--- _id: '32438' abstract: - lang: eng text: |- Abstract Objective External focus (EF) of attention leads to improved balance performance. Consideration of the neuromodulatory effects of EF may inform its clinical utility in addressing neuroplastic impairments after musculoskeletal injuries. We aimed to determine whether electrocortical activity and balance performance changed with attentional foci that prioritized differing sensory feedback and whether changes in electrocortical activity and balance were associated. Methods Individuals who were healthy (n = 15) performed a single-limb balance task under 3 conditions: internal focus (IF), somatosensory focus [EF with a baton (EF-baton)], and visual focus [EF with a laser (EF-laser)]. Electrocortical activity and postural sway were recorded concurrently using electroencephalography and a triaxial force plate. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in θ and α-2 frequency bands. Postural sway signals were analyzed with center-of-pressure sway metrics (eg, area, distance, velocity) and knee angle. The relationship between percent change in clustered brain activity and task performance metrics was assessed. Results Both EF conditions resulted in increased cortical activity and improved balance performance compared to IF. EF-laser had the largest effect, demonstrating increased frontal θ power (d = 0.64), decreased central θ power (d = −0.30), and decreased bilateral motor, bilateral parietal, and occipital α-2 power (d = −1.38 to −4.27) as well as a shorter path distance (d = −0.94) and a deeper (d = 0.70) and less variable (d = −1.15) knee angle than IF. Weak to moderate associations exist between increases in cortical activity and improved balance performance (ρ = 0.405–0.584). Conclusions EF resulted in increased cortical activity associated with cognitive, motor, somatosensory, and visual processing. EF-laser, which prioritized visual feedback, had the largest and broadest effects. Changes in cortical activity resulting from EF were independently associated with improved balance performance. Impact This study demonstrates that goal-oriented attention results in functional increases in brain activity compared to internally directed self-focus. These results suggest EF may target neurophysiologic impairments and improve balance in clinical populations. author: - first_name: David A full_name: Sherman, David A last_name: Sherman - first_name: Tim full_name: Lehmann, Tim last_name: Lehmann - first_name: Jochen full_name: Baumeister, Jochen last_name: Baumeister - first_name: Alli full_name: Gokeler, Alli last_name: Gokeler - first_name: Luke full_name: Donovan, Luke last_name: Donovan - first_name: Grant E full_name: Norte, Grant E last_name: Norte citation: ama: Sherman DA, Lehmann T, Baumeister J, Gokeler A, Donovan L, Norte GE. External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance. Physical Therapy. Published online 2021. doi:10.1093/ptj/pzab223 apa: Sherman, D. A., Lehmann, T., Baumeister, J., Gokeler, A., Donovan, L., & Norte, G. E. (2021). External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance. Physical Therapy. https://doi.org/10.1093/ptj/pzab223 bibtex: '@article{Sherman_Lehmann_Baumeister_Gokeler_Donovan_Norte_2021, title={External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance}, DOI={10.1093/ptj/pzab223}, journal={Physical Therapy}, publisher={Oxford University Press (OUP)}, author={Sherman, David A and Lehmann, Tim and Baumeister, Jochen and Gokeler, Alli and Donovan, Luke and Norte, Grant E}, year={2021} }' chicago: Sherman, David A, Tim Lehmann, Jochen Baumeister, Alli Gokeler, Luke Donovan, and Grant E Norte. “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance.” Physical Therapy, 2021. https://doi.org/10.1093/ptj/pzab223. ieee: 'D. A. Sherman, T. Lehmann, J. Baumeister, A. Gokeler, L. Donovan, and G. E. Norte, “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance,” Physical Therapy, 2021, doi: 10.1093/ptj/pzab223.' mla: Sherman, David A., et al. “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance.” Physical Therapy, Oxford University Press (OUP), 2021, doi:10.1093/ptj/pzab223. short: D.A. Sherman, T. Lehmann, J. Baumeister, A. Gokeler, L. Donovan, G.E. Norte, Physical Therapy (2021). date_created: 2022-07-27T07:49:23Z date_updated: 2022-07-27T07:53:19Z doi: 10.1093/ptj/pzab223 keyword: - Physical Therapy - Sports Therapy and Rehabilitation language: - iso: eng publication: Physical Therapy publication_identifier: issn: - 0031-9023 - 1538-6724 publication_status: published publisher: Oxford University Press (OUP) status: public title: External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance type: journal_article user_id: '41584' year: '2021' ... --- _id: '34024' abstract: - lang: eng text: "Abstract\r\n \r\n Objective\r\n \ External focus (EF) of attention leads to improved balance performance. Consideration of the neuromodulatory effects of EF may inform its clinical utility in addressing neuroplastic impairments after musculoskeletal injuries. We aimed to determine whether electrocortical activity and balance performance changed with attentional foci that prioritized differing sensory feedback and whether changes in electrocortical activity and balance were associated.\r\n \ \r\n \r\n Methods\r\n \ Individuals who were healthy (n = 15) performed a single-limb balance task under 3 conditions: internal focus (IF), somatosensory focus [EF with a baton (EF-baton)], and visual focus [EF with a laser (EF-laser)]. Electrocortical activity and postural sway were recorded concurrently using electroencephalography and a triaxial force plate. Electroencephalographic signals were decomposed, localized, and clustered to generate power spectral density in θ and α-2 frequency bands. Postural sway signals were analyzed with center-of-pressure sway metrics (eg, area, distance, velocity) and knee angle. The relationship between percent change in clustered brain activity and task performance metrics was assessed.\r\n \ \r\n \r\n Results\r\n \ Both EF conditions resulted in increased cortical activity and improved balance performance compared to IF. EF-laser had the largest effect, demonstrating increased frontal θ power (d = 0.64), decreased central θ power (d = −0.30), and decreased bilateral motor, bilateral parietal, and occipital α-2 power (d = −1.38 to −4.27) as well as a shorter path distance (d = −0.94) and a deeper (d = 0.70) and less variable (d = −1.15) knee angle than IF. Weak to moderate associations exist between increases in cortical activity and improved balance performance (ρ = 0.405–0.584).\r\n \r\n \ \r\n Conclusions\r\n \ EF resulted in increased cortical activity associated with cognitive, motor, somatosensory, and visual processing. EF-laser, which prioritized visual feedback, had the largest and broadest effects. Changes in cortical activity resulting from EF were independently associated with improved balance performance.\r\n \ \r\n \r\n Impact\r\n \ This study demonstrates that goal-oriented attention results in functional increases in brain activity compared to internally directed self-focus. These results suggest EF may target neurophysiologic impairments and improve balance in clinical populations.\r\n " author: - first_name: David A full_name: Sherman, David A last_name: Sherman - first_name: Tim full_name: Lehmann, Tim id: '41584' last_name: Lehmann - first_name: Jochen full_name: Baumeister, Jochen id: '46' last_name: Baumeister orcid: 0000-0003-2683-5826 - first_name: Alli full_name: Gokeler, Alli last_name: Gokeler - first_name: Luke full_name: Donovan, Luke last_name: Donovan - first_name: Grant E full_name: Norte, Grant E last_name: Norte citation: ama: Sherman DA, Lehmann T, Baumeister J, Gokeler A, Donovan L, Norte GE. External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance. Physical Therapy. Published online 2021. doi:10.1093/ptj/pzab223 apa: Sherman, D. A., Lehmann, T., Baumeister, J., Gokeler, A., Donovan, L., & Norte, G. E. (2021). External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance. Physical Therapy. https://doi.org/10.1093/ptj/pzab223 bibtex: '@article{Sherman_Lehmann_Baumeister_Gokeler_Donovan_Norte_2021, title={External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance}, DOI={10.1093/ptj/pzab223}, journal={Physical Therapy}, publisher={Oxford University Press (OUP)}, author={Sherman, David A and Lehmann, Tim and Baumeister, Jochen and Gokeler, Alli and Donovan, Luke and Norte, Grant E}, year={2021} }' chicago: Sherman, David A, Tim Lehmann, Jochen Baumeister, Alli Gokeler, Luke Donovan, and Grant E Norte. “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance.” Physical Therapy, 2021. https://doi.org/10.1093/ptj/pzab223. ieee: 'D. A. Sherman, T. Lehmann, J. Baumeister, A. Gokeler, L. Donovan, and G. E. Norte, “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance,” Physical Therapy, 2021, doi: 10.1093/ptj/pzab223.' mla: Sherman, David A., et al. “External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance.” Physical Therapy, Oxford University Press (OUP), 2021, doi:10.1093/ptj/pzab223. short: D.A. Sherman, T. Lehmann, J. Baumeister, A. Gokeler, L. Donovan, G.E. Norte, Physical Therapy (2021). date_created: 2022-11-07T11:57:53Z date_updated: 2023-03-13T15:07:10Z department: - _id: '17' - _id: '172' doi: 10.1093/ptj/pzab223 keyword: - Physical Therapy - Sports Therapy and Rehabilitation language: - iso: eng publication: Physical Therapy publication_identifier: issn: - 0031-9023 - 1538-6724 publication_status: published publisher: Oxford University Press (OUP) status: public title: External Focus of Attention Influences Cortical Activity Associated with Single Limb Balance Performance type: journal_article user_id: '46' year: '2021' ...