Running head: ATTENTION ON A STABILITY BALL

Students Perception of Attention While Sitting on a Stability Ball Michelle Ashley, Jillian Battson, Josee Lundquist, and Nicole Quisao Touro University Nevada

ATTENTION ON A STABILITY BALL

Defining the Constructs Attention is defined as a fluid process by which a person focuses on a given target. while maintaining an awareness of background events (Wheatley, 2001) A stability ball is also known as exercise or balance balls are large, inflatable rubber balls used to develop and strengthen the core muscles of the body (North, 2011). Self-regulation is the ability to develop, implement, and flexibly maintain planned behavior in order to achieve ones goals (Brown & Miller, 1999). Cognitive engagement is defined as the intentional and purposeful processing of lesson content. Engagement, in effect, requires strategies that promote manipulation rather than memorization, as the means through which learners acquire both lesson knowledge and deeper conceptual insight (Cognitive). Physical engagement for this study is defined as involuntary active engagement of body components subconsciously. As defined by Brown, Miller, and Lawendowski (1999), the constructs were defined as the following: Receiving is how the participant is receiving relevant information, triggering is a change in the individuals perception while comprehending the material being received, searching is the individuals ability to utilize the information being received and search for alternative options, and implementing is the individuals ability to put the chosen plan into action. Theoretical Framework Self-Regulation is the ability to develop, implement, and flexibly maintain planned behavior in order to achieve ones goals (Brown, Miller, & Lawendowski, 1999). According to Cleary and Zimmerman (2012), the self-regulation framework is a cyclical feedback loop, a process that operates in a temporal sequence (before, during, and after a learning activity) and is

ATTENTION ON A STABILITY BALL

largely cognitive in nature. All theories of self-regulation assume that students interpret learning outcomes as having tangible or intangible personal implications. Behaviorally oriented approaches focus on tangible outcomes such as material or social gains, whereas cognitively oriented approaches emphasize intangible outcomes such as self-actualization, self-efficacy, or reduced cognitive dissonance (Zimmerman, 1990). Systematic Review of Literature Stability Ball and Children with Attention Deficit Hyperactivity Disorder The majority of research available on our current topic is focused towards children with attention deficit hyperactivity disorder (ADHD). The current research investigates the effects of two different classroom seating conditions for children, stability balls or chairs. Schilling, Washington, Billingsley, and Deitx (2003), examined the influence of stability balls on in-seat behavior and legible word productivity. Schilling et al. (2003) used a single subject time series design with three students who currently were diagnosed with ADHD. Within this study, the stability ball was implemented to determine its influence of in-seat behavior in comparison to inseat behavior while seated in a chair. The intervention was twelve weeks in length and through convenience sampling the participants selected used the stability ball during language arts (Schilling et al., 2003). All participants, including the subjects were individually fitted for stability balls and were allowed a week prior to the initial phase of testing to explore the new seating option therefore decreasing novelty effects. Within the study done by Schilling et al. (2003) the therapist observed and documented the in-seat behavior of the ball and chair every ten second interval for the duration of that data collection. The results documented the subjects displayed increased performance while seated on stability balls versus chairs.

ATTENTION ON A STABILITY BALL Fedewa and Erwin, (2001) conducted a study to further explore the stability balls effect on childrens behavior with ADHD as documented in Schilling et al. (2003). This study continued the research of in-seat and on-task behavior of students while using the stability balls

versus a chair in the classroom setting. The researchers focused on the frequency of the variables while seated on the stability ball. The sample included a group of 8 students who were observed three times a week for a period of twelve weeks. Similarly to Schilling et al. (2003) the current study used a single subject continuous time-series design to evaluate the pre-test and post-test results of the intervention. In addition, participants were also individually fitted to the stability balls and were allowed time to orient themselves to limit novelty effects. Through convenience sampling all participants were given the Attention-Deficit/Hyperactivity Disorder Test (ADHDT) and the sample was composed of 8 students out of the total 76 participants who scored greater than or equal to 120 (Fedewa & Erwin, 2011). Observers collected data every thirty seconds while documenting the samples in-seat on the ball or chair or out of seat on the ball or chair and if the students were on or off task. In this study, results indicated that there were differences between the pre-test and post-test scores of the ADHDT assessment displaying lowered mean quotients while using the stability ball in the classroom. The teachers reported within a social validity scale that they viewed the stability ball to enhance levels of attention, inseat behavior and work completion throughout the intervention (Fedewa & Erwin, 2011). Stability Ball and Posture Retail businesses have claimed that stability balls reduce, and even prevent low back pain because of the promotion of increased core stability and strength, which has been speculated to reduce lower back pain.

ATTENTION ON A STABILITY BALL Gregory, Dunk, and Callaghan (2006) conducted a study to compare the difference each

participant of the study experienced with trunk muscle activation, and lumbar spine posture when sitting on a stability ball verse a traditional office chair, as well as the influence of the task at hand to the muscle activation and posture. The study consisted of 14 participants, including 7 males with an average age of 25.4 and 7 females with an average age of 22.3 who had not experiences any lower back pain in last 12 months prior to the study (Gregory et al., 2006). The participants each sat on both a traditional office chair without arm rests and a stability ball with hips and knees in 90 degrees of flexion for an hour at a time while participating in 4 different tasks at a desk. The tasks performed were typing, computer-aided design, typing/mouse combined work, and reading (Gregory et al., 2006). According to Gregory et al. (2006), as the participants performed each task on both the traditional office chair, and stability ball their muscles and posture were being monitored by an EMG to monitor muscle activation and the ISOTRAK 3Space to monitor postural components. The data from both instruments was then synchronized to collect pertinent data. Statistical analysis of the data was performed using the Three-way analyses of variance (ANOVAs), to compare the sitting on a stability ball, and a traditional office chair, accounting for the different tasks performed in each position, gender, postural variables, and perceived discomfort. A 95% confidence level was used to reject the null hypothesis, and to look further into significant findings, Tukeys post hoc multiple comparisons was used (Gregory et al., 2006). Gregory et al. (2006) reported no significant differences of the average EMG of the muscles except the left thoracic erector spinae which had a maximum voluntary contraction of 1.36 % on the chair, and 2.06 % on the ball. According to Gregory et al. (2006), the study did not discover any significant difference for co-contraction, flexion, or range of flexion when

ATTENTION ON A STABILITY BALL comparing the two different seated positions. The study discovered a significant difference in

perceived discomfort of the lower back for both sitting positions, but only pain in the entire body as a whole when using the stability ball. The study also concluded that the task being performed while in the seated position also had an influence on the discomfort of each participant (Gregory et al., 2006). Looking at gender overall, men showed more lumbar flexion compared to women. A trend that was recognized in the study was the increase in lumbar flexion women had while sitting on the stability ball compared to office chair, whereas the men showed higher lumbar flexion in the chair compared to the stability ball (Gregory et al., 2006). This study didnt find any significant findings to support the benefits of using a stability ball to replace the typical office chair and stated, the increased reported discomfort and potential safety issues associated with sitting on an unstable surface question the use of a stability ball as an office chair (Gregory et al., 2006). Although this study has its limitations including population size, and a short time period, this study opens up the idea to the biomechanical differences between prolonged sitting in an office chair, and on a stability ball (Gregory et al., 2006). McGill, Kavcic, and Harvey (2006), performed a study to assess the relevance in using stability balls as opposed to office chairs to reduce lower back pain. It has been suggested that sitting for a prolonged period of time could cause individuals to have issues with their lower back. In most situations individuals choose varied sitting positions rather than a single comfortable position, this is termed dynamic sitting. Dynamic sitting sparked an interest in using stability balls instead of office chairs, claiming they would reduce back pain and aid in better posture. Despite the popular use of stability balls in replacement of office chairs, little

ATTENTION ON A STABILITY BALL quantitative evidence exists to support these claims and hence forms the purpose of this paper (McGill, Kavcic & Harvey, 2004). For the current research study, two separate studies were performed. The first study assessed the differences in torso muscle activation, spine load and stability in men sitting on a

stability ball versus a stool. It consisted of eight male subjects, which were similar in age, height and weight. The participants sat for 30 min on an exercise ball and 30 min on a wooden stool and lumbar position was measured every 5 min. There was no significant interaction between time and seat conditions of any of the muscles observed (McGill et al., 2004). The second study assessed pressure distribution over the buttocks and posterior thighs while men sat on a stool, office chair and stability ball. It consisted of seven male subjects. The participants sat on a stability ball, a wooden stool and a padded office chair. They sat on each surface for a total of 5 s, this was repeated three times. Pressure measurements were obtained over the 5 s. There was no significant difference found in pressure distribution among the different sit surfaces (McGill, Kavcic and Harvey, 2004). The research study failed to find any beneficial changes to either spine stability or compression while sitting on a stability ball over a 30 min period of time. Based on the study, it appears that sitting on a stability ball has little effect on spine stability and muscle activity in regards to a static sitting task. A change in muscle activation might be seen if the individual were performing a dynamic sitting task. Attention and Posture According to Huxhold, Li, Schmiedek, and Ulman (2006), postural control in daily situations routinely takes place while at least one other concurrent task is being performed. It was found that maintaining an erect stance may tax cognitive factors, such as attentional processes,

ATTENTION ON A STABILITY BALL when the standing conditions are challenging or when attentional interference between postural control and cognitive processes is high (Huxhold et al., 2006). The previous research suggests that an erect stance may affect cognitive performance in attention if the position of the stance is challenging, or if the attentional cognitive demand is higher (Huxhold et al., 2006). In other words, if an individual is standing on a surface that has an uneven terrain while simultaneously completing a cognitive task, it would be difficult to

remain stable and upright. Thus, the individual would focus more on the task of posture and less on the cognitive task and attention would be divided between two different types of tasks. When an individual needs to maintain the balance of upright stance while performing a concurrent cognitive task, attention is divided between the sensorimotor and cognitive tasks (Huxhold et al., 2006). The sharing of attentional resources between two domains of functioning reduces the amount of attention that is available for postural control. (Huxold et al., 2006). Huxhold et al., (2006) conducted a study which tested the theoretical proposition that postural control sway and cognitive demand are related to each other by a U-shaped function. Huxhold et al. (2006) studied the role of attentional capacities and examined by contrasting young and old adults. A sample of 41 adults participated in the study. The sample consisted of 19 older adults and 20 young adults, with an approximate even distribution of men and women. Each participant was tested individually within a single session to measure postural control. Specifically, ground reaction forces and center of body pressure positions were measured. A platform with built in sensors was used to measure ground reaction forces, and a computer measure was used to calculate coordinated of center of body pressure positions. This

ATTENTION ON A STABILITY BALL measurement indicated the efficacy of postural control. The larger displacement of center of body pressure signified worse postural control performance (Huxhold et al., 2006). The experiment included three single-task cognitive conditions while seated and five experimental conditions in which the participants stood on the force platform. Sequencing effects in the set of between-condition comparisons of interest used a nested counterbalancing

scheme to rule out sequential effects. Verbal-based and visio-spatial cognitive tasks with varying levels of cognitive demands were used (Huxhold et al., 2006). Huxhold et al., (2006) found that their study replicated former findings, which might implicate that attentional resource competition in dual tasking postural control results in shortterm lapses in postural control behavior (p. 302). When a task is introduced that is not overtly focused on the highly automatized task of postural performance, it seems that the attention is shifted away from posture and to the demand of the cognitive task. Huxhold et al., (2006) found that in older adults, attention decreased when the cognitive demand of a task increased. This finding was slightly attributed to the generalization that older adults have more limited attentional capacity. Since younger adults generally have a relatively higher level of cognitive capacity, it did not challenge them as much in the experiment to split their focus between cognitive task and postural stance (Huxhold et al., 2006). Purpose and Overview of the Proposed Study We chose to focus on the impact that the stability ball has on attention within adults due to the limitations of previous research. Generally, the previous research focused on children in the classroom who have ADHD. These previous studies used small sample sizes thus limiting the ability to generalize to the greater population. Also, some of the studies only sampled one gender. With the limited research available, we have chosen to study whether students

ATTENTION ON A STABILITY BALL perceptions will change regarding physical and cognitive engagement when sitting in a traditional chair versus a stability ball. Hypothesis and Predictions

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This study tested the hypothesis that students perception of their physical and cognitive engagement while attending class will positively increase while seated on a stability ball as opposed to a traditional chair. In general, we predicted that the stability balls will improve attention. Methods Study Design This study is a two-group pretest-posttest experimental design. Participants were randomly assigned to one of two groups: (1) seated on a stability ball; (2) seated on a traditional chair. Participants and Setting Thirty-two participants were recruited to participate in this study. The age of participants ranged from 23-48 years (M=29, SD=5.15). There were 7 males (22%) and 25 females (78%) participants. The race of the participants in the study were as follows; 52% Caucasian/white, 2% Black/African-American, 17% Asian, 10% Native Hawaiian/Pacific Islander, 17% Hispanic/Latino, and 2% Non-Hispanic/Latino. The marital statuses of the participants were; 62% single/never married, 35% married, 2% separated, and 2%. The highest level of education completed was; 90% obtained a four-year college degree and 10% already received a masters degree. Instruments and Materials

ATTENTION ON A STABILITY BALL Attention was measured using the Self-regulation Questionnaire developed by Brown, Miller, and Lawendowski (1999). The Self-regulation Questionnaire is a sixty-three item instrument which measures receiving relevant information, evaluating the information and comparing it to norms, triggering change, searching for options, formulating a plan,

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implementing the plan, and assessing. For the purpose of this study the instrument was modified to address receiving relevant information, triggering change, searching for options, and implementing the plan. Thirty-six items were carefully selected and inputted in to Qualtrics. Some example item includes; I usually keep track of my progress toward my goals (receiving); Others tell me that I keep on with things too long (triggering); I doubt I could change even if I wanted to (searching); and I get easily distracted from my plans (implementing). It ems were answered on a 5-point likert scale. The Self-regulation Questionnaire (SRQ) has been utilized in several studies and has been shown to have high validity. The SRQ has also been shown to have high reliability. From previous studies, the test rettest reliability and internal consistency to the total SRQ score was also high. As displayed in previous research, the SRQ is valid in measuring what it intends to measure, self-regulation. Procedures Permission was obtained from the Touro University Nevada physical therapy department to utilize their stability balls. Additional permission was obtained to conduct the study within an occupational therapy class period from a professor within the occupational therapy department. Students were enrolled in the Master of Science in occupational therapy cohort at Touro University Nevada. These students recruited were randomly assigned to either one of the two groups; stability ball or classroom chair. The participants were given pre-test survey, attended a

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normal length lecture for approximately thirty minutes, and finally completed a post-test survey. Participants gave verbal consent prior to completing the survey. Data Analysis Plan To analyze the constructs of this study, a doubly multivariate analysis of variance (MANOVA) was conducted. Pearsons Product-Moment Correlation coefficients were also requested for relevant variables in the study. Results The results of the doubly repeated measures (RM) MANOVA demonstrated that although neither the interaction nor the individual main effects exhibited statistical significance, the practical significance of the analyses was robust. Eta Squared coefficients ranged from .07 to .11, indicating moderate strength of association between the independent variable and the linear combination of dependent variables. The univariate results demonstrated that the receiving scale was the only one that exhibited robust practical significance. It appears that participants in the chair were more attentive at pretest with respect to receiving information whereas those in the ball were more attentive to receiving information at posttest. The time main effect showed that searching increased over time, with participants showing greater searching strategies at posttest. The between-subjects main effect showed that those sitting in a ball were significantly more attentive to receiving information than those sitting in chairs. Thus, preliminarily the ball appears to be an effective method at increasing certain aspects of attention. A correlation matrix of the data is provided on the following page.

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Correlations Receiving Scale Pre Receiving Scale Pre Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Pearson Correlation Sig. (2tailed) N Implementing Scale Post Pearson Correlation Sig. (2tailed) N *. Correlation is significant at the 0.05 level (2-tailed). 1 Trigger Scale Pre .153 .419 30 1 Searching Scale Pre .266 .149 31 .314 .091 30 1 Implementing Scale Pre .065 .727 31 .229 .223 30 .240 .193 31 1 Receiving Scale Post .050 .795 29 .076 .700 28 -.176 .351 30 -.242 .206 29 1 Trigger Scale Post .087 .649 30 -.053 .783 29 -.052 .782 31 -.235 .212 30 .369
*

Searching Scale Post .145 .461 28 -.208 .298 27 -.042 .830 29 .117 .554 28 .234 .221 29 .264 .166 29 1

Implementing Scale Post -.422

*

.025 28 .058 .774 27 -.223 .244 29 -.044 .823 28 .375

*

Trigger Scale Pre

Searching Scale Pre

Implementing Scale Pre

Receiving Scale Post

.045 30 1

.045 29 .220 .252 29 .228 .243 28 1

Trigger Scale Post

Searching Scale Post

ATTENTION ON A STABILITY BALL Discussion

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The main research objective of our study was to examine the impact of a stability ball on attention within adults within a classroom setting in accordance with the Self-Regulation Theory. We collected a baseline score for self-regulation while the participants were seated on a traditional chair. Participants were randomly assigned to one of two treatment conditions: traditional chair or stability ball. Following the assignment, the participants were seated for thirty minutes during an occupational therapy course lecture. A posttest was administered after the treatment condition. This study evaluated the influence of; receiving, triggering, searching, and implementing in regards to the participants perceived attention during a lecture. We hypothesized that students perception of their physical and cognitive engagement while attending class will positively increase while seated on a stability ball as opposed to a traditional chair. In general, we expected that the stability balls will improve attention. Out of the four self-regulating variables; receiving, triggering, searching, and implementing, a notable increase was observed with the receiving variable. The participants were able to receive relevant information more accurately on a stability ball as opposed to the traditional chair. From this data, we can infer that more neuronal pathways were activated due to full body engagement on the stability ball. Furthermore, our results indicate that over time, the searching variable increased from pretest to posttest showing higher searching strategies on the stability ball. Conclusion Our study demonstrated a relationship between attention while seated on a stability ball in adults. The previous research was limited to school-aged children with ADHD. For this reason we chose to focus on the adult population, specifically at the graduate level. The

ATTENTION ON A STABILITY BALL objective was to see if our results would be consistent with the previously studied populations.

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Similar to the previous research, our sample size was limited to convenience sampling within the occupational therapy program. Although we our results aligned with our hypothesis, we would need to increase the sample size in order to determine the validity of the research. Also, observing the differences in relation to gender may affect the attention of participants while seated on a stability ball. Our sample did not account for gender differences. To increase further validity, the stability ball should be fitted properly based on the participants height. Overall, our research was consistent with our hypotheses. Further research should be conducted in order to support the relevance that stability ball seating increases attention and enhanced learning in the classroom. Also, some of the studies only sampled one gender. With the limited research available, we have chosen to study whether students perceptions will change regarding physical and cognitive engagement when sitting in a traditional chair versus a stability ball.

ATTENTION ON A STABILITY BALL References Brown J. M., Miller W. R., Lawendowski, L. A. The self-regulation questionnaire. In:

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VandeCreek L, Jackson TL, editors. Innovations in clinical practice: A sourcebook. Vol. 17. Sarasota, FL: Professional Resource Press/Professional Resource Exchange; 1999. pp. 281292. Cleary, T. J., & Zimmerman, B. J. (2012). A cyclical self-regulatory account of student engagement: theoretical foundations and applications. In S. L. Christenson, A. L. Reschly, & Wylie, C. (Eds), Handbook of research on student engagement (237-257). New York: Springer Science + Business Media, LLC Cognitive engagement. (n.d.). In Social Science Dictionary. Retrieved from http://www.social sciencedictionary.com/cognitive_engagement Fedewa, A. L., & Erwin, H. E. (2011). Stability balls and students with attention and hyperactivity concerns: Implications for on-task and in-seat behavior. American Journal of Occupational Therapy, 65, 393399. doi: 10.5014/ajot.2011.000554 Gregory, D. E., Dunk, N. M., Callaghan, J. P. (2006). Stability balls versus office chair: Comparison of muscle activation and lumbar spine posture during prolonged sitting. Human Factors, 48(1), 142-153. Huxhold, O., Li, S., Schmiedek, F., Lindenberger U. (2006). Dual-tasking postural control: Aging and the effects of cognitive demand in conjunction with focus of attention. Brain Research Bulletin, 69, 294-305. doi: 10.1016/j.brainresbull.2006.01.002 McGill, S. M., Kavcic, N. S., and Harvey, E. (2006). Sitting on a chair or an exercise ball: various perspectives to guide decision making. Clinical Biomechanics 21, 353-360.

ATTENTION ON A STABILITY BALL North, D. (2011). What is a stability ball? Retrieved from http://www.livestrong.com /article/452239-what-is-a-stability-ball/ Schilling, D. L., Washington, K., Billingsley, F. F., and Deitz, J. (2003). Classroom seating for children with attention deficit hyperactivity disorder: Therapy balls versus chairs. American Journal of Occupational Therapy, 57, 534541. Wheatley, C.J.(2001). Visual Perceptive Aspects of Driving. American Occupational Therapy Association, 24(3), 1-4. Zimmerman, B.J. (1990). Self-regulated learning and academic achievement: an overview. Educational psychologist, 25(1), 3-17.

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