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Ghamari N, Ghaderpanah R, Sadrian SH, Fallah N. Effect of a visual dual task on postural stability-A comparative study using linear and nonlinear methods. Health Sci Rep 2023; 6:e1437. [PMID: 37520463 PMCID: PMC10375842 DOI: 10.1002/hsr2.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023] Open
Abstract
Background and Aims The dual-task experimental paradigm is used to study the attentional demands of postural control. Postural control is impaired in poststroke patients, and dual-task balance studies address the visual needs of postural control in stroke patients. A nonlinear approach can help us understand the overall behavior of the dynamic system. Methods A total of 20 chronic stroke patients and 20 healthy subjects with similar age, height, and weight participated in this study. The stability and complexity of postural control were assessed using linear and nonlinear methods. All data and parameters (center of pressure [COP] velocity, anteroposterior and mediolateral directions displacement, length of COP path, and phase plane) were analyzed using the Kolmogorov-Smirnov test. Results When postural control was examined based on linear analysis, the results showed that the main effect of the group was not significant, but the main impact of position was significant for all parameters of the COP variation (p < 0.05). Examination of postural control based on nonlinear analysis also showed that the main effect of the group was not significant, and the main effect of status was significant only for the parameters of approximate entropy in both directions and short-term Lyapunov view in the anterior-posterior direction (p < 0.05). Conclusion According to the results of this study, the assessment of postural control and gait performance in poststroke patients, as well as the dual tasks they have to perform in daily life, is crucial for their independence in activities of daily living.
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Affiliation(s)
- Narges Ghamari
- Bone and Joint Diseases Research CenterShiraz University of Medical SciencesShirazIran
| | - Rezvan Ghaderpanah
- Department of Physical Medicine and Rehabilitation, Students Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Seyed Hassan Sadrian
- Department of Physical Medicine and Rehabilitation, Students Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Nahid Fallah
- Department of Health, Sports Physiotherapy Research CommitteeUniversity of Bath, Claverton DownBathUK
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Salihu AT, Hill KD, Jaberzadeh S. Effect of cognitive task complexity on dual task postural stability: a systematic review and meta-analysis. Exp Brain Res 2022; 240:703-731. [PMID: 35034175 DOI: 10.1007/s00221-021-06299-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
The dual task experimental paradigm is used to probe the attentional requirements of postural control. However, findings of dual task postural studies have been inconsistent with many studies even reporting improvement in postural stability during dual tasking and thus raising questions about cognitive involvement in postural control. A U-shaped non-linear relationship has been hypothesized between cognitive task complexity and dual task postural stability suggesting that the inconsistent results might have arisen from the use of cognitive tasks of varying complexities. To systematically review experimental studies that compared the effect of simple and complex cognitive tasks on postural stability during dual tasking, we searched seven electronic databases for relevant studies published between 1980 to September 2020. 33 studies involving a total of 1068 participants met the review's inclusion criteria, 17 of which were included in meta-analysis (healthy young adults: 15 studies, 281 participants; Stroke patients: 2 studies, 52 participants). Narrative synthesis of the findings in studies involving healthy old adults was carried out. Our result suggests that in healthy population, cognitive task complexity may not determine whether postural stability increases or decreases during dual tasking (effect of cognitive task complexity was not statistically significant; P > 0.1), and thus the U-shaped non-linear hypothesis is not supported. Rather, differential effect of dual tasking on postural stability was observed mainly based on the age of the participants and postural task challenge, implying that the involvement of cognitive resources or higher cortical functions in the control of postural stability may largely depends on these two factors.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Shapour Jaberzadeh
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia
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El-Gohary TM, Emara HA, Al-Shenqiti A, Hegazy FA. Biodex balance training versus conventional balance training for children with spastic diplegia. J Taibah Univ Med Sci 2017; 12:534-540. [PMID: 31435291 PMCID: PMC6694958 DOI: 10.1016/j.jtumed.2017.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022] Open
Abstract
Objective The purpose of this study was to compare the effectiveness of balance training using the Biodex balance system and a conventional balance training programme on balance score and on gross motor skills of children with spastic diplegia. Methods A randomized controlled study was conducted on 48 spastic diplegic children with cerebral palsy (26 boys and 22 girls) in the age range of 5-8 years. The children were randomly allocated to two equal groups. The investigators performed balance and gross motor function assessments for every child using the paediatric Berg balance scale and the gross motor function measure -88 scale (dimensions D and E) before and after the treatment programme. Passive repositioning sense was measured by a Biodex III isokinetic dynamometer. The study group received Biodex balance training and traditional physical therapy programme training, whereas the control group received conventional balance training in addition to the traditional physical therapy programme training, 3 times per week for 12 weeks. Results Significant improvement was observed in all outcome measures of the two groups, comparing their pre- and post-treatment mean values. Furthermore, the results revealed a significant (P < 0.05) improvement in mean post-treatment values for the Biodex balance training group. Conclusion Balance training using the Biodex balance system is superior to conventional balance training for improving the balance abilities and gross motor functions of children with cerebral palsy and spastic diplegia.
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Affiliation(s)
- Tarek M El-Gohary
- College of Medical Rehabilitation, Taibah University, Almadinah Almunawwarah, KSA
| | - Hatem A Emara
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
| | - Abdulla Al-Shenqiti
- College of Medical Rehabilitation, Taibah University, Almadinah Almunawwarah, KSA
| | - Fatma A Hegazy
- Physiotherapy Department, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Ghai S, Ghai I, Effenberg AO. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clin Interv Aging 2017; 12:557-577. [PMID: 28356727 PMCID: PMC5367902 DOI: 10.2147/cia.s125201] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of dual tasks and dual-task training on postural stability still remain unclear. A systematic review and meta-analysis were conducted to analyze the effects of dual task and training application on static and dynamic postural stability among various population groups. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, from inception until June 2016, on the online databases Scopus, PEDro, MEDLINE, EMBASE, and SportDiscus. Experimental studies analyzing the effects of dual task and dual-task training on postural stability were extracted, critically appraised using PEDro scale, and then summarized according to modified PEDro level of evidence. Of 1,284 records, 42 studies involving 1,480 participants met the review’s inclusion criteria. Of the studies evaluating the effects of dual-task training on postural stability, 87.5% of the studies reported significant enhancements, whereas 30% of the studies evaluating acute effects of dual tasks on posture reported significant enhancements, 50% reported significant decrements, and 20% reported no effects. Meta-analysis of the pooled studies revealed moderate but significant enhancements of dual-task training in elderly participants (95% CI: 1.16–2.10) and in patients suffering from chronic stroke (−0.22 to 0.86). The adverse effects of complexity of dual tasks on postural stability were also revealed among patients with multiple sclerosis (−0.74 to 0.05). The review also discusses the significance of verbalization in a dual-task setting for increasing cognitive–motor interference. Clinical implications are discussed with respect to practical applications in rehabilitation settings.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University, Hannover, Germany; Department of Sports Science, University of Waikato, Hamilton, New Zealand
| | - Ishan Ghai
- School of Engineering & Life Sciences, Jacobs University, Bremen, Germany
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Rougier PR, Bonnet CT. How providing more or less time to solve a cognitive task interferes with upright stance control; a posturographic analysis on healthy young adults. Hum Mov Sci 2016; 47:106-115. [PMID: 26949920 DOI: 10.1016/j.humov.2016.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
Abstract
Contrasted postural effects have been reported in dual-task protocols associating balance control and cognitive task that could be explained by the nature and the relative difficulty of the cognitive task and the biomechanical significance of the force platform data. To better assess their respective role, eleven healthy young adults were required to stand upright quietly on a force platform while concomitantly solving mental-calculation or mental-navigation cognitive tasks. Various levels of difficulty were applied by adjusting the velocity rate at which the instructions were provided to the subject according to his/her maximal capacities measured beforehand. A condition without any concomitant cognitive task was added to constitute a baseline behavior. Two basic components, the horizontal center-of-gravity movements and the horizontal difference between center-of-gravity and center-of-pressures were computed from the complex center-of-pressure recorded movements. It was hypothesized that increasing the delay should infer less interaction between postural control and task solution. The results indicate that both mental-calculation and mental-navigation tasks induce reduced amplitudes for the center-of-pressure minus center-of-gravity movements, only along the mediolateral axis, whereas center-of-gravity movements were not affected, suggesting that different circuits are involved in the central nervous system to control these two movements. Moreover, increasing the delays task does not infer any effect for both movements. Since center-of-pressure minus center-of-gravity expresses the horizontal acceleration communicated to the center-of-gravity, one may assume that the control of the latter should be facilitated in dual-tasks conditions, inferring reduced center-of-gravity movements, which is not seen in our results. This lack of effect should be thus interpreted as a modification in the control of these center-of-gravity movements. Taken together, these results emphasized how undisturbed upright stance control can be impacted by mental tasks requiring attention, whatever their nature (calculation or navigation) and their relative difficulty. Depending on the provided instructions, i.e. focusing our attention on body movements or on the opposite diverting this attention toward other objectives, the evaluation of upright stance control capacities might be drastically altered.
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Affiliation(s)
- Patrice R Rougier
- Laboratoire de Physiologie de l'Exercice, EA4338, Université de Savoie, Domaine Scientifique de Savoie-Technolac, 73376 Le Bourget du Lac cedex, France.
| | - Cédrick T Bonnet
- Laboratoire de Sciences Cognitives et de Sciences Affectives, UMR CNRS 9193, Faculté de Médecine, pôle recherche, 59045 Lille, France
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Beurskens R, Haeger M, Kliegl R, Roecker K, Granacher U. Postural Control in Dual-Task Situations: Does Whole-Body Fatigue Matter? PLoS One 2016; 11:e0147392. [PMID: 26796320 PMCID: PMC4721871 DOI: 10.1371/journal.pone.0147392] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022] Open
Abstract
Postural control is important to cope with demands of everyday life. It has been shown that both attentional demand (i.e., cognitive processing) and fatigue affect postural control in young adults. However, their combined effect is still unresolved. Therefore, we investigated the effects of fatigue on single- (ST) and dual-task (DT) postural control. Twenty young subjects (age: 23.7 ± 2.7) performed an all-out incremental treadmill protocol. After each completed stage, one-legged-stance performance on a force platform under ST (i.e., one-legged-stance only) and DT conditions (i.e., one-legged-stance while subtracting serial 3s) was registered. On a second test day, subjects conducted the same balance tasks for the control condition (i.e., non-fatigued). Results showed that heart rate, lactate, and ventilation increased following fatigue (all p < 0.001; d = 4.2–21). Postural sway and sway velocity increased during DT compared to ST (all p < 0.001; d = 1.9–2.0) and fatigued compared to non-fatigued condition (all p < 0.001; d = 3.3–4.2). In addition, postural control deteriorated with each completed stage during the treadmill protocol (all p < 0.01; d = 1.9–3.3). The addition of an attention-demanding interference task did not further impede one-legged-stance performance. Although both additional attentional demand and physical fatigue affected postural control in healthy young adults, there was no evidence for an overadditive effect (i.e., fatigue-related performance decrements in postural control were similar under ST and DT conditions). Thus, attentional resources were sufficient to cope with the DT situations in the fatigue condition of this experiment.
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Affiliation(s)
- Rainer Beurskens
- Research Focus Cognition Sciences, Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany
- Geriatric Center at the University of Heidelberg, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Matthias Haeger
- Research Focus Cognition Sciences, Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany
| | - Reinhold Kliegl
- Department of Psychology, Division of Cognitive Psychology, University of Potsdam, Potsdam, Germany
| | - Kai Roecker
- Faculty of Applied Public Health, University of Furtwangen, Furtwangen, Germany
| | - Urs Granacher
- Research Focus Cognition Sciences, Division of Training and Movement Sciences, University of Potsdam, Potsdam, Germany
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Ihira H, Makizako H, Mizumoto A, Makino K, Matsuyama K, Furuna T. Age-Related Differences in Postural Control and Attentional Cost During Tasks Performed in a One-Legged Standing Posture. J Geriatr Phys Ther 2015; 39:159-64. [PMID: 26352519 DOI: 10.1519/jpt.0000000000000063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE In dual-task situations, postural control is closely associated with attentional cost. Previous studies have reported age-related differences between attentional cost and postural control, but little is known about the association in conditions with a one-legged standing posture. The purpose of this study was to determine age-related differences in postural control and attentional cost while performing tasks at various difficulty levels in a one-legged standing posture. METHODS In total, 29 healthy older adults aged 64 to 78 years [15 males, 14 females, mean (SD) = 71.0 (3.8) years] and 29 healthy young adults aged 20 to 26 years [14 males, 15 females, mean (SD) = 22.5 (1.5) years] participated in this study. We measured the reaction time, trunk accelerations, and lower limb muscle activity under 3 different one-legged standing conditions-on a firm surface, on a soft surface with a urethane mat, and on a softer more unstable surface with 2 piled urethane mats. Reaction time as an indication of attentional cost was measured by pressing a handheld button as quickly as possible in response to an auditory stimulus. A 2-way repeated-measures analysis of variance was performed to examine the differences between the 3 task conditions and the 2 age groups for each outcome. RESULTS AND DISCUSSION Trunk accelerations showed a statistically significant group-by-condition interaction in the anteroposterior (F = 9.1, P < .05), mediolateral (F = 9.9, P < .05), and vertical (F = 9.3, P < .05) directions. Muscle activity did not show a statistically significant group-by-condition interaction, but there was a significant main effect of condition in the tibialis anterior muscle (F = 33.1, P < .01) and medial gastrocnemius muscle (F = 14.7, P < .01) in young adults and the tibialis anterior muscle (F = 24.8, P < .01) and medial gastrocnemius muscle (F = 10.8, P < .01) in older adults. In addition, there was a statistically significant interaction in reaction time (F = 8.2, P < .05) for group-by-condition. CONCLUSIONS The study results confirmed that reaction times in older adults are more prolonged than young adults in the same challenging postural control condition.
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Affiliation(s)
- Hikaru Ihira
- 1Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan. 2Department of Health and Welfare, Hokkaido Government, Sapporo, Japan. 3Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Morioka, Obu, Japan. 4Department of Occupational Therapy, School of Health Sciences, Sapporo Medical University, Chuo-ku, Japan
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Deveze A, Bernard-Demanze L, Xavier F, Lavieille JP, Elziere M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol Clin 2014; 44:49-57. [DOI: 10.1016/j.neucli.2013.10.138] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/18/2013] [Accepted: 10/18/2013] [Indexed: 10/26/2022] Open
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