Simultaneous cognitive-physical dual task training based on fairy tales in older adults with mild cognitive impairment: A pilot study

Background: Older adults with Mild Cognitive Impairment (MCI) are at higher risk of falls and injuries, but the underlying mechanism is poorly understood. Inappropriate anticipatory postural adjustments to overcome balance perturbations are affected by cognitive decline. However, it is unknown whether anticipatory gait control to avoid an obstacle is affected in MCI. Objective: Using the dual-task paradigm, we aim to assess whether gait control is affected during obstacle negotiation challenges in older adults with MCI. Methods: Seventy-nine participants (mean age = 72.0 ± 2.7 years; women = 30.3%) from the “Gait and Brain Study” were included in this study (controls = 27; MCI = 52). In order to assess the anticipatory control behaviour for obstacle negotiation, a 6-m electronic walkway embedded with sensors recorded foot prints to measure gait speed and step length variability, during early (3 steps before the late phase) and late (3 steps before the obstacle) pre-crossing phases of an ad hoc obstacle, set at 15% of participant’s height. Participants walked under single- and dual-task gait (counting backwards by 1’s from 100 while walking) conditions. Three-way mixed repeated-measures analysis of variance models examined differences in gait performance between groups when transitioning between pre-crossing phases towards an obstacle during single- and dual-task conditions. Analyses were adjusted for age, sex, years of education, lower limb function, fear of falling, medical status, depressive symptoms, baseline gait speed and executive function. Results: A significant three-way interaction among groups, pre-crossing phases and task showed that participants with MCI attenuated the gait deceleration (p = 0.02) and performed fewer step length adjustments (p = 0.03) when approaching the obstacle compared with controls while dual-tasking. These interactions were attenuated when executive function performance was added as a covariate in the adjusted statistical model. Conclusion: Older adults with MCI attenuate the anticipatory gait adjustments needed to avoid an obstacle when dual-tasking. Deficits in higher-order cognitive processing may limit obstacle negotiation capabilities in MCI populations, being a potential falls risk factor.

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The Role of Cognitive Factors in Old Age Balance Impairments

International Journal of Indian Psychology ◽

10.25215/0402.093 ◽

2017 ◽

Vol 4 (2) ◽

Author(s):

Priyanka Yadav

Keyword(s):

Older Adults ◽

Dual Task ◽

Sensory System ◽

T Test ◽

Cognitive Factors ◽

Attention And Memory ◽

Mobility Assessment ◽

Task Training ◽

Dual Task Training

The ability of human beings to perform more than one task at a time has long been focus of study in the literature on human attention and memory. Older adults are more penalized when they must divide their attention between two input resources i.e input and holding or holding and responding. Falls have potentially devastating physical, social and psychological consequences. Falling is one of the most serious problems associated with ageing. Sensory system deteriorates with age, increased attention is allocated to “HIGHTEN” the signal coming from this system in order to gain necessary information for postural control. Older adults show marked reduction in the ability to perform the postural and cognitive task simultaneously. A study was conducted by physiotherapy and psychology students in a small town of Haryana on institutionalized older adults in which Dual task training under various sets of instruction that is Fixed priority and Variable priority instruction sets effects the balance who are living in residential care facilities. Tinneti Performance Oriented Mobility Assessment (POMA) and Mini mental status examination were used as tools to assess balance and cognitive abilities. Various studies related to the role of cognitive factors in balance impairments were reviewed. Data was analyzed using SPSS 13.0 software packages and paired sample t –test within the group and independent sample t – test between the groups with p – value at a significance level of p < 0.05 was used. The result of the study supported the hypothesis that there is significant improvement in balance of institutionalized elderly people who received dual task training with variable priority instruction set. (p < 0.001). The use of validated measurement tool like Tinnetti performance oriented mobility assessment on balance allowed clearer interpretation of the results. There is improvement in TPOMA Scores after 4 weeks training program in both groups. This shows that cognitive factors do play an important role in maintaining balance and coordination. Any impairment related to sensory system or cognition leads to balance impairments and increased risk for falls.

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