Dual task walking in healthy aging: Effects of narrow and wide walking paths

Dual-task walking may lead to gait instability and a higher fall risk in older adults, particularly when walking in a busy city street. Challenging street features such as narrow sidewalks not only discourage walking, but are also likely to be taxing for older adults’ cognitive resources and gait characteristics. The aim of this study was to assess the way older adults’ gait characteristics are affected by walking on a narrow path while performing a challenging cognitive task in lab conditions imitating common urban environments. Nineteen young and eighteen older adults walked on a narrow (40cm) and a wide (80cm) path and performed a cognitive (n-back) task individually adjusted to 80% accuracy. The two tasks were performed separately (Single-Task) and concurrently (Dual-Task). Both groups walked faster, and their step width was narrower on the narrow path. During dual-task walking on the narrow path, older adults showed significant dual-task costs in the cognitive task, gait speed, step width, and stride length. Dual-task walking was associated with decreased gait speed and stride length in both age groups, suggesting that dual-task walking may adversely affect gait, particularly when walking on narrow paths. These conditions may lead to gait instability and an increased fall risk for older adults, particularly when walking along the narrow sidewalks commonly found within the built environment. However, more research is needed in an urban setting to determine the extent of the fall risk narrow sidewalks present for older adults.

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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A-26 Performance on Design Fluency and Visuoperception Measures is Related to Single and Dual Task Treadmill Gait Parameters in Healthy Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.26 ◽

2019 ◽

Vol 34 (6) ◽

pp. 885-885

Author(s):

L Wadia ◽

C Higginson ◽

M Bifano ◽

K Seymour ◽

R Orr ◽

...

Keyword(s):

Dual Task ◽

Stride Length ◽

Block Design ◽

Healthy Adults ◽

Step Width ◽

Single Task ◽

Gait Characteristics ◽

Gait Parameters ◽

Design Fluency ◽

Task Step

Abstract Objective Research suggests a link between gait and cognition. Executive functions have been related to gait speed, however the relation between design fluency and visuoperception and other spatiotemporal gait characteristics that are related to falling is unclear. The objective of the study was to determine whether performance on design fluency and visuoperception tasks is related to spatiotemporal gait parameters during single and dual task treadmill walking in a sample of healthy adults. Method Nineteen healthy adults averaging 40 years of age completed cognitive measures of design fluency, visual attention, and visuoperception. They underwent gait analysis while walking on an instrumented treadmill in single task and dual task conditions. Results Performance on Spatial Span significantly correlated with single task stride length, r = 0.47, p = 0.043. Performance on Block Design significantly correlated with dual task stride length, r = 0.46, p = 0.049. Performance on Design Fluency significantly correlated with single task stride length variability, r = -0.50, p = 0.030, dual task stride length variability, r = -0.62, p = 0.005, and dual task step width variability, r = -0.56, p = 0.012. Performance on Picture Completion also correlated with dual task step width variability, r = -0.54, p = 0.017. Conclusions Design fluency and visuoperception appear related to spatiotemporal gait parameters in healthy adults. Worse cognitive performance was related to greater variability in dual task stride length and step width, gait characteristics associated with falling in aging and neurological populations.

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Diabetes Mellitus and Gait Dysfunction: Possible Explanatory Factors

Physical Therapy ◽

10.2522/ptj.20080016 ◽

2008 ◽

Vol 88 (11) ◽

pp. 1365-1374 ◽

Cited By ~ 46

Author(s):

Jennifer S Brach ◽

Jaime B Talkowski ◽

Elsa S Strotmeyer ◽

Anne B Newman

Keyword(s):

Physical Activity ◽

Older Adults ◽

Health Status ◽

Lower Extremity ◽

Gait Speed ◽

Cardiovascular Health Study ◽

Step Width ◽

Explanatory Factors ◽

Gait Characteristics ◽

Lower Extremity Strength

Background and Objective Gait characteristics differ in individuals with diabetes compared with those without diabetes. Limited information regarding potential explanatory factors for this association exists. This study examined the association between diabetes and gait characteristics in older adults and explored potential explanatory factors. Design A cross-sectional, observational study design was used. Methods At the 1998–1999 clinic visit, 558 ambulatory older adults (mean age=79 years) from the Pittsburgh site of the Cardiovascular Health Study had an assessment of their gait characteristics, diabetes, health status, cognition, mood, lower-extremity circulation and sensation, vision, lower-extremity strength (force-producing capacity), physical activity, and body mass index (BMI). A series of linear regression models were developed to examine the association between diabetes and gait characteristics and to examine potential explanatory factors for the associations. Results Diabetes was related to gait speed (β=−.06 m/s); however, the association was partially explained by health status variables, cognition, mood, lower-extremity circulation and sensation, visual impairment, lower-extremity strength, physical activity, and BMI. Health status and lower-extremity strength each explained the greatest proportion of the association (β reduced 66% by each). Diabetes was related to step width (β=.02 m), and the association could not be explained by the examined factors. Conclusions Diabetes was associated with gait alterations in older adults. Slowed gait speed appears to be secondary to the peripheral effect of the disease on other body systems. The effect of diabetes on step width was not explained in the analyses and may be related to peripheral motor nerve function or central influences of the disease, which could not be assessed in this study.

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Cognitive Load and Dual-Task Performance During Locomotion Poststroke: A Feasibility Study Using a Functional Virtual Environment

Physical Therapy ◽

10.2522/ptj.20090061 ◽

2010 ◽

Vol 90 (2) ◽

pp. 252-260 ◽

Cited By ~ 64

Author(s):

Rachel Kizony ◽

Mindy F. Levin ◽

Lucinda Hughey ◽

Claire Perez ◽

Joyce Fung

Keyword(s):

Older Adults ◽

Virtual Environment ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Community Dwelling ◽

Control Group ◽

Dual Task Condition ◽

Dual Tasking ◽

Stroke Group

Background Gait and cognitive functions can deteriorate during dual tasking, especially in people with neurological deficits. Most studies examining the simultaneous effects of dual tasking on motor and cognitive aspects were not performed in ecological environments. Using virtual reality technology, functional environments can be simulated to study dual tasking. Objectives The aims of this study were to test the feasibility of using a virtual functional environment for the examination of dual tasking and to determine the effects of dual tasking on gait parameters in people with stroke and age-matched controls who were healthy. Design This was a cross-sectional observational study. Methods Twelve community-dwelling older adults with stroke and 10 age-matched older adults who were healthy participated in the study. Participants walked on a self-paced treadmill while viewing a virtual grocery aisle projected onto a screen placed in front of them. They were asked to walk through the aisle (single task) or to walk and select (“shop for”) items according to instructions delivered before or during walking (dual tasking). Results Overall, the stroke group walked slower than the control group in both conditions, whereas both groups walked faster overground than on the treadmill. The stroke group also showed larger variability in gait speed and shorter stride length than the control group. There was a general tendency to increase gait speed and stride length during dual-task conditions; however, a significant effect of dual tasking was found only in one dual-task condition for gait speed and stride duration variability. All participants were able to complete the task with minimal mistakes. Limitations The small size and heterogeneity of the sample were limitations of the study. Conclusions It is feasible to use a functional virtual environment for investigation of dual tasking. Different gait strategies, including an increase or decrease in gait speed, can be used to cope with the increase in cognitive demands required for dual tasking.

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The age-related decline in spatiotemporal gait characteristics is moderated by concerns of falling, history of falls & diseases, and sociodemographic-anthropometric characteristics in 60–94 years old adults

European Review of Aging and Physical Activity ◽

10.1186/s11556-021-00275-9 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Daniel Niederer ◽

Tobias Engeroff ◽

Johannes Fleckenstein ◽

Oliver Vogel ◽

Lutz Vogt

Keyword(s):

Gait Speed ◽

Stride Length ◽

Sociodemographic Characteristics ◽

Specific Situation ◽

Step Width ◽

Moderating Effects ◽

Old Adults ◽

Gait Characteristics ◽

Age Related ◽

History Of

Abstract Background Associations between age, concerns or history of falling, and various gait parameters are evident. Limited research, however, exists on how such variables moderate the age-related decline in gait characteristics. The purpose of the present study was to investigate the moderating effects of concerns of falling (formerly referred to as fear of falling), history of falls & diseases, and sociodemographic characteristics on changes in gait characteristics with increasing age in the elderly. Methods In this individual participant level data re-analysis, data from 198 participants (n = 125 females) from 60 to 94 years of age were analysed (mean 73.9, standard deviation 7.7 years). Dependent variables were major spatiotemporal gait characteristics, assessed using a capacitive force measurement platform (zebris FDM-T). Age (independent variable) and the moderating variables concerns of falling (FES-I), gender/sex, history of falls and fall-related medical records, number of drugs daily taken, and body mass index were used in the statistical analysis. Hierarchical linear mixed moderation models (multilevel analysis) with stepwise (forward) modelling were performed. Results Decreases of gait speed (estimate = −.03, equals a decrease of 0.03 m/s per year of ageing), absolute (− 1.4) and gait speed-normalized (−.52) stride length, step width (−.08), as well as increases in speed normalized cadence (.65) and gait speed variability (.15) are all age-related (each p < .05). Overall and specific situation-related concerns of falling (estimates: −.0012 to −.07) were significant moderators. History of potentially gait- and/or falls-affecting diseases accelerated the age-related decline in gait speed (−.002) and its variability (.03). History of falls was, although non-significant, a relevant moderator (in view of increasing the model fit) for cadence (.058) and gait speed (−.0027). Sociodemographics and anthropometrics showed further moderating effects (sex moderated the ageing effect on stride length, .08; height moderated the effect on the normalised stride length, .26; BMI moderated the effects on step width, .003). . Conclusion Age-related decline in spatiotemporal gait characteristics is moderated by concerns of falling, (non-significantly) by history of falls, significantly by history of diseases, and sociodemographic characteristics in 60–94 years old adults. Knowing the interactive contributions to gait impairments could be helpful for tailoring interventions for the prevention of falls. Trial registration Re-analysis of [21–24].

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Gait Abnormalities and the Risk of Falls in CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13871118 ◽

2019 ◽

Vol 14 (7) ◽

pp. 983-993 ◽

Cited By ~ 6

Author(s):

Jeannie Tran ◽

Emmeline Ayers ◽

Joe Verghese ◽

Matthew K. Abramowitz

Keyword(s):

Older Adults ◽

Gait Speed ◽

Fall Risk ◽

Stride Length ◽

Gait Cycle ◽

Hazard Ratio ◽

Double Support ◽

Lower Egfr ◽

Risk Of Falls ◽

Gait Abnormalities

Background and objectivesOlder adults with CKD are at high risk of falls and disability. It is not known whether gait abnormalities contribute to this risk.Design, setting, participants, & measurementsQuantitative and clinical gait assessments were performed in 330 nondisabled community-dwelling adults aged ≥65 years. CKD was defined as an eGFR <60 ml/min per 1.73 m2. Cox proportional hazards models were created to examine fall risk.ResultsA total of 41% (n=134) of participants had CKD. In addition to slower gait speed, participants with CKD had gait cycle abnormalities including shorter stride length and greater time in the stance and double-support phases. Among people with CKD, lower eGFR was independently associated with the severity of gait cycle abnormalities (per 10 ml/min per 1.73 m2 lower eGFR: 3.6 cm [95% confidence interval (95% CI), 1.4 to 5.8] shorter stride length; 0.7% [95% CI, 0.3 to 1.0] less time in swing phase; 1.1% [95% CI, 0.5 to 1.7] greater time in double-support phase); these abnormalities mediated the association of lower eGFR with slower gait speed. On clinical gait exam, consistent with the quantitative abnormalities, short steps and marked swaying or loss of balance were more common among participants with CKD, yet most had no identifiable gait phenotype. A gait phenotype defined by any of these abnormal signs was associated with higher risk of falls among participants with CKD: compared with people without CKD and without the gait phenotype, the adjusted hazard ratio was 1.72 (95% CI, 1.06 to 2.81) for those with CKD and the phenotype; in comparison, the adjusted hazard ratio was 0.71 (95% CI, 0.40 to 1.25) for people with CKD but without the phenotype (P value for interaction of CKD status and gait phenotype =0.01).ConclusionsCKD in older adults is associated with quantitative gait abnormalities, which clinically manifest in a gait phenotype that is associated with fall risk.

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Improving Sensitivity to Detect Mild Cognitive Impairment: Cognitive Load Dual-Task Gait Speed Assessment

Journal of the International Neuropsychological Society ◽

10.1017/s1355617717000261 ◽

2017 ◽

Vol 23 (6) ◽

pp. 493-501 ◽

Cited By ~ 20

Author(s):

Rebecca K. MacAulay ◽

Mark T. Wagner ◽

Dana Szeles ◽

Nicholas J. Milano

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Load ◽

Dual Task ◽

Gait Speed ◽

Cognitive Task ◽

Executive Attention ◽

Sensitive Measure ◽

Gait Assessment

AbstractObjectives: Longitudinal research indicates that cognitive load dual-task gait assessment is predictive of cognitive decline and thus might provide a sensitive measure to screen for mild cognitive impairment (MCI). However, research among older adults being clinically evaluated for cognitive concerns, a defining feature of MCI, is lacking. The present study investigated the effect of performing a cognitive task on normal walking speed in patients presenting to a memory clinic with cognitive complaints. Methods: Sixty-one patients with a mean age of 68 years underwent comprehensive neuropsychological testing, clinical interview, and gait speed (simple- and dual-task conditions) assessments. Thirty-four of the 61 patients met criteria for MCI. Results: Repeated measure analyses of covariance revealed that greater age and MCI both significantly associated with slower gait speed, ps<.05. Follow-up analysis indicated that the MCI group had significantly slower dual-task gait speed but did not differ in simple-gait speed. Multivariate linear regression across groups found that executive attention performance accounted for 27.4% of the variance in dual-task gait speed beyond relevant demographic and health risk factors. Conclusions: The present study increases the external validity of dual-task gait assessment of MCI. Differences in dual-task gait speed appears to be largely attributable to executive attention processes. These findings have clinical implications as they demonstrate expected patterns of gait-brain behavior relationships in response to a cognitive dual task within a clinically representative population. Cognitive load dual-task gait assessment may provide a cost efficient and sensitive measure to detect older adults at high risk of a dementia disorder. (JINS, 2017, 23, 493–501)

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Task matters: an investigation on the effect of different secondary tasks on dual-task gait in older adults

BMC Geriatrics ◽

10.1186/s12877-021-02464-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hui-Ting Goh ◽

Miranda Pearce ◽

Asha Vas

Keyword(s):

Older Adults ◽

Young Adults ◽

Reaction Time ◽

Dual Task ◽

Gait Speed ◽

Cognitive Task ◽

Cognitive Tasks ◽

Difficulty Level ◽

Secondary Tasks ◽

Task Conditions

Abstract Background Dual-task gait performance declines as humans age, leading to increased fall risk among older adults. It is unclear whether different secondary cognitive tasks mediate age-related decline in dual-task gait. This study aimed to examine how type and difficulty level of the secondary cognitive tasks differentially affect dual-task gait in older adults. Methods Twenty young and twenty older adults participated in this single-session study. We employed four different types of secondary tasks and each consisted of two difficulty levels, yielding eight different dual-task conditions. The dual-task conditions included walking and 1) counting backward by 3 s or by 7 s; 2) remembering a 5-item or 7-item lists; 3) responding to a simple or choice reaction time tasks; 4) generating words from single or alternated categories. Gait speed and cognitive task performance under single- and dual-task conditions were used to compute dual-task cost (DTC, %) with a greater DTC indicating a worse performance. Results A significant three-way interaction was found for the gait speed DTC (p = .04). Increased difficulty in the reaction time task significantly increased gait speed DTC for older adults (p = .01) but not for young adults (p = .90). In contrast, increased difficulty level in the counting backward task significantly increased gait speed DTC for young adults (p = .03) but not for older adults (p = .85). Both groups responded similarly to the increased task difficulty in the other two tasks. Conclusions Older adults demonstrated a different response to dual-task challenges than young adults. Aging might have different impacts on various cognitive domains and result in distinctive dual-task gait interference patterns.

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How Does Explicit Prioritization Alter Walking During Dual-Task Performance? Effects of Age and Sex on Gait Speed and Variability

Physical Therapy ◽

10.2522/ptj.20090043 ◽

2010 ◽

Vol 90 (2) ◽

pp. 177-186 ◽

Cited By ~ 164

Author(s):

Galit Yogev-Seligmann ◽

Yael Rotem-Galili ◽

Anat Mirelman ◽

Ruth Dickstein ◽

Nir Giladi ◽

...

Keyword(s):

Older Adults ◽

Young Adults ◽

Dual Task ◽

Gait Speed ◽

Cognitive Task ◽

Age Groups ◽

Cross Sectional Study ◽

Gait Variability ◽

Cross Sectional ◽

Task Conditions

BackgroundPrevious studies have demonstrated that the performance of a secondary task during walking alters gait.ObjectiveThis study investigated the effects of task prioritization on walking in young and older adults to evaluate the “default” prioritization scheme used, the flexibility to alter prioritization and cortical resources allocated to gait and a secondary cognitive task, and any age-associated changes in these abilities.DesignA cross-sectional study that explicitly altered the focus of attention was used to investigate the effects of prioritization in young and older adults who were healthy.MethodsGait speed and gait variability were evaluated in young adults (n=40) and older adults (n=17) who were healthy, both during usual walking and under 3 dual-task conditions: (1) no specific prioritization instructions, (2) prioritization of gait, and (3) prioritization of the cognitive task.ResultsYoung adults significantly increased gait speed in the gait prioritization condition compared with gait speed in the no-instruction condition; a similar tendency was seen in the older adults. Gait speed was reduced when priority was given to the cognitive task in both age groups; however, this effect was less dramatic in the older adults. In the young adults, prioritization of gait tended to have different effects on gait speed among both men and women. In the older adults, but not in the young adults, all dual-task conditions produced increased gait variability, whereas prioritization did not alter this gait feature.LimitationsThe sample size and the relative homogeneity of the older adults could be considered as possible limitations of the study.ConclusionsEven among young adults, the effects of secondary, cognitive tasks on gait speed are strongly influenced by prioritization. This finding was less significant in the older adults, suggesting that there is an age-associated decline in the ability to flexibly allocate attention to gait. Somewhat surprisingly, when prioritization was not explicitly instructed, gait speed in both young and older adults most closely resembled that of the condition when they were instructed to focus attention on the cognitive task.

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Effects of Gait and Cognitive Task Difficulty on Cognitive-Motor Interference in Aging

Journal of Aging Research ◽

10.1155/2012/583894 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 29

Author(s):

Prudence Plummer-D'Amato ◽

Briana Brancato ◽

Mallory Dantowitz ◽

Stephanie Birken ◽

Christina Bonke ◽

...

Keyword(s):

Older Adults ◽

Dual Task ◽

Gait Speed ◽

Task Difficulty ◽

Cognitive Task ◽

Task Interference ◽

Significant Group ◽

Fast Speed ◽

Task Effects ◽

Dual Task Interference

Although gait-related dual-task interference in aging is well established, the effect of gait and cognitive task difficulty on dual-task interference is poorly understood. The purpose of this study was to examine the effect of gait and cognitive task difficulty on cognitive-motor interference in aging. Fifteen older adults (72.1 years, SD 5.2) and 20 young adults (21.7 years, SD 1.6) performed three walking tasks of varying difficulty (self-selected speed, fast speed, and fast speed with obstacle crossing) under single- and dual-task conditions. The cognitive tasks were the auditory Stroop task and the clock task. There was a significant Group×Gait Task×Cognitive Task interaction for the dual-task effect on gait speed. After adjusting for education, there were no significant effects of gait or cognitive task difficulty on the dual-task effects on cognitive task performance. The results of this study provide evidence that gait task difficulty influences dual-task effects on gait speed, especially in older adults. Moreover, the effects of gait task difficulty on dual-task interference appear to be influenced by the difficulty of the cognitive task. Education is an important factor influencing cognitive-motor interference effects on cognition, but not gait.

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