Effect of external and internal focus of attention on acquisition, retention, and transfer phase of motor learning in Parkinson's disease

The purpose of this study was to evaluate the effectiveness of external focus of attention and internal focus of attention in different phases of motor learning in people with Parkinson's disease (PD). Twenty-four patients (17 men and 7 women) with idiopathic PD participated in the study. The participants were randomly assigned to either the internal focus of attention group (n = 12) or the external focus of attention group (n = 12). The task was to throw darts at the centre of a target. The attention of the patients in the internal focus group was directed at the movements of upper extremity joints, whereas the attention of the patients in the external focus group was directed at the target, dart, and dart course. The results showed that the external focus group had significantly less mean radial error for the acquisition phase (fifth block, p = 0.005) and the transfer phase (p = 0.005). In summary, an external focus of attention enhanced learning in the last block of the acquisition phase and the whole transfer phase, whereas an internal focus of attention resulted in no improvement. External focus of attention may be the preferred method for facilitating the learning of motor skills in patients with PD.