Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 32726
Effects of External and Internal Focus of Attention in Motor Learning of Children Cerebral Palsy

Authors: Morteza Pourazar, Fatemeh Mirakhori, Fazlolah Bagherzadeh, Rasool Hemayattalab


The purpose of study was to examine the effects of external and internal focus of attention in the motor learning of children with cerebral palsy. The study involved 30 boys (7 to 12 years old) with CP type 1 who practiced throwing beanbags. The participants were randomly assigned to the internal focus, external focus, and control groups, and performed six blocks of 10-trial with attentional focus reminders during a practice phase and no reminders during retention and transfer tests. Analysis of variance (ANOVA) with repeated measures on the last factor was used. The results show that significant main effects were found for time and group. However, the interaction of time and group was not significant. Retention scores were significantly higher for the external focus group. The external focus group performed better than other groups; however, the internal focus and control groups’ performance did not differ. The study concluded that motor skills in Spastic Hemiparetic Cerebral Palsy (SHCP) children could be enhanced by external attention.

Keywords: Cerebral Palsy, external attention, internal attention, throwing task.

Digital Object Identifier (DOI):

Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1455


[1] Chiviacowsky, S., Wulf, G., & Ávila, L. (2013). An external focus of attention enhances motor learning in children with intellectual di¬sabilities. Journal of Intellectual Disability Research, 57, 627-634.
[2] McNevin, N. H., Shea, C. H., & Wulf, G. (2003). Increasing the distance of an external focus of attention enhances learning. Psychological Research-Psychologische Forschung, 67, 22–29.
[3] Wulf, G., McConnel, N., Gärtner, M., & Schwarz, A. (2002). Enhancing the learning of sport skills through external focus feedback. Journal of Motor Behavior, 34, 171–82.
[4] Wulf, G., Höß, M., & Prinz, W. (1998). Instructions for motor learning: differential effects of internal versus external focus of attention. Journal of Motor Behavior, 30, 169–79.
[5] Wulf, G., Lauterbach, B., & Toole, T. (1999). The learning advantage of an external focus of attention in golf. Research Quarterly for Exercise and Sport, 70, 120–126.
[6] Lohse, K. R., & Sherwood, D. E. (2012). Thinking about muscles: The neuromuscular effects of attentional focus on accuracy and fatigue. Acta Psychologica, 140, 236–245.
[7] Vance, J., Wulf, G., Töllner, T., McNevin, N. H., & Mercer, J. (2004). EMG activity as a function of the perform¬er’s focus of attention. Journal of Motor Behavior, 36, 450-459.
[8] Zachry, T., Wulf, G., Mercer, J., & Bezodis, N. (2005). Increased movement accuracy and reduced EMG activity as the result of adopting an external focus of attention. Brain Research Bulletin, 67, 304–309.
[9] Schücker, L., Hagemann, N., Strauss, B., & Völker, K. (2009). The effect of attentional focus on running economy. Journal of Sport Sciences, 27, 1241-1248.
[10] Lohse, K. R., Sherwood, D. E., & Healy, A. F. (2010). How changing the focus of attention affects performance, kinematics, and electromyography in dart throwing. Human Movement Science, 29, 542–555.
[11] Freudenheim, A. M., Wulf, G., Madureira, F., & Corrêa, U. C. (2010). An external focus of attention results in greater swimming speed. International Journal of Sports Science & Coaching, 5, 533–542.
[12] Ashraf, R., Aghdasi, M. T., Sayyah, M., & Taghibiglo, N. (2012). The Effects of Internal and External Focus of Attention on Children`s Performance in Vertical Jump Task, International Journal of Basic Sciences & Applied Research, 1, 1- 5.
[13] Marchant, D. C., Greig, M., & Scott, C. (2009). Attentional focus instructions influence force production and muscular activity during isokinetic elbow flexion. Journal of Strength and Conditioning Research, 23, 2358-2366.
[14] Bell, J., & Hardy, J. (2009). Effects of attentional focus on skilled performance in golf. Journal of Applied Sport Psychology, 21, 163–177.
[15] Wulf, G., & Su, J. (2007). External focus of attention enhances golf shot accuracy in beginners and experts. Research Quarterly for Exercise & Sport, 78, 384-389.
[16] Abernethy, B. (1988). Dual-task methodology and motor skills research: some methodological constraints. Journal of Human Movement Studies, 14, 101–132.
[17] Marchant, D. C., Clough, P., & Crawshaw, M. (2007). The effects of attentional focusing strategies on novice dart throwing performance and their task experiences. International Journal of Sport and Exercise Psychology, 5, 291– 303.
[18] Marchant, D. C., Clough, P. J., Crawshaw, M., & Levy, A. (2009). Novice motor skill performance and task experience is influenced by attentional focusing instructions and instruction preferences. International Journal of Sport and Exercise Psychology, 7, 488–502.
[19] Wulf, G., & Lewthwaite, R. (2010). Effortless motor learning? An external focus of attention enhances movement effectiveness and efficiency. In B. Bruya (Ed.), Effortless attention: A new perspective in attention and action (pp. 75–101). Cambridge, MA: MIT Press.
[20] Mohamadi,J., Kordi,H., & Ghotbi M. (2012). “The effects of attentional focus strategies on acquisition, retention and transfer of dart throwing task in children and adolescences”. European Journal of Sports and Exercise Science, 1, 26-32.
[21] Hadler, R., Chiviacowsky, S., Wulf, G., & Schild, J. (2014). Children’s learning of tennis skills is facilitated by external focus instructions. Motriz, Rio Claro, 20, 418-422.
[22] Emanuel, M., Jarus, T., & Bart, O. (2008). Effect of focus of attention and age on motor acquisition, retention, and transfer: A randomized trial. Physical Therapy, 88, 251-260.
[23] Abdollahipour, R., Bahram, A., Shafizadeh, M., & Khalaji, H. (2008). “The effects of attentional focus on the learning of a soccer dribbling-task in children and adolescences”. Journal of Movement Sciences & Sports, 1, 83-92.
[24] Landers, M., Wulf, G., Wallmann, H., & Guadagnoli, M. A. (2005). An external focus of attention attenuates balance impairment in Parkinson’s disease. Physiotherapy, 91, 152–185.
[25] Wulf, G., Landers, M., Lewthwaite, R., & Töllner, T. (2009). External focus instructions reduce postural instability in individuals with Parkinson disease. Physical Therapy, 89, 162–168.
[26] Fasoli, S. E., Trombly, C. A., Tickle-Degnen, L., & Verfaellie, M. H. (2002). Effect of instructions on functional reach in persons with and without cerebrovascular accident. American Journal of Occupational Therapy, 56, 380–390.
[27] Jarus, T., Ghanouni, P., Abel, R. L., Fomenoff, SH. L., Lundberg, J., Davidson, S., Caswell, S., Bickerton, L., & Zwicker, J. Z. (2015). Effect of internal versus external focus of attention on implicit motor learning in children with developmental coordination disorder, Research in Developmental Disabilities, 37, 119 – 126.
[28] Kulak, W., & Sobaniec, W. (2004). Comparisons of right and left Hemiparetic Cerebral Palsy. Pediatric Neurology, 31, 101–108.
[29] Hemayattalab, R., Arabameri, E., Pourazar, M., Dehestani Ardakani, M., & Kashefi, M. (2013). Effects of self-controlled feedback on learning of a throwing task in children with spastic hemiplegic cerebral palsy. Research in Developmental Disabilities, 34, 2884–2889.
[30] Jaspers, E., Desloovere, K., Bruyninckx, H., Klingels, K., Molenaers, G., Aertbelie, E., Gestel, L.V., & Feys, H. (2011). Three-dimensional upper limb movement characteristics in children with hemiplegic cerebral palsy and typically developing children. Research in Developmental Disabilities, 32, 2283–2294.
[31] Chang, J. J., Wu, T. I., Wu, W. L., & Su, F. C. (2005). Kinematical measure for spastic reaching in children with cerebral palsy. Clinical Biomechanics, 20, 381–388.
[32] Chen, Y. P., & Yang, T. F. (2007). Effect of task goals on the reaching patterns of children with cerebral palsy. Journal of Motor Behavior, 39(4), 317–324.
[33] Van der Heide, J., Fock, J., Otten, B., Stremmelaar, E., & Hadders-Algra, M. (2005). Kinematic characteristics of reaching movements in preterm children with cerebral palsy. Pediatric Research, 57(6), 883–889.
[34] Hemayattalab, R., & Rashidi Rostami, L. (2010). Effects of frequency of feedback on the learning of motor skill in individuals with cerebral palsy. Research in Developmental Disabilities, 31, 212–217.
[35] Mutsaarts, M., Steenbergen, B., & Bekkering, H. (2006). Anticipatory planning deficits and task context effects in hemiplegic cerebral palsy. Experimental Brain Research, 172, 151–162.
[36] Wulf, G., Chiviacowsky, S., Schiller, E., & Ávila, L.T. (2010). Frequent external-focus feedback enhances learning. Frontiers in Psychology 1, 190. doi: 10.3389/fpsyg.2010.00190.
[37] Palisano, R. J., Hanna, S. E., Rosenbaum, P. L., Russell, D. J., Walter, S. D., & Wood, E. P. (2000). Validation of a model of gross motor function for children with cerebral palsy. Physical Therapy, 80, 974–985.
[38] Eliasson, A.C., Krumlinde-Sundholm, L., Rösblad, B., Beckung, E., Arner, M., Öhrvall, A.M., & Rosenbaum, P.L. (2006). The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol, 48, 549–554.
[39] McLaughlin, J.F., Felix, S.D., Nowbar, S., Ferrel, A., Bjornson, K., & Hays, R.M. (2005). Lower extremity sensory function in children with cerebral palsy. Pediatric Rehabilitation, 8, 45-52.
[40] Thibault A, Forget R, Lambert J. (1994). Evaluation of cutaneous and proprioceptive sensation in children: A reliability study. Developmental Medicine and Child Neurology, 36: 796-812.
[41] Wulf, G. (2007). Attention and Motor Skill Learning. Human Kinetics, Champaign, IL.
[42] Schmidt, R. A., & Lee, T. D. (2011). Motor control and learning (5th Ed.). Champaign, IL: Human Kinetics.
[43] Wulf, G. (2013). Attentional focus and motor learning: A review of 15 years. International Review of Sport and Exercise Psychology, 6, 77–104.
[44] McNevin, N. H., & Wulf, G. (2002). Attentional focus on supra-postural tasks affects postural control. Hum Mov Sci 21:187–202.
[45] Carson, H. J., Collins, D., & Jones, B. (2014). A case study of technical change and rehabilitation: Intervention design and interdisciplinary team interaction. International Journal of Sport Psychology, 45, 57–75.
[46] Wulf, G. (2016). An external focus of attention is a conditio sine qua non for athletes: a response to Carson, Collins, and Toner (2015). Journal of Sports Sciences, 34 (13), 1293-1295.
[47] Henry, F. M. (1960). Influence of motor and sensory sets on reaction latency and speed of discrete movements. Research Quarterly for Exercise and Sport, 31, 459-468.