Balance & Cognition: Duel Task Training

1. Balance & Cognition: Duel Task Training Lindsay Harris July 20, 2010

2. Introduction • A major cause of morbidity, mortality and decreased functioning in older adults is falls. • The decrease in the multiple systems involved in balance cause increase risk of falls in older adults • During ADLs, concentration must be on balancing, doing the activity, and anything else going on around them. • Falls often occur when performing more than one task at once. • Especially when concurrently when partaking in a balancing activity while doing a cognitive exercise

3. Congnition & Balance • Duel Tasking is performing 2 activities at the same time. • Postural sway increases when a person is simultaneously doing a cognitive task • Studies have found that older adults have a decreased performance when performing duel task activities compared to younger adults. • Decreased performance of the stability task & the cognitive task • Balance tends to be mostly taught as a single task and in isolation. • Most older adults have trouble doing 2 tasks at once.

4. How should training for duel task activities be done? – 2 theories • Limited Resource or Capacity Theories of Attention • Brain has limited capacity • Needs to be able to perform the sum of the tasks requirement of attention • Interference occurs when the brain doesn’t have the capacity to perform the multiple tasks • Dual task interference will decrease if trained on a single task, which makes it easier to do the 2nd task

5. Theories Cont • Action Selecting Theory (Task Automatization Model) • 2 tasks simultaneously are not independent • Action planning & coordination • Needs practice • Become higher order skill

6. What is the most optimal way of developing duel task balance? • Studies compared: • older adults to younger adults • healthy versus balance impaired adults • Type of training • Single task training • Duel task training with fixed priority • Duel task training with variable priority • Outcome measures used: • Berg Balance Scale • Self-selected gait speed • Postural Sway • Timed up & Go (with duel tasking too) • Mini-Mental State Examination

7. What is the most optimal way of developing duel task balance? • Training • 45 min for 3 sessions for 4 weeks • Balance • Narrow walking • Obstacle walking • Cognitive • Tone discrimination • Counting backwards by 3s • Stroop Task

8. Which groups were most successful? • Some studies found some carryover from single task training but it was minimal. • Dual Task training was found optimal • Varied Priority Instructions has the greatest increase • Novel learning?

9. Clinical Relivence • These tasks could be incooperated into daily therapy by making patients perform a posture task while doing cognitive therapy or cognitive task while doing their balance therapy • Keep conversations with patients when they are doing their exercises

10. Some Examples

11. References • BrauerSandra, W. M.-C. (2001). The Interacing Effects of Cognitive Deman and Recovery of Postural stability in Balance-Impaired Elderly Persons. Journal of Gerontology , M489-M496. • KisnerCarlyn, C. L. (2007). Therapeutic Exercise.Philidelphia: F.A. Davis Company. • Pelecchina, G. (2005). Dual-Task Training Reduces Impact of Cognitive Task on Postural Sway. Journal of Motor Behavior , 239-246. • Silsupadl P, L. V.-S. (2007). Effects of Single vs. Dual-Task Training in Older Adults with Balance Impairment. Gait & Balance , S124. • SilsupadolPatima, L. V.-C. (2009). Training-related changes in dual-task walking performance of elderly persons with balance impairment: A double-blind, randomized controled trial. Gait & Posture , 634-639. • SilsupadolPatima, S. K.-C.-C. (2006). Training of Balance Under Singe and Dual-Task Conditions in Older Adults with Balance Impairment. Physical Therapy , 269-281.