Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study Mental Fatigue Increases Gait Variability During Dual-task Walking in Old Adults Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Dual-task performances can be improved in patients with dementia Does Change in Gait while Counting Backward Predict the Occurrence of a First Fall in Older Adults? Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial Effects of Physical-Cognitive Dual Task Training on Executive Function and Gait Performance in Older Adults: A Randomized Controlled Trial Evidence for motor learning in Parkinson's disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation.
Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov Background Reliability of quantitative gait assessment while dual-tasking ( walking while doing a secondary task such as talking ) in people with cognitive impairment is unknown . Dual-tasking gait assessment is becoming highly important for mobility research with older adults since better reflects their performance in the basic activities of daily living . Our purpose was to establish the test-retest reliability of assessing quantitative gait variables using an electronic walkway in older adults with mild cognitive impairment ( MCI ) under single and dual-task conditions . Methods The gait performance of 11 elderly individuals with MCI was evaluated using an  electronic walkway ( GAITRite ® System ) in two sessions , one week apart . Six gait parameters ( gait velocity , step length , stride length , step time , stride time , and double support time ) were assessed under two conditions : single-task ( sG : usual walking ) and dual-task ( dG : counting backwards from 100 while walking ) . Test-retest reliability was determined using intra-class correlation coefficient ( ICC ) . Gait variability was measured using coefficient of variation ( CoV ) . Results Eleven participants ( average age = 76.6 years , SD = 7.3 ) were assessed . They were high functioning ( Clinical Dementia Rating Score = 0.5 ) with a mean Mini-Mental Status Exam ( MMSE ) score of 28 ( SD = 1.56 ) , and a mean Montreal Cognitive Assessment ( MoCA ) score of 22.8 ( SD = 1.23 ) . Under dual-task conditions , mean gait velocity ( GV ) decreased significantly ( sGV = 119.11 ± 20.20 cm/s ; dGV = 110.88 ± 19.76 cm/s ; p = 0.005 ) . Additionally , under dual-task conditions , higher gait variability was found on stride time , step time , and double support time . Test-retest reliability was high ( ICC>0.85 ) for the six parameters evaluated under both conditions . Conclusion In older people with MCI  , variability of time-related gait parameters increased with dual-tasking suggesting cognitive control of gait performance . Assessment of quantitative gait variables using an electronic walkway is highly reliable under single and dual-task conditions . The presence of cognitive impairment did not preclude performance of dual-tasking in our sample supporting that this methodology can be reliably used in cognitive impaired older individuals Background Mental fatigue is a psychobiological state induced by sustained periods of dem and ing cognitive activity and is characterized by feelings of tiredness which are common in everyday life . Recently , it has been hypothesized that mental fatigue might have an impact on gait performance in old adults . Therefore , the effect of mental fatigue on gait performance under single- and dual-task conditions was investigated in young and old participants . Methods Spatio-temporal gait parameters of 16 young and 16 old healthy participants were measured using a photoelectric system during single- and dual-task walking before and after a r and omly assigned mental fatigue ( performing a stop-signal task for 90 minutes ) and control intervention ( watching a video for 90 minutes ) , respectively . Changes in subjective fatigue , wakefulness , mood , arousal , and psychophysiological workload ( heart rate variability indices ) were assessed . Results Psychometric measures indicated increased subjective fatigue and arousal as well as decreased mood and wakefulness after the mental fatigue task . Heart rate variability indices revealed a higher psychophysiological workload during the mental fatigue intervention in old compared to young participants . Gait measures ( coefficient of variation of speed , stride length , and stance time ) revealed impaired dual-task walking performance following the mental fatigue intervention only in old participants . Conclusion Data indicate that mental fatigue , induced by sustained cognitive activity , can impair gait performance during dual-task walking in old adults . The susceptibility to mental fatigue could be a new intrinsic risk factor for falls in older people and should be taken into account when dual-task gait analyses are performed OBJECTIVE To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment . DESIGN A double-blind , r and omized controlled trial . SETTING University research laboratory . PARTICIPANTS Older adults ( N=23 ) with balance impairment ( mean age , 74.8y ) . They scored 52 or less on the Berg Balance Scale ( BBS )  and /or walked with a self-selected gait speed of 1.1 m/s or less . INTERVENTIONS Participants were r and omly assigned to 1 of 3 interventions : single-task training , dual-task training with fixed-priority instructions , and dual-task training with variable-priority instructions . Participants received 45-minute individualized training sessions , 3 times a week for 4 weeks . MAIN OUTCOME MEASURES Gait speed under single-task and dual-task conditions was obtained at baseline , the second week , the end of training , and the twelfth week after the end of training . Other measures , including the BBS and the Activities-specific Balance Confidence ( ABC ) Scale , were collected at baseline and after training . RESULTS Participants in all groups improved on the BBS ( P<.001 ; effect size [ES]=.72 ) , and walked significantly faster after training ( P=.02 ; ES=.27 ) . When a cognitive task was added , however , only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed ( P<.001 , ES=.57 ; and P<.001 , ES=.46 , respectively ) . In addition , only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up . Only the single-task training group showed a significant increase on the ABC after training ( P<.001 ; ES=.61 ) . CONCLUSIONS Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment . Training balance under single-task conditions may not generalize to balance control during dual-task context s. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect Background : Deficits in attention-related cognitive performance measured as dual-task performance represent early markers of dementia and are associated with motor deficits and increased risk of falling . The purpose of this study was to examine the effect of a specific dual-task training in patients with mild to moderate dementia . Methods : Sixty-one geriatric patients with confirmed dementia took part in a 12-week r and omized , controlled trial . Subjects in the intervention group ( IG ) underwent dual-task – based exercise training . The control group ( CG ) performed unspecific low-intensity exercise .  Motor performance ( gait speed , cadence , stride length , stride time , single support ) and cognitive performance ( serial 2 forward calculation [ S2 ] , serial 3 backward calculation [ S3 ] ) were examined as single and dual tasks . Decrease in performance during dual tasks compared to single task expressed as motor , cognitive , and combined motor/cognitive dual-task cost ( DTC ) was calculated before and after intervention . Primary outcome was defined as DTC for gait speed under complex S3 conditions . Results : Specific training significantly improved dual-task performance under complex S3 conditions compared to the CG ( reduction of DTC : gait speed 21.7 % IG , 2.6 % CG , p < 0.001 ; other gait variables : 8.7 % to 41.1 % IG , −0.9 % to 8.1 % CG , p ≤ 0.001 to 0.056 ; combined motor/cognitive : 20.6 % IG , 2.2 % CG , p = 0.026 ) . No significant effects were found under less challenging dual-task S2 conditions or for cognitive dual-task S3 performance . Conclusions : The specific exercise program was effective to improve dual-task performance in patients with dementia . Classification of evidence : This study provides Class II evidence that specific dual-task training  improves dual-task performance during walking under complex S3 conditions in geriatric patients with mild to moderate dementia Background : Dual-task-based assessment tests failed to establish a dependable relationship between dual-task-related gait changes and the risk of falls in the elderly . Objective : The aim of this study was to examine whether changes in gait while counting backward could be associated with the occurrence of a  first fall among older adults . Methods : Walking while counting backward was investigated prospect ively in a cohort of 187 older adults living independently in senior housing facilities . During enrollment , walking time , number of steps , and frequency of lateral line stepping-over and stops were measured while walking only and while walking with backward counting aloud . Information on the incident falls during the follow-up year was collected monthly . Results : Walking time and the number of steps increased significantly under the dual-task condition compared to the single-task condition among fallers and non-fallers ( p < 0.001 ) . Compared to non-fallers , fallers had significantly lower scores in the Mini-Mental State Examination ( p = 0.029 ) and higher scores in the 15-item Geriatric Depression Scale ( p = 0.003 ) and Timed Up & Go Test ( p = 0.006 ) and increased walking time under both walking conditions ( p = 0.030 for single-task condition and p = 0.007 for dual-task condition ) . After adjusting for these variables , depressive symptoms ( adjusted OR = 2.6 with p = 0.041 and adjusted OR = 2.5 with p = 0.045 when walking time while walking only and walking with backward counting is considered , respectively ) and walking time while walking only ( OR = 2.3 with p = 0.032 ) were significantly associated with falls . Conclusion : Dual-task-related gait changes were poorly associated with the occurrence of a first fall and provided no additional predictive value compared to gait performance under a single task , suggesting that changes in basic clinical gait parameters while counting backward are unsuccessful to predict the first fall among older adults This study examined transfer effects of fall training on fear of falling ( Falls Efficacy Scale-International [ FES-I ] ) , balance performance , and spatiotemporal gait characteristics in older adults . Eighteen community-dwelling older adults ( ages 65 - 85 ) were r and omly assigned to an intervention or control group . The intervention group completed 12 training sessions ( 60 min , 6 weeks ) . During pre- and posttesting , we measured FES-I , balance performance ( double limb , closed eyes ; single limb , open eyes ; double limb , open eyes with motor-interfered task ) , and gait parameters ( e.g. , velocity ; cadence ; stride time , stride width , and stride length ; variability of stride time and stride length ) under single- and motor-interfered tasks . Dual tasks were applied to appraise improvements of cognitive processing during balance and gait . FES-I ( p = .33 ) and postural sway did not significantly change ( 0.36 < p < .79 ) . Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task ( p = .05 , ηp 2 = .22 ) . Fall training did not sufficiently improve fear of falling , balance , or gait performance under single- or dual-task conditions in healthy older adults Objective : To evaluate the effects of a balance training program including dual- and multi-task exercises on fall-related self-efficacy , fear of falling , gait and balance performance , and physical function in older adults with osteoporosis with an increased risk of falling and to evaluate whether additional physical activity would further improve the effects . Design : R and omized controlled trial , including three groups : two intervention groups ( Training , or Training+Physical activity ) and one Control group , with a 12-week follow-up . Setting : Stockholm County , Sweden . Participants : Ninety-six older adults , aged 66 - 87 , with verified osteoporosis . Interventions : A specific and progressive balance training program including dual- and multi-task three times/week for 12 weeks , and physical activity for 30 minutes , three times/week . Main measures : Fall-related self-efficacy ( Falls Efficacy Scale-International ) , fear of falling ( single-item question – ‘ In general , are you afraid of falling ? ’ ) , gait speed with and without a cognitive dual-task at preferred pace and fast walking ( GAITRite ® ) , balance performance tests ( one-leg stance , and modified figure of eight ) , and physical function ( Late-Life Function and Disability Instrument ) . Results : Both intervention groups significantly improved their fall-related self-efficacy as compared to the controls ( p ≤ 0.034 , 4 points ) and improved their balance performance . Significant differences over time and between groups in favour of the intervention groups were found for walking speed with a dual-task ( p=0.003 ) , at fast walking speed ( p=0.008 ) , and for advanced lower extremity physical function ( p=0.034 ) . Conclusions : This balance training program , including dual- and multi-task , improves fall-related self-efficacy , gait speed , balance performance , and physical function in older adults with osteoporosis Physical and cognitive training seem to counteract age-related decline in physical and mental function . Recently , the possibility of integrating cognitive dem and s into physical training has attracted attention . The purpose of this study was to evaluate the effects of twelve weeks of design ed physical-cognitive training on executive cognitive function and gait performance in older adults . Thirty-six healthy , active individuals aged 72.30 ± 5.84 years were assigned to two types of physical training with major focus on physical single task ( ST ) training ( n = 16 ) and physical-cognitive dual task ( DT ) training ( n = 20 ) , respectively . They were tested before and after the intervention for executive function ( inhibition , working memory ) through R and om Number Generation and for gait ( walking with/without negotiating hurdles ) under both single and dual task ( ST , DT ) conditions . Gait performance improved in both groups , while inhibitory performance decreased after exercise training with ST focus but tended to increase after training with physical-cognitive DT focus . Changes in inhibition performance were correlated with changes in DT walking performance with group differences as a function of motor task complexity ( with/without hurdling ) . The study supports the effectiveness of group exercise classes for older individuals to improve gait performance  , with physical-cognitive DT training selectively counteracting the age-related decline in a core executive function essential for daily living People with Parkinson 's disease ( PD ) have difficulty learning new motor skills . Evidence suggests external stimuli ( cues ) may enhance learning ; however , this may be specific to cued rather than non-cued performance . We aim ed to test effects of cued training on motor learning in PD . We defined motor learning as acquisition ( single task ) , automaticity ( dual task ) and retention of single- and dual-task performance ( follow-up ) . 153 subjects with PD received 3 weeks cued gait training as part of a r and omised trial ( the RESCUE trial ) . We measured changes in  cued gait performance  with three external rhythmical cues ( ERC ) ( auditory , visual and somatosensory ) during single and dual tasks after training and 6 weeks follow-up . Gait was tested without cues to compare specificity of learning ( transfer ) . Subjects were ' on ' medication and were cued at preferred step frequency during assessment . Accelerometers recorded gait and walking speed , step length and step frequency were determined from raw data . Data were analysed with SAS using linear regression models . Walking speed and step length significantly increased with all cues after training during both single- and dual-task gait and these effects were retained . Training effects were not specific to cued gait and were observed in dual-task step length , and walking speed however was more limited in single-task non-cued gait . These results support the use of ERC to enhance motor learning in PD as defined by increased acquisition , automaticity and retention . They also highlight the potential for sustained improvement in walking and complex task performance The present study highlights the effects of the dual-task cognitive-gait intervention ( CGI ) on working memory and gait functions in older adults with a history of falls . Thirteen older adults with a history of falls were recruited from local community centers and r and omly stratified into either the control ( n = 5 ) or experimental ( n = 8) group . The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor ( walking ) and cognitive ( memory recall ) task whereas the control group received a placebo treatment ( walking with simple music ) . The intervention was provided 30 minutes per session , over a 6-week period . Memory measures included a combination of word recall and arithmetic task . Gait function measures included velocity and center of pressure ( COP ) stability . Non-parametric tests were used at p < 0.05 . The experimental group showed a greater memory performance than the control ( p < 0.05 ) . However , no significant intervention-related changes in gait velocity and stability were observed . Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition
Gait speed significantly reduced with the addition of a dual task , with increasing complexity showing greater decrements .
Cadence , stride time , and measures of gait variability were all negatively affected under the dual-task condition .
In older adults , the addition of a dual task significantly reduces gait speed and cadence , with possible implication s for the assessment of older people , as the addition of a dual task may expose deficits not observed under single-task assessment
This review examines the effect of a dual task on the gait parameters of older adults with a mean gait speed of 1.0 m/s or greater , and the effect of type and complexity of task .