Making Balance Automatic Again: Using Dual Tasking as an Intervention in Balance Rehabilitation for Older Adults

Abstract The simultaneous performance of a secondary task while walking (i.e., dual tasking) increases motor-cognitive interference and fall risk in older adults. Combining transcranial direct current stimulation (tDCS) with the concurrent performance of a task that putatively involves the same brain networks targeted by the tDCS may reduce the negative impact of dual-tasking on walking. We examined whether tDCS applied while walking reduces the dual-task costs to gait and whether this combination is better than tDCS alone or walking alone (with sham stimulation). In 25 healthy older adults (aged 75.7±10.5yrs), a double-blind, within-subject, cross-over pilot study evaluated the acute after-effects of 20 minutes of tDCS targeting the primary motor cortex and the dorsal lateral pre frontal cortex during three separate sessions:1) tDCS while walking on a treadmill in a virtual-reality environment (tDCS+walking), 2) tDCS while seated (tDCS+seated), and 3) walking in the virtual-reality environment with sham tDCS (sham+walking). The complex walking condition taxed motor and cognitive abilities. During each session, single- and dual-task walking and cognitive function were assessed before and immediately after stimulation. Compared to pre-tDCS performance, tDCS+walking reduced the dual-task cost to gait speed (p=0.004) and other gait features (e.g., variability p=0.02), and improved (p<0.001) executive function (Stroop interference score). tDCS+seated and sham+walking did not affect the dual-task cost to gait speed (p>0.17). These initial findings demonstrate that tDCS delivered during challenging walking ameliorates dual-task gait and executive function in older adults, suggesting that the concurrent performance of related tasks enhances the efficacy of the neural stimulation and mobility.

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Enhancing Physical Activity of Walking and Dual-Tasking among Older Adults Using Personalized Navigation Practice

Extended Abstracts of the 2020 CHI Conference on Human Factors in Computing Systems ◽

10.1145/3334480.3375034 ◽

2020 ◽

Author(s):

Yasmin Felberbaum

Keyword(s):

Physical Activity ◽

Older Adults ◽

Dual Tasking

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Dual-tasking over an extended walking distance is associated with falls among community-dwelling older adults

Clinical Interventions in Aging ◽

10.2147/cia.s77432 ◽

2015 ◽

pp. 643 ◽

Cited By ~ 6

Author(s):

Kenichi Hirashima ◽

Yumi Higuchi ◽

Masakazu Imaoka ◽

Emiko Todo ◽

Tomomi Kitagawa ◽

...

Keyword(s):

Older Adults ◽

Community Dwelling ◽

Walking Distance ◽

Dual Tasking ◽

Community Dwelling Older Adults

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Mild Cognitive Impairment Affects Obstacle Negotiation in Older Adults: Results from “Gait and Brain Study”

Gerontology ◽

10.1159/000492931 ◽

2018 ◽

Vol 65 (2) ◽

pp. 164-173 ◽

Cited By ~ 13

Author(s):

Frederico Pieruccini-Faria ◽

Yanina Sarquis-Adamson ◽

Manuel Montero-Odasso

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Executive Function ◽

Mild Cognitive Impairment ◽

Dual Task ◽

Gait Speed ◽

Step Length ◽

Gait Control ◽

Dual Tasking ◽

Brain 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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Does dual-tasking provide additional value in timed “up and go” test for predicting the occurrence of falls? A longitudinal observation study by age group (young-older or old-older adults)

Aging Clinical and Experimental Research ◽

10.1007/s40520-020-01510-6 ◽

2020 ◽

Cited By ~ 2

Author(s):

Tsuyoshi Asai ◽

Kensuke Oshima ◽

Yoshihiro Fukumoto ◽

Yuri Yonezawa ◽

Asuka Matsuo ◽

...

Keyword(s):

Older Adults ◽

Age Group ◽

Observation Study ◽

Timed Up And Go ◽

Dual Tasking ◽

Longitudinal Observation ◽

Additional Value

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Effects of aging on motor control strategies during bimanual isometric force control

Adaptive Behavior ◽

10.1177/1059712319849896 ◽

2019 ◽

Vol 27 (4) ◽

pp. 267-275

Author(s):

Yan Jin ◽

JiWon Seong ◽

YoungChae Cho ◽

BumChul Yoon

Keyword(s):

Older Adults ◽

Motor Control ◽

Control Strategy ◽

Force Control ◽

Isometric Force ◽

Control Strategies ◽

Force Variability ◽

Dual Tasking ◽

Effects Of Aging ◽

Force Accuracy

Aging-induced degeneration of the neuromuscular system would result in deteriorated complex muscle force coordination and difficulty in executing daily activities that require both hands. The aim of this study was to provide a basic description of how aging and dual-task activity would affect the motor control strategy during bimanual isometric force control in healthy adults. In total, 17 young adults (aged 25.1 ± 2.4 years) and 14 older adults (aged 72.6 ± 3.4 years) participated in the study. The subjects were instructed to press both hands simultaneously to match the 1 Hz sine curve force under two conditions (with or without calculation) with continuous visual feedback. Differences in bimanual motor synergy, bimanual coordination, force accuracy, force variability, and calculation speed were compared. This study found that the specific motor control strategy of older adults involved a decreased bimanual force control ability with both increased VUCM and VORT, and was not influenced by dual tasking. These findings might have implications for establishing interventions for aging-induced hand force control deficits.

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Screening older adults for amnestic mild cognitive impairment and early-stage Alzheimer’s disease using upper-extremity dual-tasking

Scientific Reports ◽

10.1038/s41598-019-46925-y ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Nima Toosizadeh ◽

Hossein Ehsani ◽

Christopher Wendel ◽

Edward Zamrini ◽

Kathy O’ Connor ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Older Adults ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Upper Extremity ◽

Early Stage ◽

Amnestic Mild Cognitive Impairment ◽

Dual Tasking

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Clinical Markers of the Intensity of Balance Challenge: Observational Study of Older Adult Responses to Balance Tasks

Physical Therapy ◽

10.2522/ptj.20140524 ◽

2016 ◽

Vol 96 (3) ◽

pp. 313-323 ◽

Cited By ~ 5

Author(s):

Melanie K. Farlie ◽

Elizabeth Molloy ◽

Jennifer L. Keating ◽

Terry P. Haines

Keyword(s):

Older Adults ◽

Observational Study ◽

High Intensity ◽

Task Difficulty ◽

Exercise Prescription ◽

Interpretive Description ◽

Clinical Markers ◽

Postural Reactions ◽

Balance Exercise ◽

Balance Rehabilitation

BackgroundEffective balance rehabilitation is critically important to the aging population. Optimal exercise prescription for balance rehabilitation has not been described, as there is no measure of balance exercise intensity. To rate the intensity of balance exercise, an item set is required.ObjectivesThe aim of this study was to explore verbal and nonverbal markers that differentiated tasks of high, medium, and low balance intensity to inform the development of an instrument to measure the intensity of balance challenge.DesignThis was an observational study utilizing an interpretive description approach.MethodsTwenty older adults were observed performing 3 balance tasks that challenged balance at low to high intensity. Verbal and nonverbal responses were recorded. After each task, participants were asked to describe the test experience. Data were analyzed to identify potential markers of balance challenge intensity.ResultsMarkers of the intensity of balance challenge were grouped by time periods defined as pretask, in-task, and posttask. A key pretask finding was an increased delay to task commencement with increased task difficulty. Commencement delay was accompanied by talk in 19 of 21 instances. Physical markers of the intensity of balance challenge were grouped into 3 categories—bracing, postural reactions, and sway—and were increasingly observed as intensity of balance challenge increased. Participants described tasks as pushing them toward the limits of their balancing capacity as the intensity of balance challenge increased.ConclusionsVerbal and nonverbal markers of the intensity of balance challenge in older adults performing balance tasks that differentiated high-intensity tasks from medium- to low-intensity tasks were identified. The pretask phase of balance exercise performance is an important diagnostic space, rich in verbal and nonverbal markers.

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