ArticleNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology2026
Effect of external versus internal focus of attention instructions on gait performance in people with multiple sclerosis.
Article in Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundConsidering the increased dependency on conscious control processes for gait control in people with multiple sclerosis(PwMS), there is a clear need to identify potential interventional strategies that could improve gait performance by diverting attention away from internal movement processes. Therefore, this study aimed to compare the effects of external focus of attention(EFA) and internal focus of attention(IFA) on gait performance between PwMS and healthy controls.
methodsTwenty people with MS and 20 healthy controls were recruited in this quasi-experimental study. Gait assessment was performed at preferred walking speed on the treadmill during three attentional focus(AF) conditions: control with no AF instructions, internally focusing on their lower limb movements, and externally focusing on maintaining laser dot within the specified limit.
resultsThe results showed a significant interaction of group by condition for cadence(p = 0.03) and stride time parameters(p = 0.03). Additionally, the main effect of condition was statistically significant for double support time (p = 0.002), stride length(p < 0.001), step width(p < 0.001), and stride time variability parameters(p = 0.006). The main effect of group was also statistically significant for double support time(p = 0.002), stride length(p < 0.001), step width(p = 0.01), swing time(p = 0.005), stride time variability(p < 0.001), and stride length variability parameters(p < 0.001).
conclusionThe results of this study indicate the potential immediate influence of EFA on spatiotemporal gait characteristics in PwMS with gait deficits. From a clinical perspective, these results may offer preliminary insight into the potential role of EFA instructions during gait training in PwMS. However, further longitudinal studies are warranted to determine whether these gait modifications translate into long-term clinical benefits.
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