Effect of external versus internal focus of attention instructions on gait performance in people with multiple sclerosis.

BACKGROUND: Considering 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. METHODS: Twenty 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. RESULTS: The 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). CONCLUSION: The 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.