and personal perceptions. Therefore, in the current study, we focus on the interaction between intensity and attentional focus. We aim to address the question of whether adopting an internal (IAF; breathing) or an external attentional focus (EAF; environment), compared to a control condition, leads in differences in speed, heart rate, and affect during running at different intensities in experienced runners. Data from 59 participants were analyzed (Mage: 26.95 (SD = 4.78) years; 34 male; 25 female). Participants ran 9 × 3 min in an outdoor park with three intensity conditions (light, somewhat hard, hard) and three attention conditions (internal, external, control). Intensity, but not attentional focus, impacted affective responses. Results revealed a significant interaction between attentional focus and intensity on heart rate (p < 0.001, ω2p = 0.199): during the somewhat hard intensity, the control focus condition was significantly lower compared the internal and external attentional focus conditions. Additionally, we used exploratory multilevel models (MLM). In the best-fitting MLM of heart rate, 45% of the variance is attributed to differences between athletes, and thus 55% of the variance within athletes. Furthermore, the model indicated that athletes running at a somewhat hard intensity and maintaining an EAF (b = 7.69) or IAF (b = 6.36) had an increase in heart rate compared to the control condition. We speculate that simultaneously monitoring effort and following an attentional instruction was such a difficult task that led to a favorable effect for the control condition. In practice, this could mean that the implementation of an unfamiliar focus of attention, for example, initially requires additional energy expenditure.

Do attentional focus cues affect the type or number of explicit rules? Proof of concepts of the self-invoking trigger or explicit knowledge hypotheses

Internal focus has been shown to be detrimental to performance by disrupting the motor system, whereas external focus enhances performance by promoting automaticity. One hypothesis, which explains the underlying mechanism of the disruption of the motor system, proposes that internal focus affects the type of thoughts (explicit rules) by invoking self-conscious, evaluative thoughts (McKay et al., 2015). In contrast, another hypothesis proposes that internal focus increases the number of explicit rules, loading working memory (Poolton et al., 2006). To examine the competing hypotheses, neurotypical young adults (22.98 ± 4.46 years old, n = 20 males, n = 40 females) were assigned to one of three groups: external focus (n = 20), internal focus (n = 20), and control (n = 20) groups, and practiced a reciprocal aiming task for two days with retention/transfer tests. Between trials, participant's thoughts were evaluated by an open-ended questionnaire. The type of explicit rules was analyzed using a chi-square test, and the number of explicit rules was analyzed using a mixed-effect Poisson regression. The results showed that external focus resulted in a greater proportion of explicit rules about the task and a lesser proportion of self-evaluative thoughts. The number of explicit rules did not differ between groups. Our results suggest that external focus may strengthen focus on task-relevant features, while internal focus moves people's attention away from important features, potentially explaining why the motor system is disrupted by internal focus.

Immediate effects of verbal instructions with internal focus of attention and external focus of attention on forward reach movement while standing

[Purpose] This study aimed to examine the immediate effects of verbal instructions with an internal and external focus of attention on forward reach movement while standing. [Participants and Methods] Thirty-seven healthy young males performed reach movement in three conditions: control, internal focus of attention, and external focus of attention. The measurements recorded were the movement distance of the third metacarpal bone (reach distance), the distance of the center of pressure, and the movement angles between the acromion and malleolus lateralis and between the acromion and trochanter major. [Results] Compared to the control condition, the internal focus of attention condition had a lower reach distance, angles between the acromion and malleolus lateralis and between the acromion and trochanter major, and center of pressure distance. In contrast, compared to the control condition, the external focus of attention condition showed higher reach distance and angles between the acromion and malleolus lateralis and between the acromion and trochanter major. The change rate of reach distance in the internal and external focus of attention conditions correlated significantly with the change rates of the angles between the acromion and malleolus lateralis and between the acromion and trochanter major. [Conclusion] Verbal instructions with attentional focus resulted in the simultaneous adjustment of the positional relationship between trunk and hip and immediately affected the reach distance. Our findings suggest that verbal instruction with attentional focus is an important factor affecting reach movement.

To be or not to be relevant: Comparing short- and long-term consequences across working memory prioritization procedures

Priority-based allocation of attentional resources has shown robust effects in working memory (WM) with both cue-based and reward-based prioritization. However, direct comparisons between these effects in WM are needed. Additionally, the consequences of WM prioritization for remembering in the long term remain unclear for both prioritization procedures. Here, we tested and compared the immediate and long-term memory (LTM) effects of cue-based versus reward-based retrospective prioritization of WM content. Participants encoded four memory items and were then indicated to prioritize one of the items through the presentation of either a retro-cue or a reward pattern. We then tested their immediate and delayed memory. The results of the first experiment showed better memory for prioritized than for unprioritized information in WM and LTM, but the WM effect was driven solely by the retro-cue, making it difficult to interpret any reward-based effects in LTM. In the second experiment, using a more explicit and meaningful reward-based manipulation, the results showed a prioritization benefit in WM for both prioritization procedures. In LTM, however, the prioritization effect was predominantly driven by the retro-cue manipulation. Taken together, we found that (1) the way in which attention is directed in WM impacts the size of the prioritization benefit in WM, (2) WM prioritization generally results in a prioritization effect in LTM, and (3) that the effect in LTM is more robust for cue-based prioritization. Exploratory analyses indicated that the LTM effect of cue-based prioritization reflected a cost in performance for noncued items rather than a benefit for cued items.

Attentional switching between perception and memory: Examining asymmetrical switch costs

Attention can be defined as a mechanism for the selection and prioritization of elements among many. When attention is directed to a specific piece of information, this information is assumed to be in the focus of attention. On a day-to-day basis, we need to rely on efficient switching between information we are holding in working memory (internal modality) and information presented in the world around us (external modality). A recent set of studies investigated between-modality attentional switches and found that there is an asymmetrical switch cost for switching between the internal and external focus of attention (Verschooren et al., 2020, Journal of Experimental Psychology: Human Perception and Performance, 46[9], 912-925; Verschooren, Liefooghe, et al., 2019a, Journal of Experimental Psychology: Human Perception and Performance, 45[10], 1399-1414). In particular, participants switched on a trial-by-trial basis between an internal task using stimuli retrieved from memory and an external task using on-screen presented stimuli. A larger cost was found when switching from the external modality towards the internal modality than the other way around. The authors found that this cost asymmetry could be best explained in terms of associative interference (i.e., differences in shielding efficiency against the memory traces from the competing task set). The present study aimed to replicate the asymmetrical switch cost (Experiment 1) and investigate whether an alternative explanation in terms of stimulus strength can account for the asymmetrical switch cost (Experiment 2). Overall, the results confirm the presence of a subtle, asymmetrical switch cost, but we observed little to no contribution of stimulus strength.

Effects of attentional focus and gaze instruction during observational learning of a basketball free-throw

Observational learning has long been used to instruct individuals on how to perform a novice motor skill. Recently, research has shown a benefit to instructing learners to focus externally when viewing a video model (Asadi, Aiken, Heidari, & Kochackpour, 2021). Research has also highlighted the effectiveness of modeling correct gaze behaviors when learning a cognitive task (Jarodzka, van Gog, Dorr, Scheiter, & Gerjets, 2013). The purpose of the present study was to investigate the effectiveness of combining these two modalities. 40 individuals with a mean age of 21.77 ± 1.40 performed a novel motor task where they were asked to either focus internally or externally, and were provided with traditional instruction or were provided with an experienced performer's gaze behaviors while viewing a video demonstration. It was observed that both the external focus groups and the gaze instructed groups performed a basketball free-throw more accurately and had longer periods of quiet eye than an internal focus or traditional verbal instruction (p's < 0.05). Eye tracking also allowed for the assessment of attentional focus adherence. Participants focused on the instructed cues significantly more than irrelevant task aspects or a different focus types (p's < 0.05). These results highlight the effectiveness of cuing a learner to focus externally during observational learning. It also highlights the usefulness of providing correct gaze behaviors when observing a model.

Using an external focus of attention for gait retraining in runners: A case report

INTRODUCTION

Many gait retraining studies use cues that promote internal focus of attention. However, the motor control literature clearly shows the beneficial effects of using cues that promote an external focus of attention (EFOA) when teaching new movements. This case report seeks to illustrate the outcomes of using an EFOA for running gait retraining. It also examines whether retrained mechanics transfer across different running speeds.

CASE DESCRIPTIONS

A 22-year-old female competitive runner with a history of tibial stress injuries was the participant.

PATIENT MANAGEMENT

Baseline assessments of flexibility, strength, and running biomechanics were performed after which an eight-session gait retraining protocol was implemented. Visual (mirror) and verbal feedback (EFOA) cues were provided during the retraining protocol. Outcomes showed improved hip, knee, and ankle kinematics, reduced ground reaction forces, and earlier onset and longer durations of muscle activity following retraining. These improvements transferred across running speeds.

DISCUSSION AND CONCLUSION

In this participant, EFOA cues were effective for the gait retraining protocol and the benefits were transferable across running speeds. Clinicians should consider how EFOA cues may be incorporated to improve gait retraining outcomes.

Shifting attention in visuospatial short-term memory does not require oculomotor planning: Insight from congenital gaze paralysis

Attention allows pieces of information stored in visuospatial short-term memory (VSSTM) to be selectively processed. Previous studies showed that shifts of attention in VSSTM in response to a retro-cue are accompanied by eye movements in the direction of the position of the memorized item although there is nothing left to look at. This finding raises the possibility that shifts of attention in VSSTM are underpinned by mechanisms originally involved in the planning and control of eye movements. To explore this possibility, we investigated the ability of an individual with congenital horizontal gaze paralysis (HGP2) to shift her attention horizontally or vertically toward a memorized item within VSSTM using a retro-cue paradigm. As efficient oculomotor programming is not innate but requires some trial and error learning and adaptation to develop, congenital paralysis prevents this development. Consequently, if shifts of attention in VSSTM rely on the same mechanisms as those supporting the programming of eye movements, then horizontal congenital gaze paralysis should necessarily prevent typical retro-cueing effect in the paralyzed axis. At odds with this prediction, HGP2 showed a typical retro-cueing effect in her paralyzed axis. This original finding indicates that selecting an item within VSSTM does not depend on the ability to program a saccade.

The effect of attentional instructions during modeling on gaze behavior and throwing accuracy in 7 to 10 year-old children

Research has shown the effectiveness of attentional instructions and observation on the performance and learning in children. However, there is little research on the effects of instruction that manipulates attentional focus during observation. The purpose of the study was to investigate performance following instructions that directed an individual to focus internally or externally during the viewing of a model. Eye tracking was also used to investigate the visual search strategy under different instructional groups. 24 children between the ages of 7 and 10 years were randomly divided into an internal (IFM) or external (EFM) modeling group. Children performed a 10-trial pre-test to measure throwing accuracy and quiet eye duration (QED). Following pre-test, children observed a model performing the correct overarm throw 10 times while eye movement was recorded. They then performed a 10-trial post-test. Results revealed that both groups improved accuracy from pre-test to post-test (p < .001) and increased QED from pre- to post-test (p < .001). It was also observed that EFM had greater accuracy and (p = .01) and longer QED (p < .001) than IFM during post-testing. Evidence was also observed for adherence to the attentional focus strategy as EFM and IFM looked more frequently at the specific cue provided (p < .001). Directing visual attention to the movement effects while observing a model significantly benefits motor performance and learning in children. Changing the focus of instruction to an external focus improved both throwing accuracy and increased QED.

Looking beyond the binary: an extended paradigm for focus of attention in human motor performance

Focus of attention (FOA) has been shown to affect human motor performance. Research into FOA has mainly posited it as either external or internal to-the-body (EFOA and IFOA, respectively). However, this binary paradigm overlooks the dynamic interactions among the individual, the task, and the environment, which are core to many disciplines, including dance. This paper reviews the comparative effects of EFOA and IFOA on human motor performance. Next, it identifies challenges within this EFOA-IFOA binary paradigm at the conceptual, definitional, and functional levels, which could lead to misinterpretation of research findings thus impeding current understanding of FOA. Building on these challenges and in effort to expand the current paradigm into a non-binary one, it offers an additional FOA category-dynamic interactive FOA-which highlights the dynamic interactions existing between EFOA and IFOA. Mental imagery is then proposed as a suitable approach for separately studying the different FOA subtypes. Lastly, clinical and research applications of a dynamic interactive FOA perspective for a wide range of domains, from motor rehabilitation to sports and dance performance enhancement, are discussed.

Free-recall benefit, inhomogeneity and between-item interference in working memory

We investigated visual working memory (VWM) with a whole-report task, where participants were asked to sequentially recall all the items in an order either chosen by themselves (free recall) or randomly chosen by the computer (forced recall). Comparisons between free and forced recalls helped us understand important but largely neglected aspects of VWM, such as inhomogeneity (different levels of precision) and between-item interference. One unique part of our task was the introduction of a separate item-selection stage before each recall, during which participants located the next item to recall. Their mouse trajectory was recorded and served as a dynamic measure of between-item interference over time. We found a free-recall benefit: the overall precision of all items is higher in free recall than in forced recall. Meanwhile, during item-selection, free recall is associated with faster localization of the target and less interference from the other items in memory. We also found evidence for inhomogeneity and discuss the connection of inhomogeneity and between-item interference to the free-recall benefit.

Skilled swimmers maintain performance stability under changing attentional focus constraints

Focusing attention externally, rather than internally, has generally proved advantageous as it avoids interfering with self-organzing processes. However, some research has suggested that this may not necessarily be the case with highly skilled individuals who by definition possess a greater capacity to either adapt or maintain stability under varied task constraints. This study aimed to address this gap by comparing the performance of skilled athletes under internal and external attentional focus conditions using the swimming dive start as a task vehicle. Using a counterbalanced repeated measures design, skilled swimmers performed dive starts in conditions of differing attentional focus - internal and external attentional focus. Kinetic and kinematic variables were collected and statistical analyses conducted to compare differences between conditions. The results revealed no differences in outcome performance (relative peak power, horizontal velocity, and time to 5 m) between internal and external focus conditions. However, remaining kinematic and kinetic measures revealed that all movement events occurred earlier in the movement sequence, suggesting superior self-organization of movement in the external focus condition. An external focus may be beneficial for the organization of movement control in skilled swimmers, but may not have an immediate impact upon the outcome of the task.

The effect of attentional focus on movement accuracy in an immersive and interactive virtual reality environment

The effects of attentional focus (AF) instruction were examined in a reciprocal aiming task implemented in a 3-dimensional, fully immersive virtual environment (VE). Within the VE, participants (N = 19) moved a cube between two targets at two paces (750 ms and 500 ms) while being asked to focus externally (EXF) and internally (INF). Performance accuracy was measured as two-dimensional error and its variability between the center of the target to the center of the cube and one-dimensional bias (undershooting/overshooting behavior in the anteroposterior and mediolateral directions). The results indicated better performance, specifically greater accuracy and lower one-dimensional bias in the anteroposterior direction when adopting an EXF compared to an INF. Our findings reveal that the beneficial effects of an EXF on motor performance are not restricted movements within physical environments only but also work in VE. This has implications for rehabilitation and training protocols in VE.

Manual motor reaction while being absorbed into popular music

In three experiments, we investigated the behavioral consequences of being absorbed into music on performance in a concurrent task. We tested two competing hypotheses: Based on a cognitive load account, captivation of attention by the music and state absorption might slow down reactions in the decisional task. Alternatively, music could induce spontaneous motor activity, and being absorbed in music might result in a more autonomous, flow-driven behavior with quicker motor reactions. Participants performed a simple, visual, two-alternative forced-choice task while listening to popular musical excerpts. Subsequently, they rated their subjective experience using a short questionnaire. We presented music in four tempo categories (between 80 and 140 BPM) to account for a potential effect of tempo and an interaction between tempo and absorption. In Experiment 1, absorption was related to decreased reaction times (RTs) in the visual task. This effect was small, as expected in this setting, but replicable in Experiment 2. There was no effect of the music's tempo on RTs but a tendency of mind wandering to relate to task performance. After slightly changing the study setting in Experiment 3, flow predicted decreased RTs, but absorption alone - as part of the flow construct - did not predict RTs. To sum up, we demonstrated that being absorbed in music can have the behavioral consequence of speeded manual reactions in specific task contexts, and people seem to integrate the music into an active, flow-driven and therefore enhanced performance. However, shown relations depend on task settings, and a systematic study of context is necessary to understand how induced states and their measurement contribute to the findings.

Internal and Imagined External Foci of Attention Do Not Influence Pirouette Performance in Ballet Dancers

Ballet dancers need to constantly improve their performance. Several studies show that an internal focus (on body movements) leads to inferior motor performance relative to an external focus of attention (on the movement effects), but the majority of dancers usually adopt an internal focus. It is not clear if the benefits of an external focus are relevant for form-based tasks performed in a ballet. Purpose: Test whether an imagined external focus of attention can improve ballet dancers' performance of a form-based task, the en dehors double pirouette (EDDP). Method: 23 experienced amateurs and 17 professional dancers between 18 and 35 years old performed three EDDP under each of three attentional focus instruction conditions (No Focus, Internal, Imagined External). Order of presentation of Internal and Imagined External focus instructions was blocked and balanced across participants. Movement quality was assessed by three experts with a customized observational scale. Movement kinematics were measured by the angle of inclination of the trunk and inclination of the rotation axis with respect to the global vertical during the EDDP. Results: Movement quality and trunk inclination were significantly different between amateurs and professionals, but the rotation axis inclination was not. No quantitative or qualitative effects of focus were found for the performance of the EDDP across focus conditions. Conclusions: There appears to be no differential effects of using an internal or imagined external focus on the immediate performance of the EDDP for amateur and professional ballet dancers. Personal and task factors might account for the lack of effects.

Does focus of attention alter craniocervical flexion test motor learning? A randomized controlled trial

OBJECTIVE

To evaluate the effects of three different foci of attention (internal, external and mixed) on motor learning using craniocervical flexion test in inexperienced participants.

METHODS

Ninety healthy young adults, with no experience in the task, practiced the craniocervical flexion test under three different focus of attention: a) Mixed Focus (internal plus external), b) Internal Focus, and c) External Focus. We assessed immediate, post-training, and retention (one week after the last training session) aspects of motor learning by quantifying (i) the activity of the superficial cervical flexors muscles, (ii) craniocervical range of motion, and (iii) the performance on the craniocervical flexion test.

RESULTS

None of the groups showed any significant immediate, post-training, or retention effects on superficial neck flexors activity and craniocervical range of motion progression. At immediate assessment, mixed focus had greater craniocervical flexion performance than external (MD 0.9, 95%CI 0.2 to 1.5), and internal foci (MD 1.4, 95%CI 0.8 to 2.1). At post-training, mixed focus led to better craniocervical performance compared to external (MD 1.6, 95%CI 0.8 to 2.4) and internal foci (MD 2.7, 95%CI 1.9 to 3.5). External focus had better scores on the craniocervical flexion test performance than internal focus (MD 1.1, 95%CI 0.3 to 1.9). Results remained similar at retention, with mixed focus being superior to internal (MD 2.3, 95%CI 1.7 to 3) and external foci (MD 1.5, 95%CI 0.9 to 2.1) on craniocervical flexion test performance. Similarly, the performance on the craniocervical flexion test performance remained similar at retention between external and internal foci (MD 0.9, 95%CI 0.2 to 1.5).

CONCLUSION

In inexperienced asymptomatic participants, different foci of attention were not able to change cervical muscle activity and craniocervical range of motion during the craniocervical flexion test. Mixed focus was better than external and internal focus on the craniocervical flexion test. These findings were retained after one week.

An external focus of attention compared to an internal focus of attention improves anticipatory postural adjustments among people post-stroke

BACKGROUND

People after stroke often have postural impairments that can increase their risk of falling. Anticipatory postural adjustments (APAs) are changes in the activity of postural muscles prior to a voluntary movement in order to maintain vertical equilibrium. Previous research suggests that improving APAs leads to better postural control and reduces the risk of falls. Despite the importance of APAs and their impairment among people post-stroke, studies that aim to investigate methods for improving APAs are limited. Consistent evidence supports that an external focus of attention compared to an internal focus of attention, yields superior performance of motor skills that include postural control.

RESEARCH QUESTION

What are the effects of adopting different foci of attention on measures of APAs and movement parameters when performing a lower extremity Fitts' task among people post-stroke?

METHODS

Twelve individuals post-stroke performed a lower extremity stepping movement (Fitts' task) while adopting an external focus or an internal focus of attention in a within-subject design. A motion capture system was used to record participants' movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at endpoint (SD_T). Electromyography was used to measure muscle activity and determine APAs onset and magnitude. For all dependent variables separate repeated measures ANOVAs were conducted to compare performance between foci of attention.

RESULTS

The results showed that an external focus of attention yielded significantly better performance on all outcome measures. The improvement in performance was seen in shorter MT, higher PV, shorter ttPV, smaller SD_T, earlier APAs onset and more efficient APAs magnitude.

SIGNIFICANCE

The changes in outcome measures suggest that adopting an external focus of attention during postural tasks could be an effective strategy for improving balance control among people post-stroke.

How fast can people refresh and rehearse information in working memory?

Refreshing - briefly attending to an item in working memory - has been proposed as a domain-general maintenance process. According to the time-based resource-sharing (TBRS) theory, people refresh the contents of working memory sequentially at high speed. We measured the speed of refreshing by asking participants to sequentially refresh a small set of items in sync with a metronome, and to adjust the metronome to the fastest speed at which they could refresh. Refreshing speeds converged on about 0.2 s per item for several verbal and visual materials. This time was shorter than the speed of articulatory rehearsal measured with the same method, and - in contrast to rehearsal - did not depend on word length. We sought evidence for people refreshing in sync with the metronome by presenting recognition probes at unpredictable times. We expected that probes matching the just-refreshed item should be recognized faster and more accurately than probes matching other items. This was not the case. A parallel experiment with overt articulatory rehearsal showed poor synchronization of rehearsal with the metronome, suggesting by analogy that refreshing was equally out of sync. The results support the assumption that people can attend sequentially to items in working memory, and monitor this process. This refreshing process is probably faster than rehearsal, but it is unlikely to be as fast as the refreshing process assumed in the TBRS theory.

Immersive screens change attention width but not perception or decision-making performance in natural and basic tasks

In the last decades, a number of studies have examined people's perceptual and attentional capabilities using flat screen displays. The completion of studies using curved displays/screens has been neglected so far, despite their advantage of creating a more immersive and life-like experience. In two studies, we analysed possible performance differences between subjects' perceptual and attentional capabilities during a decision-making task whilst viewing life-size stimuli on large flat and curved immersive screens. In Study 1, participants performed an attention-demanding shape discrimination task. In Study 2, participants performed a more naturalistic football-specific discrimination task. Results of both studies revealed no differences in perception and decision making between screen conditions, but that attention can be directed across greater visual angles on immersive screens compared to flat screens. The findings suggest that attention can be directed across a larger visual angle on curved screens compared to flat screens probably because curved screens distort the image less than flat screens. This study has implications for the use of flat screens in studies that examine perceptual and attentional capabilities in the visual periphery.

Anticipatory postural adjustments during a Fitts' task: Comparing young versus older adults and the effects of different foci of attention

Anticipatory postural adjustments (APAs) are an integral part of standing balance. Previous research with balance control has shown that adopting an external focus of attention, compared to an internal focus of attention, yields better performance during motor skills. Despite the importance of APAs, especially among older adults, and the potential benefits of adopting an external focus of attention, studies investigating methods for improving APAs are limited. The aim of this study was to compare behavioral, kinematic and APAs measures while adopting different foci of attention among young and older adults when performing a lower extremity Fitts' task. Ten young adults (mean age 24 years ± 4.37) and ten older adults (mean age 75 years ± 5.85) performed a lower-extremity reaching task (Fitts' task) while adopting an external focus (focus on target) and an internal focus (focus on limb) in a within-subject design. A motion capture system was used to record participants' movement data. Custom software derived movement time (MT), peak velocity (PV), time to peak velocity (ttPV) and variability at target (SD_T). Electromyography (EMG) was used to determine APAs onset and magnitude. The findings showed that an external focus of attention led to significantly shorter MT, higher PV, shorter ttPV and more accuracy when reaching the target (SD_T) for both age groups. Also, EMG results showed that, with an external focus, APAs onset occurred earlier and APAs magnitude was more efficient. As predicted by Fitts' Law, participants spent more time executing movements to targets with higher indices of difficulty. Older adults compared to young adults were more adversely affected by the increase of difficulty of the Fitts' task, specifically, on measures of APAs. In conclusion, adopting an external focus of attention led to better overall movement performance when performing a lower extremity Fitts' task. The task used in the present study can distinguish between APAs for older and young adults. We recommend that future studies expand on our findings in order to establish a performance-based objective measure of APAs to assess clinical interventions for postural control impairment.

Evidence for spontaneous serial refreshing in verbal working memory?

Working memory (WM) keeps information temporarily accessible for ongoing cognition. One proposed mechanism to keep information active in WM is refreshing. This mechanism is assumed to operate by bringing memory items into the focus of attention, thereby serially refreshing the content of WM. We report two experiments in which we examine evidence for the spontaneous occurrence of serial refreshing in verbal WM. Participants had to remember series of red letters, while black probe letters were presented between these memory items, with each probe to be judged present in or absent from the list presented so far, as quickly as possible (i.e., the probe-span task). Response times to the probes were used to infer the status of the representations in WM and, in particular, to examine whether the content of the focus of attention changed over time, as would be expected if serial refreshing occurs spontaneously during inter-item pauses. In sharp contrast with this hypothesis, our results indicate that the last-presented memory item remained in the focus of attention during the inter-item pauses of the probe-span task. We discuss how these findings help to define the boundary conditions of spontaneous refreshing of verbal material in WM, and discuss implications for verbal WM maintenance and forgetting.

External relative to internal attentional focus enhances motor performance and learning in visually impaired individuals

Background: Research has demonstrated the advantages of an external relative to internal focus of attention for enhancing motor performance and learning across diverse tasks, contexts and populations. However, research has yet to examine whether this finding holds true for individuals who have a major visual impairment in discrete and locomotion-based continuous motor tasks.Methods: In experiment 1, twenty-four visually impaired participants were asked to kick a soccer ball with their dominant foot to a target 7 meters away. Participants performed 10 trials within an internal focus (concentration on inside of the foot), external focus (concentration on the ball), and control (no focus instructions) conditions, in a counterbalanced order. In experiment 2, thirty-nine visually impaired adults were asked to ride a rehabilitation Pedalo for a distance of 7 meters. Participants were randomly assigned to either an internal focus (focus on the feet), external focus (focus on the platform), or control (no focus instructions) group. Retention and transfer tests were conducted on day 2.Results: An external focus resulted in more accurate kicks and faster pedalo movement times compared to an internal focus.Conclusions: These findings indicate that visual information does not mediate external focus benefits for motor performance and learning.Implications for RehabilitationPractitioners should use instructions that encourage visually impaired individuals who are going through rehabilitation to adopt an appropriate focus of attention for enhancing motor performance and learning of discrete or locomotion-based motor skills.Instructions that foster an external focus, relative to an internal focus, enhances performance of both discrete and continuous motor skills in individuals with visual impairment.

External feedback during walking improves measures of plantar pressure in individuals with chronic ankle instability

BACKGROUND

Individuals with chronic ankle instability (CAI) commonly present with an altered walking gait which favors the lateral aspect of their foot. Current rehabilitative protocols are unable to address these gait modifications which are potentially hindering improvements in patient-reported outcomes. Protocols for gait retraining are scarce, thus there is a need to develop intervention strategies and instruments to specifically target foot motion to address gait deficits in individuals with CAI.

RESEARCH QUESTION

To determine the ability of a novel laser device providing external visual feedback (ExFB) during real-time to cause alterations in plantar pressure measures in individuals with CAI.

METHODS

Twenty-six participants with CAI walked on a treadmill while real-time plantar pressure measures were being recorded during a baseline and feedback condition. Baseline trials were compared with ExFB trials within each subject.

RESULTS

The ExFB condition was able to significantly reduce plantar pressures on the lateral midfoot and forefoot compared to baseline. A statistically significant medial shift in center of pressure trajectory was also observed in the ExFB condition compared to baseline.

SIGNIFICANCE

Real-time external feedback provided by a novel laser device has the ability to reduce lateral column plantar pressures during walking in individuals with CAI.

Two distinct mechanisms of selection in working memory: Additive last-item and retro-cue benefits

In working memory research, individual items are sometimes said to be in the "focus of attention". According to one view, this occurs for the last item in a sequentially presented list (last-item benefit). According to a second view, this occurs when items are externally cued during the retention interval (retro-cue benefit). We investigated both phenomena at the same time to determine whether both result from the same cognitive mechanisms. If that were the case, retro-cue benefits should be reduced when the retro-cue is directed to the item that already benefits from being presented last. We measured speed-accuracy-tradeoff functions with the response-deadline paradigm to measure retrieval dynamics in a short-term recognition task. Across three experiments, we found that retro-cues benefited the last item and other items to the same extent. The additivity of the last-item benefit and the retro-cue benefit points towards the co-existence of at least two distinct forms of attentional prioritization in working memory.

The attention training technique causally reduces self-focus following worry provocation and reduces cognitive anxiety among self-focused individuals

BACKGROUND AND OBJECTIVES

The attention training technique (ATT) is a component of metacognitive therapy developed to interrupt self-focused, threat-based processing underlying anxiety disorders. Whereas extant research supports the benefits of ATT, including in relation to anxiety reduction, study findings lead to equivocal conclusions as to whether ATT causally interrupts self-focused attention (SFA) as intended. An additional gap in the literature relates to investigating if ATT is especially effective for reducing anxiety among individuals experiencing a heightened self-focused state. The present study sought to address those two gaps in the literature.

METHOD

Participants scoring high on a measure of general worry severity completed a worry provocation that increased SFA and then were randomized to ATT (n = 45), a mindfulness task (n = 44), or a distraction task (n = 44).

RESULTS

ATT caused large reductions in SFA, whereas there were no changes in focus of attention following the mindfulness or distraction task. Anxiety reduction was found in relation to all three tasks; however, ATT, relative to distraction, was found to cause greater reduction in cognitive anxiety for individuals highly self-focused before the task.

LIMITATIONS

The present study used an analogue sample and the design did not allow for an examination of the long-term benefit of ATT.

CONCLUSIONS

Results support ATT causally interrupting self-focused states and that ATT is particularly effective in reducing cognitive anxiety among individuals who are self-focused.

Suppression of salient stimuli inside the focus of attention

We investigated how attention is distributed when one of two attended stimuli stands out from the visual context. Participants judged whether the line orientations within two geometric shapes at two predictable locations were same or different, which induced a wide focus of attention around the two locations. One of the geometric shapes surrounding the lines could be a salient color or shape singleton but was irrelevant for the task. In Experiment 1, the salient and non-salient items were both placed on the horizontal midline. Electrophysiological recordings at posterior electrode locations PO7/8 revealed a positivity between 200 and 300 ms contralateral to the singleton, consistent with the occurrence of the P_D. The P_D is thought to reflect attentional suppression. In Experiment 2, one attended item was placed on the vertical meridian and the other one on a lateral position. Lateral line targets triggered robust N2pc components when there was no singleton present, reflecting attentional selection. However, this N2pc to lateralized line targets was abolished when a singleton was presented at the same lateral position, and conversely, was increased when a singleton was presented on the vertical position. This suggests that salient elements inside the focus of attention are suppressed and attention is enhanced at the other location. It can be concluded that salient elements inside the focus of attention do not capture attention, as bottom-up control of attention would propose, but that salient elements are suppressed, possibly to assure unbiased processing of equally relevant stimuli.

Motor learning and movement automatization in typically developing children: The role of instructions with an external or internal focus of attention

The aim of the current study was to examine the effects of an external focus of attention (i.e., on the movement outcome) versus an internal focus of attention (i.e., on the movement itself) on motor learning in typically developing children. We examined both immediate motor performance (i.e., practice effect, when focus instructions are given) as well as motor performance after one week (i.e., learning effect). In addition, we examined if an external and an internal focus of attention differently affected movement automatization, as measured using a dual-task paradigm. Finally, we explored whether the effect of attentional focus instructions on motor learning was influenced by children's working memory capacity. Participants were 8-12 year old (N = 162) typically developing children. Participants practiced a new motor task (i.e., 'Slingerball throwing task'). Results showed that an external focus of attention led to higher throwing accuracy during practice, but this beneficial effect did not extent to the retention test one week later. Furthermore, movement automatization did not differ after external or internal focus of attention instructions, and working memory capacity did not predict motor learning in children in either of the instruction conditions. This is the first study to show that the beneficial effects of an external focus of attention on discrete motor tasks found in previous studies with a child population seem to be short lived and decline after a one-week interval.

Merging with the path not taken: Wilhelm Wundt's work as a precursor to the embedded-processes approach to memory, attention, and consciousness

Early research on memory was dominated by two researchers forging different paths: Hermann Ebbinghaus, interested in principles of learning and recall, and Wilhelm Wundt, founder of the first formal laboratory of experimental psychology, who was interested in empirical evidence to interpret conscious experience. Whereas the work of Ebbinghaus is a much-heralded precursor of modern research on long-term memory, the work of Wundt appears to be a mostly-forgotten precursor to research on working memory. We show how his scientific perspective is germane to more recent investigations, with emphasis on the embedded-processes approaches of Nelson Cowan and Klaus Oberauer, and how it is in contrast with most other recent theoretical approaches. This investigation is important because the embedded-process theorists, apparently like most modern researchers, have recognized few of Wundt's specific contributions. We explore commonalities between the approaches and suggest that an appreciation of these commonalities might enrich the field going forward.

The precision of spatial selection into the focus of attention in working memory

Attention helps manage the information held in visual working memory (vWM). Perceptual attention selects the stimuli to be represented in vWM, whereas internal attention prioritizes information already in vWM. In the present study we assessed the spatial precision of perceptual and internal attention in vWM. Participants encoded eight colored dots for a local-recognition test. To manipulate attention, a cue indicated the item most likely to be tested (~65% validity). The cue appeared either before the onset of the memory array (precue) or during the retention interval (retrocue). The precue guides perceptual attention to gate encoding into vWM, whereas the retrocue guides internal attention to prioritize the cued item within vWM. If attentional selection is spatially imprecise, attention should be preferentially allocated to the cued location, with a gradual drop-off of attention over space to nearby uncued locations. In this case, memory for uncued locations should vary as a function of their distance from the cued location. As compared to a no-cue condition, memory was better for validly cued items but worse for uncued items. The spatial distance between the uncued and cued locations modulated the cuing costs: Items close in space to the cued location were insulated from cuing costs. The extension of this spatial proximity effect was larger for precues than for retrocues, mostly because the benefits of attention were larger for precues. These results point to similar selection principles between perceptual and internal attention and to a critical role of spatial distance in the selection of visual representations.

Exploring the switching of the focus of attention within working memory: A combined event-related potential and behavioral study

Working memory enables humans to maintain selected information for cognitive processes and ensures instant access to the memorized contents. Theories suggest that switching the focus of attention between items within working memory realizes the access. This is reflected in object-switching costs in response times when the item for the task processing is to be changed. Another correlate of attentional allocation in working memory is the P3a-component of the human event-related potential. The aim of this study was to demonstrate that switching of attention within working memory is a separable processing step. Participants completed a cued memory-updating task in which they were instructed to update one memory item at a time out of a memory list of four digits by applying a mathematical operation indicated by a target sign. The hypotheses predicted (1) prolonged updating times in switch (different item compared to previous trial) versus repetition trials (same item), (2) an influence of cues (valid/neutral) presented before the mathematical target on switching costs, and (3) that the P3a-component is more pronounced in the cue-target interval in the valid cue condition and more pronounced in the post-target interval in the neutral cue condition. A student's t-test verified the first hypothesis, repeated-measurement analyses of variance demonstrated that hypotheses 2 and 3 should be rejected. Results suggest that switching of attention within working memory could not be separated from further processing steps and retro-cue benefits are not due to a head start of retrieval as well as that switch costs represent internal processes.

The simplest acquisition protocol is sometimes the best protocol: performing and learning a 1:2 bimanual coordination task

An experiment was conducted to determine if the performance and learning of a multi-frequency (1:2) coordination pattern between the limbs are enhanced when a model is provided prior to each acquisition trial. Research has indicated very effective performance of a wide variety of bimanual coordination tasks when Lissajous plots with goal templates are provided, but this research has also found that participants become dependent on this information and perform quite poorly when it is withdrawn. The present experiment was designed to test three forms of modeling (Lissajous with template, Lissajous without template, and limb model), but in each situations, the model was presented prior to practice and not available during the performance of the task. This was done to decrease dependency on the model and increase the development of an internal reference of correctness that could be applied on test trials. A control condition was also collected, where a metronome was used to guide the movement. Following less than 7 min of practice, participants in the three modeling conditions performed the first test block very effectively; however, performance of the control condition was quite poor. Note that Test 1 was performed under the same conditions as used during acquisition. Test 2 was conducted with no augmented information provided prior to or during the performance of the task. Only participants in the limb model condition were able to maintain performance on Test 2. The findings suggest that a very simple intuitive display can provide the necessary information to form an effective internal representation of the coordination pattern which can be used guide performance when the augmented display is withdrawn.

Searching for serial refreshing in working memory: Using response times to track the content of the focus of attention over time

One popular idea is that, to support the maintenance of a set of elements over brief periods of time, the focus of attention rotates among the different elements, thereby serially refreshing the content of working memory (WM). In the research reported here, probe letters were presented between to-be-remembered letters, and response times to these probes were used to infer the status of the different items in WM. If the focus of attention cycles from one item to the next, its content should be different at different points in time, and this should be reflected in a change in the response time patterns over time. Across a set of four experiments, we demonstrated a striking pattern of invariance in the response time patterns over time, suggesting either that the content of the focus of attention did not change over time or that response times cannot be used to infer the content of the focus of attention. We discuss how this pattern constrains models of WM, attention, and human information processing.

THE IMPACT OF ATTENTIONAL FOCUS ON THE TREATMENT OF MUSCULOSKELETAL AND MOVEMENT DISORDERS

Treatment plans employed by physical therapists involved in musculoskeletal rehabilitation may follow a conventional medical-model approach, isolating care at the tissue level but neglecting consideration for neurocognitive contributions to recovery. Understanding and integration of motor learning concepts into physical therapy practice is integral for influencing the human movement system in the most effective manner. One such motor learning concept is the use of verbal instruction to influence the attentional focus of the learner. Evidence suggests that encouraging an external focus of attention through verbal instruction promotes superior motor performance, and more lasting effects of a learning experience than an internal focus of attention. Utilizing an external focus of attention when instructing a patient on a motor task may facilitate improved motor performance and improved functional outcomes in treatment plans devised to address musculoskeletal injury and movement disorders. The purpose of this review is to summarize the basic principles of motor learning and available evidence on the influence an external focus of attention has on motor learning and performance, including the benefits of an external focus of attention over an internal focus of attention and how therapists may inadvertently encourage the latter. Furthermore, the benefits of possessing greater awareness of neurocognitive mechanisms are discussed to exhibit how implementing such concepts into musculoskeletal rehabilitation can maximize treatment outcomes.

LEVEL OF EVIDENCE

5.

Experience level influences the effect of attentional focus on sprint performance

Two experiments evaluated the influence of attentional focus on 10-meter sprint time and start kinetics in a group of collegiate soccer players and highly experienced sprinters. In Experiment 1, the collegiate soccer players were asked to perform 10-meter sprints under an external focus condition, an internal focus condition and a control condition. For the 10-meter sprint time, the results showed that both the external focus and control conditions resulted in significantly faster sprint times than the internal focus condition. There were no significant differences observed between the external focus and control conditions. There were also no significant differences observed across any of the conditions for a select set of kinetic variables. In Experiment 2, the highly experienced sprinters performed the same 10-meter sprint task using the same instructional conditions as in Experiment 1. For the 10-meter sprint time and kinetic variables, there were no significant differences observed across any of the conditions. These results provide new evidence that experience level mediates the influence of attentional focus on sprint performance.

Mental Objects in Working Memory: Development of Basic Capacity or of Cognitive Completion?

Working memory is the small amount of information that we hold in mind and use to carry out cognitive processes such as language comprehension and production, problem solving, and decision making. In order to understand cognitive development, it would be helpful to know whether working memory increases in capacity with development and, if so, how and why. I will focus on two major stumbling blocks toward understanding working memory development, namely that (1) many potentially relevant aspects of the mind change in parallel during development, obscuring the role of any one change; and (2) one cannot use the same test procedure from infancy to adulthood, complicating comparisons across age groups. With regard to the first stumbling block, the parallel development of different aspects of the mind, we discuss research in which attempts were made to hold constant some factors (knowledge, strategies, direction of attention) to investigate whether developmental differences remain. With regard to the second stumbling block, procedural differences in tests for different age groups, I suggest ways in which the results might be reconciled across procedures. I highlight the value of pursuing research that could distinguish between two different key hypotheses that emerge: that there is a developmental increase in the number of working memory slots (or in a basic resource that holds items in working memory), and that there is a developmental increase in the amount of detail that each of these slots can hold.

Selection in spatial working memory is independent of perceptual selective attention, but they interact in a shared spatial priority map

We examined the relationship between the attentional selection of perceptual information and of information in working memory (WM) through four experiments, using a spatial WM-updating task. Participants remembered the locations of two objects in a matrix and worked through a sequence of updating operations, each mentally shifting one dot to a new location according to an arrow cue. Repeatedly updating the same object in two successive steps is typically faster than switching to the other object; this object switch cost reflects the shifting of attention in WM. In Experiment 1, the arrows were presented in random peripheral locations, drawing perceptual attention away from the selected object in WM. This manipulation did not eliminate the object switch cost, indicating that the mechanisms of perceptual selection do not underlie selection in WM. Experiments 2a and 2b corroborated the independence of selection observed in Experiment 1, but showed a benefit to reaction times when the placement of the arrow cue was aligned with the locations of relevant objects in WM. Experiment 2c showed that the same benefit also occurs when participants are not able to mark an updating location through eye fixations. Together, these data can be accounted for by a framework in which perceptual selection and selection in WM are separate mechanisms that interact through a shared spatial priority map.

Optimization of a motor learning attention-directing strategy based on an individual's motor imagery ability

Motor learning performance has been shown to be affected by various cognitive factors such as the focus of attention and motor imagery ability. Most previous studies on motor learning have shown that directing the attention of participants externally, such as on the outcome of an assigned body movement, can be more effective than directing their attention internally, such as on body movement itself. However, to the best of our knowledge, no findings have been reported on the effect of the focus of attention selected according to the motor imagery ability of an individual on motor learning performance. We measured individual motor imagery ability assessed by the Movement Imagery Questionnaire and classified the participants into kinesthetic-dominant (n = 12) and visual-dominant (n = 8) groups based on the questionnaire score. Subsequently, the participants performed a motor learning task such as tracing a trajectory using visuomotor rotation. When the participants were required to direct their attention internally, the after-effects of the learning task in the kinesthetic-dominant group were significantly greater than those in the visual-dominant group. Conversely, when the participants were required to direct their attention externally, the after-effects of the visual-dominant group were significantly greater than those of the kinesthetic-dominant group. Furthermore, we found a significant positive correlation between the size of after-effects and the modality-dominance of motor imagery. These results suggest that a suitable attention strategy based on the intrinsic motor imagery ability of an individual can improve performance during motor learning tasks.

Effect of internal versus external focus of attention on implicit motor learning in children with developmental coordination disorder

Children with developmental coordination disorder (DCD) struggle to learn new motor skills. It is unknown whether children with DCD learn motor skills more effectively with an external focus of attention (focusing on impact of movement on the environment) or an internal focus of attention (focusing on one's body movements) during implicit (unconscious) and explicit (conscious) motor learning.

PURPOSE

This paper aims to determine the trends of implicit motor learning in children with DCD, and how focus of attention influences motor learning in children with DCD in comparison with typically developing children.

METHODS

25 children, aged 8-12, with (n=12) and without (n=13) DCD were randomly assigned to receive instructions that focused attention externally or internally while completing a computer tracking task during acquisition, retention, and transfer phases. The motor task involved tracking both repeated and random patterns, with the repeated pattern indicative of implicit learning.

RESULTS

Children with DCD scored lower on the motor task in all three phases of the study, demonstrating poorer implicit learning. Furthermore, graphical data showed that for the children with DCD, there was no apparent difference between internal and external focus of attention during retention and transfer, while there was an advantage to the external focus of attention group for typically developing children.

CONCLUSION

Children with DCD demonstrate less accuracy than typically developing children in learning a motor task. Also, the effect of focus of attention on motor performance is different in children with DCD versus their typically developing counterparts during the three phases of motor learning.

IMPLICATIONS

Results may inform clinicians how to facilitate motor learning in children with DCD by incorporating explicit learning with either internal or external focus of attention within interventions.

Effect of different attentional instructions on the acquisition of a serial movement task

Recent research in attentional focus of instruction has predominantly over-emphasized the investigation of discrete and continuous skills rather than serial skills. The purpose of this study was therefore to examine the effect of different attentional focus instructions on learning a serial skill task (i.e., taekwondo routine) in novice learners. It was predicted that the use of movement outcome instructions could enhance the learning of a serial skill as previously supported in studies examining the acquisition of discrete and continuous skills. Thirteen female participants were recruited for this study and were assigned to either movement form condition - control group (n = 7) or movement outcome condition - treatment group (n = 6). All participants underwent 12 practice sessions over an 8-week period with their respective instructional conditions with each session lasting 30 minutes. Video recording of the serial skill tasks (hand techniques, kicking techniques and 10-step routine) were captured at "the-twelfth-training session", "after 1-week", and "after 1-month". It was found that more participants in the treatment group obtained a higher score in all three serial skill tasks, especially in Mastery component of 'Kicking' techniques at 'after 1-week' (p < 0.05, r = 0.57). This study suggested that movement outcome instructions have positive medium effect on balance control for serial skill task, especially in kicking actions. Key PointsMovement outcome (MO) instructions have a positive impact on learning a serial task, especially in kicking actions.More functional coordination during movement executions for MO participants.Benefits for MO instructions may be individual specific.

Working memory retrieval differences between medial temporal lobe epilepsy patients and controls: a three memory layer approach

Multi-store models of working memory (WM) have given way to more dynamic approaches that conceive WM as an activated subset of long-term memory (LTM). The resulting framework considers that memory representations are governed by a hierarchy of accessibility. The activated part of LTM holds representations in a heightened state of activation, some of which can reach a state of immediate accessibility according to task demands. Recent neuroimaging studies have studied the neural basis of retrieval information with different states of accessibility. It was found that the medial temporal lobe (MTL) was involved in retrieving information within immediate access store and outside this privileged zone. In the current study we further explored the contribution of MTL to WM retrieval by analyzing the consequences of MTL damage to this process considering the state of accessibility of memory representations. The performance of a group of epilepsy patients with left hippocampal sclerosis in a 12-item recognition task was compared with that of a healthy control group. We adopted an embedded model of WM that distinguishes three components: the activated LTM, the region of direct access, and a single-item focus of attention. Groups did not differ when retrieving information from single-item focus, but patients were less accurate retrieving information outside focal attention, either items from LTM or items expected to be in the WM range. Analyses focused on items held in the direct access buffer showed that consequences of MTL damage were modulated by the level of accessibility of memory representations, producing a reduced capacity.

External attentional focus enhances movement automatization: a comprehensive test of the constrained action hypothesis

An external focus of attention has been shown to result in superior motor performance compared to an internal focus of attention. This study investigated whether this is due to enhanced levels of movement automatization, as predicted by the constrained action hypothesis (McNevin, Shea, & Wulf, 2003). Thirty healthy participants performed a cyclic one-leg extension-flexion task with both the dominant and non-dominant leg. Focus of attention was manipulated via instructions. The degree of automatization of movement was assessed by measuring dual task costs as well as movement execution parameters (i.e., EMG activity, movement fluency, and movement regularity). Results revealed that an external focus of attention led to significantly better motor performance (i.e., shorter movement duration) than an internal focus. Although dual task costs of the motor task did not differ as a function of attentional focus, cognitive dual task costs were significantly higher when attention was directed internally. An external focus of attention resulted in more fluent and more regular movement execution than an internal focus, whereas no differences were found concerning muscular activity. These results indicate that an external focus of attention results in more automatized movements than an internal focus and, therefore, provide support for the constrained action hypothesis.

Three layers of working memory: Focus-switch costs and retrieval dynamics as revealed by the N-count task

Two experiments explored the process of switching items in and out of the focus of attention using a new paradigm, the N count task (adapted from Garavan, 1998; N varied from 1 to 4). This task yielded a focus size of one, indicated by a substantial focus switch cost for 2 count. Additionally, the focus switch costs in response time increased with working memory load, indicating an effortful search process occurring at a speed of about 240 ms/item. Maintaining and switching to and from a passive load did not increase the focus switch costs or decrease memory accuracy, indicating that there is no crosstalk between passive and active items. The results support a concentric theory of working memory: a small focus at its core, a surrounding area of (at least) three readily available items referred to as the outer store, and a still wider region of passive storage, possibly more long term memory than working memory.