Attentional focus influences postural control and reaction time performances only during challenging dual-task conditions in healthy young adults

The dual-task paradigm has previously been used to investigate the attentional demands associated with postural control. Previous studies have identified both the focus of attention and the difficulty of a postural task as potential factors influencing dual-task performance. The aim of this study was to examine how the instructed focus of attention influences dual-task performance during quiet standing tasks of various levels of difficulty. Thirteen young adults participated in two testing sessions consisting of standing as still as possible on a force platform in different postural conditions, while simultaneously performing a simple reaction time (RT) task. Postural task difficulty was manipulated by various combinations of three bases of support (feet together, tandem and single leg) and two visual conditions (eyes opened and closed). Participants were instructed to focus on either their balance or their RT performance, depending on the testing session. When comparing postural control with respect to session focus, anterior-posterior sway velocity decreased with the addition of the simple RT task when the focus was on balance, but only during the more difficult dual-task conditions. In contrast, sway area and medial-lateral sway velocity did not change between the two instructed focus sessions. Participants responded faster in all dual-task conditions when focusing on RT performance than on balance. The modified attention allocation index indicated that participants' ability to modulate their allocation of attentional resources to respond positively to instruction was more pronounced in the most challenging postural condition. The present findings could have important implications for the interpretation of dual-task performance in both clinical and research settings.