ORIGINAL RESEARCH article
Front. Rehabil. Sci.
Sec. Interventions for Rehabilitation
Expansion of Attentional Scope Modulates Postural Control, Motor Strategies, and Attentional Network Connectivity in Healthy Adults: A Proof-of-Concept Mixed-Methods Study
Keisuke Goto 1
Rui Watanabe 2,3
Satoshi Yamamoto 4
Vivian Sihan Lim 1
Ryusuke Shimada 5
Hironobu Kuruma 3
Atsushi Senoo 6
Yumi Ikeda 3
1. Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Chiba, Japan
2. Turku PET Centre and Turku University Hospital, University of Turku, Turku, Finland
3. Department of Physical Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
4. Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
5. Department of Rehabilitation, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan
6. Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Abstract
Introduction: Plantar sensory input plays a key role in postural control. However, training protocols that solely amplify this bottom-up input have demonstrated inconsistent efficacy. We hypothesized that a top-down protocol using plantar sensations as a perceptual anchor and expanding the attentional scope from localized plantar sensations to a whole-body reference frame would yield greater improvements than sensory discrimination alone. Methods: Forty-eight healthy adults (N = 48) participated in a single 10-minute session of either Sensory Discrimination Only (SDO) or Sensory Discrimination with Expansion of Attentional Scope (SDE). The SDE protocol employs a brief therapeutic dialogue to facilitate this expansion. The Index of Postural Stability (IPS) was assessed at baseline (T0), immediately after the training (T1), and 30 minutes after (T2). Semi-structured interviews at T0/T1 were text-mined to quantify motor strategies. Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected at T0/T1 for region-of-interest (ROI)-to-ROI connectivity analyses, focusing on major large-scale brain networks. Results: The SDE group demonstrated a significant IPS improvement (ΔIPS ≈ +0.09, dz = 0.42) and maintained this improvement at 30 minutes (T0 vs. T2: dz = 0.32), whereas the SDO group demonstrated no change. Qualitative analyses of self-reported motor strategies in the SDE group indicated attentional expansion beyond a plantar perceptual anchor toward whole-body alignment, reflected by increased references to the shoulders while foot-related references remained common. In rs-fMRI, a cluster within attentional circuitry, including the salience and ventral attention networks, demonstrated a significant group × time interaction (threshold-free cluster enhancement [TFCE]/family-wise error [FWE]-corrected p < .05), characterized by reduced connectivity following SDE and a trend toward increased connectivity following SDO. Conclusions: In this proof-of-concept study, expanding attentional scope from a plantar perceptual anchor toward a whole-body reference frame was associated with immediate, group-level changes across measures. Postural stability improved, alongside changes in self-reported motor strategies and resting-state connectivity within attentional circuitry. Enhancing sensitivity to bottom-up plantar input remains fundamental; however, these findings suggest a potential next step— learning how to interpret and use plantar input as a whole-body reference signal for balance regulation. Confirmation in randomized and longitudinal studies, including evaluation in clinical populations, is warranted.
Summary
Keywords
attentional scope, Mixed-methods study, Postural control, Resting-state fMRI, salience network, ventral attention network
Received
02 December 2025
Accepted
19 February 2026
Copyright
© 2026 Goto, Watanabe, Yamamoto, Lim, Shimada, Kuruma, Senoo and Ikeda. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Keisuke Goto; Yumi Ikeda
Disclaimer
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