The effect of divided attention on gait stability following concussion. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial Balance performance with a cognitive task: a dual-task testing paradigm. Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Review article: Methodology for the ‘rapid review’ series on musculoskeletal injuries in the emergency department Prevalence of neurocognitive and balance deficits in collegiate aged football players without clinically diagnosed concussion.
BACKGROUND The need to identify functional impairment following a brain injury is critical to prevent re-injury during the period of recovery . While many neuropsychological tests have been developed to assess cognitive performance , relatively little information on gait and dynamic stability is available on motor task performance for young adults following concussion . This study was performed to investigate the effect of divided attention following concussion on various gait variables . It was hypothesized that , when compared to uninjured controls , concussed subjects would demonstrate deficits in maintenance of dynamic stability . METHODS Ten subjects with Grade 2 concussion completed testing within 48 h of injury as well as 10 age- , height- , weight- , and activity-matched controls . The gait protocol consisted of level walking under two conditions : ( 1 ) undivided attention ( single-task ) and ( 2 ) while simultaneously completing simple mental tasks ( dual-task ) . Whole-body motion data were collected using a six-camera motion analysis system . A 13-segment biomechanical model was used to compute whole body center of mass motion and velocity . FINDINGS Walking with a concurrent cognitive task result ed in significant changes in gait and center of mass measurements for both groups . Concussed subjects were found to be able to conservatively adjust their whole body center of mass motion to maintain dynamic stability while walking without divided attention . However , while walking with divided attention , subjects with concussion demonstrated a significantly greater medio-lateral center of mass sway . INTERPRETATION These data suggest that the ability to control and maintain stability in the frontal plane during walking is diminished under divided attention in individuals following a concussion Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment Background Exercise interventions often do not combine physical and cognitive training . However , this combination is assumed to be more beneficial in improving walking and cognitive functioning compared to isolated cognitive or physical training . Methods A multicenter parallel r and omized controlled trial was conducted to compare a motor to a cognitive-motor exercise program .  A total of 182 eligible residents of homes-for-the-aged ( n = 159 ) or elderly living in the vicinity of the homes ( n = 23 ) were r and omly assigned to either strength-balance ( SB ) or strength-balance-cognitive ( SBC ) training . Both groups conducted similar strength-balance training during 12 weeks . SBC additionally absolved computerized cognitive training . Outcomes were dual task costs of walking , physical performance , simple reaction time , executive functions , divided attention , fear of falling and fall rate . Participants were analysed with an intention to treat approach . Results The 182 participants ( mean age ± SD : 81.5 ± 7.3 years ) were allocated to either SB ( n = 98 ) or SBC ( n = 84 ) . The attrition rate was 14.3 % . Interaction effects were observed for dual task costs of step length ( preferred walking speed : F(1,174 ) = 4.94 , p = 0.028 , η2 = 0.027 , fast walking speed : F(1,166 ) = 6.14 , p = 0.009 , η2 = 0.040 ) and dual task costs of the st and ard deviation of step length ( F(1,166 ) = 6.14 , p = 0.014 , η2 = 0.036 ) , in favor of SBC . Significant interactions in favor of SBC revealed for in gait initiation ( F(1,166 ) = 9.16 , p = 0.003 , η2 = 0.052 ) , ‘ reaction time ’ ( F(1,180 ) = 5.243 , p = 0.023 , η2 = 0.028 ) & ‘ missed answers ’ ( F(1,180 ) = 11.839 , p = 0.001 , η2 = 0.062 ) as part of the test for divided attention . Within-group comparison revealed significant improvements in dual task costs of walking ( preferred speed ; velocity ( p = 0.002 ) , step time ( p = 0.018 ) , step length ( p = 0.028 ) , fast speed ; velocity ( p < 0.001 ) , step time ( p = 0.035 ) , step length ( p = 0.001 ) ) , simple reaction time ( p < 0.001 ) , executive functioning ( Trail making test B ; p < 0.001 ) , divided attention ( p < 0.001 ) , fear of falling ( p < 0.001 ) , and fall rate ( p < 0.001 ) . Conclusions Combining strength-balance training with specific cognitive training has a positive additional effect on dual task costs of walking , gait initiation , and divided attention . The findings further confirm previous research showing that strength-balance training improves executive functions and reduces falls . Trial registration This trial has been registered under IS RCT PURPOSE Athletic performance dem and s simultaneous use of cognitive and postural control capabilities . Decrements to both systems have been observed following concussion . This study evaluated a dual-task methodology to establish the tenability of using this testing model in concussed athletes . METHODS Nonconcussed subjects were assessed over 2 d. Subjects were introduced to the task-switching cognitive assessment test and a NeuroCom Smart Balance Master postural control assessment protocol on day 1 . In the following session , subjects were evaluated on  postural control and cognitive function tests independently ( single task ) , and then concurrently ( dual task ) . RESULTS Significant improvements were seen in three of the four balance conditions and in three of the four reaction times when the cognitive and balance task were performed simultaneously ( P<0.05 ) . No significant balance by cognitive task interaction was revealed ( P>0.05 ) ; however , significant differences existed in reaction time based on stimulus position and increasing balance dem and s ( P<0.05 ) . CONCLUSION Combining the cognitive and balance assessment s result ed in healthy subjects showing improved performance when compared with individual task performance . The dual-task methodology brought about systematic changes to reaction time in relation to increasing balance dem and s. The ability of this protocol to detect changes in postural control or cognitive function following concussive injury requires further study During aging , the prefrontal cortex ( PFC ) undergoes age-dependent neuronal changes influencing cognitive and motor functions . Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults . Especially , video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults . The aim of this study was to compare conventional balance training with video game-based physical exercise , a so-called exergame , on the relative power ( RP ) of electroencephalographic ( EEG ) frequencies over the PFC , executive function ( EF ) , and gait performance .  Twenty-seven participants ( mean age 79.2 ± 7.3 years ) were r and omly assigned to one of two groups . All participants completed 24 trainings including three times a 30 min session/week . The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [ L(14 ) = 6.23 , p = 0.007 ] . Comparing pre- vs. post-test , EFs improved both within the exergame ( working memory : z = −2.28 , p = 0.021 ; divided attention auditory : z = −2.51 , p = 0.009 ; divided attention visual : z = −2.06 , p = 0.040 ; go/no-go : z = −2.55 , p = 0.008 ; set-shifting : z = −2.90 , p = 0.002 ) and within the balance group ( set-shifting : z = −2.04 , p = 0.042 ) . Moreover , spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions ( speed normal walking : z = −2.90 , p = 0.002 ; speed fast walking : z = −2.97 , p = 0.001 ; cadence normal walking : z = −2.97 , p = 0.001 ; stride length fast walking : z = −2.69 , p = 0.005 ) and within the balance group under single-task conditions ( speed normal walking : z = −2.54 , p = 0.009 ; speed fast walking : z = −1.98 , p = 0.049 ; cadence normal walking : z = −2.79 , p = 0.003 ) . These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and /or function in varying proportion Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Musculoskeletal injuries are a common presentation to the ED , with significant costs involved in the management of these injuries , variances in care within the ED and associated morbidity . A series of rapid review papers were completed to guide best practice for the assessment and management of common musculoskeletal injuries presenting to the ED . This paper presents the methodology used across the rapid review s. PubMed , CINAHL , EMBASE , TRIP and the grey literature , including relevant organisational websites , were search ed in 2015 . The search was repeated consistently for each topic area ( injuries of the foot and ankle , knee , h and and wrist , elbow , shoulder , lumbar spine and cervical spine ) . English- language primary studies , systematic review s and guidelines that were published in the last 10 years and addressed acute musculoskeletal injury management were considered for inclusion . Data extraction of each included article was conducted , followed by a quality appraisal . The extracted data from each article was synthesis ed to group similar evidence together . For each rapid review , the evidence has been organised in a way that a clinician can direct their attention to a specific component of the clinical cycle of care in the ED , such as the assessment , diagnostic tests , management and follow-up considerations from ED . The series of rapid review s are design ed to foster evidence -based practice within the ED , targeting the injuries most commonly presenting . The review s provide clinicians in EDs with rapid access to the best current evidence , which has been synthesis ed and organised to assist decision-making STUDY DESIGN Prospect i ve cohort . OBJECTIVES To identify the prevalence of neurocognitive and balance deficits in collegiate football players 48 hours following competition . BACKGROUND Neurocognitive testing , balance assessment s , and subjective report of symptoms are a commonly used test battery in examining athletes when concussion is suspected . Previous literature suggests many concussions go unreported . Little research exists examining the prevalence of neurocognitive or balance deficits in athletes who do not report concussion-like symptoms to a health care provider . METHODS Forty-five Division IA collegiate football players participated in this study . Preseason baseline scores using the  Balance Error Scoring System , the Immediate Post-Concussion Assessment and Cognitive Testing , and the Postconcussion Symptom Scale  were compared to posttest results obtained 48 hours following a game . Prevalence of symptoms was analyzed and reported . RESULTS Thirty-two ( 71 % ) of the 45 athletes tested demonstrated at least 1 deficit in either the Postconcussion Symptom Scale , Balance Error Scoring System , or at least 1 composite score of the Immediate Post-Concussion Assessment and Cognitive Testing . Nineteen of the 32 subjects demonstrated a change in 2 or more categories of neurocognitive and balance function . CONCLUSION In a cohort of football players tested 48 hours following their last game of the season , who did not seek medical attention related to a concussion , a significant number demonstrated limitations in neurocognitive and balance performance , suggesting that further research may need to be performed to improve recognition of an athlete 's deficits and to improve the ability to assess concussion . LEVEL OF EVIDENCE Differential diagnosis/symptom prevalence , level 3b
Response times are greater , gait strategies are less efficient , and postural control deficits are greater in concussed participants compared with healthy controls both immediately and for some period following concussive injury , specifically under divided attention conditions .
Dual task assessment s in some cases were more reliable than single task assessment s and may be better able to detect lingering effects following concussion .
This article is a systematic review of the literature on divided attention assessment inclusive of a cognitive and motor task ( balance or gait ) for use in concussion management .