A narrative review of texting as a visually-dependent cognitive-motor secondary task during locomotion

Feasibility, criterion and construct convergent validity of the 2-minute walk test and the 10-meter walk test in an oncological context

Objective

To examine the feasibility, the criterion, and the construct convergent validity of the 2-Minute Walk Test (2MWT) and the 10-Meter Walk Test (10MeWT) against the 6-Minute Walk Test (6MWT) to assess walking capacity in people with cancer. The criterion concurrent validity of a self-test version of the 10MeWT (10MeWTself-test) was also evaluated against the 10MeWT.

Methods

Fifty-six people with cancer performed the 2MWT, the 10MeWT at comfortable and fast speeds, the 6MWT, and the 10MeWTself-test. The feasibility of the tests was assessed using safety, adverse events, space requirements, time taken to administer and interpret the tool, equipment or training required, cost, and portability as criteria. Validity was assessed using Pearson correlation coefficients and Bland Altman plots.

Results

The 2MWT, 6MWT, 10MeWT, and 10MeWTself-test were feasible for people with cancer. The 2MWT and the 10MeWT results were moderately to strongly correlated with the 6MWT results (0.61 < r < 0.84, p < 0.001). The 10MeWTself-test results were strongly correlated with the 10MeWT results at comfortable and fast speeds (r = 0.99, p < 0.001).

Conclusions

The 2MWT, 10MeWT, and 10MeWTself-test are simple, rapid, and feasible tests for use in people with cancer. The strong correlation between the 2MWT and 6MWT results indicates that the 2MWT can be used as an alternative walking capacity assessment tool. The 10MeWT results moderately correlated with those of the other two tests, suggesting that it partially measures the same construct of walking capacity in walking-independent outpatients with cancer. The 10MeWTself-test showed promising results but needs further investigations in ecological settings.

Impact of Using Smartphone While Walking or Standing: A Study Focused on Age and Cognition

BACKGROUND

Using smartphones during a task that requires upright posture is suggested to be detrimental for the overall motor performance. The aim of this study was to determine the role of age and specific aspects of cognitive function on walking and standing tasks in the presence of smartphone use.

METHODS

51 older (36 women) and 50 young (35 women), mean age: 66.5 ± 6.3 and 22.3 ± 1.7 years, respectively, were enrolled in this study. The impact of using a smartphone was assessed during a dynamic (timed up and go, TUG) and a static balance test (performed on a force platform). Multivariate analyses of variance were applied to verify main effects of age, task, estimates of cognitive function and interactions.

RESULTS

Compared to young, older individuals exhibited a poorer performance on the dynamic and on the static test (age effect: p = 0.001 for both variables). Dual-tasking with a smartphone had a negative impact on both groups (task effect: p = 0.001 for both variables). The negative impact, however, was greater in the older group (age × task effect: p = 0.001 for both variables). Executive function and verbal fluency partially explained results of the dynamic and static tests, respectively.

CONCLUSIONS

The negative impact of using a smartphone while performing tasks similar to daily activities is higher in older compared to young people. Subclinical deficits in distinct aspects of cognitive function partially explain the decreased performance when dual-tasking.

The effect of mobile phone task and age on gait: A systematic review and meta-analysis

Objective: Mobile phone usage while performing postural-locomotor tasks is everyday activity across persons of all ages in various environmental contexts and health conditions. However, it is also an important factor contributing to accidents. To lower the risk of pedestrian accidents, this meta-analysis aimed to examine how mobile phones affect pedestrian gait and identify how mobile phone tasks and participant age affect gait differently.

Methods: Electronic database searches were performed in The Cochrane Library, PubMed, and Medline. Two examiners evaluated the eligibility and quality of included studies using the Downs and Black checklist. The mean differences (MD) or standardized mean differences (SMD) were calculated for each outcome. Subgroup analyses were used to compare the differential effects of mobile phone task and participant age on gait.

Results: Among 22 eligible studies, 592 participants in 10 countries were analyzed in this meta-analysis. The overall meta-analysis showed that using a mobile phone significantly decreased pedestrian gait velocity (SMD = −1.45; 95% CI: −1.66 to −1.24; p &lt; 0.00001; I2 = 66%), step length (SMD = −1.01; 95% CI: −1.43 to −0.59; p &lt; 0.00001; I2 = 82%), and stride length (SMD = −0.9; 95% CI: −1.19 to −0.60; p &lt; 0.00001; I2 = 79%), significantly increased pedestrian step time (SMD = 0.77; 95% CI: 0.45 to 1.08; p &lt; 0.00001; I2 = 78%), stride time (SMD = 0.87; 95% CI: 0.69 to 1.06; p &lt; 0.00001; I2 = 24%), step width (SMD = 0.79; 95% CI: 0.34 to 1.24; p = 0.0006. I2 = 75%), double support time (SMD = 1.09; 95% CI: 0.86 to 1.31; p &lt; 0.00001; I2 = 42%), and double support (%gait cycle, %GC) (MD = 2.32; 95% CI: 1.75 to 2.88; p &lt; 0.00001; I2 = 26%).

Conclusion: In summary, the effects of mobile phone tasks and participant age on gait were inconsistent. Our study found that resource-intensive tasks (texting and reading) significantly reduced gait velocity, and step time; however, small resource-intensive tasks (calling, talking, and dialing) did not affect these outcomes. In contrast to young adults, step length and step time were not affected by mobile phone use in older adults. Tips: Pedestrians should consider using a mobile phone in their daily lives according to the application scenarios (walking environment, the complexity of mobile phone tasks, pedestrians’ task processing abilities, etc.) as appropriate to avoid dangerous accidents.

Systematic Review Registration: identifier CRD42022358963.

Dual-tasking interference is exacerbated outdoors: A pilot study

Introduction

Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments.

Methods

Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments.

Results

While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008).

Discussion

Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.

Designing Mobile Health Applications to Support Walking for Older Adults

Physical activity is extremely important at an older age and has major benefits. There is a range of applications that help maintain physical activity. However, their adoption among older adults is still limited. The purpose of the study is to explore the key aspects of the design of mobile applications that support walking for older adults. We conducted a field study with older adults, aged 69-79 years, using a technology probe (a mobile application developed as an early prototype) with the purpose of eliciting requirements for mobile health applications. We interviewed the participants during and after the study period, asking them about their motivation for walking, usage of the application, and overall preferences when using such technologies. The findings suggest that mobile applications that support walking should address a range of walking variables, support a long-term learning process, and enable the user to take control and responsibility for the walk. In addition, we provide design guidelines concerning the motivation for walking and the data visualization that would make technology adoption easier. The findings from this study can be used to inform the design of more usable products for older users.

How Reliable and Valid are Dual-Task Cost Metrics? A Meta-analysis of Locomotor-Cognitive Dual-Task Paradigms

OBJECTIVE

To assess the retest reliability, predictive validity, and concurrent validity of locomotor and cognitive dual-task cost (DTC) metrics derived from locomotor-cognitive dual-task paradigms.

DATA SOURCES

A literature search of electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, and Scopus) was conducted on May 29th, 2021, without time restriction.

STUDY SELECTION

For 1559 search results, titles and abstracts were screened by a single reviewer and full text of potentially eligible papers was considered by 2 independent reviewers. 25 studies that evaluated retest reliability, predictive validity, and concurrent validity of locomotor-cognitive DTC in healthy and clinical groups met inclusion criteria.

DATA EXTRACTION

Study quality was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instrument checklist. Data relating to the retest reliability, predictive validity, and concurrent validity of DTC were extracted.

DATA SYNTHESIS

Meta-analysis showed that locomotor DTC metrics (intraclass correlation coefficient [ICC]=0.61, 95% confidence interval [CI; 0.53.0.70]) had better retest reliability than cognitive DTC metrics (ICC=0.27, 95% CI [0.17.0.36]). Larger retest reliability estimates were found for temporal gait outcomes (ICC=0.67-0.72) compared with spatial (ICC=0.34-0.53). Motor DTC metrics showed weak predictive validity for the incidence of future falls (r=0.14, 95% CI [-0.03.0.31]). Motor DTC metrics had weak concurrent validity with other clinical and performance assessments (r=0.11, 95% CI [0.07.0.16]), as did cognitive DTC metrics (r=0.19, 95% CI [0.08.0.30]).

CONCLUSIONS

Gait-related temporal DTC metrics achieve adequate retest reliability, while predictive and concurrent validity of DTC needs to be improved before being used widely in clinical practice and other applied settings. Future research should ensure the reliability and validity of DTC outcomes before being used to assess dual-task interference.

Does texting while walking affect spatiotemporal gait parameters in healthy adults, older people, and persons with motor or cognitive disorders? A systematic review and meta-analysis

BACKGROUND

Smartphone use during postural-locomotor tasks is an everyday activity for individuals of all ages in diverse environmental situations and with various health conditions. Nevertheless, the use of smartphones during walking is responsible for many accidents.

RESEARCH QUESTION

This systematic review and meta-analysis examined spatiotemporal gait parameters during the dual-task situation "texting + gait" versus isolated gait task (single task) in adult persons (>18 years).

METHODS

Electronic database searches were performed in PubMed, Embase, CINHAL, and LISSA. Two examiners assessed the eligibility and quality of appraisal with the Downs and Black checklist. The standardized mean difference (SMD) with 95 % confidence intervals was calculated to compare single- and dual-task situations. The pooled estimates of the overall effect were computed using a random or fixed effects method, and forest plots were generated.

RESULTS AND SIGNIFICANCE

A total of 25 studies were included. All studies included healthy adults, with four studies including older persons and three including people with pathological conditions. The walking task was with (N = 4) and without (N = 21) obstacles and in laboratory (N = 21) or ecological conditions (N = 7). The quality scores were 6-8/16 for eight studies, 9-12/16 for seven studies, and more than 12/16 for three studies. During the "texting + gait" tasks, the meta-analysis highlighted a significant impairment of gait speed, step and stride length, cadence, and double and single support (p < 0.05). The spatiotemporal parameters of gait were systematically altered during the texting task regardless of the population and test conditions. However, the quality of the studies is moderate, and few studies have been conducted for people with motor deficiencies. The impact of texting on walking should be better considered to develop prevention actions.

Foot pressure-based analysis of gait while using a smartphone

BACKGROUND

The number of incidents related to walking while using smartphones is rising. However, it is not clear how smartphone usage might affect a gait pattern in terms of the foot pressure, and this may address the mechanism leading to incidents while using smartphones.

RESEARCH QUESTION

How do the characteristics of walking while using a smartphone affect foot pressure patterns?

METHODS

In this cross-sectional study, we recruited 40 healthy young participants and investigated the walking speed, step length, coefficient of variance of the walking cycle (CV), anteroposterior length of the center of pressure (COP) trajectory (%Long), partial foot pressure ratios (% partial foot pressure [%PFP]), and COP existence time (COPexT) under the following four conditions: normal walking, screen gazing, while using social networking services (SNS), and while using a cognitive application. Parameters were compared among the four conditions using a repeated-measures ANOVA. Further, according to the presence or absence of an incident history (e.g. stumbles, collisions), participants were divided into either the incident or non-incident group. Parameters were compared between the two groups using a two-way repeated-measures ANOVA.

RESULTS

Under the SNS and cognitive application conditions, the walking speed, step length, %Long, %PFP, and COPexT in the heel were significantly lower, and the CV and %PFP in the metatarsal region were higher than those under normal walking or screen gazing. %PFP in the heel and metatarsal regions showed a significant group-by-condition interaction; the incident group had lower %PFP in the heel region and higher %PFP in the metatarsal region than the non-incident group.

SIGNIFICANCE

These findings indicate a trend of loading more pressure on the forefoot than on the heel. This pattern was markedly evident in individuals with a history of incidents related to the smartphone usage and may be one of the factors causing stumbles and collisions.

Factors associated with texting and walking performance in children with ADHD: The role of age, environment, and symptom severity

BACKGROUND

Children with ADHD show deficits in executive function, as well as motor symptoms such as difficulties in gross and fine motor skills and gait stability. Texting while walking is becoming increasingly common and is a significant health risk among people of all ages.

RESEARCH QUESTION

The objective of this work was to compare texting and walking performance between children with ADHD and controls and between two environments (indoors and outdoors), and evaluate the role of age and symptom severity in dual-task performance.

METHODS

Nineteen children with ADHD and 30 healthy children walked across an indoors corridor and an outdoors street, with and without texting on a mobile phone. Walking and texting performance were measured using inertial measurement units and a custom-made mobile app.

RESULTS

No between-group differences were found in texting or walking performance. Walking and texting were similar across environments. In both groups, older children had smaller dual-task performance deficits for both gait and texting speed. Children with ADHD who had more severe symptoms of hyperactivity had larger dual task costs for gait speed outdoors (r = 0.69, p = 0.002), and those with more motor symptoms typed faster under dual-task conditions indoors (r = 0.6, p = 0.007) but were less accurate (r = - 0.60, p = 0.009).

SIGNIFICANCE

Children with ADHD do not demonstrate deficits in dual-task performance of a texting and walking task indoors or outdoors. The relationship of age, hyperactivity and motor symptoms with texting and walking performance supports a more personalized approach for examination of dual-task performance in children with ADHD.

The Impact of Using Mobile Phones on Gait Characteristics: A Narrative Review

The aim of this study was to summarize the research status and reveal the impact of mobile phone use on gait characteristics by reviewing the existing studies in terms of research status, participants, independent variables, dependent variables, main findings, etc. Twenty-nine studies which investigated the impact of using mobile phones on gait characteristics were identified through a literature search. The majority of these studies examined the effects of mobile phone use on gait characteristics in young people. The preliminary results showed that walking while using a mobile phone has significant impacts on gait. It can decrease gait velocity, cadence, step length and stride length, along with significantly increasing step width, step time and double support time. The results varied among different mobile phone usage, which resulted from the different motor and mental demands. Additionally, age and environment could affect the results as well. As well as the kinematic characteristics, we suggest that kinetic and EMG analysis are conducted in future studies.

Prefrontal Cortex Brain Activation During Texting and Walking: A Functional Near-Infrared Spectroscopy Feasibility Study

Texting while walking is an increasingly common, potentially dangerous task but its functional brain correlates have yet to be reported. Therefore, we evaluated prefrontal cortex (PFC) activation patterns during single- and dual-task texting and walking in healthy adults. Thirteen participants (29–49 years) walked under single- and dual-task conditions involving mobile phone texting or a serial-7s subtraction task, while measuring PFC activation (functional near-infrared spectroscopy) and behavioral task performance (inertial sensors, mobile application). Head lowering during texting increased PFC activation. Texting further increased PFC activation, and decreased gait performance similarly to serial-7 subtraction. Our results support the key role of executive control in texting while walking.

Performance of the CYBERLEGs motorized lower limb prosthetic device during simulated daily activities

Background

The CYBERLEGs-gamma (CLs-ɣ) prosthesis has been developed to investigate the possibilities of powerful active prosthetics in restoring human gait capabilities after lower limb amputation.

Objective

The objective of this study was to determine the performance of the CLs-ɣ prosthesis during simulated daily activities.

Methods

Eight participants with a transfemoral amputation (age: 55 ± 15 years, K-level 3, registered under: NCT03376919) performed a familiarization session, an experimental session with their current prosthesis, three training sessions with the CLs-ɣ prosthesis and another experimental session with the CLs-ɣ prosthesis. Participants completed a stair-climbing-test, a timed-up-and-go-test, a sit-to stand-test, a 2-min dual-task and a 6-min treadmill walk test.

Results

Comparisons between the two experimental sessions showed that stride length significantly increased during walking with the CLs-ɣ prosthesis (p = .012) due to a greater step length of the amputated leg (p = .035). Although a training period with the prototype was included, preferred walking speed was significantly slower (p = .018), the metabolic cost of transport was significantly higher (p = .028) and reaction times significantly worsened (p = .012) when walking with the CLs-ɣ compared to the current prosthesis.

Conclusions

It can be stated that a higher physical and cognitive effort were required when wearing the CLs-ɣ prosthesis. Positive outcomes were observed regarding stride length and stair ambulation. Future prosthetics development should minimize the weight of the device and integrate customized control systems. A recommendation for future research is to include several shorter training periods or a prolonged adaptation period.

Using a smartphone on the move: do visual constraints explain why we slow walking speed?

Viewing one’s smartphone whilst walking commonly leads to a slowing of walking. Slowing walking speed may occur because of the visual constraints related to reading the hand-held phone whilst in motion. We determine how walking-induced phone motion affects the ability to read on-screen information. Phone-reading performance (PRP) was assessed whilst participants walked on a treadmill at various speeds (Slow, Customary, Fast). The fastest speed was repeated, wearing an elbow brace (Braced) or with the phone mounted stationary (Fixed). An audible cue (‘text-alert’) indicated participants had 2 s to lift/view the phone and read aloud a series of digits. PRP was the number of digits read correctly. Each condition was repeated 5 times. 3D-motion analyses determined phone motion relative to the head, from which the variability in acceleration in viewing distance, and in the point of gaze in space in the up-down and right-left directions were assessed. A main effect of condition indicated PRP decreased with walking speed; particularly so for the Braced and Fixed conditions (p = 0.022). Walking condition also affected the phone’s relative motion (p < 0.001); post-hoc analysis indicated that acceleration variability for the Fast, Fixed and Braced conditions were increased compared to that for Slow and Customary speed walking (p ≤ 0.05). There was an inverse association between phone acceleration variability and PRP (p = 0.02). These findings may explain why walking speed slows when viewing a hand-held phone: at slower speeds, head motion is smoother/more regular, enabling the motion of the phone to be coupled with head motion, thus making fewer demands on the oculomotor system. Good coupling ensures that the retinal image is stable enough to allow legibility of the information presented on the screen.

Mobile Phone Use during Gait: The Role of Perceived Prioritization and Executive Control

(1) Background: Mobile phone use during gait is associated with adverse health outcomes, namely increased risk of pedestrian injury. Healthy individuals can voluntarily prioritize concurrent task performance, but the factors underlying the impact of phone use during walking remain largely unknown. Thus, the objective of this work was to evaluate the relationship between subjective (perceived) prioritization, cognitive flexibility and dual-task performance when using a mobile phone during walking. (2) Methods: Thirty young participants walked for one minute with and without reading or texting on a mobile phone, as well as reading or texting while sitting. Walking performance (kinematics) was recorded, as well as phone use (text comprehension, text read/written), mental workload, perceived prioritization (visual analog scale), and cognitive flexibility (trail-making test). (3) Results: Texting while walking was associated with larger decreases in gait speed, larger gait variability, higher mental workload, and lower text comprehension compared to reading. Perceived prioritization was associated with walking dual-task costs (DTCs) (r = 0.39–0.42, p < 0.04) when texting, and better cognitive flexibility was associated with lower gait DTCs when texting (r = 0.55, p = 0.002) but not reading. (4) Conclusions: The context-dependent link between perceived prioritization, cognitive flexibility, and walking DTCs promotes our understanding of the factors underlying texting-while-walking performance. This could identify individuals who are more prone to dual-task interference in this increasingly common and dangerous task.

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

Background

Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall.

Methods

Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures.

Results

There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F_(1,32) = 154.96, p < 0.0001) with higher step lengths (F_(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F_(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F_(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F_(1,32) = 19.77, p < 0.0001) and total time (F_(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F_(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment.

Conclusions

This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

The effects of walking speed and mobile phone use on the walking dynamics of young adults

Walking while using a mobile phone has been shown to affect the walking dynamics of young adults. However, this has only been investigated using treadmill walking at a fixed walking speed. In this study, the dynamics of over ground walking were investigated using lower trunk acceleration measured over 12 consecutive trials, following differing walking speed and mobile phone use instructions. Higher walking speed significantly increased the proportion of acceleration along the vertical measurement axis, while decreasing the proportion of acceleration along the anteroposterior axis (p < 0.001). Moreover, higher walking speed also resulted in increased sample entropy along all measurement axes (p < 0.05). When walking while texting, the maximum Lyapunov exponent increased along the anteroposterior and vertical measurement axes (p < 0.05), while sample entropy decreased significantly along the vertical axis (p < 0.001). Walking speed and mobile phone use both affect the walking dynamics of young adults. Walking while texting appears to produce a reduction in local dynamic stability and an increase in regularity, however, caution is required when interpreting the extent of this task effect, since walking speed also affected walking dynamics.

Effects of the use of mobile phone on postural and locomotor tasks: a scoping review

BACKGROUND

Using a mobile phone while performing a postural and locomotor tasks is a common, daily situation. Conversing or sending messages (SMS) while walking account for a significant share of accidental injuries. Therefore, understanding the consequences of using a mobile phone on balance and walking is important, all the more so when these postural and locomotor tasks are aggravated by a disease.

RESEARCH QUESTION

Our objective was to conduct a scoping review on the influence of a dual-task situation - generated by the use of mobile phone - on users' postural and/or locomotor tasks.

METHODS

The literature search was conducted in English on PubMed/Medline and CINHAL databases, using keywords associated with postural and locomotor tasks and with the use of mobile phone. Study location, population, number of subjects, experimental design, types of phone use, evaluated postural-locomotor tasks and expected effects were then analyzed.

RESULTS AND SIGNIFICANCE

46 studies were included in this work, 24 of which came from North America. All studies compared postural and locomotor tasks with and without the use of a smartphone. Ten studies also compared at least 2 groups with different characteristics. Only 4 studies included pathological subjects. Various modalities were tested, and most studies focused on walking. Results show that the use of smartphones slows down movement and induces a systematic imbalance, except when listening to music. The dual task of "using the smartphone during a postural or locomotor tasks" induces systematic disturbances of balance and movement, which must be taken into account in the rehabilitation approach. Future studies will have to extend the knowledge regarding pathological situations.

The Effects of Mobile Texting and Walking Speed on Gait Characteristics of Normal Weight and Obese Adults

The aim of this study was to examine how usage of mobile devices while simultaneously walking affects walking characteristics and texting performance of normal weight (NW) and obese (OB) individuals. Thirty-two OB (body mass index [BMI] = 34.4) and NW (BMI = 22.7) adults performed two 60-s walking trials at three-step frequencies along a rectangular walkway in two conditions (No Texting and Texting). Dual-task cost as well as unadjusted spatial and temporal gait characteristics were measured. Dual-task costs for the gait parameters as well as texting performance were not different between the groups, except for the lateral step variability showing a larger variability at the preferred frequency in OB individuals. For the unadjusted variables, OB exhibited longer double support, longer stance time, and lower turn velocity compared with NW. Overall, the results highlight a similar dual-task cost for the OB individuals compared with the NW individuals, in spite of underlying differences in gait mechanics.

The Effect of Age on Gait Speed When Texting

Texting while walking exerts a high cognitive load, and may be a sensitive test of the integrity of the cognitive–motor interface. We aimed to investigate the association between chronological age and gait speed while texting. A convenience sample of 308 community-dwellers was recruited: n ≥ 50 in each age group (20–29, 30–39, 40–49, 50–59) and n = 100 aged ≥60 years. Gait speed was measured over 10 metres under two experimental conditions: 1) walking at usual pace; 2) walking at usual pace while texting the message “Good morning Harry” on their smartphone. Both median gait speed with and without texting decreased with increasing age (p < 0.001). The differences between single- and dual-task gait speed were substantial for each age group and increased after the age of 50 years (p < 0.001). Median gait speeds while texting in people aged 50–59 (1.07 m/s) and ≥60 years (1.00 m/s) were below the recommended minimum for safely crossing roads (1.20 m/s). Texting while walking currently exposes people aged 50 and over to considerable environmental hazards. The significant slowing of gait speed while texting from middle age may be a marker of neurodegeneration, a cohort effect, or an appropriate compensatory response to reduce the risk of injury.

The effects of mobile phone use on walking: a dual task study

OBJECTIVES

The aim of this study was to examine the effects of walking at different speeds while using a mobile phone on spatiotemporal stride parameters among young adults. Ten participants (7 male, 3 female; age = 24.7 ± 4.4 years, mean ± 1SD) completed 12 walking trials. Trials consisted of tasks performed at both normal and fast walking speeds-walking only, walking while texting, and walking while talking on a mobile phone. Gait velocity, stride length, cadence, and double support time were computed using data from accelerometers on either shoe.

RESULTS

The effects of distracted walking were not significantly larger when performed at a self-selected fast walking speed compared with a normal walking speed. However, walking while texting produced significant decreases in gait velocity, stride length, and cadence, with a significant increase in double support time at both walking speeds. Moreover texting increased the size of the relative variability of walking, observed through a significant increase in the coefficient of variation of cadence, stride length, and double support time. The observed changes may be suggestive of compromised balance when walking while texting regardless of walking speed. This may place the individual at a greater risk of, slips, trips and falls.

Phone messages affect the detection of approaching pedestrians in healthy young and older adults immersed in a virtual community environment

Background

Mobile phones are increasingly associated with accidents while walking. Little is known, however, about the impact of phone messaging on the actual perception of other pedestrians. This study aimed to investigate the extent to which the detection of approaching pedestrians is affected by the sensory modality (text or audio) of phone messages in young vs. older adults.

Methods

Eighteen healthy young (24 ± 2.9 years) and 15 older adults (68 ± 4.2 years) performed a phone message deciphering task, an obstacle detection task, and a dual-task condition combining both tasks. Participants were tested while seated and viewing a virtual subway station (VE) in a helmet mounted display. As they were passively moved within the VE one of three virtual pedestrians randomly approached them from the center (0°), right (+40°) or left (+40°). When present, phone message conditions were delivered at obstacle movement onset and presented either as (1) text messages on the screen of a virtual phone or (2) audio messages delivered through earphones. Participants were instructed to press a joystick button as soon as they detected the approaching virtual pedestrian and to report the message content at the end of the trials.

Results

Young and older participants showed delayed obstacle detection times with vs. without text messages. Older adults further showed reduced accuracy of message report for texts compared to audio messages. In both groups, audio messages yielded no difference in obstacle detection time or accuracy of message report compared to the no message condition.

Conclusions

Findings indicate that text messages prolong the detection of approaching pedestrians, suggesting that they compromise safe ambulation in community environments. Older adults, who show larger deteriorations on the obstacle detection and message deciphering tasks, may be at even greater risk of collision. Audio messages could be a safer alternative for on-the-go communication.

Effects of Age on Obstacle Avoidance while Walking and Deciphering Text versus Audio Phone Messages

BACKGROUND

Widely popular among young, and more recently older adults, mobile phones are increasingly used while walking. Knowledge of the impact of phone message modality (e.g., text vs. audio) on the ability to avoid collisions with other pedestrians, however, remains limited.

OBJECTIVES

This study aimed to investigate the extent to which the circumvention of an approaching pedestrian is affected by text versus audio phone messages in healthy young and older adults.

METHOD

Sixteen young (aged 24 ± 3 years) and 14 older adults (aged 68 ± 4.5 years) were tested while walking and viewing a virtual environment depicted as a subway station in a helmet-mounted display. As they walked, one of three virtual humans randomly approached from the center (0°), right (+40°), or left (+40°). Phone messages, when present, were delivered at obstacle displacement onset and presented either as text messages on a virtual phone or as audio messages delivered through earphones. Participants were instructed to avoid collisions with pedestrians and to fully report the message content at the end of trials.

RESULTS

Both groups showed decreased accuracy of message report (AMR), slower walking speed, and more collisions in response to text versus audio messages. Compared to young adults, older adults showed greater reduction in AMR, more collisions, and similar speed adaptation in the presence of text messages. In both age groups, no significant differences in walking speed emerged between the audio message and the no-message condition, but only older adults experienced collisions and reduced AMR with the audio messages. Obstacle clearance and the onset time of avoidance strategy were not affected by message condition.

CONCLUSIONS

Results suggest that coping with text messages while walking leads to greater risk of collision and alters message deciphering accuracy, while audio messages stand out as a safer and more efficient alternative for on-the-go communication. In general, older adults experienced larger motor-cognitive interference than younger adults, resulting in reduced AMR and more collisions without further changes in gait adaptation. Consequently, older adults failed to prioritize their safety when attending to phone messages while walking.

Cognitive and visual demands, but not gross motor demand, of concurrent smartphone use affect laboratory and free-living gait among young and older adults

BACKGROUND

As smartphones are an integral part of daily activities, understanding the underlying mechanism associated with concurrent cell phone use while walking may help reduce the risks of injury.

RESEARCH QUESTION

This study examined the effect of cognitive, visual, and gross motor demands while using a phone during gait among young and older adults in the laboratory and free-living environments.

METHODS

Twelve young and twelve older adults walked along a 10-m walkway under five conditions: single-task walking (Walk), walking and bi-manually holding a phone (Walk-Hold), walking while looking at a phone held in front of the participants (Walk-Look), walking while answering questions (Walk-Answer), and walking while texting (Walk-Text). All conditions were performed in laboratory and free-living environments. Gait velocity, step time, step length, and cadence were obtained using a smartphone with a built-in accelerometer attached to the body. The dual-task cost (DTC) was also assessed. A three-way ANOVA was utilized for all parameters.

RESULTS

While no three-way interactions were found for any parameter, group × condition interactions were significant for gait velocity, step time, step length, cadence and their corresponding DTC. Decreased gait velocity, step length and cadence, with increased step time was demonstrated during Walk-Look, Walk-Answer, and Walk-Text, compared to Walk and Walk-Hold. While older adults markedly changed their gait during Walk-Answer and Walk-Text, these changes were less pronounced among young adults.

SIGNIFICANCE

Visual and cognitive demand while concurrently using a phone influenced gait, especially among the elderly. Environment did not accentuate gait alterations during concurrent phone use. Therefore, smartphone technology should be developed to detect dual-task walking and temporarily modify functionality to reduce risk of injury from divided attention.

Texting While Walking Induces Gait Pattern Alterations in Healthy Older Adults

The use of a mobile phone for texting purposes results in distracted walking which may lead to injuries. In particular, texting while walking has been shown to induce significant alterations in gait patterns. This study aimed to assess whether changes in the main spatio-temporal parameters of gait when simultaneously engaged in texting on a smartphone and walking are different in older adults relative to young and middle- aged individuals. A total of 57 participants divided in three groups (19 older adults aged over 65, 19 young aged 20-40 and 19 middle-aged aged 41-64) were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. The results show that texting induced similar reduction of gait speed, stride length and cadence in all groups. Slight (although significant) alterations of stance, swing and double support phases duration were found only for middle-aged participants. Such findings suggest that modifications of gait patterns due to texting seem unaffected by age, probably due to different perceptions of the cognitive complexity of the task and differential prioritization of its motor and cognitive aspects.

Tapping the Full Potential? Jumping Performance of Volleyball Athletes in Game-Like Situations

Background: One key issue in elite interactive team sports is the simultaneous execution of motor actions (e.g., dribbling a ball) and perceptual-cognitive tasks (e.g., visually scanning the environment for action choices). In volleyball, one typical situation is to prepare and execute maximal block jumps after multiple-options decision-making and concurrent visual tracking of the ongoing game dynamics to find an optimal blocking location. Based on resource-related dual- and multi-tasking theories simultaneous execution of visual-cognitive and motor tasks may interfere with each other. Therefore, the aim of this study was to investigate whether volleyball-specific perceptual-cognitive demands (i.e., divided attention, decision making) affect blocking performance (i.e., jumping performance and length of the first step after the ready-block-position) compared to relatively isolated jumping performance.

Methods: Twenty-two elite volleyball players (1st – 3rd German league) performed block jumps in front of a net construction in a single-task condition (ST) and in two perceptual (-cognitive) dual-task conditions including a dual-task low (DT_L; presenting a picture of an opponent attack on a screen) and a dual-task high condition (DT_H; presenting videos of an offensive volleyball set play with a two-alternative choice).

Results: The results of repeated-measures ANOVAs showed a significant effect of conditions on jumping performance [F(2,42) = 33.64, p < 0.001, η_p² = 0.62] and on the length of the first step after the ready-block-position [F(2,42) = 7.90, p = 0.001, η_p² = 0.27). Post hoc comparisons showed that jumping performance in DT_H (p < 0.001) and DT_L (p < 0.001) was significantly lower than in ST. Also, length of the first step after the ready-block-position in DT_H (p = 0.005) and DT_L (p = 0.028) was significantly shorter than in ST.

Conclusion: Our findings suggest that blocking performance (i.e., jumping height, length of the first step) decreases in elite volleyball players when a perceptual (-cognitive) load is added. Based on the theory of Wickens (2002), this suggests a resource overlap between visual-processing demands for motor performance and for tracking the dynamics of the game. Interference with the consequence of dual-task related performance costs can therefore also be found in elite athletes in their specific motor expert domain.

Older Adults Pay an Additional Cost When Texting and Walking: Effects of Age, Environment, and Use of Mixed Reality on Dual-Task Performance

BACKGROUND

Texting while walking (TeWW) has become common among people of all ages, and mobile phone use during gait is increasingly associated with pedestrian injury. Although dual-task walking performance is known to decline with age, data regarding the effect of age on dual-task performance in ecological settings are limited.

OBJECTIVE

The objective of this study was to evaluate the effect of age, environment (indoors/outdoors), and mixed reality (merging of real and virtual environments) on TeWW performance.

DESIGN

A cross-sectional design was used.

METHODS

Young (n = 30; 27.8 ± 4.4 years) and older (n = 20; 68.9 ± 3.9 years) adults performed single- and dual-task texting and walking indoors and outdoors, with and without a mixed reality display. Participants also completed evaluations of visual scanning and cognitive flexibility (Trail Making Test) and functional mobility (Timed "Up & Go" Test).

RESULTS

Indoors, similar interference to walking and texting occurred for both groups, but only older adults' gait variability increased under dual task conditions. Outdoors, TeWW was associated with larger age-related differences in gait variability, texting accuracy, and gait dual-task costs. Young adults with better visual scanning and cognitive flexibility performed TeWW with lower gait costs (r = 0.52-0.65). The mixed reality display was unhelpful and did not modify walking or texting.

LIMITATIONS

Older adults tested in this study were relatively high functioning. Gaze of participants was not directly monitored.

CONCLUSIONS

Although young and older adults possess the resources necessary for TeWW, older adults pay an additional "price" when dual-tasking, especially outdoors. TeWW may have potential as an ecologically valid assessment and/or an intervention paradigm for dual-task performance among older adults as well as for clinical populations.

Specific smartphone usage and cognitive performance affect gait characteristics during free-living and treadmill walking

BACKGROUND

Mobile phone tasks like texting, typing, and dialling during walking are known to impact gait characteristics. Beyond that, the effects of performing smartphone-typical actions like researching and taking self-portraits (selfie) on gait have not been investigated yet.

RESEARCH QUESTION

We aimed to investigate the effects of smartphone usage on relevant gait characteristics and to reveal potential association of basic cognitive and walking plus smartphone dual-task abilities.

METHODS

Our cross-sectional, cross-over study on physically active, healthy participants was performed on two days, interrupted by a 24-h washout in between. Assessments were: 1) Cognitive testing battery consisting of the trail making test (TMT A and B) and the Stroop test 2) Treadmill walking under five smartphone usage conditions: no use (control condition), reading, dialling, internet searching and taking a selfie in randomized order. Kinematic and kinetic gait characteristics were assessed to estimate conditions influence.

RESULTS

In our sample of 36 adults (24.6 ± 1 years, 23 female, 13 male), ANCOVAs followed by post-hoc t-tests revealed that smartphone usage impaired all tested gait characteristics: gait speed (decrease, all conditions): F = 54.7, p < 0.001; cadence (increase, all): F = 38.3, p < 0.001; double stride length (decrease, all): F = 33.8, p < 0.001; foot external rotation (increase during dialling, researching, selfie): F = 16.7, p < 0.001; stride length variability (increase): F = 11.7, p < 0.001; step width variability (increase): F = 5.3, p < 0.001; step width (Friedmann test and Wilcoxon Bonferroni-Holm-corrected post-hoc analyses, increase): Z = -2.3 to -2.9; p < 0.05); plantar pressure proportion (increase during reading and researching) (Z = -2.9; p < 0.01). The ability to keep usual gait quality during smartphone usage was systematically associated with the TMT B time regarding cadence and double stride length for reading (r = -0.37), dialling (r = -0.35) and taking a selfie (r = -0.34).

SIGNIFICANCE

Smartphone usage substantially impacts walking characteristics in most situations. Changes of gait patterns indicate higher cognitive loads and lower awareness.

Texting during stair negotiation and implications for fall risk

BACKGROUND/AIM

Walking requires the integration of the sensory and motor systems. Cognitive distractions have been shown to interfere with negotiation of complex walking environments, especially in populations at greater risk for falls (e.g. the elderly). With the pervasiveness of mobile messaging and the recent introduction of augmented reality mobile gaming, it is increasingly important to understand how distraction associated with the simultaneous use of a mobile device impacts navigation of the complex walking environments experienced in daily life. In this study, we investigated how gait kinematics were altered when participants performed a texting task during step negotiation.

METHODS

Twenty participants (13 female, 7 males) performed a series of walking trials involving a step-deck obstacle, consisting of at least 3 texting trials and 3 non-texting trials.

RESULTS

When texting, participants ascended more slowly and demonstrated reduced dual-step foot toe clearance. Participants similarly descended more slowly when texting and demonstrated reduced single-step foot heel clearance as well as reduced dual-step foot fore-aft heel clearance.

CONCLUSION

These data support the conclusion that texting during stair negotiation results in changes to gait kinematics that may increase the potential for gait disruptions, falls, and injury. Further research should examine the effect texting has on performing other common complex locomotor tasks, actual fall risk, and the patterns of resulting injury rate and severity when negotiating complex environments.