Dual-task training reduces impact of cognitive task on postural sway

Postural sway increases when a cognitive task is performed concurrently with a postural task. The author examined the hypothesis that following dual-task training, a concurrent cognitive task would not amplify postural sway. Participants (N = 18) were assigned to no-training, single-task training, or dual-task training groups. Single-task training consisted of 3 sessions in which the postural task, quiet standing on a compliant surface, and the cognitive task, counting backward by 3s, were practiced separately. Dual-task training consisted of 3 sessions of concurrent practice of the cognitive and postural tasks. After training, performance of a concurrent cognitive task increased postural sway in the no-training and single-task training groups but not in the dual-task training group. Results suggest that dual-task practice improves dual-task performance.     

A concurrent attention-demanding task did not interfere with balance recovery function in standing and walking among young adults – An explorative laboratory study

This study aimed to explore the ability to overcome unannounced surface perturbations of different magnitudes during standing and walking under single-task and dual-task conditions. Balance recovery abilities during perturbed walking and concurrently performing cognitive tasks has rarely been investigated although it provides more ecological information in regard to real-life situations than perturbations during single-task conditions (i.e., just walking). Thirteen young adults were asked to perform: 1) a cognitive task while sitting; 2) perturbed standing; 3) a concurrent cognitive task during perturbed standing; 4) perturbed walking; and 5) a concurrent cognitive task during perturbed walking. The cognitive task was to perform number subtractions by seven. The participants were instructed to “try to avoid a fall” during the perturbation trials. Step threshold, cognitive task performance, and 3D kinematic analysis of the first recovery step, i.e., the spatiotemporal characteristics, were compared between all conditions. Step threshold and the spatiotemporal parameters of the first recovery stepping responses were similar between all task conditions. Cognitive performance was also unaffected by the postural challenges in all task conditions. These results suggest that the first balance recovery stepping response among young adults is automatic. Furthermore, young adults seem to have sufficient motor-cognitive resources to perform concurrently both balance recovery and cognitive tasks with no interference effects.     

Unveilling the cerebral and sensory contributions to automatic postural control during dual-task standing

ObjectivesThe postural control dual-task literature has demonstrated greater postural stability during dual-task in comparison to single task (i.e., standing balance alone through the examination of multiple kinetic and kinematic measures. This improve stability is thought to reflect an automatic mode of postural control during dual-task. Recently, sample entropy (SampEn) and wavelet discrete transform have supported the claim of automaticity, as higher SampEn values and a shift toward increased contributions from automatic sensory systems have been demonstrated in dual-task settings. In order to understand the cortical component of postural control, functional near-infrared spectroscopy has been used to measure cortical activation during postural control conditions. However, the neural correlates of automatic postural behaviour have yet to be fully investigated. Therefore, the purpose of this study is to confirm the presence of automatic postural control through static and dynamic balance measures, and to investigate the prefrontal cortex activation when concurrently performing quiet standing and the auditory cognitive tasks of varied difficulty.MethodEighteen healthy young adults (21.4 ± 3.96 yo), 12 females and 6 males, with no balance deficits were recruited. Participants were instructed to either quietly stand on a force platform (SM), perform three cognitive tasks while seated (SC) or perform both aforementioned tasks concurrently (DT).ResultsResults supported automatic postural control with lower area and standard deviation of center-of-pressure in DT conditions compared to SM. As for SampEn and the wavelet analysis, DT conditions demonstrated greater values than SM, and a shift from vision to a cerebellar contribution. For the most difficult cognitive task, the DNS task, a trend toward significantly lower right hemisphere prefrontal cortex activation compared to left hemisphere activation in DT was found, potentially representing a decrease in cognitive control, and the presence of automaticity.ConclusionThese findings suggest that the simultaneous performance of a difficult cognitive task and posture yields automatic postural behaviour, and provides insight into the neural correlates of automaticity.     

“The threat is in the head,not in the legs”: Activating negative age stereotypes generates extra cognitive load during walking

ObjectiveActivating negative age stereotypes has been consistently shown to impair cognitive performance in older adults, but not motor performance, especially on mobility tasks. We tested the hypothesis that older adults may still experience stereotype threat, even if mobility performance is not affected. To do so, we examined whether inducing negative stereotypes may increase cognitive load during a walking task.MethodThis question was investigated in a dual-task paradigm: older adults performed simultaneously a walking task and a Stroop task, in stereotype and control conditions.ResultsResults showed that the stereotype induction did not affect walking parameters but decreased performance on the Stroop task, indicating that this induction increased cognitive load during walking.DiscussionThese results suggest that negative age stereotypes may be damaging even if walking parameters are not affected, by altering older adults' attention to their walking environment. We conclude by highlighting theoretical and practical implications.     

Additional effects of a cognitive task on dual-task training to reduce dual-task interference

ObjectiveWhen we perform dual-tasks in daily life, task performance is generally reduced. As these reductions in performance (i.e., dual-task interference) are responsible for various accidents such as falls, the repeated practice of dual-task (i.e., dual-task training) is often implemented to reduce dual-task interference. However, the risk of various accidents increases with longer dual-task training, as dual-task interference cannot be avoided. Therefore, it is important to achieve training goals more rapidly during dual-task training. This study sought to determine whether a combination of dual-task training and cognitive tasks would accelerate training effects.DesignThe experimental design included four groups: 1) cognitive task training group, 2) dual-task training group, 3) cognitive task and dual-task training group, and 4) non training group.MethodWe assessed single- and dual-task performance before and after the 2-week training sessions. We adopted a dual-task involving knee extension and an auditory reaction, and used N-back task as a cognitive task. On the other hand, dual-task training was the same method to assess dual-task performance.ResultDual-task interference was reduced in all groups in both the tasks. However, the number of participants in the cognitive task and dual-task training group who achieved a reduction in dual-task cost was significantly higher than those in other groups.ConclusionThese findings could contribute to the development of an effective method for reducing dual-task interference and resolving issues caused by dual-task interference in daily life.     

Influence of cognitive and motor tasks using smartphone during gait: EMG and gait performance analysis – Dual-task study

Previous studies reported changes in spatiotemporal gait parameters during dual-task performance while walking using a smartphone compared to walking without a smartphone. However, studies that assess muscle activity while walking and simultaneously performing smartphone tasks are scarce. So, this study aimed to assess the effects of motor and cognitive tasks using a smartphone while simultaneously performing gait on muscle activity and gait spatiotemporal parameters in healthy young adults. Thirty young adults (22.83 ± 3.92 years) performed five tasks: walking without a smartphone (single-task, ST); typing on a smartphone keyboard in a sitting position (secondary motor single-task); performing a cognitive task on a smartphone in a sitting position (cognitive single-task); walking while typing on a smartphone keyboard (motor dual-task, mot-DT) and walking while performing a cognitive task on a smartphone (cognitive dual-task, cog-DT). Gait speed, stride length, stride width and cycle time were collected using an optical motion capture system coupled with two force plates. Muscle activity was recorded using surface electromyographic signals from bilateral biceps femoris, rectus femoris, tibialis anterior, gastrocnemius medialis, gastrocnemius lateralis, gluteus maximus and lumbar erector spinae. Results showed a decrease in stride length and gait speed from the single-task to cog-DT and mot-DT (p < 0.05). On the other hand, muscle activity increased in most muscles analyzed from single- to dual-task conditions (p < 0.05). In conclusion, performing a cognitive or motor task using a smartphone while walking promote a decline in spatiotemporal gait parameters performance and change muscle activity pattern compared to normal walking.     

Role of Gender in Dual-Tasking Timed Up and Go Tests: A Cross-Sectional Study

Gender plays a role in cognitive performance. Yet the selection of a secondary task, an important paradigm in studies of posture control, has not considered gender as a variable. We explored whether different cognitive tasks differentially influence performance during the Timed Up and Go (TUG) test in men and women. Twenty young adults performed five cognitive tasks while seated and during the TUG test. Men exhibited a slower normalized cadence than women. When seated, women recalled more items than men and men were more accurate in mental calculation task. There were no changes in spatiotemporal measures. We conclude that gender did not play a major role in motor-cognitive interference during dual task TUG test.     

Changes in step time variability,not changes in step length and width,are associated with lower-trunk sway during dual-task gait in older adults

Individuals are exposed to repetitive dual-task-like situations in daily life, particularly while walking, and falls among community-dwelling older adults typically occur in such situations. Thus, understanding how individuals adapt their walking-related motion under dual-task conditions is of clinical importance. The present study was conducted to investigate the association between dual-task-related changes (DT-changes) in lower-limb gait parameters and DT-changes in lower-trunk sway. We hypothesized that DT-changes in both spatial- and temporal-lower-limb gait parameters would be associated with DT-changes in lower-trunk sway. Participants were older adults aged > 60 years who lived independently in communities (n = 43, 73.7 [6.1] years old), and younger adults (n = 28, 22.7 [5.1] years old). Participants were asked to walk while performing an additional cognitive task, or with no additional task. During walking, lower-limb gait parameters (step time, step length and width) and lower-trunk sway were measured using a photoelectric cell system and inertial sensors. In older adults, DT-changes in step time variability was significantly associated with DT-changes in lower-trunk sway (standard beta = 0.683, p = 0.003), and DT-changes in lower-trunk sway variability (standard beta = 0.493, p = 0.029). In younger adults, DT-changes in step width were significantly associated with DT-changes in lower-trunk sway (standard beta = 0.395, p = 0.041). The current results partially supported our hypotheses. The association between DT-changes in lower limb and DT-changes in lower-trunk sway varied according to age group.     

Dual-task costs of texting while walking forward and backward are greater for older adults than younger adults

Cognitive-motor dual-tasking involves concurrent performance of two tasks with distinct cognitive and motor demands and is associated with increased fall risk. In this hypothesis-driven study, younger (18–30 years, n = 24) and older (60–75 years, n = 26) adults completed six walking tasks in triplicate. Participants walked forward and backward along a GAITRite mat, in isolation or while performing a verbal fluency task. Verbal fluency tasks involved verbally listing or typing on a smartphone as many words as possible within a given category (e.g., clothes). Using repeated measures MANOVA models, we examined how age, method of fluency task (verbal or texting), and direction of walking altered dual-task performance. Given that tasks like texting and backward walking require greater cognitive resources than verbal and forward walking tasks, respectively, we hypothesized older adults would show higher dual-task costs (DTCs) than younger adults across different task types and walking directions, with degree of impairment more apparent in texting dual-task trials compared to verbal dual-task trials. We also hypothesized that both age groups would have greater DTCs while walking backward than while walking forward, regardless of task.Independent of age group, velocity and stride length were reduced for texting compared to the verbal task during both forward and backward walking; cadence and velocity were reduced while walking forward compared to walking backward for the texting task; and stride length was reduced for forward walking compared to backward walking during the verbal task. Younger adults performed better than older adults on all tasks with the most pronounced differences seen in velocity and stride length during forward-texting and backward-texting. Interaction effects for velocity and stride length while walking forward indicated younger adults performed better than older adults for the texting task but similarly during the verbal task. An interaction for cadence during the verbal task indicated younger adults performed better than older adults while walking backward but similarly while walking forward.In summary, older adults experienced greater gait decrement for all dual-task conditions. The greater declines in velocity and stride length in combination with cadence being stable suggest reductions in velocity during texting were due to shorter strides rather than a reduced rate of stepping. Contrary to our hypotheses, we found greater DTCs while walking forward rather than backward, which may be due to reduced gait performance during single-task backward walking; thus, further decrements with dual-tasking are unlikely. These findings underscore the need for further research investigating fall risk potential associated with texting and walking among aging populations and how interventions targeting stride length during dual-task circumstances may improve performance.     

Absence of Ankle Stiffening While Standing in Focus and Cognitive Task Conditions in Older Adults

Abstract

Research suggests that an external focus or cognitive task may improve postural control. Removing attention from movement production may promote automaticity, or the tasks may promote ankle stiffening. To investigate these two theories, twenty older adults stood while performing baseline standing, internal focus, external focus, and two cognitive tasks. Changes in postural control occurred in external focus and cognitive task conditions compared to baseline and internal focus, while no change occurred in cocontraction indices. This suggests that an external focus and cognitive task can improve postural control in older adults. Since no change occurred in cocontraction indices across conditions, this suggests that stiffening cannot explain these changes. Instead, changes could be due to automaticity of sway.     

Everyday tasks impair spatiotemporal variables of gait in older adults with Parkinson's disease

IntroductionAlthough it is known that individuals with Parkinson's disease (PD) have difficulties performing dual-task activities, most of the studies have verified the effect of dual tasks on gait using tasks that are uncommon to perform while walking. However, the realization of tasks involving gait that really represents the daily activities carried out by the participants, allow us to detect real fall risk situations of individuals with PD during their gait.ObjectiveOur aim was to verify the influence of daily-life dual-tasks on gait spatiotemporal variables of the older adults with PD.Methods20 older adults without PD and 20 older adults with PD participated in the study. Gait kinematic was analyzed under three different conditions: walking without dual task, walking carrying bags with weight, and walking talking on the cell phone.ResultsOlder adults with PD presented lower speed (p = .001), cadence (p = .039), and shorter step length (p = .028) than older adults without PD during walking without dual tasks. When walking while carrying bags with weight, older adults with PD had a lower speed (p < .001), cadence (p = .015), shorter step length (p = .008), and greater double support time (p = .021) compared with older adults without PD. During walking while talking on the cell phone, older adults with PD walked with lower speed (p < .001), cadence (p = .013), shorter step length (p = .001) and swing time (p = .013), and increased double support time (p = .008) and support time (p = .014) in relation to older adults without PD.ConclusionDaily-life dual tasks impair the spatiotemporal variables of gait in the older adults with PD, which was most evident during walking talking on the cell phone.     

Age-associated differences in global and segmental control during dual-task walking under sub-optimal sensory conditions

The ability to safely perform cognitive-motor dual-tasks is critical for independence of older adults. We compared age-associated differences in global and segmental control during dual-task walking in sub-optimal sensory conditions. Thirteen young (YA) and 13 healthy older (OA) adults walked a straight pathway with cognitive dual-task of walking-while-talking (WT) or no-WT under four sensory conditions. On randomly selected trials, visual and vestibular inputs were manipulated using blurring goggles (BV) and Galvanic Vestibular Stimulation (GVS), respectively. Gait speed decreased more in YA than OA during WT. Gait speed increased with GVS with normal vision but not BV. Step length considerably decreased with WT. Trunk roll significantly decreased only in OA with GVS in WT. Head roll significantly decreased with GVS regardless of age. Results indicate GVS-induced adaptations were dependent on available visual information. YA reduced their gait speed more than OA to achieve a similar pace to safely perform WT. GVS resulted in both age-groups to reduce head movement. However, with the addition of WT during GVS, OA also stiffened their trunk. Therefore, with increased attentional demands healthy OA employed different compensatory strategies than YA to maintain postural control.     

Postural control,falls and Parkinson’s disease: Are fallers more asymmetric than non-fallers?

Postural control asymmetry is an important aspect of Parkinson’s disease (PD) that may be associated with falls. The aim of this study was to compare the postural control asymmetry during postural tasks between fallers and non-fallers in people with PD and neurological healthy age-matched controls (CG). Individuals with idiopathic PD (n = 24) and CG (n = 24) were sub-divided into groups of fallers and non-fallers based on their fall history over the past year. Participants performed blocks of three 30-s trials of quiet standing with feet in a side-by-side and semi-tandem stance position. The center of pressure parameters for each limb were measured and used to calculate the symmetry index. Fallers compared to non-fallers had decreased asymmetry of vertical force in the side-by-side condition. During the tandem-front leg condition, PD non-fallers increased asymmetry of the medial-lateral velocity of sway compared to CG non-fallers. In addition, for the tandem–back leg condition, PD non-fallers increased asymmetry of total displacement and medial-lateral root mean square and mean velocity of sway compared to PD fallers. The results of the study did not support the hypothesis that PD fallers are more asymmetric than PD non-fallers. On the contrary, our results indicated that PD non-fallers had higher postural control asymmetry, especially during the more challenging (semi-tandem standing) postural task.     

The effects of pain and a secondary task on postural sway during standing

BackgroundPain impairs available cognitive resources and somatosensory information, but its effects on postural control during standing are inconclusive. The aim of this study was to investigate whether postural sway is affected by the presence of pain and a secondary task during standing.MethodsSixteen healthy subjects stood as quiet as possible at a tandem stance for 30s on a force platform at different conditions regarding the presence of pain and a secondary task. Subjects received painful stimulations on the right upper arm or lower leg according to a relative pain threshold [pain 7 out 10 on a Visual Analog Scale (VAS) - 0 representing “no pain” and 10 “worst pain imaginable”] using a computer pressurized cuff. The secondary task consisted of pointing to a target using a head-mounted laser-pointer as visual feedback. Center of Pressure (COP) sway area, velocity, mean frequency and sample entropy were calculated from force platform measures.FindingsCompared to no painful condition, pain intensity (leg: VAS = 7; arm VAS = 7.4) increased following cuff pressure conditions (P < .01). Pain at the leg decreased COP area (P < .05), increased COP velocity (P < .05), mean frequency (P < .05) and sample entropy (P < .05) compared with baseline condition regardless the completion of the secondary task. During condition with pain at the leg, completion of the secondary task reduced COP velocity (P < .001) compared with condition without secondary task.InterpretationPain in the arm did not affect postural sway. Rather, postural adaptations seem dependent on the location of pain as pain in the lower leg affected postural sway. The completion of a secondary task affected postural sway measurements and reduced the effect of leg pain on postural sway. Future treatment interventions could benefit from dual-task paradigm during balance training aiming to improve postural control in patients suffering from chronic pain.     

Examining Transfer Effects of Dual-Task Training Protocols for a Complex Locomotor Task

Training protocols designed to improve dual-task performance of an obstacle crossing and auditory Stroop task (OBS+Stroop) were tested. In Experiment 1, following baseline collection of OBS+Stroop trials, proximally related walking training was performed, and participants were then retested on the OBS+Stroop test. After training, participants adopted a more cautious obstacle crossing strategy, indicating a potentially safer navigation strategy. Transfer effects from distally related training were then examined (Experiment 2); a computer game training paradigm was examined using the same testing protocol as Experiment 1. Computer training demonstrated improved dual-task performance on some measures, but did not induce a more cautious stepping strategy. Results indicate that dual-task training needs to be similar to targeted tasks to yield reliable, positive training outcomes.     

Postural costs of suprapostural task load

In an immersive visualization experiment, participants performed a conjunction search task while standing either in open (heels 10 cm apart, feet at a comfortable angle) or closed stance (feet pressed together). In the world-frame condition, the search display maintained its position in space as the participant swayed, generating optic flow informative about sway. In the head-frame condition, the display maintained constant distance and orientation with respect to the participant's head, providing no visual information about sway. In both conditions, participants (surprisingly) searched faster while in the more difficult closed stance. Interpretation of this result is unclear. Participants also swayed more as search-load increased, and made more errors in the high search-load condition. It is suggested that this performance tradeoff is a result of the sharing of a limited-capacity, modality-non-specific spatial-attentional resource between postural and suprapostural tasks.     

Interstimulus Intervals and Sensory Modality Modulate the Impact of a Cognitive Task on Postural Control

The present literature not only reveals the use of a wide variety of cognitive tasks but variability in their interaction with postural control. The question then arises, as to, whether postural control is sensitive to specific features of a cognitive task. The present experiment assessed the impact of cognitive tasks with interstimulus intervals (ISI) of varied duration and sensory modality on postural control in young adults. Seventeen participants (23.71 ± 1.99 years old) were instructed to stand on a force platform while concurrently performing cognitive tasks with ISIs of two and 5 s. The tasks were presented both, auditorily and visually. The visual tasks consisted of counting the total occurrence of a single digit. The auditory tasks consisted of counting the total occurrence of a single letter. Performing the cognitive tasks with an ISI of 2 s resulted only in an increase in the anteroposterior mean power frequency. Presenting the tasks visually also significantly reduced area of 95% confidence ellipse and AP and mediolateral sway variability. These results may suggest that ISIs can modify postural performance by altering the allocation of attentional focus. Also, presenting tasks using a visual sensory modality appears to yield lower postural sway.     

To freeze or not to freeze? Affective and cognitive perturbations have markedly different effects on postural control

Similar effects have been reported for diverting attention from postural control and increased anxiety on the characteristics of center-of-pressure (COP) time series (decreased excursions and elevated mean power frequency). These effects have also received similar interpretations in terms of increased postural stiffness, suggesting that cognitive and affective manipulations have similar influences on postural control. The present experiment tested this hypothesis by comparing postural conditions involving manipulations of attention (diverting attention from posture using cognitive and motor dual tasks) and anxiety (standing at a height), and by complementing posturography with electromyographic analyses to directly examine neuromuscular stiffness control. Affective and cognitive manipulations had markedly different effects. Unlike the height condition, diverting attention from balance induced smaller COP amplitudes and higher sway frequencies. In addition, more regular COP trajectories (lower sample entropy) were found in the height condition than the dual-task conditions, suggesting elevated attentional investment in posture under the affective manipulation. Finally, based on an analysis of the cross-correlation function between anterior-posterior COP time series and enveloped calf muscle activity, indications of tighter anticipatory neuromuscular control of posture were found for the height condition only. Our data suggest that affective and cognitive perturbations have qualitatively different effects on postural control, and thus are likely to be associated with different control processes, as evidenced by differences in neuromuscular regulation and attentional investment in posture.     

Successful adaptation of gait in healthy older adults during dual-task treadmill walking

Dual-task methods have been used to demonstrate increased prioritization of walking performance over cognition in healthy aging. This is expressed as greater dual-task costs in cognitive performance than in walking. However, other research shows that older adults can prioritize cognitive performance over walking when instructed to do so. We asked whether age-related cognitive prioritization would emerge by experimentally manipulating cognitive difficulty. Young and older adults performed mental arithmetic at two levels of difficulty, alone or while walking. Electromyography and footswitches were used to measure muscle activity and stride parameters. Under high cognitive load, older adults increased their stride time, stride length, and hamstring activity, while maintaining their cognitive performance. Young adults showed negligible dual-task costs in each domain. The older adults appeared to successfully adapt their stride in response to high cognitive demands. The results have implications for neural models of gait regulation, and age differences in task emphasis.     

Reducing postural sway by concurrently performing challenging cognitive tasks

The present experiment varied cognitive complexity and sensory modality on postural control in young adults. Seventeen participants (23.71 ± 1.99 years) were instructed to stand feet together on a force platform while concurrently performing cognitive tasks of varying degrees of difficulty (easy, moderate and difficult). The cognitive tasks were presented both, auditorily and visually. Auditory tasks consisted of counting the occurrence of one or two letters and repeating a string of words. Visual tasks consisted of counting the occurrence of one or two numbers. With increasing cognitive demand, area of 95% confidence ellipse and ML sway variability was significantly reduced. The visual tasks reduced ML sway variability, whereas the auditory tasks increased COP irregularity. We suggest that these findings are primarily due to an increase in sensorimotor integration as a result of a shift in attentional focus.