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Samadi1 H, Hajlotfalian2 M, razi M. The Effect of Different Attentional Focus Strategies on the Quality of Selected Gait Parameters in Adolescents with Educable Intellectual Disabilities. TB 2025; 24 (6) :1-15
URL: http://tbj.ssu.ac.ir/article-1-3827-en.html
URL: http://tbj.ssu.ac.ir/article-1-3827-en.html
farhangian uni , mrazi@cfu.ac.ir
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The Effect of Different Attentional Focus Strategies on the Quality of Selected Gait Parameters in Adolescents with Educable Intellectual Disabilities
Hossein Samadi(Ph.D.)1, Mostafa Hajlotfalian(Ph.D.)2, Mohammad Javad Razi(Ph.D.)3
1.Associate Professor, Department of Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.
2.Assistant Professor, Department of Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.
3.Corresponding Author: Assistant Professor, Department of Physical Education, Farhangian University, P.O. Box 14665-889, Tehran, Iran. Email:mrazi@cfu.ac.ir Tel:09136073368
Abstract
Conflict of interest: The authors declared no conflict of interest.
References
Hossein Samadi(Ph.D.)1, Mostafa Hajlotfalian(Ph.D.)2, Mohammad Javad Razi(Ph.D.)3
1.Associate Professor, Department of Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.
2.Assistant Professor, Department of Sport Sciences, Faculty of Psychology and Educational Sciences, Yazd University, Yazd, Iran.
3.Corresponding Author: Assistant Professor, Department of Physical Education, Farhangian University, P.O. Box 14665-889, Tehran, Iran. Email:mrazi@cfu.ac.ir Tel:09136073368
Abstract
Introduction: Individuals with educable intellectual disability often experience cognitive and motor limitations that may impair balance, gait, and ultimately functional independence. Given the critical role of attentional focus in motor control, this study aimed to investigate the effects of different attentional focus strategies on gait quality in adolescents with educable intellectual disabilities
Methods:This quasi-experimental study with a within-subjects design was conducted on 25 students aged 11 to 13 years with educable intellectual disability in the year 2025. Participants walked along a 10‑meter walkway under four randomized attentional focus conditions (control, internal focus, proximal external focus, and distal external focus). Kinematic data were collected using seven inertial measurement unit (IMU) sensors, and three key gait parameters -gait velocity, kinematic variability, and gait symmetry—were analyzed. Repeated-measures analysis of variance (ANOVA) was used to compare the experimental conditions. Statistical analyses were performed using SPSS version 24, with a significance level set at 0/05.
Results: The results revealed significant differences between attentional focus conditions in gait velocity (p<0/001, η²=0/413) and kinematic variability (p<0/001, η²=0/257). However, no statistically significant difference was observed in gait symmetry (p=0/160). External focus increased gait velocity, whereas internal focus was associated with greater movement variability.
Conclusion: The findings suggest that the type of attentional focus can influence gait quality in adolescents with educable intellectual disabilities. In particular, employing external focus of attention be beneficial in designing motor interventions aimed at improving functional independence and reducing fall risk in this population.
Keywords: Attention, Gait, Intellectual Disability, Adolescent, Accelerometry
Methods:This quasi-experimental study with a within-subjects design was conducted on 25 students aged 11 to 13 years with educable intellectual disability in the year 2025. Participants walked along a 10‑meter walkway under four randomized attentional focus conditions (control, internal focus, proximal external focus, and distal external focus). Kinematic data were collected using seven inertial measurement unit (IMU) sensors, and three key gait parameters -gait velocity, kinematic variability, and gait symmetry—were analyzed. Repeated-measures analysis of variance (ANOVA) was used to compare the experimental conditions. Statistical analyses were performed using SPSS version 24, with a significance level set at 0/05.
Results: The results revealed significant differences between attentional focus conditions in gait velocity (p<0/001, η²=0/413) and kinematic variability (p<0/001, η²=0/257). However, no statistically significant difference was observed in gait symmetry (p=0/160). External focus increased gait velocity, whereas internal focus was associated with greater movement variability.
Conclusion: The findings suggest that the type of attentional focus can influence gait quality in adolescents with educable intellectual disabilities. In particular, employing external focus of attention be beneficial in designing motor interventions aimed at improving functional independence and reducing fall risk in this population.
Keywords: Attention, Gait, Intellectual Disability, Adolescent, Accelerometry
Conflict of interest: The authors declared no conflict of interest.
References
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2-Karimi E, DashtBozorgi Z, Asgari P. Comparison of the effectiveness of computerized and non-computerized cognitive games on sustained attention and planning in educable intellectual disability children. Iran J Rehabil Res. 2024;10(2):66-78.
3-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text rev. American Psychiatric Association; 2022.
4-Colizzi M, Ciceri ML, Di Gennaro G & et al. Investigating gait, movement, and coordination in children with neurodevelopmental disorders: Is there a role for motor abnormalities in atypical neurodevelopment? Brain Sciences. 2020;10(9):601.
5-Zolghadr H, Sedaghati P, Daneshmandi H. The effect of selected balance/corrective exercises on the balance performance of mentally-retarded students with developmental coordination disorder. Physical Treatments: Specific Physical Therapy Journal. 2019;9(1):23-30.[Persian]
6-Zhou J, Zhong Y, Xu W. Effects of core stability exercises on balance ability of children and adolescents with intellectual disabilities: A systematic review and meta-analysis. PLoS One. 2024;19(12):e0314664.
7-Jouira G, Alexe CI, Herlo JN & et al. Effects of smartphone activities on postural balance in adolescents with intellectual disabilities. Children. 2023;10(11):1810.
7-Azimizad M, Hosseini SA, Norasteh AA. The effect of an eight-week combined strength and proprioception training program on balance and walking speed of children with educable intellectual disabilities. Quarterly Journal of Sports Biomechanics. 2021;7(2):136-147.[Persian]
8-Şeker FS, Çamlıyer H. The effect of movement training on balance skills in children with intellectual disability. European Journal of Special Education Research. 2021;7(4):1-14.
8-Kim SA, Ryu YU, Shin HK. The effects of different attentional focus on poststroke gait. Journal of Exercise Rehabilitation. 2019;15(4):592-598.
9-Bahiraei S, Daneshmandi H, Norasteh AA & et al. The study of biomechanical gait cycle and balance characteristics in intellectual disabilities: A systematic review. Physical Treatments: Specific Physical Therapy Journal. 2018;8(2):63-76.[Persian]
10-Siavoshi H, Seddighi A. The effect of a balance exercise program on improving stepping performance and temporal and spatial indicators of walking in adolescents with intellectual disabilities. Exceptional Education. 2016;16(138):68-79.[Persian]
11- Achiron A, Menascu S. Gait variability, not walking speed, is related to cognition in adolescents with multiple sclerosis. Journal of Child Neurology. 2019;34(1):27-32.
12-Hausdorff JM. Gait variability: Methods, modeling and meaning. Journal of NeuroEngineering and Rehabilitation. 2005;2(1):19.
13-Daunoraviciene K, Ziziene J, Pauk J & et al. EMG-based analysis of gait symmetry in healthy children. Sensors. 2021;21(17):5983.
14-Wilmut K, Gentle J, Barnett AL. Gait symmetry in individuals with and without developmental coordination disorder. Research in Developmental Disabilities. 2017;60:107-114.
15-Cimolin V, Cau N, Sartorio A & et al. Symmetry of gait in underweight, normal and overweight children and adolescents. Sensors. 2019;19(9):2054.
16-Mak TC, Ng SS, Chan DC & at al. The influence of attentional focus on gait stability and conscious movement processing during challenging walking conditions in older adults. The Journals of Gerontology: Series B. 2025;80(6):2059.
17-Hallemans A, Van de Walle P, Wyers L & et al. Clinical usefulness and challenges of instrumented motion analysis in patients with intellectual disabilities. Gait & Posture. 2019;71:105-115.
18-Izzo R, Bertoni M, Cejudo A & et al. The global symmetry index, symmetry index, quality index and kinematics of the gait cycle with the synchronized contribution of the latest generation magnetic-inertial and electromyographic technology. Journal of Physical Education and Sport. 2022;22(5):1258-1270.
19-Shin SY, Kim Y, Jayaraman A & et al. Relationship between gait quality measures and modular neuromuscular control parameters in chronic post-stroke individuals. Journal of NeuroEngineering and Rehabilitation. 2021;18:12.
20-Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. The Quarterly Journal of Experimental Psychology Section A. 2001;54(4):1143-1154.
21-Mak TC, Ng SS, Chan DC & et al. The influence of attentional focus on gait stability and conscious movement processing during challenging walking conditions in older adults. J Gerontol B Psychol Sci Soc Sci. 2025;80(6):2059.
22-Zorlular R, Akinci M, Elbasan B. Effects of focus of attention on gait parameters and balance performance in children with unilateral cerebral palsy: a randomized controlled trial. Disabil Rehabil. 2026;48(3):829-841.
23-Akhondzadeh M, Samadi H, Ahar S & et al. Comparison of nonlinear dynamics of stepping in educable girls with intellectual disabilities under internal and external attention focus instructions. J Paramed Sci Rehabil. 2025;14(3):54-66.
24-Mohammadzadeh M, Yamada Y, Masahiro M. Maghayese-ye asar-e dastoor-ol-amal-haye tamarkoz-e tavajjoh-e mortabet ba taklif bar amalkard-e maharat-e partab-e dart-e danesh-amoozan-e pesar. Roshd Yadgiri Harkati Varzeshi. 2025.
25-McKay B, Corson A, Seedu J & et al. Reporting bias, not external focus: A robust Bayesian meta-analysis and systematic review of the attentional focus literature. Published online 2024.
26-Doosti F, Forughipour M, Sohrabi M & et al. Investigating the effect of internal and external attraction instructions (near and far) on balance of patients with multiple sclerosis. Med J Mashhad Univ Med Sci. 2014;56(1):15-20.
27-Kheirkhiz MM, Bahram A. The effect of increasing distance of external attention on electromyography in dart throwing. Motor Behav. 2014;19:51-64.
28-Zang L, Guo W, Wang B. The farther, the better? The effect of attentional focus distance on motor performance: a systematic review and meta-analysis. PeerJ. 2025;13:e20012.
29-Yang S, Li Q. Inertial sensor-based methods in walking speed estimation: A systematic review. Sensors. 2012;12(5):6102-6116.
30-Washabaugh EP, Kalyanaraman T, Adamczyk PG & et al. Validity and repeatability of inertial measurement units for measuring gait parameters. Gait Posture. 2017;55:87-93.
31-Yeo SS, Park GY. Accuracy verification of spatio-temporal and kinematic parameters for gait using inertial measurement unit system. Sensors. 2020;20(5):1343.
32-Wang K, Li D, Feng C & et al. Comparison of internal vs external vs holistic attentional focus in golf putting performance among children: the role of skill level. Front Psychol. 2026;17:1801673.
33-Krieg M, Christen G, Tschopp M & et al. Evaluation of external vs internal focus of attention in Parkinson disease: A systematic review and meta-analysis during on and off medication states. F1000Res. 2025;14:272.
34-Campolina AB, Machado NLR, Mazoni AF & et al. Effects of attentional focus on dual-task walking performance in older and young adults. J Mot Behav. 2025;57(3):278-286.
35-Samadi H, Mousavi SH, Shirvani H. The effect of internal attentional focus instructions and various distances of external attention on the static and dynamic balance of the chemical veterans with movement impairment. J Mil Med. 2022;21(6):596-605.
36-Siltanen S, Bottas R. Instructions for external focus of attention improved taekwondo kicking performance only among less skilled youth. Perceptual and Motor Skills. 2022;129(3):787-799
37-Krajenbrink H, van Abswoude F, Vermeulen S & et al. Motor learning and movement automatization in typically developing children: The role of instructions with an external or internal focus of attention. Human Movement Science. 2018;60:183-190.
2-Karimi E, DashtBozorgi Z, Asgari P. Comparison of the effectiveness of computerized and non-computerized cognitive games on sustained attention and planning in educable intellectual disability children. Iran J Rehabil Res. 2024;10(2):66-78.
3-American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text rev. American Psychiatric Association; 2022.
4-Colizzi M, Ciceri ML, Di Gennaro G & et al. Investigating gait, movement, and coordination in children with neurodevelopmental disorders: Is there a role for motor abnormalities in atypical neurodevelopment? Brain Sciences. 2020;10(9):601.
5-Zolghadr H, Sedaghati P, Daneshmandi H. The effect of selected balance/corrective exercises on the balance performance of mentally-retarded students with developmental coordination disorder. Physical Treatments: Specific Physical Therapy Journal. 2019;9(1):23-30.[Persian]
6-Zhou J, Zhong Y, Xu W. Effects of core stability exercises on balance ability of children and adolescents with intellectual disabilities: A systematic review and meta-analysis. PLoS One. 2024;19(12):e0314664.
7-Jouira G, Alexe CI, Herlo JN & et al. Effects of smartphone activities on postural balance in adolescents with intellectual disabilities. Children. 2023;10(11):1810.
7-Azimizad M, Hosseini SA, Norasteh AA. The effect of an eight-week combined strength and proprioception training program on balance and walking speed of children with educable intellectual disabilities. Quarterly Journal of Sports Biomechanics. 2021;7(2):136-147.[Persian]
8-Şeker FS, Çamlıyer H. The effect of movement training on balance skills in children with intellectual disability. European Journal of Special Education Research. 2021;7(4):1-14.
8-Kim SA, Ryu YU, Shin HK. The effects of different attentional focus on poststroke gait. Journal of Exercise Rehabilitation. 2019;15(4):592-598.
9-Bahiraei S, Daneshmandi H, Norasteh AA & et al. The study of biomechanical gait cycle and balance characteristics in intellectual disabilities: A systematic review. Physical Treatments: Specific Physical Therapy Journal. 2018;8(2):63-76.[Persian]
10-Siavoshi H, Seddighi A. The effect of a balance exercise program on improving stepping performance and temporal and spatial indicators of walking in adolescents with intellectual disabilities. Exceptional Education. 2016;16(138):68-79.[Persian]
11- Achiron A, Menascu S. Gait variability, not walking speed, is related to cognition in adolescents with multiple sclerosis. Journal of Child Neurology. 2019;34(1):27-32.
12-Hausdorff JM. Gait variability: Methods, modeling and meaning. Journal of NeuroEngineering and Rehabilitation. 2005;2(1):19.
13-Daunoraviciene K, Ziziene J, Pauk J & et al. EMG-based analysis of gait symmetry in healthy children. Sensors. 2021;21(17):5983.
14-Wilmut K, Gentle J, Barnett AL. Gait symmetry in individuals with and without developmental coordination disorder. Research in Developmental Disabilities. 2017;60:107-114.
15-Cimolin V, Cau N, Sartorio A & et al. Symmetry of gait in underweight, normal and overweight children and adolescents. Sensors. 2019;19(9):2054.
16-Mak TC, Ng SS, Chan DC & at al. The influence of attentional focus on gait stability and conscious movement processing during challenging walking conditions in older adults. The Journals of Gerontology: Series B. 2025;80(6):2059.
17-Hallemans A, Van de Walle P, Wyers L & et al. Clinical usefulness and challenges of instrumented motion analysis in patients with intellectual disabilities. Gait & Posture. 2019;71:105-115.
18-Izzo R, Bertoni M, Cejudo A & et al. The global symmetry index, symmetry index, quality index and kinematics of the gait cycle with the synchronized contribution of the latest generation magnetic-inertial and electromyographic technology. Journal of Physical Education and Sport. 2022;22(5):1258-1270.
19-Shin SY, Kim Y, Jayaraman A & et al. Relationship between gait quality measures and modular neuromuscular control parameters in chronic post-stroke individuals. Journal of NeuroEngineering and Rehabilitation. 2021;18:12.
20-Wulf G, McNevin N, Shea CH. The automaticity of complex motor skill learning as a function of attentional focus. The Quarterly Journal of Experimental Psychology Section A. 2001;54(4):1143-1154.
21-Mak TC, Ng SS, Chan DC & et al. The influence of attentional focus on gait stability and conscious movement processing during challenging walking conditions in older adults. J Gerontol B Psychol Sci Soc Sci. 2025;80(6):2059.
22-Zorlular R, Akinci M, Elbasan B. Effects of focus of attention on gait parameters and balance performance in children with unilateral cerebral palsy: a randomized controlled trial. Disabil Rehabil. 2026;48(3):829-841.
23-Akhondzadeh M, Samadi H, Ahar S & et al. Comparison of nonlinear dynamics of stepping in educable girls with intellectual disabilities under internal and external attention focus instructions. J Paramed Sci Rehabil. 2025;14(3):54-66.
24-Mohammadzadeh M, Yamada Y, Masahiro M. Maghayese-ye asar-e dastoor-ol-amal-haye tamarkoz-e tavajjoh-e mortabet ba taklif bar amalkard-e maharat-e partab-e dart-e danesh-amoozan-e pesar. Roshd Yadgiri Harkati Varzeshi. 2025.
25-McKay B, Corson A, Seedu J & et al. Reporting bias, not external focus: A robust Bayesian meta-analysis and systematic review of the attentional focus literature. Published online 2024.
26-Doosti F, Forughipour M, Sohrabi M & et al. Investigating the effect of internal and external attraction instructions (near and far) on balance of patients with multiple sclerosis. Med J Mashhad Univ Med Sci. 2014;56(1):15-20.
27-Kheirkhiz MM, Bahram A. The effect of increasing distance of external attention on electromyography in dart throwing. Motor Behav. 2014;19:51-64.
28-Zang L, Guo W, Wang B. The farther, the better? The effect of attentional focus distance on motor performance: a systematic review and meta-analysis. PeerJ. 2025;13:e20012.
29-Yang S, Li Q. Inertial sensor-based methods in walking speed estimation: A systematic review. Sensors. 2012;12(5):6102-6116.
30-Washabaugh EP, Kalyanaraman T, Adamczyk PG & et al. Validity and repeatability of inertial measurement units for measuring gait parameters. Gait Posture. 2017;55:87-93.
31-Yeo SS, Park GY. Accuracy verification of spatio-temporal and kinematic parameters for gait using inertial measurement unit system. Sensors. 2020;20(5):1343.
32-Wang K, Li D, Feng C & et al. Comparison of internal vs external vs holistic attentional focus in golf putting performance among children: the role of skill level. Front Psychol. 2026;17:1801673.
33-Krieg M, Christen G, Tschopp M & et al. Evaluation of external vs internal focus of attention in Parkinson disease: A systematic review and meta-analysis during on and off medication states. F1000Res. 2025;14:272.
34-Campolina AB, Machado NLR, Mazoni AF & et al. Effects of attentional focus on dual-task walking performance in older and young adults. J Mot Behav. 2025;57(3):278-286.
35-Samadi H, Mousavi SH, Shirvani H. The effect of internal attentional focus instructions and various distances of external attention on the static and dynamic balance of the chemical veterans with movement impairment. J Mil Med. 2022;21(6):596-605.
36-Siltanen S, Bottas R. Instructions for external focus of attention improved taekwondo kicking performance only among less skilled youth. Perceptual and Motor Skills. 2022;129(3):787-799
37-Krajenbrink H, van Abswoude F, Vermeulen S & et al. Motor learning and movement automatization in typically developing children: The role of instructions with an external or internal focus of attention. Human Movement Science. 2018;60:183-190.
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Received: 2025/09/14 | Accepted: 2025/11/20 | Published: 2026/09/1
Received: 2025/09/14 | Accepted: 2025/11/20 | Published: 2026/09/1
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