Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis

Effects of a 24-week dual-task training on postural control complexity during standing and walking in older adults: Secondary analysis from a randomized controlled trial

BACKGROUND

Functional decline in gait motor control and the capacity to maintain balance during upright standing posture in older adults is influenced by deterioration in the complexity of various physiological systems involved in these daily activities.

RESEARCH QUESTION

Is a 24-week dual-task protocol training, beginning with alternating cognitive demands and progressing to simultaneous dual-tasking, more effective than a control group training only with alternating dual tasks in improving the physiological complexity of postural control in older adults during upright standing posture under interoceptive and exteroceptive demands and gait under dual tasks?

METHODS

This randomized controlled trial enrolled 60 community-dwelling older adults of both sexes, aged between 60 and 80. The experimental group (EG; n = 30) underwent training with progression from alternating dual-task (ADT) to simultaneous dual task (SDT) during activities such as gait, and static and dynamic functional balance. The control group (CG; n = 30) only underwent the ADT protocol throughout the six months of training. The primary outcome of this study was the physiological complexity of gait under dual task calculated by the refined composite multiscale fuzzy entropy method for the anteroposterior (AP), mediolateral (ML), and vertical (V) directions. The outcomes were acquired at baseline (T1) and after 24 weeks of intervention (T2). The analyses were based on the intention-to-treat principle, using generalized linear mixed models (GLMM) with a significance level of 5 %.

RESULTS

No interaction or group effects were observed. However, both groups significantly improved body sway physiological complexity in the AP direction during gait under ST, ADT, and SDT and in the V direction under ADT and SDT. No change in complexity during upright standing posture under interoceptive and exteroceptive demand was significantly observed, regardless of the group.

SIGNIFICANCE

Regardless of the training protocol, both groups significantly improved the physiological complexity of gait under dual task.

Postural control impairments following neurotoxic chemotherapy in women with cancer: a prospective observational study

PURPOSE

This study aimed to compare changes in postural control in different testing conditions involving sensory disturbances, quality of life and neurotoxicity concerns in women with cancer before and after chemotherapy with taxanes. The second aim was to compare postural control between chemotherapy-induced peripheral neuropathy (CIPN) severity subgroups.

METHOD

The 33 participants with breast cancer (age 48.15 ± 9.88 years) were tested during the month preceding (baseline) and the month after the end of chemotherapy. Postural control was assessed on a force platform (100 Hz) in different conditions: eyes open/closed, rigid/foam surface, with/without tendon vibration, dual task, and limits of stability. CIPN severity and neurotoxicity concerns were also evaluated. Paired t-tests or Wilcoxon sign rank tests were used, and a Benjamini-Hochberg correction was applied.

RESULTS

After chemotherapy, greater postural adjustments were required to maintain balance in the reference condition (p ≤ 0.02), and in conditions with visual (p ≤ 0.02), foam (p ≤ 0.04), and dual task disturbances (p ≤ 0.01), but not in the vibration and limits of stability conditions. No difference was found between the CIPN subgroups. The neurotoxicity score worsened after chemotherapy (-8.61 ± 7.53, p ≤ 0.01).

CONCLUSIONS

Postural control was impaired after chemotherapy, particularly in conditions with visual disturbances and dual task. Anteroposterior center of pressure displacements with mediolateral ground reaction forces were particularly increased.

CLINICAL IMPLICATIONS

Systematic assessment of postural control with eyes closed in women with breast cancer would help to identify chemotherapy-induced postural control disorders and determine treatment needs.

TRIAL REGISTRATION

Clinical Trial Registration number NCT04692168. Registration date: 28.12.2020.

Effects of dual-task training on cognitive-motor learning and cortical activation: A non-randomized clinical trial in healthy young adults

Dual-task (DT) training, which involves the simultaneous execution of cognitive and motor tasks, has been shown to influence task performance and cortical activation, yet evidence on the effects of DT training and cortical activation for complex postural control tasks remains limited. This study investigated the immediate and retention effects of a one-week DT training program on DT learning, performance in DT and single-task conditions, and activation in bilateral prefrontal (PFC) and vestibular cortices in healthy young adults. Eighteen individuals (age = 22.39 ± 1.73 years) participated in the study. The DT paradigm involved a dynamic stability platform (motor task) paired with either a simple or complex auditory reaction time (RT) task (cognitive). Participants completed 20-25 minutes of DT training (18 trials/day) across five consecutive days. DT performance was measured by the duration participants maintained the stability platform within 3 degrees of the horizontal while responding to auditory stimuli. Single-task motor and cognitive performances were also assessed. Cortical activation in the PFC and vestibular cortices was measured using functional near infrared spectroscopy (fNIRS), tracking changes in oxygenated hemoglobin (HbO) concentrations. Pre-training, post-training, and one-week follow-up testing was conducted. The results demonstrate that DT training significantly improves and retains DT performance, likely due to a reduction in cognitive-motor interference. Additionally, DT training led to decreased activation in the bilateral PFC and vestibular cortices, specifically for complex DT condition, suggesting enhanced attentional resource allocation and optimized vestibular input processing, indicative of neural efficiency. Notably, these training effects also transferred to single-task cognitive and motor performances, with corresponding reductions in PFC and vestibular cortex activation, despite the lack of direct training on these tasks. This study advances our understanding of the neural mechanisms underlying DT training and underscores the critical role of practice in optimizing cognitive-motor efficiency.

High-Intensity Functional Exercises Associated or Not With Cognitive Stimulation Improves Cognition and Physical Performance in Older Adults: A Double-Blind Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Studies suggest that physical exercise improves physical and cognitive function in older adults, though the benefits of dual-task interventions remain controversial. This study aimed to assess whether adding cognitive training in a dual-task fashion to a high-intensity functional exercise program enhances gait speed, lower-extremity strength, dynamic balance, balance confidence, and cognitive function in older adults after 16 weeks.

METHODS

This double-blind randomized controlled trial included 96 community-dwelling older adults, randomly assigned to either a high-intensity functional exercise program, with 50% of physical exercises incorporating a cognitive task, or the same program without the cognitive task. Both groups performed two sessions per week of group training, including progressive strength and balance exercises, over 16 weeks. Physical and cognitive performances were assessed at baseline and after 16 weeks.

RESULTS

Mixed repeated-measure analysis of variance only demonstrated a significant effect of time on most assessed outcomes (p < .05), indicating that, independent of the group, the experimental intervention had positive effects on gait speed, functional lower extremity strength, balance confidence, and cognitive function.

CONCLUSIONS

Both interventions improved cognition and physical performance. Simultaneous cognitive dual-task training does not appear to offer greater benefits compared with a high-intensity functional exercise program in community-dwelling older adults. Significance/Implications: Regardless of the simultaneous stimulation with cognitive tasks, our results add further evidence about the beneficial role of physical exercise in maintaining and/or improving health outcomes in community-dwelling older adults.

Dual task reactive balance control in older adults with mild cognitive impairment: does the cognitive task domain make a difference?

Older adults with mild cognitive impairment (OAwMCI) demonstrate higher cognitive-motor interference (CMI) than cognitively intact older adults (CIOA) during dual tasking. However, studies have rarely examined how dual tasking affects reactive balance control in OAwMCI, or the effect of different cognitive task domains. This study compared how four cognitive tasks affected CMI during reactive balance control in OAwMCI vs. CIOA. In this study, 38 OAwMCI [Montreal Cognitive Assessment (MoCA): 18-25] and 38 CIOA (MoCA ≥ 26) were included and exposed to anterior support surface perturbations in single task and while performing four cognitive tasks: two visuomotor tasks (Target, Track), auditory clock test (ACT), and letter number sequencing (LNS). Cognitive tasks were also completed during unperturbed standing. In both single and dual task conditions, OAwMCI had a higher fall rate and lower reactive center of mass (COM) stability than CIOA. Reactive balance performance deteriorated in both groups while performing Target and Track, although was not affected by ACT or LNS. Cognitive performance was lower in dual vs. single task on the Target, Track, and LNS for both groups, although OAwMCI had higher cognitive costs than CIOA. These findings suggest that dual tasking could increase fall risk in both OAwMCI and CIOA, although visuomotor tasks induced greater CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control. Furthermore, OAwMCI could experience higher CMI due to damage in sensorimotor areas involved in triggering/executing reactive balance responses, along with multidomain cognitive decline. Comprehensive dual task assessments could identify domain-specific cognitive decline in OAwMCI.NEW & NOTEWORTHY Although OAwMCI have higher CMI than CIOA during volitional balance tasks, it is unclear how dual tasking involving different cognitive domains affects reactive balance control in OAwMCI. This study showed that dual tasking could impair reactive balance responses in both CIOA and OAwMCI, although OAwMCI experienced greater performance deteriorations in dual vs. single task conditions. Furthermore, visuomotor tasks induced higher CMI than executive function/working memory tasks, suggesting greater sharing of resources with reactive balance control.

Instrumental Activities of Daily Living in Neurocognitive Disorders: Determinants and Clinical Implications for Health Promotion

Background/Objectives: Instrumental Activities of Daily Living (IADL) are the key indicators of the autonomy and functional ability in older adults with neurocognitive disorders (NCDs). However, the specific predictors of IADL performance across the NCD spectrum remains insufficiently characterized. This study aimed to identify the cognitive, motor, and caregiver-related determinants of the IADL in individuals with minor and major NCDs. Methods: A cross-sectional study was conducted involving 117 participants referred from a university-based dementia clinic. Standardized tools were administered to evaluate their IADL performance (Lawton IADL Scale), cognition [Addenbrooke's Cognitive Examination III (ACE-III)], Functional Cognitive Assessment Scale (FUCAS)], motor functions, balance, and mobility [Tinetti Test, Timed Up and Go (TUG)], emotional status [Geriatric Depression Scale (GDS)], neuropsychiatric symptoms [Neuropsychiatric Inventory (NPI)], and caregiver burden [Zarit Burden Interview (ZBI)]. Multiple regression analyses were performed to identify the significant predictors of IADL performance. Results: In the total sample (n = 117), the IADL performance was significantly predicted via ACE-III, FUCAS, and Tinetti-balance (adjusted R2 = 0.729). In the minor NCD group (n = 41), the significant predictors included sex, FUCAS, GDS, Tinetti-balance, and TUG (adjusted R2 = 0.725). In the major NCD group (n = 76), ACE-III, FUCAS, and Tinetti-balance remained the significant predictors (adjusted R2 = 0.634). Female sex and a worse profile on the other variables were associated with lower IADL scores. Conclusions: Global cognitive decline, executive dysfunction in everyday problem-solving situations, and balance impairment are the key determinants of IADL performance across both minor and major NCDs. Female sex and depressive symptoms further predicted the IADL performance in the minor NCD group. These findings highlight the need for multidisciplinary assessment and intervention strategies to promote health and autonomy and preserve the functional independence in older adults with NCDs.

The effect of brief, repetitive balance training on balance and fall risk in older people with stroke: A randomized controlled trial

ObjectiveTo evaluate the effect of integrating a specific balance-training program focused on static balance to the conventional rehabilitation program on dynamic balance, risk of falls, and activities of daily living (ADLs) in older adults post-stroke.DesignA single-blinded randomized controlled trial.SettingInstitutional Intermediate Care Hospital.SubjectsPost-stroke older adults in a subacute phase without cognitive impairment, aged 65 years and older, exhibiting trunk control in a seated position for 30 seconds without supporting the arms.InterventionThe control group underwent the usual treatment, consisting of 60-minute physiotherapy sessions, 5 days per week, for 30 days. The experimental group integrated into the usual treatment 15 minutes of the balance-training program (45 min + 15 min).Main measuresBalance impairment (Mini-BESTest and Berg Balance Scale (BBS), risk of falls (BBS), and independence for ADLs (Barthel Index)) were assessed at baseline, 15 and 30 days after the start of interventions.ResultsSeventy-one post-stroke patients (77.7 ± 9.0 years, 49.2% women) were randomized into the experimental (n = 35) or control (n = 36) groups. The experimental group showed improved dynamic balance at day 15 (Mini-BESTest: 2.90 [1.05-4.77], p = 0.003; BBS: 4.31 [1.41-7.23], p = 0.004) and day 30 (Mini-BESTest: 6.06 [2.85-9.27], p < 0.001; BBS: 8.24 [2.96-13.53], p = 0.003), as well as greater independence levels (11 [2.75-19.23], p = 0.010) compared to the control group. The control group showed higher risk of falls on day 15 (p = 0.035) and day 30 (p = 0.003) than the experimental group.ConclusionsA simple, easily reproducible approach designed by and for the older adult to rehabilitate post-stroke impairments effectively improved balance, functional gait, risk of falls, and ADLs.

Alterations in functional connectivity of the brain during postural balance maintenance with auditory stimuli: a stabilometry and electroencephalogram study

Objectives.In daily life, individuals continuously integrate motor and cognitive tasks, a process that is made possible by multisensory integration within the brain. Despite its importance, the neurophysiological mechanisms underlying the integration of stimuli from different sensory modalities remain unclear. The objective of this study was to investigate the characteristics of functional connectivity (FC) in healthy adults during a balance task with additional auditory stimuli.Materials& Methods.This study involved the simultaneous recording of stabilometry and electroencephalogram (EEG) in 17 healthy volunteers. The experimental design included two tasks. In the first task, participants were required to maintain their center of pressure on a stabilometric platform while receiving visual feedback on body position (VBF). In the second task, participants performed the same task but with the addition of auditory stimuli in the form of music (VBF+MUSIC). The FCs values of EEG signals were analyzed using the coherence method.Results.Analysis of the stabilometric data revealed that the most significant differences between the tasks were observed in the dynamic indicators related to the maintenance of the vertical body position. The values of the Quality of the balance function decreased with the expected increase in the cognitive load. EEG analysis showed that the value of functional connectivity (FC) was lower in VBF+MUSIC compared to VBF. Significant difference of FCs was detected between the right primary auditory cortex and associative auditory cortex involved in delta and theta rhythms that may reflect difference in auditory data processing, whereas differences in alpha and beta rhythms were found in the parietal region, which may reflect different level of attention.Conclusion.This study demonstrated that the presence of auditory stimuli leads to changes in postural balance indicators that specifically reflect oscillations in the sagittal plane. These findings suggest multiple neurophysiological levels of postural control in multisensory environments.

Balance Interventions to Improve Upright Balance Control and Balance Confidence in People With Motor-Incomplete Spinal Cord Injury or Disease: A Systematic Review and Meta-analysis

OBJECTIVES

To assist with clinical decision making, evidence syntheses are needed to demonstrate the efficacy of available interventions and examine the intervention components and dosage parameters. This systematic review and meta-analysis described the efficacy, components and dosage of interventions targeting upright balance control, balance confidence, and/or falls in adults with motor-incomplete spinal cord injury/disease (SCI/D).

DATA SOURCES

A search strategy following the population, intervention, control, outcome framework was developed. Six databases were searched: APA PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Embase, Emcare Nursing, Web of Science CC, and Medline.

STUDY SELECTION

Title, abstract, and full-text screening were conducted by 2 researchers independently. Inclusion criteria included the following: (1) adults with chronic, motor-incomplete SCI/D; (2) physical intervention targeting upright postural control; and (3) clinical and/or biomechanical measures of upright balance control and/or balance confidence and/or documentation of falls.

DATA EXTRACTION

Participant characteristics, balance intervention details, adverse events, and study results were extracted. The Downs and Black Checklist was used to assess methodological quality. Meta-analyses on pre-post intervention outcomes and a meta-regression of dosage were completed. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to evaluate the quality of the evidence.

DATA SYNTHESIS

The search returned 1664 unique studies; 26 were included. Methodological quality was moderate to good. Participants were 500 individuals with SCI/D, aged 18-74 years (males: females = 2.4:1). Minor adverse events were reported in 8 studies (eg, muscle soreness and fatigue). Walking interventions and upright balance training with visual feedback had clinically meaningful and significant pooled effects on improving standing balance control. Only walking interventions had a significant pooled effect on improving balance confidence. There were no significant findings on dosage response. Few studies evaluated the effects of balance interventions on the occurrence of falls.

CONCLUSIONS

Walking interventions and upright balance training with visual feedback had greater effects on upright balance control than conventional physiotherapy; however, the quality of the evidence was very low.

The Effect of Aerobic or Strength Training in Elderly with Cognitive Decline: The Fit4Alz Project

This study aimed to examine the effects of aerobic and strength training methodologies, either combined with or without cognitive training, on mitigating cognitive decline. A total of 154 subjects were recruited (72.8 ± 6.1 years, 69% females) and were divided into four groups: i) strength plus cognitive training (STCT, n = 56); ii) strength training (ST, n = 23); iii) aerobic training (AT, n = 41); and iv) aerobic plus cognitive training (ATCT, n = 34). Subjects were previously cognitively assessed and showed cognitive decline (less than 26 points on the Montreal Cognitive Assessment, MoCA). For 12 weeks, all groups performed 3 times a week, for 60 minutes, a training program corresponding to their attributed group. The MoCA test and the Senior Fitness test were applied at the beginning and the end of the intervention. A repeated-measures ANCOVA revealed significant time-by-group interactions for physical performance measures, including the 2-minute step-in-place (p = 0.026), arm curl (p < 0.001), chair sit-and-reach (p < 0.001), back-scratch (p < 0.001), 8-foot up-and-go (p < 0.001), and 6-minute walk tests (p < 0.001). However, no significant improvements were observed for cognitive function (MoCA, p = 0.242) or lower body strength (chair stand, p = 0.411). The AT group showed greater improvements in upper body strength compared to STCT and ST (p < 0.001; d = 0.698; p = 0.004; d = 0.598), while STCT significantly improved flexibility compared to ATCT (p < 0.001; d = 1.049). ATCT had the greatest improvements in aerobic endurance compared to STCT and ST (p = 0.004; d = 0.133; p < 0.001; d = 0.350). It was demonstrated that aerobic and strength training significantly improved overall physical performance in elderly individuals. However, no significant effects were observed on cognitive performance. Although these findings suggest that both aerobic and strength exercise, with or without cognitive training, improve overall physical fitness, further research is needed to determine its impact on cognitive performance.

Effect of Experimental Pain Induced by Electrical Stimulation on Static and Dynamic Balance Test Results

BACKGROUND

Patients often report experiencing pain, which can impose cognitive demands and affect balance. This cognitive burden may impact the ability to maintain a stable standing position during dual-tasking. This study aimed to investigate standing postural sway in healthy adults under electrical stimulation-induced pain.

METHODS

Twenty-one participants, including 12 men and 9 women, were included in this study. Static and dynamic balance tests were conducted using a force plate. Electrodes from the Silver Spike Point electrotherapy device were attached to the inferior end of the ulnar styloid. The static balance test involved standing on the force plate, while the dynamic balance was assessed through a cross-test under two conditions: with and without electrical stimulation. Electrical stimulation was delivered using a transcutaneous electrical nerve stimulation unit at an intensity that elicited a pain level of 5 on a numerical rating scale, as reported by the participants. Four tests, including static balance (with stimulus), static balance (without stimulus), cross (with stimulus), and cross (without stimulus), were each performed twice in a random order. Statistical analyses were performed to compare all variables between the control (without stimulus) and intervention (with stimulus) groups.

RESULTS

The static balance test showed a significantly reduced sway path length (37.16 cm without stimulation vs. 33.29 cm with stimulation). The dynamic balance test (cross-test) revealed no significant differences.

CONCLUSIONS

Healthy adult participants under electrical stimulation-induced pain had lower static standing sway. However, the dynamic balance test did not show significant changes even with the addition of electrical stimulation.

Effect of Difference of Sensory Modality in Cognitive Task on Postural Control During Quiet Stance

Cognitive loads impact postural control; however, the specific influence of sensory modalities employed in cognitive tasks during motor-cognitive dual tasks remains unclear. This study investigated the distinct effects of visual and auditory cognitive tasks on static postural control while controlling for differences in task content. Twenty-five healthy young adults were instructed to maintain a quiet stance on a force plate under three cognitive task conditions: a single motor task (control), a paced visual serial addition task (visual), and a paced auditory serial addition task (auditory). Center of pressure (COP) displacements were measured, and both linear (e.g., sway area) and non-linear assessments of postural control were analyzed. Results revealed a significant reduction in sway area during cognitive tasks compared to the control condition. However, under the auditory condition, the power spectrum density of COP displacements in the moderate frequency band was significantly higher than those in the control and visual conditions, accompanied by a notable increase in the mean power frequency. These findings suggest that auditory cognitive load exerts a more significant effect on postural control than visual cognitive load during motor-cognitive dual tasks. This highlights the relevance of sensory modalities in cognitive loads for effective fall-risk assessment.

Neuroimaging and cognitive correlates of postural control in Parkinson's disease: a systematic review

Parkinson's disease (PD) can cause postural instability, which may result in falls. These issues have been associated with motor and non-motor symptoms (NMS), including cognitive dysfunction. Several techniques have been employed to investigate the underlying neural mechanisms involved in postural control in PD. These include behavioural studies assessing associations between cognition and postural control, functional neuroimaging studies, and resting-state neural correlates. This review provides an overview of these emerging bodies of research. Scopus, PubMed, and ProQuest were searched and detailed the brain-imaging technique, cohort, and postural control measures. A total of 79 studies were identified. Findings supported the notion of cortical involvement in postural control function to compensate for subcortical damage resulting from PD. Future studies should standardise their outcome measures and data analysis to allow comparisons of results across studies and ensure more comprehensive and robust data collection to enhance the reliability and validity of these findings.

Influence of cognitive demand and auditory noise on postural dynamics

The control of human balance involves an interaction between the human motor, cognitive, and sensory systems. The dynamics of this interaction are yet to be fully understood, however, work has shown the performance of cognitive tasks to have a hampering effect on motor performance, while additive sensory noise to have a beneficial effect. The current study aims to examine whether postural control will be impacted by a concurrent working memory task, and similarly, if additive noise can counteract the expected negative influence of the added cognitive demand. Postural sway of healthy young adults was collected during the performance of a modified N-back task with varying difficulty, in the presence and absence of auditory noise. Our results show a reduction in postural stability scaled to the difficulty of the cognitive task, but this effect is less prominent in the presence of additive noise. Additionally, by separating postural sway into different frequency bands, typically used to assess the exploratory vs feedback-driven stabilizing dynamics of sway, we found a differential effect between the cognitive task and additive noise, thus demonstrating that both frequency regimes of postural sway are sensitive to high cognitive load and increased sensory information.

Angular distribution of fractal temporal correlations supports adaptive responses to wobble board instability

Contemporary dynamical models of human postural control propose an intermittent controller regulating the postural centre of pressure (CoP) about a stable saddle-shaped manifold along anatomical anteroposterior (AP) and mediolateral (ML) axes, releasing CoP in an outwards spiral when inactive. Experimental manipulations can evoke this saddle-type topology in fractal temporal correlations along the AP axis and reducing correlations along the ML axis. However, true effects of task demands may often manifest within angular space between anatomical AP and ML axes-a space not typically modelled explicitly. We tested how instability and attentional load influence postural control across the full angular range of fractal variability along the two-dimensional (2D) support surface. Forty-eight healthy young adults performed a suprapostural Trail Making Test (TMT) while standing on a wobble board, inducing continuous perturbations along the ML axis. Stable, quiet standing exhibited classic saddle-like topology, with stronger fractal temporal correlations in CoP displacements along AP axes. The attentional demand of the TMT did not affect angular variation or strength of fractal temporal correlations across the 2Dsupport surface. However, maintaining upright balance on the wobble board reshaped and reoriented the angular distribution of fractal temporal correlations, accentuating saddle-like angular variation and rotating the strongest fractal temporal correlations predominantly along the ML axis. Stabilizing posture in the face of wobble board instability prompted the saddle-type angular distribution of fractal temporal correlations. These findings challenge the traditional dependence of postural control theories exclusively on external force-plate axes and underscore the significance of multifractality in defining control parameters that govern postural stability across the full angular range of the 2D support surface.

The Effect of Cognitive-Motor Dual Tasks on the Risk of Falls in Female Saudi Students: A Cross-Sectional Study

Introduction

Dual tasking (DT) requires individuals to carry out two actions simultaneously, comparable to how the brain can perform a cognitive function while the body is in motion, which eventually enhances human balance. This paper aims to examine and compare the impact of DT on the risk of falling (ROF) among Saudi female students.

Methods

A cross-sectional design was used. 120 female students were recruited and divided into two groups: literary group (LG) (n = 34) and scientific group (SG) (n = 86). Participants, aged 18-25, had a normal body mass index (BMI) and cognitive and balancing skills. ROF was measured using the Biodex balancing device for balance alone (no DT) and with DT (motor and two cognitive tasks). After three trials, the mean and average were calculated. The ICC calculation showed a reliable result of <0.8. BMI was represented as the mean (M) and standard deviation (SD) for both groups. ROF was compared within and between groups using paired and unpaired T-tests. Mann-Whitney compared the two groups throughout DT. The level of significance was P = 0.05.

Results

There was no significant difference in ROF in SG (P = 0.06) between the performance with and without a DT; on the contrary, LG demonstrated a significant difference (P = 0.001) for the same tests. In addition, the only time there was a significant difference between the two groups was when they performed DT (P = 0.006).

Conclusion

Female students who used critical and analytical thinking and motor performance in their study and daily routine were more balanced and resistant to falling than their peers who did not. This study may improve efficient treatments for fall prevention and balance. Future research could investigate the complex nature of additional DT that may be complicated by gender and BMI outside of the normal range.

Comparing the effectiveness of different exercise interventions on quality of life in stroke patients: a randomized controlled network meta-analysis

BACKGROUND

This study evaluates the comprehensive impact of different exercise interventions on the quality of life in stroke patients through network meta-analysis, aiming to provide scientific evidence for developing more effective rehabilitation programs and improving patients' physical, psychological, and social functions.

METHODS

This systematic review, registered in PROSPERO (CRD42024541517) and following PRISMA guidelines, searched multiple databases (PubMed, Web of Science, EMbase, Cochrane, Ebsco) until November 1, 2024. Studies were selected based on the PICOS criteria, including RCTs on stroke and exercise. Methodological quality was assessed using RoB 2. Data analysis involved effect size calculations and network meta-analysis in Stata 17.0, with publication bias detected via funnel plots.

RESULTS

This meta-analysis included 41 studies (2,578 stroke patients) from 15 countries, published between 2002 and 2024. Participants aged 50-70 underwent interventions lasting 3 weeks to 6 months. DTOT (Dual-task oriented training)was most effective for Quality of Life, Mental Health, and Upper Limb Function; AQE (Aquatic Exercise) for Physical Health and Social Participation; ST(Strength Training) for Pain and Vitality; CIT(Constraint-Induced Therapy) for Mobility and Recovery; BCT for Memory and Thinking; ALCE(Aquatic and Land Combined Exercise) for Emotion and ADL; and ULT(Upper Limb Training) for Communication. No significant publication bias was found.

CONCLUSION

This study indicates that different training methods have a significant impact on various dimensions of quality of life in stroke patients. Future research should focus on personalized rehabilitation programs, considering individual differences among patients, and explore multimodal integrated interventions to optimize outcomes. Long-term follow-up and outcome assessments should be strengthened to ensure the sustainability of interventions. Additionally, integrating mental health and social participation is essential to enhance overall quality of life. Emerging technologies such as VR, AI, and wearable devices can help optimize rehabilitation training. Interdisciplinary collaboration combining neuroscience, rehabilitation science, and psychology can provide more comprehensive rehabilitation solutions.

Effects of kinesio taping on lower limb biomechanical characteristics during dynamic postural control tasks in individuals with chronic ankle instability

PURPOSE

Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI.

METHODS

A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz).

RESULTS

KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT.

CONCLUSION

KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI.

The effect of dual-task training in older adults with total hip arthroplasty: a randomized controlled trial

BACKGROUND

No other study has addressed the effectiveness of dual-task training in the postoperative period of total hip arthroplasty (THA). This study investigated the efficacy of dual-task training in older adults with THA.

METHODS

Patients were randomized into the control group (CG) (n = 14) and intervention group (IG) (n = 14). Patients in the CG received the usual post-operative rehabilitation for 8 weeks. IG-group received 8-week dual-task training in addition to the program given to the CG. Visual Analog Scale (VAS), Harris Hip Score (HHS), Mini-Mental Status Examination (MMSE), Dual Task Questionnaire (DTQ), Cognitive Timed Up and Go Test (cTUG), Lower Extremity Motor Coordination Test (LEMOCOT), 4 m Walking Speed (4MWS), Five Times Sit to Stand Test (FTSST), Activity Specific Balance Confidence Scale (ABC) were used to assess the patients after the sixth week of the surgery and after the two months of the initial assessment.

RESULTS

All evaluated parameters of the intervention group (VAS, HHS, MMSE, DTQ, cTUG, LEMOCOT, 4MWS, FTSST, and ABC) improved significantly after the intervention. Also, significant improvement was seen in all scores (VAS, HHS, MMSE, DTQ, cTUG, LEMOCOT, 4MWS, FTSST, and ABC) except for HHS-pain (0.059) and HHS-deformity (0.157) (p < 0.05) for the control group. The score change of the intervention group was significantly better for all evaluated parameters (VAS, HHS, MMSE, DTQ, LEMOCOT, 4MWS, FTSST, and ABC) (p < 0.05), except cTUG. All parameters of the intervention group were clinically meaningful regarding MCID values, except HHS-pain, HHS-living activities, and cTUG score change. Besides, HHS-pain, HHS-living activities, HHS-deformity, MMSE, LEMOCOT, FTSST, and ABC score change was not meaningful clinically.

CONCLUSION

An eight-week dual-task training provides better results on pain, function, dual-task performance, motor coordination, gait, and balance than usual rehabilitation in patients after 6-weeks of THA. The results showed that patients after THA achieved improvements with gains in motor-cognitive function.

TRIAL REGISTRATION

The study protocol was registered to "clinicaltrials.gov" (Registration Date: 19/08/2023, Clinical Trial Number: NCT06009419|| https://clinicaltrials.gov/study/NCT06009419 ).

A 3-Month Dual-Task Exercise Randomized Pilot Trial Improves Dynamic Stability and Coordination in Community-Dwelling Older Adults

INTRODUCTION

Dual-task (DT) exercises combine both physical and cognitive activities and have the potential to efficiently enhance both physical and cognitive function.

BACKGROUND/OBJECTIVES

This study aimed to determine if, compared with exercise-only (EO) and control (C) groups, adults in a DT training program improved measures of cognitive and/or physical functioning.

METHODS

Thirty-five participants (Mage = 65.7 ± 8.5 years; 74.3% female, 25.7% male) were randomly sorted into EO (n = 15), DT (n = 10), and C (n = 10). EO and DT participated in 3 months of twice weekly, 50-min exercise. DT played cognitive games on a SMARTfit Cognitive-Motor Exercise System during exercise sessions. C did not participate in any supervised sessions. Cognition was assessed with a Cognivue Thrive program. Dynamic stability, coordination, and lower body strength were assessed. Linear mixed-effects models investigated effects for different groups. For outcomes showing significant (p < .05) differences, pairwise t tests were conducted between all treatment and time comparisons.

RESULTS

Dynamic stability and coordination improved in DT and EO (p = .002 and .04, respectively), but not in C in the first 6 weeks (p = .58). Cognition and memory did not change over time among the three groups.

CONCLUSION

Healthy, independent-living older adults in either DT or EO improved dynamic stability and coordination over time and DT improved balance and functional mobility more than either EO or C. No improvements in several standard cognition or memory measurements were observed. Significance/Implications: A DT exercise program improved balance and coordination, but not cognition or memory, in healthy, independent-living older adults.

Selective engagement of long-latency reflexes in postural control through wobble board training

Long-latency reflexes (LLRs) are critical precursors to intricate postural coordination of muscular adaptations that sustain equilibrium following abrupt disturbances. Both disturbances and adaptive responses reflect excursions of postural control from quiescent Gaussian stability under a narrow bell curve, excursions beyond Gaussianity unfolding at many timescales. LLRs slow with age, accentuating the risk of falls and undermining dexterity, particularly in settings with concurrent additional tasks. We investigated whether the wobble board could cultivate the engagement of LLRs selectively in healthy young participants executing a suprapostural Trail Making Task (TMT). A concurrent additional-task demand constituted visual precision predominantly along the anteroposterior (AP) axis and mechanical instability mainly along the mediolateral (ML) axis. We scrutinized planar center-of-pressure (CoP) trajectories to quantify postural non-Gaussianity across various temporal scales. Wobble board increased engagement of LLRs and decreased engagement of compensatory postural adjustments (CPAs), indicated by the peak in non-Gaussianity of CoP planar displacements over LLR-specific timescales (50-100 ms) and non-Gaussianity of CoP planar displacements progressively diminishing over CPA-specific timescales ([Formula: see text] ms). Engagement with TMT did not show any noticeable influence on non-Gaussian postural sway patterns. Despite aligning the unstable axis of the wobble board with participants' ML axis, thus rendering posture more unstable along the ML axis, the wobble board increased engagement of LLRs significantly more along the AP axis and reduced engagement of CPAs significantly more along the ML axis. These findings offer initial mechanistic insights into how wobble boards may bolster balance and potentially reduce the occurrence of falls by catalyzing the engagement of LLRs selectively.

A Novel Method to Measure Dual-Task Capacity in Young Football Players: A Preliminary Study

CONTEXT

When deciding to return to sport, in the literature, evaluations based on physical abilities have usually been used. However, in the current literature, we have been urged to use more than physical performance evaluations. Classical dual-task testing methods do not simulate in-game loads and cannot sufficiently measure football players' dual-task capacity.

OBJECTIVE

To create a dual-task test that would simulate football players' in-game situations and measure their capacity.

DESIGN

Cross-sectional study.

SETTING

Football pitch.

PATIENTS OR OTHER PARTICIPANTS

Twenty-two football players (age = 17.37 ± 0.52 years) who played in a professional club (U19, elite league) were recruited for our study.

INTERVENTION(S)

A novel dual-task test with questions containing scenarios from a football game to cognitively load players while they are performing a modified t test.

MAIN OUTCOME MEASURE(S)

After the warmup period, participants attended 4 tests in random order: juggling (foot), speed dribbling, long passing, and novel dual-task tests.

RESULTS

No significant relationship was found between physical performance parameters and dual-task parameters (all P > .05). A significant increase was found in the completion time of the modified t test when performed under the dual-task condition (Z = -7.568, P < .001). The increase in completion time was 2.14 ± 1.29 seconds. This duration difference was calculated as 22.79% ± 14.58%, as dual-task cost.

CONCLUSIONS

Our test provides a new method to measure athletes' dual-task capacity, which is not related to physical performance and cannot be measured with current tests. This test also showed players with lower dual-task ability could not keep up their performance under dual-task conditions, such as passing a ball to a teammate when being pressed by an opponent. Players with good dual-task ability could maintain their performance (were affected only up to 10%); players with poor dual-task ability could not maintain their performance and were affected by up to 50% (with a mean of 22.79%).

The Effects of an 8-Week Cognitive-Motor Training Program on Proprioception and Postural Control Under Single and Dual Task in Older Adults: A Randomized Clinical Trial

The aim of this study was to assess the effects of an 8-week cognitive-motor training program on postural control and knee proprioception under single and dual task conditions. Design: Randomized clinical trial. Methods: The present study was registered with the ID number NCT04786132. A total of 20 healthy and physically active older adults (73.25 ± 5.98 years) volunteered to participate and were randomly assigned into an experimental and a control group (EG and CG). Postural control was measured with the Romberg test, with open (RBOE) and closed eyes (RBCE) and under unipodal dominant side (RUDL) conditions. Proprioception was assessed by measuring participants' ability to reposition their dominant knee at 45°. Finally, performance of the cognitive task was measured through a subscale of the Barcelona Test called "categorical evocation in associations". The EG and the CG completed 8-week training programs with two sessions, 30 min per week, of postural control and proprioception exercises. The EG additionally included music in each session. Results: The analysis using a mixed ANOVA model revealed no significant group × time interaction effects (p < 0.05) for any of the assessments. However, a significant main effect for the time factor was observed, with both the control and experimental groups showing improved outcomes in the post-intervention measurements. Specifically, significant results were found for RBOE (F (4,15) = 11.87, p < 0.001, η2p = 0.76), RBCE (F (4,15) = 11.62, p < 0.001, η2p = 0.75), and proprioception (F (1,18) = 11.53, p < 0.003, η2p = 0.39). Conclusions: The 8-week training program had a positive impact on the post-intervention results for motor control and proprioception, but not on the results of the cognitive task. There were no significant differences between the groups that carried out sessions with or without music.

Cortical Changes of Dual Cognitive-Task Balance Training in Patients With Chronic Ankle Instability: A Randomized Trial

CONTEXT

Researchers have shown that patients with chronic ankle instability (CAI) have deficits in memory and attention allocation. This functional deficit affects lower extremity performance. Motor-cognitive dual-task training may improve lower limb dysfunction caused by central nervous system injury. Further study is needed to determine whether dual-task training is more favorable than single-task training for improving neuromuscular control in patients with CAI.

OBJECTIVE

To compare the effects of balance-cognition dual-task training and balance single-task training on lower limb function and electroencephalography changes during static postural control in patients with CAI.

DESIGN

Randomized clinical trial (Chinese Clinical Trial Registry: ChiCTR2300073875).

SETTING

Rehabilitation training room.

PATIENTS OR OTHER PARTICIPANTS

A total of 24 patients with CAI (age = 22.33 ± 2.43 years, height = 175.62 ± 7.7 cm, mass = 70.63 ± 14.59 kg) were block randomized into 2 groups.

INTERVENTION(S)

Protocols were performed 3 times per week for 6 weeks. The single-task group underwent 1-legged static balance training with eyes open and closed and hopping balance training. The dual-task group underwent balance and cognitive training (backward-counting task).

MAIN OUTCOME MEASURE(S)

Cortical activity, proprioception, muscle onset time (difference between the muscle activation time and touchdown time), and dynamic balance were assessed before and after the interventions. We performed multivariate analyses of variance to identify main effects and interactions across groups and time. A post hoc Bonferroni test was performed for pairwise comparisons when interactions were present.

RESULTS

All participants successfully completed the 6-week interventions. Proprioception, peroneus longus (PL) muscle onset time, and dynamic postural control improved after the interventions in both groups (P < .05). Dual-task training was superior to single-task training in improving joint position sense in plantar flexion, shortening PL muscle onset time, and altering cortical activity (P < .05).

CONCLUSIONS

A 6-week program of balance training or balance combined with cognitive training could improve the functional deficits associated with CAI. The dual-task training could also improve joint position sense in plantar flexion, PL muscle onset time, and cortical activity.

Cortical activity in body balance tasks as a function of motor and cognitive demands: A systematic review

Technological tools, like electroencephalography and functional near-infrared spectroscopy, have deepened our understanding of cortical regions involved in balance control. In this systematic literature review, we aimed to identify the prevalent cortical areas activated during balance tasks with specific motor or cognitive demands. Our search strategy encompassed terms related to balance control and cortical activity, yielding 2250 results across five databases. After screening, 67 relevant articles were included in the review. Results indicated that manipulations of visual and/or somatosensory information led to prevalent activity in the parietal, frontal and temporal regions; manipulations of the support base led to prevalent activity of the parietal and frontal regions; both balance-cognitive dual-tasking and reactive responses to extrinsic perturbations led to prevalent activity in the frontal and central regions. These findings deepen our comprehension of the cortical regions activated to manage the complex demands of maintaining body balance in the performance of tasks posing specific requirements. By understanding these cortical activation patterns, researchers and clinicians can develop targeted interventions for balance-related disorders.

Individual Differences in the Impact of Distracting Environmental Sounds on the Performance of a Continuous Visual Task in Older Adults

Background/Objectives: Vulnerability to sound distraction is commonly reported in older adults with dementia and tends to be associated with adverse impacts on daily activity. However, study outcome heterogeneity is increasingly evident, with preserved resistance to distraction also evident. Contributory factors may include individual differences in distractibility in older adulthood per se, and failure to consider the influence of how difficult a person found the test. Methods: We therefore measured distractibility in a group of older adults by comparing the performance of a primary visual task (Swansea Test of Attentional Control), which includes an adaptive algorithm to take into account how difficult a person finds the test under both no-sound and sound conditions. Results: Analysis revealed no significant difference in group mean performance between no-sound versus sound conditions [t (33) = 0.181, p = 0.858; Cohen's effect size d = -0.028], but individual differences in performance both within and between sound and no-sound conditions were evident, indicating that for older adults, distracting sounds can be neutral, detrimental, or advantageous with respect to visual task performance. It was not possible to determine individual thresholds for whether sound versus no-sound conditions affected a person's actual behaviour. Conclusions: Nevertheless, our findings indicate how variable such effects may be in older adults, which in turn may help to explain outcome heterogeneity in studies including people living with dementia. Furthermore, such within-group heterogeneity highlights the importance of considering a person's individual performance in order to better understand their behaviour and initiate interventions as required.

Intersession reliability of center of pressure measurement during bipedal standing with different count-back orders

INTRODUCTION

Dual-task assessments can identify changes in postural control during balance assessments. Static standing with backward counting is frequently used to evaluate postural control while dual-tasking. The most reliable countdown method for standing postural stability has not yet been defined.

RESEARCH OBJECTIVE

to investigate postural stability's intra- and inter-day reliability while backward counting in different steps.

METHOD

Thirty-nine healthy adults (20 females, 26.94 ± 7.55 years) completed 70 s trials of stability tests with no dual-task, counting backward under five conditions (in ones, tows, threes, fours, and fives) while standing on a force-plate in three sessions: two sessions were on the same day, and the third session was one-week apart. The repeatability of measurements was tested using repeated-measure analysis of variance, interclass correlation, and standard error of measurements.

RESULTS

The interclass correlation scores ranged from 0.67 to 0.92, and the standard error of measurements ranged from 2.9% to 13.4%. No significant systematic changes (p < 0.05) occurred between the testing sessions for any backward counting.

DISCUSSION

The backward counting showed higher reliability when performed in condition 5 (counting backward in five's). The inter-day reliability scores were greater than intera-day reliability.

CONCLUSIONS

Dual-tasking with most backward counting (in ones to fives) is reliable, and a quantitative assessment of the center of pressure could be used to monitor the changes in postural stability between sessions.

Y-Balance Test after ACL Reconstruction: The relationship with knee and hip muscle strength, ankle dorsiflexion range of motion and postural stability

BACKGROUND

Y-Balance Test (YBT) assesses postural stability. When is applied to patients after anterior cruciate ligament reconstruction (ACLR), it is not clear which variables influence its result.

OBJECTIVE

To connect YBT and postural stability, quadriceps, hamstring, and gluteus complex muscle strength, ankle dorsiflexion range of motion (ADFROM).

STUDY DESIGN

Cross-sectional.

METHODS

Fifty-nine participants (52 males and 7 females) with ACLR ≥6 months were evaluated. YBT anterior, posterolateral, posteromedial, and composite, isokinetic peak torque of the knee, strength of the gluteal complex with Hip Stability Isometric Test, ADFROM with Weight-Bearing Lunge Test, postural stability with Stability Index of Biodex Balance System® were applied.

RESULTS

In the ACLR limb, the multivariate regression linear models pointed out an association between the quadriceps muscle strength and ADFRM with anterior, posteromedial and composite reaches (R2 = 0.30; 0.23; 0.26). Hamstring muscle strength and ADFRM with posterolateral (R2 = 0.13). In the uninjured limb, overall stability index and ADFRM with anterior reach (R2 = 0.25), strength of gluteal complex with posteromedial (R2 = 0.31), hamstring muscle strength, Overall and lateromedial stability indexes with posterolateral (R2 = 0.20), hamstring muscle strength, Overall stability index, ADFRM and strength of gluteal complex with composite (R2 = 0.32).

CONCLUSIONS

The quadriceps muscle strength and ADFRM are important variables for YBT performance in the ACLR limb. In the uninjured limb, ADFROM, the strength of the gluteal complex and hamstring, overall and lateromedial stability indexes are associated with YBT performance. We question the utility of the YBT to measure postural stability given the lack of association with other postural stability measures.

The effect of dual-task training on postural and cognitive performances in adolescents with down syndrome

BACKGROUND

The dual task training (DTT) has been shown to improve postural and cognitive performances in many populations. Therefore, it seems of interest to explore the effect of such training modality in individuals with Down syndrome (DS) presenting both cognitive and postural deficits.

AIMS

This study explored the effect of a DTT compared to a single task training (STT) on postural and cognitive performances in adolescents with DS.

METHODS AND PROCEDURES

The center of pressure velocity (CoPVm) and the cognitive performance in the selective word recall test were recorded under single task (ST) and DT conditions before and after 8 weeks in the STT group (STTG), the DTTG and the control group (CG).

OUTCOMES AND RESULTS

Before training, CoPVm values increased and cognitive performances decreased (p < 0.001) during the DT compared to ST conditions in all groups. After training, CoPVm decreased (p < 0.001) in the DTTG and the STTG under the ST conditions. However, under DT conditions, these values decreased (p < 0.001) only in the DTTG. The cognitive performance increased (p < 0.001) only in the DTTG in both ST and DT conditions.

CONCLUSION

The DTT is strongly recommended to improve both postural and cognitive performances in individuals with DS notably in DT conditions.

Regional brain activity and neural network changes in cognitive-motor dual-task interference: A functional near-infrared spectroscopy study

Previous neuroimaging studies have reported dual-task interference (DTi) and deterioration of task performance in a cognitive-motor dual task (DT) compared to that in a single task (ST). Greater frontoparietal activity is a neural signature of DTi; nonetheless, the underlying mechanism of cortical network in DTi still remains unclear. This study aimed to investigate the regional brain activity and neural network changes during DTi induced by highly demanding cognitive-motor DT. Thirty-four right-handed healthy young adults performed the spiral-drawing task. They underwent a paced auditory serial addition test (PASAT) simultaneously or independently while their cortical activity was measured using functional near-infrared spectroscopy. Motor performance was determined using the balanced integration score (BIS), a balanced index of drawing speed and precision. The cognitive task of the PASAT was administered with two difficulty levels defined by 1 s (PASAT-1 s) and 2 s (PASAT-2 s) intervals, allowing for the serial addition of numbers. Cognitive performance was determined using the percentage of correct responses. These motor and cognitive performances were significantly reduced during DT, which combined a drawing and a cognitive task at either difficulty level, compared to those in the corresponding ST conditions. The DT conditions were also characterized by significantly increased activity in the right dorsolateral prefrontal cortex (DLPFC) compared to that in the ST conditions. Multivariate Granger causality (GC) analysis of cortical activity in the selected frontoparietal regions of interest further revealed selective top-down causal connectivity from the right DLPFC to the right inferior parietal cortex during DTs. Furthermore, changes in the frontoparietal GC connectivity strength between the PASAT-2 s DT and ST conditions significantly correlated negatively with changes in the percentage of correct responses. Therefore, DTi can occur even in cognitively proficient young adults, and the right DLPFC and frontoparietal network being crucial neural mechanisms underlying DTi. These findings provide new insights into DTi and its underlying neural mechanisms and have implications for the clinical utility of cognitive-motor DTs applied to clinical populations with cognitive decline, such as those with psychiatric and brain disorders.

Dual-Task Performance in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis

Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS-I). The meta-analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06-1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD.

Implicit learning provides advantage over explicit learning for gait-cognitive dual-task interference

Dual-task performance holds significant relevance in real-world scenarios. Implicit learning is a possible approach for improving dual-task performance. Analogy learning, utilizing a single metaphor to convey essential information about motor skills, has emerged as a practical method for fostering implicit learning. However, evidence supporting the effect of implicit learning on gait-cognitive dual-task performance is insufficient. This exploratory study aimed to examine the effects of implicit and explicit learning on dual-task performance in both gait and cognitive tasks. Tandem gait was employed on a treadmill to assess motor function, whereas serial seven subtraction tasks were used to gauge cognitive performance. Thirty healthy community-dwelling older individuals were randomly assigned to implicit or explicit learning groups. Each group learned the tandem gait task according to their individual learning styles. The implicit learning group showed a significant improvement in gait performance under the dual-task condition compared with the explicit learning group. Furthermore, the implicit learning group exhibited improved dual-task interference for both tasks. Our findings suggest that implicit learning may offer greater advantages than explicit learning in acquiring autonomous motor skills. Future research is needed to uncover the mechanisms underlying implicit learning and to harness its potential for gait-cognitive dual-task performance in clinical settings.

Balance Performance in Young Adults With Hearing Aids: How Can It Be Affected by the Visual Cognitive Task?

OBJECTIVE

The aim of this study was to investigate the effect of a visual cognitive additional task on balance performance in young adults with hearing aids (HAs).

METHOD

Twenty young adult HA users and 20 controls were recruited for the study. Participants were asked to stand on a force plate using computerized dynamic posturography and perform a Sensory Organization Test (SOT) as a balance task under single-task (ST) and dual-task (DT) conditions. The DT condition involved performing a visual cognitive task (Backward Digit Recall) while maintaining balance. Balance performance was measured using equilibrium scores under four different conditions.

RESULTS

The results showed that SOT scores of HA users decreased significantly in the DT compared to the ST (p of Condition 1: < .001; p of Condition 4: < .001; p of Condition 6: = .001). HA users' SOT scores in the DT condition were statistically significantly lower than controls (p of Condition 1: < .003; p of Condition 4: < .009; p of Condition 6: = .004). This suggests that the presence of a visual cognitive additional task has a negative impact on balance performance in young adults with HAs.

CONCLUSIONS

These findings highlight the importance of considering the impact of cognitive tasks on balance performance in young adults with HAs. Further studies should investigate the specific needs of hearing loss patients in multitasking conditions, including age, degree of hearing loss, and cognitive ability, to develop effective interventions to reduce the risk of falls.

Adapted Training to Boost Upper Body Sensorimotor Control and Daily Living Functionality in Visually Impaired Baseball Players

Background and Objectives: Vision significantly contributes to postural control, balance, coordination, and body kinematics, thus deeply influencing everyday functionality. Sight-impaired subjects often show upper body anatomofunctional and kinetic chain alterations negatively impacting daily living efficiency and autonomy. The present study aimed to investigate and train, for the first time, upper body sensorimotor control in an Italian blind baseball team to boost global and segmental functionality while contemporarily prevent injuries. Materials and Methods: The whole team underwent a validated test battery using both quantitative traditional tools, such as goniometric active range of motion and muscular/functional tests, and an innovative biofeedback-based device, a Libra proprioceptive board. Consequently, a 6-week adapted training protocol was designed and leaded to improve sensorimotor control and, hence, counteract disability-related deficits and sport-specific overuse syndromes. Results: Statistically significant improvements were observed in all the investigated parameters. Noteworthy, an overall boost of global and segmental stability was detected through an orthostatic dynamic balance enhancement during the Y Balance test (p = 0.01) and trunk multiplanar control improvement on the Libra board (p = 0.01). Concurrently, the comparison of baseline vs. post-intervention outcomes revealed a consistent increase in upper body mobility (p < 0.05 for all the assessed districts), core recruitment (p = 0.01 for all the administered functional tests), and proprioceptive postural control (p = 0.01 for the Libra board validated test). Conclusions: Our findings suggest that a tailored sensorimotor training, conceived and led by an adapted physical activity kinesiologist, may effectively improve upper body functional prerequisites and global proprioceptive control, thus potentially promoting autonomy, quality of life, and physical activity/sport practice adherence in visually impaired individuals.

The Influence of Separate and Combined Exercise and Foreign Language Acquisition on Learning and Cognition

Aging contributes significantly to cognitive decline. Aerobic exercise (AE) has been shown to induce substantial neuroplasticity changes, enhancing cognitive and brain health. Likewise, recent research underscores the cognitive benefits of foreign language learning (FLL), indicating improvements in brain structure and function across age groups. However, the lack of a comprehensive paradigm integrating language learning with exercise limits research on combined effects in older adults. In order to address this gap, we devised a novel approach using a virtual world tourism scenario for auditory-based language learning combined with aerobic cycling. Our study examines the impact of simultaneous AE and FLL integration on cognitive and language learning outcomes compared to FLL alone. A total of 20 older adults were randomly assigned to AE + FLL and FLL-only groups. The results revealed significantly improved Spanish language learning outcomes in both combined and language learning-only groups. Additionally, significant cognitive function improvement was observed in the FLL group following short-term language learning.

Postural Control and Muscle Activity during Dual-Task in Young Adults

In everyday life, we recurrently perform two tasks simultaneously, which is called dual-tasking. A common dual task is smartphone use while standing or walking. According to previous studies, this task can compromise postural stability. However, few studies have analyzed lower limb muscle activity during dual-tasking using smartphones. This study aimed to assess the postural sway and muscle activity during dual-tasking in young adults. Thirty-six healthy young adults (23.08 ± 3.92 years) participated in this study. They performed a single task (ST: keeping a quiet standing posture) and a dual task (DT: keeping the ST while simultaneously performing a cognitive task on their smartphone). Postural sway was assessed through the center of pressure (CoP) analysis using a force platform: total CoP displacement, CoP displacement in the anterior-posterior and medial-lateral directions, mean total velocity of the CoP, mean velocity of the CoP in the anterior-posterior and medial-lateral directions, and 95% confidence ellipse sway area. A surface electromyography system recorded the muscle activity of the lumbar spinal erector and five muscles of the lower limb (bilaterally). The results showed an increase in postural sway from the ST to the DT in all CoP variables (p < 0.05), and muscle activity in most muscles analyzed decreased from the ST to the DT (p < 0.05). In conclusion, our results reflect a decentralization of attention from motor performance once postural sway increased and muscle activity decreased in dual-task conditions.

Effects of Dalcroze Eurhythmics Exercise Versus Multicomponent Exercise on Physical and Cognitive Function, and Falls in Older Adults: The EPHYCOS Randomized Controlled Trial

Currently, robust evidence is lacking to support one exercise type over another in the prevention of physical and cognitive decline and falls among older adults, primarily because of the lack of comparative trials of proven interventions. Therefore, a 12-month randomized, single-blind, comparative effectiveness trial is conducted, in which 142 older adults at high risk for falls are randomized (1:1) to receive an evidence-based Dalcroze Eurhythmics (DE) exercise program (once weekly, group-based) or an evidence-based multicomponent (MULTI) exercise program incorporating balance, functional, and strength training activities (twice weekly, group- and home-based), for 12 months. The primary outcome is gait variability under dual-task at 12 months. At 12 months, the DE group has significant improvements compared with MULTI group on gait under both dual-task (adjusted β for stride variability: -2.3, 95%CI, -3.1 to -1.4; p < 0.001) and single-task, and on a variety of secondary physical and cognitive/executive function outcomes. The adjusted hazard ratio for falls is 0.58 (95%CI, 0.37 to 0.93) for the DE group compared with MULTI group. In conclusion, DE exercise is more effective than MULTI exercise in improving physical and cognitive function and reducing falls in older adults. The mechanisms underlying DE exercise-induced benefits remain to be fully elucidated.

Benefits of a Dual-Task Training on Motor and Cognitive Functions in Community-Dwelling Older Adults: A Controlled Clinical Trial

OBJECTIVE

The aim of the study is to verify the effects of a 3-mo dual-task training on motor and cognitive functions in community-dwelling older adults.

DESIGN

In this prospective, single-blinded, controlled clinical trial, a total of 40 participants were allocated to either the experimental or the control (no-exercise) group. The intervention program consisted of a combination of motor and cognitive exercises conducted twice a week on nonconsecutive days. The main outcome measures were postural stability, mobility, fear of falling, and cognitive functions. Multiple analyses of variance were used to assess the impact of the dual-task training. Effect sizes (η 2 p) were reported. Significance was set at 5%.

RESULTS

Compared with the control group, participants who underwent the dual-task training showed positive outcomes in terms of postural stability (η 2 p = 0.298, P = 0.020), mobility (η 2 p = 0.285, P = 0.003), and cognitive functions (η 2 p = 0.536, P = 0.001). No significant differences were observed between the groups in terms of the fear of falling ( P = 0.566).

CONCLUSIONS

Three-month dual-task training was beneficial for postural control, mobility, and cognitive functions in community-dwelling older adults. Based on the present findings, healthcare professionals should consider incorporating dual-task training into clinical practice.

Exploring barriers and educational needs in implementing dual-task training for Parkinson's disease: insights from professionals

Introduction

There is growing evidence suggesting that dual-task training benefits people with Parkinson's disease (PD) on both physical and cognitive outcomes. However, there is no known data regarding professionals' educational needs and barriers to its implementation. This study aimed to explore the barriers and educational needs of healthcare and exercise professionals to integrate dual-task training into their practice with people with PD.

Methods

We conducted a study based on a web survey. Social media channels were used to recruit a convenience sample of exercise and healthcare professionals working with people with PD.

Results

Of the 185 eligible responses, the majority were physiotherapists (68.1%) followed by occupational therapists (10.8%). Most participants attended Parkinson specific training (88.6%) and employed the treatments set up in individual one on-one sessions (58.9%). We identified several barriers to dual-task training implementation, with lack of time (to prepare materials), staying creative and/ or accessing new ideas, unreliable tools for measuring gains, and insufficient expertise as the most referred by participants. The educational needs most referred included accessing examples of interventions in general, knowing what strategies to apply and their application for people with different symptoms.

Discussion

Our results highlight that professionals remain challenged to integrate dualtask training into PD clinical care mainly due to knowledge gaps, difficulties in accessing new ideas, and lack of time.

The effectiveness of dual task exercise training on balance, mobility, physical performance, and quality of life in children with cerebral palsy: a single-blind randomized controlled trial

BACKGROUND

Most activities of daily living require more than one activity, including motor-motor or motor-cognitive task. Few studies have investigated the effects of dual-task training in children with cerebral palsy (CP).

AIMS

This study was aimed at investigating the effectiveness of motor-cognitive dual-task exercise training in children with cerebral palsy (CP).

METHODS

A single-blind randomized controlled trial was conducted with thirty children with CP. Participants were randomized into dual group training group (DTG) and control group (CG). Children were evaluated before the intervention and after 12 weeks of treatment with Gross Motor Function Classification Scale (GMFCS), Pediatric Berg Balance Test (PBBS), Single Leg Stance Test (SLST), Timed Up and Go Test (TUG), 3 Meter Backwards Walk Test (3-MBWT), 6 Meter Walk Test (6-MWT), and General Children's Quality of Life Measure (KINDL).

RESULTS

DTG demonstrated significantly improved all KINDL scores (p < 0.01). In comparisons between groups adjusted analysis, results showed a better improvement of all KINDL scores in-favor-of DTG (p < 0.01). Significant improvements were found in all SLST scores and PBS in DTG (p < 0.01). Adjusted analysis results proved there was a significant improvement in all balance scores on behalf of DTG (p < 0.01). Significant improvement was observed in DTG for TUG, 3MBWT, and 6MWT scores (p = 0.001). An improvement in-favor-of DTG was found for all performance tests in the adjusted analysis (p < 0.001).

CONCLUSION

The results of this randomized controlled trial highlighted the advantage of dual-task training on balance, physical performance, and quality of life in children with CP.

How does a motor or cognitive dual-task affect our sense of upper limb proprioception?

BACKGROUND

Daily upper limb activities require multitasking and our division of attention. How we allocate our attention can be studied using dual-task interference (DTi). Given the vital role proprioception plays in movement planning and motor control, it is important to investigate how conscious upper limb proprioception is impacted by DTi through cognitive and motor interference.

PURPOSE

To examine how dual-task interference impacts conscious upper limb proprioception during active joint repositioning tasks (AJRT).

METHODS

Forty-two healthy participants, aged between 18 and 35, took part in this cross-sectional study. Participants completed two AJRT during three conditions: baseline (single task), dual-cognitive task (serial subtractions), and dual-motor task (non-dominant hand movements). The proprioceptive error (PE; difference between their estimation and targeted position) was measured using an AJRT of 75% and 90% of maximum internal rotation using the Biodex System IIITM and the Upper Limb Proprioception Reaching Test (PRO-Reach). To determine if PEs differed during dual-task interference, interference change scores from baseline were used with one sample t-tests and analyses of variance.

RESULTS

The overall mean PE with the Biodex was 4.1° ± 1.9 at baseline. Mean change scores from baseline reflect a mean improvement of 1.5° ± 1.0 (p < .001) during dual-cognitive task and of 1.5° ± 1.2 (p < .001) during dual-motor task. The overall mean PE with the PRO-Reach was 4.4cm ± 1.1 at baseline. Mean change scores from baseline reflect a mean worsening of 1.0cm ± 1.1 (p < .001) during dual-cognitive task and improvement of 0.8cm ± 0.6 (p < .001) during dual-motor task. Analysis of variance with the Biodex PEs revealed an interference effect (p < .001), with the cognitive condition causing greater PEs compared to the motor condition and a criterion position effect (p = .006), where 75% of maximum IR produced larger PEs during both interference conditions. An interference effect (p = .022) with the PRO-Reach PEs was found highlighting a difference between the cognitive and motor conditions, with decreased PEs during the contralateral motor task.

CONCLUSION

Interference tasks did impact proprioception. Cognitive interference produced mixed results, whereas improved proprioception was seen during motor interference. Individual task prioritization strategies are possible, where each person may choose their own attention strategy when faced with dual-task interference.

Positive skill transfer in balance and speed control from balance bike to pedal bike in adults: A multiphase intervention study

BACKGROUND

Learning to cycle can be challenging for adults who did not acquire the necessary skills during childhood. Balance bikes have been used to teach children how to cycle, but it was unclear whether this approach could also be effective for adults.

PURPOSE

To address this, a multi-phase intervention study was conducted to investigate whether healthy adults could be taught to cycle independently through the use of a balance bike.

METHODS

In Phase 1, a case-control observational study was conducted in which 13 cyclists and 8 non-cyclists completed balance bike tests. Based on the findings, an 8-session intervention pre- and post-test study was conducted in Phase 2, using an 8 × 20-minute balance bike training programme to improve cycling postural stability and control. Another 11 non-cyclists completed the novel programme. The time taken to complete the balance bike tests was compared before and after the program, while their cycling confidence was recorded in each session. To assess the effectiveness of the programme, participants were invited to cycle on a pedal bike to evaluate their ability to cycle independently.

RESULTS

The results in Phase 1 showed that cyclists performed better on the balance bike than non-cyclists, with Bayes factor analyses providing evidence of this difference, BF01 = 0.228 in the 15 m sprint test and BF01 = 0.138 in the two-turn curved sprint test. The novel training programme in Phase 2 demonstrated remarkable effectiveness in improving their balance bike riding performance, as evidenced by the Bayes factor for completion times in the repeated measures being BF01 < 0.001. All participants were able to cycle independently with confidence after the programme.

CONCLUSIONS

This study sheds light on the idea that it's never too late for adults to learn how to ride a bike. It provides evidence that healthy adults can learn to ride independently with the help of a balance bike, a tool that's commonly used for teaching children. The study identifies five key principles for effective balance bike training in adults, including focusing on riding speed, gliding to turn, building cycling confidence, engaging high motor skills, and using a dual-task approach. Our evidence-based training programme offers a safe, enjoyable, and effective way for adults to develop the skills and confidence they need to ride, even if they've never ridden before.

Effects of Task Interference on Kinematics and Dual-Task Cost of Running in Early Childhood

Children aged 3-8 are in a critical period for motor development and postural control. Running is a basic motor skill that children need to master in early childhood. While running, children are prone to dangerous events such as falls. This study investigates the kinematic characteristics of running by children associated with different interference tasks, i.e., normalized running, cognitive dual-tasks, and obstacle crossing tasks, and provides a theoretical foundation for the interference mechanism of children's dynamic postural control and for screening of motor disorders. Two hundred children aged 3-8 were recruited. The BTS Bioengineering infrared motion capture system was used to collect spatiotemporal and kinematic running data under three tasks. Repeated measures of variance analysis were used to compare the effects of different interference tasks and ages on children's running signs. The main and interaction effect tests were compared by the Bonferroni method. The results and conclusions are as follows: (1) Running characteristics of early childhood are influenced by interference tasks and age. With interference tasks, the overall characteristics of running by children aged 3-8 showed an increasing trend in running cycle time and a decreasing trend in stride length, step length, cadence, and speed. (2) Both cognitive and obstacle crossing tasks had costs, and cognitive task costs were greater than obstacle crossing costs. Children adopted a "task first" running strategy with different interference tasks. When facing cognitive tasks, their overall joint motion decreased, and they reduced joint motions to promote task completion. When facing obstacle crossing tasks, because of the characteristics of the task itself, children increased joint motions to cope with interference. (3) In terms of age, the running characteristics showed a nonlinear development trend in various indicators, with a degree of recurrence and high variability in adjacent age groups. (4) The dual-task interference paradigm of "postural-cognition" can be used as a motor intervention tool to promote the development of basic motor skills in early childhood.

Cognitive-motor dual-task training improves dynamic stability during straight and curved gait in patients with multiple sclerosis: a randomized controlled trial

BACKGROUND

Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, degenerative disease of the central nervous system and the second most frequent cause of permanent disability in young adults. One of the most common issues concerns the ability to perform postural and gait tasks while simultaneously completing a cognitive task (namely, dual-task DT).

AIM

Assessing cognitive-motor dual-task training effectiveness in patients with Multiple Sclerosis (PwMS) for dynamic gait quality when walking on straight, curved, and blindfolded paths.

DESIGN

Two-arm single-blind randomized controlled trial. Follow-up at 8 weeks.

SETTING

Neurorehabilitation Hospital.

POPULATION

A sample of 42 PwMS aged 28-71, with a score of 4.00±1.52 on the Expanded Disability Status Scale were recruited.

METHODS

Participants were randomized in conventional (CTg) neurorehabilitation and dual-task training (DTg) groups and received 12 sessions, 3 days/week/4 weeks. They were assessed at baseline (T0), after the treatment (T1), and 8 weeks after the end of the treatment (T2) through Mini-BESTest, Tinetti Performance Oriented Mobility Assessment, Modified Barthel Index, and a set of spatiotemporal parameters and gait quality indices related to stability, symmetry, and smoothness of gait extracted from initial measurement units (IMUs) data during the execution of the 10-meter Walk Test (10mWT), the Figure-of-8 Walk Test (Fo8WT) and the Fukuda Stepping Test (FST).

RESULTS

Thirty-one PwMS completed the trial at T2. Significant improvement within subjects was found in Mini-BESTest scores for DTg from T0 to T1. The IMU-based assessment indicated significant differences in stability (P<0.01) and smoothness (P<0.05) measures between CTg and DTg during 10mWT and Fo8WT. Substantial improvements (P<0.017) were also found in the inter-session comparison, primarily for DTg, particularly for stability, symmetry, and smoothness measures.

CONCLUSIONS

This study supports the effectiveness of DT in promoting dynamic motor abilities in PwMS.

CLINICAL REHABILITATION IMPACT

Cognitive-motor DT implemented into the neurorehabilitation conventional program could be a useful strategy for gait and balance rehabilitation.

Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis

The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.

Floor-hugging Intervention: A Perspective on Floor Exposure and After-Fall Contingency Intervention

The fear of falling is a pressing public health issue, yet current interventions often fall short in addressing it effectively. As a result, there is a need for innovative interventions that go beyond symptom relief to address the underlying causes. From this standpoint, we propose that limited exposure to floors and a lack of post-fall contingencies may contribute to the uncertainty that amplifies the fear of falling, particularly in fall prone populations. We explore the theoretical underpinnings of this hypothesis and propose a framework based on the Uncertainty and Anticipation model to elucidate potential connections. Building upon this, we introduce the Floor-hugging intervention-a two-part strategy designed to confront these challenges. Firstly, we propose gradual exposure to different floor scenarios through guided imagery to diminish fear by familiarizing individuals with such situations. Secondly, we advocate for the adoption of evidence-based ways to get up from the floor for developing after fall contingencies. We delve into the theoretical framework supporting our approach and its potential to reduce the fear of falling while improving physical, social, and psychological well-being. Additionally, we outline prospective outcome measures to comprehensively assess the impact of the intervention across biopsychosocial domains. This perspective aims to stimulate discussion on the potential role of floor exposure and post-fall strategies in reducing the fear of falling, while also advocating for innovative interventions to empower and protect fall-prone populations.

Effects of Perturbation-Based Treadmill Training on Balance Performance, Daily Life Gait, and Falls in Older Adults: REACT Randomized Controlled Trial

OBJECTIVE

The aim of this study was to evaluate the effect of perturbation-based treadmill training on gait quality in daily life, a predictor of fall risk that was used as the primary outcome. An additional aim was to evaluate the effects on secondary outcomes, including balance, gait performance, self-efficacy, daily life physical activity, and falls.

METHODS

Seventy community-dwelling older adults (mean age = 74.73 [SD = 5.69] years; 46 women) at risk of falling were randomized and received 4 weeks of dual-task treadmill training, either with or without treadmill perturbations. Balance, gait performance, self-efficacy, and daily life trunk accelerometry at baseline, after intervention, and at a 6-month follow-up were assessed and compared within group over time and between groups for each time point, and their change rates between groups over time were also assessed.

RESULTS

Both groups improved in their balance, gait performance, and self-efficacy; the experimental group showed a significantly larger decrease in concern of falling and an increase in physical performance than the controls. These training effects did not translate into significant improvements in daily life gait quality or physical activity. However, the number of daily life falls and the percentage of fallers decreased significantly more in the experimental group.

CONCLUSION

A 4-week perturbation-based dual-task treadmill training program can improve self-efficacy, balance, and gait performance in a controlled setting and reduce daily life falls, although not through changes in quantity or quality of daily life gait.

IMPACT

Perturbation-based treadmill training is a safe and efficient way to train older adults' balance recovery and gait performance, increase self-efficacy, and prevent falls.

Neural correlates of weight-shift training in older adults: a randomized controlled study

Mediolateral weight-shifting is an important aspect of postural control. As it is currently unknown whether a short training session of mediolateral weight-shifting in a virtual reality (VR) environment can improve weight-shifting, we investigated this question and also probed the impact of practice on brain activity. Forty healthy older adults were randomly allocated to a training (EXP, n = 20, age = 70.80 (65-77), 9 females) or a control group (CTR, n = 20, age = 71.65 (65-82), 10 females). The EXP performed a 25-min weight-shift training in a VR-game, whereas the CTR rested for the same period. Weight-shifting speed in both single- (ST) and dual-task (DT) conditions was determined before, directly after, and 24 h after intervention. Functional Near-Infrared Spectroscopy (fNIRS) assessed the oxygenated hemoglobin (HbO2) levels in five cortical regions of interest. Weight-shifting in both ST and DT conditions improved in EXP but not in CTR, and these gains were retained after 24 h. Effects transferred to wider limits of stability post-training in EXP versus CTR. HbO2 levels in the left supplementary motor area were significantly increased directly after training in EXP during ST (change < SEM), and in the left somatosensory cortex during DT (change > SEM). We interpret these changes in the motor coordination and sensorimotor integration areas of the cortex as possibly learning-related.

Altered gait parameters in distracted walking: a bio-evolutionary and prognostic health perspective on passive listening and active responding during cell phone use

The underpinnings of bipedal gait are reviewed from an evolutionary biology and prognostic health perspective to better understand issues and concerns related to cell phone use during ambulation and under conditions of distraction and interference. We also consider gait-related health issues associated with the fear of or risk of falling and include prognostic dimensions associated with cognitive decline, dementia, and mortality. Data were acquired on 21 healthy young adults without hearing loss, vestibular, balance, otological or neurological dysfunction using a computerized walkway (GAITRite® Walkway System) combined with specialized software algorithms to extract gait parameters. Four experimental conditions and seven temporo-spatial gait parameters were studied: gait velocity, cadence, stride length, ambulatory time, single-support time, double-support time, and step count. Significant main effects were observed for ambulation time, velocity, stride velocity, and double-support time. The greatest impact of distraction and interference occurred during the texting condition, although other significant effects occurred when participants were verbally responding to queries and passively listening to a story. These experimental observations show that relatively simple distraction and interference tasks implemented through the auditory sensory modality can induce significant perturbations in gait while individuals were ambulating and using a cell phone. Herein, emphasis is placed on the use of quantifiable gait parameters in medical, psychological, and audiological examinations to serve as a foundation for identifying and potentially averting gait-related disturbances.

Common law enforcement load carriage systems have limited acute effects on postural stability and muscle activity

Law enforcement officers are inherently at a high risk of injury and the loads they must carry during their occupational duties further increase their injury risk. It is unknown how different methods of carrying a law enforcement officer's load influence factors related to injury risk. This study assessed the effects of common law enforcement load carriage systems on muscular activity and postural stability while standing. Twenty-four participants performed single and dual-task (i.e. concurrent performance of cognitive tasks) standing while wearing a duty belt, tactical vest, and no load. The postural stability and muscle activity were measured and effects of condition and task examined. Dual task standing decreased postural stability and increased muscular activity. The belt and vest (7.2 kg each) increased muscle activity compared to control for the right abdominals, low back, right thigh. The duty belt resulted in less muscle activity in the right abdominals but more muscle activity in the left multifidus compared to the control. The findings indicate that common law enforcement load carriage systems increase muscular activity but do not affect postural stability. However, the lack of differences between the duty belt and tactical vest did not provide clear support for one load carriage system versus the other.