Purpose: This randomized controlled trial examined the effects of a treatment program based on external focus of attention (EFA) and internal focus of attention (IFA) on spatiotemporal gait parameters and balance performance in children with unilateral cerebral palsy (uCP).
Methods: Twenty-four children with uCP, aged 6-12 years, were randomly assigned to EFA (n = 12) or IFA (n = 12) groups. Both groups received the same balance and gait exercises for six weeks, differing only in attentional focus instructions. Assessments included the C-Mill VR+ gait system, Single-Leg Stance Test, Pediatric Balance Scale (PBS), and Trunk Control Measurement Scale.
Results: After the intervention, the EFA group showed significantly greater improvements in cadence (+15.8 steps/min), affected limb stance phase (+4,17%), and PBS scores (+5 points) compared to the IFA group. Cadence and PBS changes suggest clinical relevance, though the stance phase increase may reflect compensation rather than functional improvement.
Conclusion: Both attentional focus and gait and balance parameters improved. EFA-based training was more effective than IFA in improving some parameters of gait and balance. These findings suggest that externally focused instructions can enhance motor learning in children with uCP, though further research is warranted to assess the clinical relevance of smaller differences.
Clinical trials: https://clinicaltrials.gov/study/NCT06170814.
Keywords: Unilateral cerebral palsy; balance; external focus of attention; gait; internal focus of attention.
Clinically meaningful improvements in gait and balance can be achieved through the combination of external attentional focus strategies and task-specific training in rehabilitation programs.Professionals are recommended to schedule follow-up assessments to determine whether improvements achieved through attentional focus are maintained over time.Future rehabilitation programs should investigate the effectiveness of attentional focus interventions in other types of cerebral palsy.