Background/Purpose: Gait instability during adaptive walking increases fall risk in older adults. While an external focus typically enhances movement automaticity, older adults may still tend to rely more on internal focus strategies. However, the role of gaze direction during an internal focus remains poorly understood. This study examined how pairing an internal focus with specific gaze direction affects gait stability in older adults during narrowed-path walking.

Methods: Twenty-eight older adults (72.9±5.0 years) walked along an 8-m level-ground narrowed path (0.3m wide) with their self-selected pace for nine trials under three different manipulations: control (CON; no instruction), internal focus (INT; focus on body movement), and internal focus-front (INTF; focus on body movement while gazing ahead at the destination). The outcome for gait stability was assessed by the variability of spatial and temporal gait parameters and compared among the three conditions.

Results: There were significant main effects of conditions in step width variability [F(2, 54)=4.159, p=0.021]. Post hoc analysis revealed that step width variability was significantly lower under INTF relative to both INT and CON (all p0.05).

Conclusion: Combining internal focus with forward gaze during narrow-path walking reduced step width variability—a key predictor of falls—in older adults, outperforming internal focus alone and control. This suggests that internal focus instructions might require explicit gaze guidance to enhance gait safety. Clinicians can consider integrating forward visual strategies with internal focus to improve gait stability and mitigate fall risk in the aging population.

Authors:
Toby C.T. Mak, The Hong Kong Polytechnic University, Hong Kong
Thomson W.L. Wong, The Hong Kong Polytechnic University, Hong Kong

About the Presenter(s)
Dr Toby Mak is a postdoctoral fellow in the Department of Rehabilitation Sciences, Faculty of Health and Social Sciences at the Hong Kong Polytechnic University.

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