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Prof, G. S. Ramesh Kumar. "WONDERFEELZ HUMMING WALKING AND COGNITIVE WALKING – MULTIPLE TASK WALKING CONCEPT AND CASE REPORT OF ENGINEERING EMPLOYEE." International Research Journal of Modernization in Engineering Technology and Science 4, no. 5 (2022): 5772–81. https://doi.org/10.5281/zenodo.6613710.
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Stress is handled by variety of ways. Dual Task walking is also one such measure but the concept requires more clarity. Operational Definition of Dual Task Walking, Multiple Task Walking are proposed. Humming walking, Cognitive Walking and Cognitively Controlled walking techniques are clarified operationally. A variant of Multiple Task Walking systematized by current author is also outlined along with a case report of an engineering employee. Keywords: Dual Task Walking, Multiple Task Walking, Humming Walking, Cognitive Walking, Cognitively Controlled-Walking.
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Strel’nikova, Ekaterina V., Margarita A. Kashirina та Anna O. Kantserova. "Нейрофизиологические механизмы двойных задач (обзор)". Journal of Medical and Biological Research, № 3 (20 вересня 2024): 368–82. http://dx.doi.org/10.37482/2687-1491-z196.
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This review considers articles studying neural mechanisms of dual (cognitive-motor) tasks in healthy young and older people using electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). A bibliometric network is presented showing the frequency of keywords (postural balance, gait, walking, neuropsychological tests, attention) used in publications and the associations between these keywords, as well as demonstrating the relevance of applying the cognitive-motor paradigm as a method for studying the neurophysiological mechanisms of dual-tasking. The design of the cognitive-motor dual-task paradigm used in the works varied greatly. The cognitive tasks included various computational-logical, spatial-figurative, auditory and verbal tasks as well as a modified version of a smartphone game. As motor tasks, static (stand, tandem stand) and dynamic (stand on a dynamic platform, treadmill walking, walking under the actual conditions of outside environment) tasks were used. Spatial and frequency distribution of brain activation when performing various types of cognitive and motor tasks was considered. Frontal cortical haemodynamic correlates of dual-tasking were demonstrated. Possible interpretations of research results proposed by the authors of the articles under study were indicated. The conclusions demonstrate that the actual set of tasks used in the experiment plays an essential role in the way the dual task will be processed. Dual-tasking involves activating executive functions that coordinate information processing in each task (cognitive or motor). The dual-task paradigm can be used as a model to investigate and evaluate executive functions, attention, working memory and postural control.
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Raghunadh, N., G. Swathi, and T. Sunil Kumar. "Effectiveness of Dual Task Exercises on Community Ambulation in Hemiparetic Patients." International Journal of Science and Healthcare Research 7, no. 2 (2022): 272–81. http://dx.doi.org/10.52403/ijshr.20220439.
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Background: Stroke is one of the major contributing factors for disability and handicap in adults. Hemiparetic stroke causes weakness of one side of the body and less severe than hemiplegia. Major problem following stroke is loss of walking ability, recovery of community ambulation is a priority goal for most patients. Various approaches in stroke rehabilitation have been studied to improve the walking ability of people with hemiparesis. The dual task is defined as simultaneous production of two tasks one "primary" and one "secondary", for which changes in performance are measured. Using dual-task paradigms as part of treatment may prove helpful in community ambulation, hence this study is to find out the effectiveness of dual task exercises on gait variables in subjects with hemiparesis. Method: Total of 30 subjects with Hemiparesis was taken by convenience sampling. All the subjects were explained about their condition & mode of assessment and written informed consent was obtained from them and divided into 2 groups. The experimental group was scheduled to attend dual task exercises thrice in a week for four weeks. The control group were scheduled to attend supervised conventional therapy sessions weekly thrice for four weeks. Gait assessment was done by using foot print method. The outcome measures of the study were velocity, cadence, step length, stride length. Results: Statistical Analysis were performed with SPSS version 16.0 package. On observing the means of post test parameters of experimental group A and control group B Independent t-test was done and the P- value is <0.05. There is a statistically significant difference in all gait parameters. Conclusion: This study concludes that dual task exercises can be considered as effective treatment method for motivated patients with hemiparesis to improve the walking ability and community ambulation. Keywords: Stroke, Hemiparesis, Dual Task, Gait, Foot Print Method.
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Anwar, Yulinar. "Pengaruh Dual-Task Training (Motor-Cognitive) terhadap Keseimbangan Dinamis pada Anak Usia Sekolah." Jurnal Fisioterapi dan Rehabilitasi 3, no. 2 (2019): 77–89. http://dx.doi.org/10.33660/jfrwhs.v3i2.86.
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Background : School-age Children are characterized by agile movements and motor activity coupled with the need to begin exploring the environment so that motor skills are needed. One aspect of motor skills is dynamic balance. Dual-task training (motor-cognitive) is a method of training that combines motor and cognitive tasks. The purpose of this exercise is to activation pattern of circuits in brain to achieve an adaptive system so that automation can be generated which can affect dynamic balance. Methods : this research is experimental quasi with time series design. The sampling technique used purposive sampling with a sample size of 30 students in 10- and 11- years-old who were not flat foot, not obese, and did not experience balance disorders. Primary data collection is obtained through dynamic balance instruments with balance beam walking test. The collected data used Shapiro Wilk for the normality test and obtained a value of p <0.05, which means that the distribution of data is abnormally distributed then a difference test of the of the pre-test and post-test using Friedman post hoc Wilcoxon Test. Results : the study was conducted for four weeks with 12 training sessions. The result of the analysis were started from pre-test, post-test 1, post-test 2, post-test 3, and post-test 4. The results overall showed a changed in dynamic balance between before and after 12 times of exercise with a significant value p=0,0001 (p <0,05). Conclusion : Therefore, it can be conclused that there is an effect of dual-task training (motor-cognitive) to dynamic balance of school-age children. 
 Keywords : Dual-Task Training (Motor Cognitive), Dynamic Balance, School-age Children
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Nisaruddin, Muslim Khan, Saima Rahman, and Iqra Muslim. "Dual-Task Specific Training or Conventional Physiotherapeutic Interventions, Which one is more Effective?" Journal of Saidu Medical College, Swat 14, no. 2 (2024): 109–14. http://dx.doi.org/10.52206/jsmc.2024.14.2.821.
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Background: Physiotherapeutic interventions play a crucial role in motor re-learning and functional recovery for stroke patients with upper and lower limb motor impairments. Among these interventions, dual-task training (DTT) has demonstrated significant effectiveness in enhancing the functional recovery of stroke patients. Objective: This study aims to compare the effectiveness of DTT and conventional physical therapy in ambulating right-hemiplegic stroke patients.Material and Methods: A randomized control trial (RCT) was conducted at the Department of Rehabilitation Medicine, Saidu group of Teaching Hospital, 2nd March 2020 to 3rd August 2020. Chronic right-hemiplegic stroke patients meeting set inclusion criteria were randomly assigned to two groups: the treatment group (TG) receiving DTT and the control group (CG) undergoing conventional physical therapy. DTT interventions included walking forward, backward, and sideways on a smooth surface while holding an 80-gram sandbag. The CG received conventional physiotherapy involving mat activities, strengthening, stretching exercises, and ambulation/gait training. Pre- and post-tests collected clinical data analyzed on SPSS 22 included spatial and temporal variables, 10-Meter Walk Test (10MWT), Time Up & Go Test (TUG), step length, cadence, cycle time, and stride length. Results: Out of 18 patients, each group had 50%, comprising 5 males (28%) and 4 females (22%). The mean age in CG was 57.20± 5.20, and in TG, it was 57.27± 6.10 years. Baseline clinical parameters were nearly identical between groups (P>0.05). Post-test scores revealed significant improvements in spatial and temporal gait variables, 10MWT score, cadence, step length, stride, and cycle time in TG compared to CG (P<0.05). Conclusion: Dual-task training and conventional physical therapy both significantly enhance the functional ability of right-hemiplegic patients across all gait temporal and spatial parameters. Keywords: Conventional physical therapy, Dual task training, Gait & ambulation, Stroke.
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Baek, Chang Yoon, Hyeong Dong Kim, Dong Yup Yoo, Kyoung Yee Kang, and Jang Woo Lee. "Effect of automaticity induced by treadmill walking on prefrontal cortex activation and dual-task performance in older adults." PLOS ONE 18, no. 8 (2023): e0287252. http://dx.doi.org/10.1371/journal.pone.0287252.
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As individuals age, they may experience a decline in gait automaticity, which requires increased attentional resources for the control of gait. This age-related decline in gait automaticity has been shown to contribute to higher prefrontal cortex (PFC) activation and lower dual-task performance during dual-task walking in older adults. This study is to investigate the effect of treadmill walking on PFC activation and dual-task performance in older adults. A total of 20 older adults (mean age, 64.35 ± 2.74 years) and 20 younger adults (mean age, 30.00 ± 3.15 years) performed single- and dual-task walking in overground and treadmill conditions. A wearable functional near-infrared spectroscopy and gait analyzer were used to analyze PFC activation and dual-task performance, respectively. To determine the dual-task (gait and cognitive) performance, the dual-task cost (DTC) was calculated using the following formula: (single-task − dual-task)/single-task × 100. In both groups, dual-task treadmill walking led to reduced PFC activation and reduced DTC compared to dual-task overground walking. Furthermore, despite a higher DTC in gait variability, correct response, total response, response index and a higher error score in older adults than in younger adults during overground walking, there was no difference in treadmill walking. The difference in PFC activation between single- and dual-tasks was also observed only in overground walking. Performing dual-task walking on a treadmill compared to overground walking results in different levels of dual-task performance and PFC activity. Specifically, older adults are able to maintain similar levels of dual-task performance as younger adults while walking on a treadmill, with reduced PFC activation due to the automaticity induced by the treadmill. Therefore, older adults who exhibit low dual-task performance during overground walking may be able to improve their performance while walking on a treadmill with fewer attentional resources.
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Kelly, Valerie E., Alexis J. Eusterbrock, and Anne Shumway-Cook. "The Effects of Instructions on Dual-Task Walking and Cognitive Task Performance in People with Parkinson's Disease." Parkinson's Disease 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/671261.
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Gait impairments are prevalent among people with Parkinson’s disease (PD). Instructions to focus on walking can improve walking in PD, but the use of such a cognitive strategy may be limited under dual-task walking conditions, when walking is performed simultaneously with concurrent cognitive or motor tasks. This study examined how dual-task performance of walking and a concurrent cognitive task was affected by instructions in people with PD compared to healthy young and older individuals. Dual-task walking and cognitive task performance was characterized under two sets of instructions as follows: (1) focus on walking and (2) focus on the cognitive task. People with PD and healthy adults walked faster when instructed to focus on walking. However, when focused on walking, people with PD and young adults demonstrated declines in the cognitive task. This suggests that dual-task performance is flexible and can be modified by instructions in people with PD, but walking improvements may come at a cost to cognitive task performance. The ability to modify dual-task performance in response to instructions or other task and environmental factors is critical to mobility in daily life. Future research should continue to examine factors that influence dual-task performance among people with PD.
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Kelly, Valerie E., Alexis J. Eusterbrock, and Anne Shumway-Cook. "A Review of Dual-Task Walking Deficits in People with Parkinson's Disease: Motor and Cognitive Contributions, Mechanisms, and Clinical Implications." Parkinson's Disease 2012 (2012): 1–14. http://dx.doi.org/10.1155/2012/918719.
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Gait impairments in Parkinson's disease (PD) are exacerbated under dual-task conditions requiring the simultaneous performance of cognitive or motor tasks. Dual-task walking deficits impact functional mobility, which often requires walking while performing concurrent tasks such as talking or carrying an object. The consequences of gait impairments in PD are significant and include increased disability, increased fall risk, and reduced quality of life. However, effective therapeutic interventions for dual-task walking deficits are limited. The goals of this narrative review are to describe dual-task walking deficits in people with PD, to discuss motor and cognitive factors that may contribute to these deficits, to review potential mechanisms underlying dual-task deficits, and to discuss the effect of therapeutic interventions on dual-task walking deficits in persons with PD.
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Orcioli-Silva, Diego, Rodrigo Vitório, Priscila Nóbrega-Sousa, et al. "Levodopa Facilitates Prefrontal Cortex Activation During Dual Task Walking in Parkinson Disease." Neurorehabilitation and Neural Repair 34, no. 7 (2020): 589–99. http://dx.doi.org/10.1177/1545968320924430.
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Background. Although dopaminergic medication improves dual task walking in people with Parkinson disease (PD), the underlying neural mechanisms are not yet fully understood. As prefrontal cognitive resources are involved in dual task walking, evaluation of the prefrontal cortex (PFC) is required. Objective. To investigate the effect of dopaminergic medication on PFC activity and gait parameters during dual task walking in people with PD. Methods. A total of 20 individuals with PD (69.8 ± 5.9 years) and 30 healthy older people (68.0 ± 5.6 years) performed 2 walking conditions: single and dual task (walking while performing a digit vigilance task). A mobile functional near infrared spectroscopy system and an electronic sensor carpet were used to analyze PFC activation and gait parameters, respectively. Relative concentrations of oxygenated hemoglobin (HbO2) from the left and right PFC were measured. Results. People with PD in the off state did not present changes in HbO2 level in the left PFC across walking conditions. In contrast, in the on state, they presented increased HbO2 levels during dual task compared with single task. Regardless of medication state, people with PD presented increased HbO2 levels in the right PFC during dual task walking compared with single task. The control group demonstrated increased PFC activity in both hemispheres during dual task compared with single task. People with PD showed increases in both step length and velocity in the on state compared with the off state. Conclusions. PD limits the activation of the left PFC during dual task walking, and dopaminergic medication facilitates its recruitment.
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Edwards, Erin M., Deborah A. Kegelmeyer, Anne D. Kloos, et al. "Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS." Multiple Sclerosis International 2020 (September 8, 2020): 1–10. http://dx.doi.org/10.1155/2020/6707414.
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Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.
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Wrightson, James G., Emma Z. Ross, and Nicholas J. Smeeton. "The Effect of Cognitive-Task Type and Walking Speed on Dual-Task Gait in Healthy Adults." Motor Control 20, no. 1 (2016): 109–21. http://dx.doi.org/10.1123/mc.2014-0060.
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In a number of studies in which a dual-task gait paradigm was used, researchers reported a relationship between cognitive function and gait. However, it is not clear to what extent these effects are dependent on the type of cognitive and walking tasks used in the dual-task paradigm. This study examined whether stride-time variability (STV) and trunk range of motion (RoM) are affected by the type of cognitive task and walking speed used during dual-task gait. Participants walked at both their preferred walking speed and at 25% of their preferred walking speed and performed a serial subtraction and a working memory task at both speeds. Although both tasks significantly reduced STV at both walking speeds, there was no difference between the two tasks. Trunk RoM was affected by the walking speed and type of cognitive task used during dual-task gait: Mediolateral trunk RoM was increased at the slow walking speed, and anterior-posterior trunk RoM was higher only when performing the serial subtraction task at the slow walking speed. The reduction of STV, regardless of cognitive-task type, suggests that healthy adults may redirect cognitive processes away from gait toward cognitive-task performance during dual-task gait.
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Hennah, Charlotte, Geraint Ellis, and Michail Doumas. "Dual task walking in healthy aging: Effects of narrow and wide walking paths." PLOS ONE 16, no. 12 (2021): e0261647. http://dx.doi.org/10.1371/journal.pone.0261647.
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Dual-task walking may lead to gait instability and a higher fall risk in older adults, particularly when walking in a busy city street. Challenging street features such as narrow sidewalks not only discourage walking, but are also likely to be taxing for older adults’ cognitive resources and gait characteristics. The aim of this study was to assess the way older adults’ gait characteristics are affected by walking on a narrow path while performing a challenging cognitive task in lab conditions imitating common urban environments. Nineteen young and eighteen older adults walked on a narrow (40cm) and a wide (80cm) path and performed a cognitive (n-back) task individually adjusted to 80% accuracy. The two tasks were performed separately (Single-Task) and concurrently (Dual-Task). Both groups walked faster, and their step width was narrower on the narrow path. During dual-task walking on the narrow path, older adults showed significant dual-task costs in the cognitive task, gait speed, step width, and stride length. Dual-task walking was associated with decreased gait speed and stride length in both age groups, suggesting that dual-task walking may adversely affect gait, particularly when walking on narrow paths. These conditions may lead to gait instability and an increased fall risk for older adults, particularly when walking along the narrow sidewalks commonly found within the built environment. However, more research is needed in an urban setting to determine the extent of the fall risk narrow sidewalks present for older adults.
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Jor’dan, Azizah J., Brad Manor, Ikechukwu Iloputaife, et al. "Diminished Locomotor Control Is Associated With Reduced Neurovascular Coupling in Older Adults." Journals of Gerontology: Series A 75, no. 8 (2019): 1516–22. http://dx.doi.org/10.1093/gerona/glz006.
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Abstract Background Walking, especially while dual-tasking, requires functional activation of cognitive brain regions and their connected neural networks. This study examined the relationship between neurovascular coupling (NVC), as measured by the change in cerebral blood flow in response to performing a cognitive executive task, and dual-task walking performance. Methods Seventy community-dwelling older adults aged 84 ± 5 years within the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly (MOBILIZE) Boston Study were divided into LOW (n = 35) and HIGH (n = 35) NVC. NVC was quantified by transcranial Doppler ultrasound and stratified by the median change in cerebral blood flow velocity of the middle cerebral artery induced by the performance of the n-back task of executive function. Walking metrics included walking speed, step width, stride length, stride time, stride time variability, and double-support time from single- and dual-task walking conditions, as well as the “cost” of dual-tasking. Results During both single- and dual-task walking, older adults with LOW NVC displayed narrower step width (p = .02 and p = .02), shorter stride length (p = .01 and p = .02), and longer double-support time (p = .03 and p = .002) when compared with the HIGH group. During single-task walking only, LOW NVC was also linked to slower walking speed (p = .02). These associations were independent of age, height, hypertension, atrial fibrillation, and assistive device. The LOW and HIGH NVC groups did not differ in dual-task costs to walking performance. Conclusion In older adults, diminished capacity to regulate cerebral blood flow in response to an executive function task is linked to worse walking performance under both single- and dual-task conditions, but not necessarily dual-task costs.
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Agmon, Maayan, Einat Kodesh, and Rachel Kizony. "The Effect of Different Types of Walking on Dual-Task Performance and Task Prioritization among Community-Dwelling Older Adults." Scientific World Journal 2014 (2014): 1–6. http://dx.doi.org/10.1155/2014/259547.
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Background. The ability to safely conduct different types of walking concurrently with a cognitive task (i.e., dual task) is crucial for daily life. The contribution of different walking types to dual-task performance has not yet been determined, nor is there agreement on the strategies that older adults use to divide their attention between two tasks (task prioritization).Objectives. To compare the effect of walking in three different directions (forward, backward, and sideways) on dual-task performance and to explore the strategies of older adults to allocate their attention in response to different motor task demands.Design. A cross-sectional study.Subjects. Thirty-two (22 female) community-dwelling older adults (aged72.7±5.7years).Methods. Subjects randomly conducted single and dual task: walking to three directions separately, cognitive tasks separately, and combination of the two.Results. Walking forward was the least demanding task, during single (FW < BW, SW) (P<.001) and dual tasks (FW < BW < SW) (P<.001). The calculation of DTC revealed the same pattern (P<.001). DTC of the cognitive tasks was not significantly different among the three walking types.Conclusions. The decline mainly in the motor performance during dual task indicates that participants prioritized the cognitive task. These findings challenge the “posture first” paradigm for task prioritization.
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Soangra, Rahul, and Thurmon E. Lockhart. "Dual-Task Does Not Increase Slip and Fall Risk in Healthy Young and Older Adults during Walking." Applied Bionics and Biomechanics 2017 (2017): 1–12. http://dx.doi.org/10.1155/2017/1014784.
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Dual-task tests can identify gait characteristics peculiar to fallers and nonfallers. Understanding the relationship between gait performance and dual-task related cognitive-motor interference is important for fall prevention. Dual-task adapted changes in gait instability/variability can adversely affect fall risks. Although implicated, it is unclear if healthy participants’ fall risks are modified by dual-task walking conditions. Seven healthy young and seven healthy older adults were randomly assigned to normal walking and dual-task walking sessions with a slip perturbation. In the dual-task session, the participants walked and simultaneously counted backwards from a randomly provided number. The results indicate that the gait changes in dual-task walking have no destabilizing effect on gait and slip responses in healthy individuals. We also found that, during dual-tasking, healthy individuals adopted cautious gait mode (CGM) strategy that is characterized by reduced walking speed, shorter step length, increased step width, and reduced heel contact velocity and is likely to be an adaptation to minimize attentional demand and decrease slip and fall risk during limited available attentional resources. Exploring interactions between gait variability and cognitive functions while walking may lead to designing appropriate fall interventions among healthy and patient population with fall risk.
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Hausdorff, Jeffrey, Nofar Schneider, Marina Brozgol, et al. "Combining tDCS With a Motor-Cognitive Task to Reduce the Negative Impact of Dual-Tasking on the Gait of Older Adults." Innovation in Aging 4, Supplement_1 (2020): 287–88. http://dx.doi.org/10.1093/geroni/igaa057.921.
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Abstract The simultaneous performance of a secondary task while walking (i.e., dual tasking) increases motor-cognitive interference and fall risk in older adults. Combining transcranial direct current stimulation (tDCS) with the concurrent performance of a task that putatively involves the same brain networks targeted by the tDCS may reduce the negative impact of dual-tasking on walking. We examined whether tDCS applied while walking reduces the dual-task costs to gait and whether this combination is better than tDCS alone or walking alone (with sham stimulation). In 25 healthy older adults (aged 75.7±10.5yrs), a double-blind, within-subject, cross-over pilot study evaluated the acute after-effects of 20 minutes of tDCS targeting the primary motor cortex and the dorsal lateral pre frontal cortex during three separate sessions:1) tDCS while walking on a treadmill in a virtual-reality environment (tDCS+walking), 2) tDCS while seated (tDCS+seated), and 3) walking in the virtual-reality environment with sham tDCS (sham+walking). The complex walking condition taxed motor and cognitive abilities. During each session, single- and dual-task walking and cognitive function were assessed before and immediately after stimulation. Compared to pre-tDCS performance, tDCS+walking reduced the dual-task cost to gait speed (p=0.004) and other gait features (e.g., variability p=0.02), and improved (p&lt;0.001) executive function (Stroop interference score). tDCS+seated and sham+walking did not affect the dual-task cost to gait speed (p&gt;0.17). These initial findings demonstrate that tDCS delivered during challenging walking ameliorates dual-task gait and executive function in older adults, suggesting that the concurrent performance of related tasks enhances the efficacy of the neural stimulation and mobility.
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Etemadi, Yasaman. "Dual task cost of cognition is related to fall risk in patients with multiple sclerosis: a prospective study." Clinical Rehabilitation 31, no. 2 (2016): 278–84. http://dx.doi.org/10.1177/0269215516637201.
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Objective: To examine whether change in cognitive performance during dual task condition compared with a task in isolation, known as dual task cost, is related to fall risk of patients with multiple sclerosis. Design: Prospective cohort. During baseline assessment, data about balance, walking and cognitive performance of patients with multiple sclerosis were collected under a single and dual task condition. The dual task cost was calculated as a percentage of change in parameters from single to dual task conditions. Falls were recorded prospectively for six months and participants were classified as none/one time fallers and recurrent fallers (⩾2 falls). The association between dual task costs and fall status was evaluated by logistic regression. Setting: Balance research lab of university hospital. Participants: A total of 60 patients with relapsing-remitting multiple sclerosis. Interventions: Not applicable. Main outcome measures: The dual task cost of the center of pressure sway area, walking velocity and correct response rate were outcome measures for balance, walking and cognitive performance, respectively. Results: A total of 79 falls were reported by 38 of the participants who experienced one or more falls; 26 (43.3%) of them had recurrent falls. Dual tasking resulted in increased sway area and decreased walking velocity and correct response rate during walking (all p values <0.05). Logistic regressions showed that the dual task cost of the correct response rate during walking and walking velocity were associated with increased risk of recurrent falls ( P = 0.02, odds ratio = 1.34; confidence interval (CI) 1.04–3.74; P = 0.05, odds ratio = 1.23, CI = 1.02–4.45, respectively). Conclusions: The dual task cost of cognition was related to fall, which should be considered as a target for falls evaluation and prevention strategies.
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Donoghue, Orna A., Cara Dooley, and Rose Anne Kenny. "Usual and Dual-Task Walking Speed." Journal of Aging and Health 28, no. 5 (2015): 850–62. http://dx.doi.org/10.1177/0898264315614004.
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Lin, Yen-Po, I.-I. Lin, Wei-Da Chiou, et al. "The Executive-Function-Related Cognitive–Motor Dual Task Walking Performance and Task Prioritizing Effect on People with Parkinson’s Disease." Healthcare 11, no. 4 (2023): 567. http://dx.doi.org/10.3390/healthcare11040567.
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To safely walk in a community environment requires dual cognitive–walking ambulation ability for people with Parkinson’s disease (PD). A past study showed inconsistent results on cognitive–walking performance for PD patients, possibly due to the various cognitive tasks used and task priority assignment. This study designed cognitive–walking tests that used executive-related cognitive tasks to evaluate patients with early-stage Parkinson’s disease who did not have obvious cognitive deficits. The effect of assigning task prioritization was also evaluated. Sixteen individuals with PD (PD group) and 16 individuals without PD (control group) underwent single cognitive tests, single walking tests, dual walking tests, and prioritizing task tests. Three types of cognitive, spatial memory, Stroops, and calculation tasks were employed. The cognitive performance was evaluated by response time, accuracy, and speed–accuracy trade off composite score. The walking performance was evaluated by the temporal spatial gait characteristics and variation in gait. The results showed that the walking performance of the PD group was significantly worse than the control group in both single and dual walking conditions. The group difference in cognitive performance was shown in composite score under the dual calculation walking task but not under the single task. While assigning priority to walking, no group difference in walking was observed but the response accuracy rate of PD groups declined. This study concluded that the dual task walking test could sharpen the cognitive deficits for early-stage PD patients. The task priority assignment might not be recommended while testing gait deficits since it decreased the ability to discriminate group differences.
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Morgan, Sara J., Brian J. Hafner, Deborah Kartin, and Valerie E. Kelly. "Dual-task standing and walking in people with lower limb amputation: A structured review." Prosthetics and Orthotics International 42, no. 6 (2018): 652–66. http://dx.doi.org/10.1177/0309364618785728.
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Background: People with lower limb amputation report the need to concentrate on walking. Dual-task paradigms are often used to study such interactions between cognition and the control of balance and gait in people with lower limb amputation. Objectives: To summarize evidence related to dual-task standing and walking in people with lower limb amputation and discuss implications for future research. Study design: Structured review. Methods: A structured search was completed in PubMed, CINAHL, and Web of Science from database inception to May 2017. Eligible articles were in English, included participants with lower limb amputation, and assessed dual-task standing or walking. Study information was extracted by one reviewer and assessed for accuracy by a second. Results: A total of 12 articles met eligibility criteria. Seven examined differences in dual-task standing or walking, and five assessed dual-task walking across microprocessor-controlled and non-microprocessor-controlled prosthetic knee conditions. Conclusion: Results suggest that (1) dual-task interference in standing is greater for people with lower limb amputation than non-amputees and (2) the use of microprocessor-controlled knees improves dual-task performance for people with limited mobility compared to non-microprocessor-controlled knees. The small number of studies, diversity of dual-task methods, and methodological limitations challenge the synthesis of study results. Future research should assess specific clinical characteristics that can affect dual-task performance in people with lower limb amputation. Clinical relevance Understanding how people with lower limb amputation use increased attention in balance and gait to compensate for limb loss can inform prosthetic interventions and training. Dual-task research suggests that people with amputation use increased cognitive control for standing compared to controls and microprocessor-controlled knees improve dual-task walking in people with limited mobility.
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Xu, Kaiyue, Wenqiang Yu, Shui Yu, Minghui Zheng, and Hao Zhang. "The Detection of Gait Events Based on Smartphones and Deep Learning." Bioengineering 12, no. 5 (2025): 491. https://doi.org/10.3390/bioengineering12050491.
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This study aims to detect gait events using a smartphone combined with deep learning and evaluate the remote effects and clinical significance of this method in different elderly populations and patients with cerebral small vessel disease (CSVD). In total, 150 healthy individuals aged 20–70 years were asked to attach a smartphone to their thighs and walk six gait cycles at self-selected low, normal, and high speeds, using an insole pressure sensor as the reference standard for gait events. A deep learning model was then established using BiTCN-BiGRU-CrossAttention, and two models (TCN-GRU and BiTCN-BiGRU) were compared. In total, 48 elderly (25 healthy, 12 with mild cognitive impairment, 11 with Parkinson’s disease) participated in an online home assessment, completing single-task and cognitive dual-task walking. Overall, 35 CSVD patients participated in an offline clinical assessment, completing single-task, cognitive dual-task, and physical dual-task walking. The BiTCN-BiGRU-CrossAttention model had the lowest MAE for detecting gait events compared to the other models. All models had lower MAEs for detecting heel strikes than toe-offs, and the MAE for low and high walking was higher than for normal speed walking. There were significant differences (p < 0.05) in gait parameters (Cadence, Stride time, Stance phase, Swing phase, Stance time, Swing time, Stride length, and walking speed) between single-task and cognitive dual-task walking for all online elderly participants. CSVD patients showed significant differences (p < 0.05) in gait parameters (Cadence, Stride time, Stance phase, Swing phase, Stance time, Stride length, and walking speed) between single-task and cognitive dual-task and between single-task and physical dual-task walking.
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Timmermans, Celine, Melvyn Roerdink, Thomas W. J. Janssen, Carel G. M. Meskers, and Peter J. Beek. "Dual-Task Walking in Challenging Environments in People with Stroke: Cognitive-Motor Interference and Task Prioritization." Stroke Research and Treatment 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/7928597.
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Cognitive-motor interference may contribute to the risk of falling in people with stroke, as may be the associated phenomenon of inappropriate task prioritization. Examining dual-task walking could provide valuable insights as to how to best evaluate and treat walking in people with stroke. This study aimed to examine the effect of different walking environments on cognitive-motor interference and task prioritization in dual-task walking in people with stroke. Using a repeated-measures design, cognitive-motor interference and task prioritization were assessed in 30 stroke survivors, while walking in a plain environment and in two challenging environments that were enriched with either stationary physical context or suddenly appearing projector-augmented context. All three walking environment conditions were performed with and without a concurrent serial-3 subtraction task. We found stronger cognitive-motor interference for the two challenging environments than for the plain walking environment. Cognitive-motor interference did not differ between challenging walking environments, but task prioritization did: motor performance was prioritized more in the environment with physical context than in the environment with projector-augmented context and vice versa for cognitive-task performance. In conclusion, walking environment strongly influenced cognitive-motor interference and task prioritization during dual-task walking in people with stroke.
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Oh, Chorong. "Single-Task or Dual-Task? Gait Assessment as a Potential Diagnostic Tool for Alzheimer’s Dementia." Journal of Alzheimer's Disease 84, no. 3 (2021): 1183–92. http://dx.doi.org/10.3233/jad-210690.
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Background: A person’s gait performance requires the integration of sensorimotor and cognitive systems. Therefore, a person’s gait may be influenced by concurrent cognitive load such as simultaneous talking. Although it has been known that gait performance of people with Alzheimer’s dementia (AD) is compromised when they attempt a dual-task walking task, it is unclear if using a dual-task gait performance during an AD assessment yields higher diagnostic accuracy. Objective: This study was designed to compare the predictive power for AD of dual-task gait performance in an AD assessment to that of single-task gait performance. Methods: Participants (14 with AD and 15 healthy controls) walked across the GAITRite© Portable Walkway mat under three different cognitive load conditions: no simultaneous cognitive load, walking while counting numbers by ones, and walking while completing category naming. Results: Multiple logistic regression revealed that the gait performance under a dual-task condition (i.e., concurrent counting or category naming) increased the proportion of variance explained by the FAP, SL, and DST, of the incidence of AD. Conclusion: Dual-task walking and talking may be a more effective diagnostic feature than single-task walking in a comprehensive AD diagnostic assessment.
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Orcioli-Silva, Diego, Lucas Simieli, Fabio Augusto Barbieri, Florindo Stella, and Lilian Teresa Bucken Gobbi. "Adaptive Walking in Alzheimer's Disease." International Journal of Alzheimer's Disease 2012 (2012): 1–6. http://dx.doi.org/10.1155/2012/674589.
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The aim of this study is to analyze dual-task effects on free and adaptive gait in Alzheimer's disease (AD) patients. Nineteen elders with AD participated in the study. A veteran neuropsychiatrist established the degree of AD in the sample. To determine dual-task effects on free and adaptive gait, patients performed five trials for each experimental condition: free and adaptive gait with and without a dual-task (regressive countdown). Spatial and temporal parameters were collected through an optoelectronic tridimensional system. The central stride was analyzed in free gait, and the steps immediately before (approaching phase) and during the obstacle crossing were analyzed in adaptive gait. Results indicated that AD patients walked more slowly during adaptive gait and free gait, using conservative strategies when confronted either with an obstacle or a secondary task. Furthermore, patients sought for stability to perform the tasks, particularly for adaptive gait with dual task, who used anticipatory and online adjustments to perform the task. Therefore, the increase of task complexity enhances cognitive load and risk of falls for AD patients.
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Manor, Brad, Junhong Zhou, Azizah Jor'dan, Jue Zhang, Jing Fang, and Alvaro Pascual-Leone. "Reduction of Dual-task Costs by Noninvasive Modulation of Prefrontal Activity in Healthy Elders." Journal of Cognitive Neuroscience 28, no. 2 (2016): 275–81. http://dx.doi.org/10.1162/jocn_a_00897.
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Dual tasking (e.g., walking or standing while performing a cognitive task) disrupts performance in one or both tasks, and such dual-task costs increase with aging into senescence. Dual tasking activates a network of brain regions including pFC. We therefore hypothesized that facilitation of prefrontal cortical activity via transcranial direct current stimulation (tDCS) would reduce dual-task costs in older adults. Thirty-seven healthy older adults completed two visits during which dual tasking was assessed before and after 20 min of real or sham tDCS targeting the left pFC. Trials of single-task standing, walking, and verbalized serial subtractions were completed, along with dual-task trials of standing or walking while performing serial subtractions. Dual-task costs were calculated as the percent change in markers of gait and postural control and serial subtraction performance, from single to dual tasking. Significant dual-task costs to standing, walking, and serial subtraction performance were observed before tDCS (p < .01). These dual-task costs were less after real tDCS as compared with sham tDCS as well as compared with either pre-tDCS condition (p < .03). Further analyses indicated that tDCS did not alter single task performance but instead improved performance solely within dual-task conditions (p < .02). These results demonstrate that dual tasking can be improved by modulating prefrontal activity, thus indicating that dual-task decrements are modifiable and may not necessarily reflect an obligatory consequence of aging. Moreover, tDCS may ultimately serve as a novel approach to preserving dual-task capacity into senescence.
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Baillargeon, Emma, Anisha Suri, Theodore Huppert, Ervin Sejdic, and Andrea Rosso. "DUAL-TASK CHANGES IN PREFRONTAL ACTIVATION AND GAIT QUALITY IN OLDER ADULTS." Innovation in Aging 6, Supplement_1 (2022): 332. http://dx.doi.org/10.1093/geroni/igac059.1311.
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Abstract We compared the impact of performing dual-task walking on gait quality and prefrontal cortical activation assessed by functional near-infrared spectroscopy (fNIRS). We hypothesized a greater increase in fNIRS averaged over the left prefrontal cortex during dual-task walking would be associated with a greater decrease in gait quality (increased step-time variability; decreased gait speed, cadence, smoothness, and adaptability). In older adults (n=60, 75±5.8 years, 57% female), we quantified the change in fNIRS and gait metrics from single-task walking (even surface) to walking with attentional (reciting every-other letter of the alphabet) and physical (uneven surface) dual-task challenges using four 15m repetitions of each task. Gait metrics were computed from a tri-axial accelerometer at the lower-back. Changes in fNIRS from single to dual-task walking were not associated with changes in gait quality for both attentional and physical challenges (Spearman correlations, all p&gt;0.08). Variability in response across individuals may contribute to our findings.
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Veldkamp, Renee, Ilse Baert, Alon Kalron, et al. "Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT." Journal of Clinical Medicine 8, no. 12 (2019): 2177. http://dx.doi.org/10.3390/jcm8122177.
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The aim was to compare the effectiveness of dual-task training (DTT) compared to single mobility training (SMT) on dual-task walking, mobility and cognition, in persons with Multiple Sclerosis (pwMS). Forty pwMS were randomly assigned to the DTT or SMT groups. The DTT-group performed dual-task exercises using an interactive tablet-based application, while the SMT-group received conventional walking and balance exercises. Both interventions were supervised and identical in weeks (8) and sessions (20). Nine cognitive-motor dual-task conditions were assessed at baseline, after intervention and at 4-weeks follow-up (FU). The dual-task cost (DTC), percentage change of dual-task performance compared to single-task performance, was the primary outcome. Mobility and cognition were secondarily assessed. Mixed model analyses were done with group, time and the interaction between group and time as fixed factors and participants as random factors. Significant time by group interactions were found for the digit-span walk and subtraction walk dual-task conditions, with a reduction in DTC (gait speed) for the DTT maintained at FU. Further, absolute dual-task gait speed during walking over obstacles only improved after the DTT. Significant improvements were found for both groups in various motor and cognitive measures. However, the DTT led to better dual-task walking compared to the SMT.
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Hollman, John H., James W. Youdas, and Desiree J. Lanzino. "Gender Differences in Dual Task Gait Performance in Older Adults." American Journal of Men's Health 5, no. 1 (2009): 11–17. http://dx.doi.org/10.1177/1557988309357232.
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Although attention-dividing dual tasks hinder gait performance in older persons, gender differences in gait have not been examined. The purpose of this study was to examine whether gait performance differs between older men and women during dual task walking. A total of 44 healthy adults (20 men and 24 women) aged 65 years or older participated in the study. Participants walked under normal and dual task (backward spelling) conditions at self-selected speeds. Mean gait speed and stride-to-stride variability in gait speed were quantified with GAITRite ® instrumentation. Whereas gait speed decreased and variability in gait speed increased in both groups during dual task walking, men walked with greater variability during dual task walking than did women. The magnitude of the increase in variability in gait speed observed in men indicates that stride-to-stride variability in gait speed during dual task walking requires more investigation as a potential risk factor for falls in older men.
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Beurskens, Rainer, Fabian Steinberg, Franziska Antoniewicz, Wanja Wolff, and Urs Granacher. "Neural Correlates of Dual-Task Walking: Effects of Cognitive versus Motor Interference in Young Adults." Neural Plasticity 2016 (2016): 1–9. http://dx.doi.org/10.1155/2016/8032180.
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Walking while concurrently performing cognitive and/or motor interference tasks is the norm rather than the exception during everyday life and there is evidence from behavioral studies that it negatively affects human locomotion. However, there is hardly any information available regarding the underlying neural correlates of single- and dual-task walking. We had 12 young adults (23.8 ± 2.8 years) walk while concurrently performing a cognitive interference (CI) or a motor interference (MI) task. Simultaneously, neural activation in frontal, central, and parietal brain areas was registered using a mobile EEG system. Results showed that the MI task but not the CI task affected walking performance in terms of significantly decreased gait velocity and stride length and significantly increased stride time and tempo-spatial variability. Average activity in alpha and beta frequencies was significantly modulated during both CI and MI walking conditions in frontal and central brain regions, indicating an increased cognitive load during dual-task walking. Our results suggest that impaired motor performance during dual-task walking is mirrored in neural activation patterns of the brain. This finding is in line with established cognitive theories arguing that dual-task situations overstrain cognitive capabilities resulting in motor performance decrements.
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Baillargeon, Emma, Theodore Huppert, Caterina Rosano, and Andrea Rosso. "HETEROGENEITY OF PREFRONTAL CORTICAL ACTIVITY DURING WALKING AMONG OLDER ADULTS." Innovation in Aging 7, Supplement_1 (2023): 168–69. http://dx.doi.org/10.1093/geroni/igad104.0551.
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Abstract Higher prefrontal cortical (PFC) activity during simple walking may indicate neural compensation for impaired gait automaticity. On average, older adults have higher PFC activity during walking than younger adults, but the heterogeneity amongst older adults is understudied. We examined PFC activity during simple and dual-task walking in adults aged 65+ (n=173, mean age=72, 62% female). Participants walked quietly and while reciting every-other-letter of the alphabet (dual-task; 4 repsx15 meters). Change in PFC activity from standing was estimated using functional near-infrared spectroscopy. We grouped participants with significantly increased, significantly decreased, or no change in PFC activity from standing to simple walking (t-test, alpha=0.05). We tested for group differences in PFC activity change from simple to dual-task walking, task performance (gait speed, rate of correct letters), age, and cognitive function (trail-making A/B). PFC activity increased from standing to walking in 52 (30%), decreased in 21 (12%), and did not change in 100 (58%) participants. Those who reduced PFC activity from standing to simple walking (vs no change or increased, respectively) walked faster (mean+/-SD=1.12+/-0.17 vs 1.00+/-0.17 0.99+/-0.18m/s; both p=0.014) and had a greater increase in PFC activity from simple to dual-task walking (t-stat=1.96+/-2.2 vs 0.49+/-1.53 vs -0.26+/-1.43; p=0.008, p=0.0006). Those who increased PFC activity from standing to simple walking had a smaller PFC change (vs no change) from simple to dual-task walking (p=0.005). Age, alphabet performance, and cognitive function did not differ across groups. Differences in PFC activity during simple walking may contribute to differences in task performance and capacity for walking challenges.
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Wrightson, J. G., and N. J. Smeeton. "Walking modality, but not task difficulty, influences the control of dual-task walking." Gait & Posture 58 (October 2017): 136–38. http://dx.doi.org/10.1016/j.gaitpost.2017.07.042.
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Tao, Weiyuan, Jiawei Chen, Jiahui Peng, and Wenwu Xiao. "Comparing the effectiveness of dual-task and single-task training on walking function in stroke recovery: A systematic review and meta-analysis." Medicine 104, no. 10 (2025): e41776. https://doi.org/10.1097/md.0000000000041776.
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Background: Stroke is a prevalent neurological disease with high morbidity and disability. Single-task walking training has limitations, and dual-task walking training has emerged. Yet, research on the relative effectiveness of dual- and single-task training for stroke patients’ walking function is inconclusive. This study aims to systematically compare the efficacy of dual-task with single-task training interventions on improving walking function among stroke survivors. Methods: A comprehensive search of electronic databases was conducted to identify randomized controlled trials investigating the application of dual-task training on walking function in stroke patients. Two reviewers independently screened the references, selected relevant studies, extracted data, and assessed the risk of bias. The primary outcome measures related to walking function included step speed, step length, stride length, step frequency, Berg balance scale (BBS), and timed up and go (TUG) test. The Cochrane risk of bias tool was used for methodological quality assessment of the included literature. Statistical analysis was performed using RevMan 5.4 software. Furthermore, the quality of evidence of the outcome measures was evaluated using the GRADEPro software. Results: A total of 17 studies were enrolled in this systematic review and meta-analysis. The results revealed that dual-task training exhibited significantly superior efficacy compared to single-task training in enhancing step speed, step length, stride length, step frequency, and BBS score (P < .05). However, no significant difference was observed in the TUG test (P = .100). Conclusion: Compared with traditional single-task training, dual-task training could be more effective in improving walking function among stroke patients, especially with regard to temporal and spatial parameters such as step length and speed, stride frequency and BBS score, but the effect on enhancing TUG test still remains unclear. These findings would help clinicians to formulate a more rational stroke rehabilitation strategy.
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Hamilton, F., L. Rochester, L. Paul, D. Rafferty, CP O'Leary, and JJ Evans. "Walking and talking: an investigation of cognitive—motor dual tasking in multiple sclerosis." Multiple Sclerosis Journal 15, no. 10 (2009): 1215–27. http://dx.doi.org/10.1177/1352458509106712.
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Background: Deficits in motor functioning, including walking, and in cognitive functions, including attention, are known to be prevalent in multiple sclerosis (MS), though little attention has been paid to how impairments in these areas of functioning interact. Objectives: This study investigated the effects of performing a concurrent cognitive task when walking in people with MS. Level of task demand was manipulated to investigate whether this affected level of dual-task decrement. Method: Eighteen participants with MS and 18 healthy controls took part. Participants completed walking and cognitive tasks under single- and dual-task conditions. Results: Compared to healthy controls, MS participants showed greater decrements in performance under dual-task conditions in cognitive task performance, walking speed and swing time variability. In the MS group, the degree of decrement under dual-task conditions was related to levels of fatigue, a measure of general cognitive functioning and self-reported everyday cognitive errors, but not to measures of disease severity or duration. Conclusions: Difficulty with walking and talking in MS may be a result of a divided attention deficit or of overloading of the working memory system, and further investigation is needed. We suggest that difficulty with walking and talking in MS may lead to practical problems in everyday life, including potentially increasing the risk of falls. Clinical tools to assess cognitive—motor dual-tasking ability are needed.
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Sosnoff, Jacob J., Douglas A. Wajda, Brian M. Sandroff, Kathleen L. Roeing, JongHun Sung, and Robert W. Motl. "Dual task training in persons with Multiple Sclerosis: a feasability randomized controlled trial." Clinical Rehabilitation 31, no. 10 (2017): 1322–31. http://dx.doi.org/10.1177/0269215517698028.
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Objective: To determine the feasibility of dual task training in persons with Multiple Sclerosis. Design: Randomized, single-blinded controlled trial. Setting: University research laboratory. Participants: A total of 234 individuals inquired about the investigation. After screening, 20 individuals with multiple sclerosis who self-reported problems with multitasking and were ambulatory volunteered for the investigation. 14 participants completed the post-assessment following the 12-week intervention. Intervention: Participants were randomly assigned to either single task training program which focused on balance and walking function ( n=6) or dual task training program that incorporated cognitive tasks in balance and walking training ( n=8). Measures: Before and after the 12-week interventions participants underwent assessments of walking; dual task walking; balance (Berg Balance Scale and balance confidence) and cognition as indexed by the Brief International Cognitive Assessment for MS. Results: There was an 8.5% recruitment rate, a 70% retention rate, and a 100% adherence rate. There was a trend for dual task gait speed to improve in the dual task training group following the intervention (Pre: task 1: 109.8±39, task 2: 104.2±34.1; Post: task 1:127.6±40.1, task 2: 122.8±37.4; P=0.14; η2 = 0.24). There was also a trend for the dual task training group (28.1) to have greater performance than the control group (24.7) on visuospatial memory ( P=0.10; η2= 0.23). There were no changes in cognitive performance during walking trials. Conclusions: The study procedures were found to be feasible and improvements should be made in recruitment efforts going forward. Further examination of dual task training programs in individuals with multiple sclerosis is warranted.
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Nonnekes, Jorik, Valeria Dibilio, Claudia Barthel, Teodoro Solis-Escalante, Bastiaan R. Bloem, and Vivian Weerdesteyn. "Understanding the dual-task costs of walking: a StartReact study." Experimental Brain Research 238, no. 5 (2020): 1359–64. http://dx.doi.org/10.1007/s00221-020-05817-8.
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Abstract The need to perform multiple tasks more or less simultaneously is a common occurrence during walking in daily life. Performing tasks simultaneously typically impacts task performance negatively. Hypothetically, such dual-task costs may be explained by a lowered state of preparation due to competition for attentional resources, or alternatively, by a ‘bottleneck’ in response initiation. Here, we investigated both hypotheses by comparing ‘StartReact’ effects during a manual squeezing task under single-task (when seated) and dual-task (when walking) conditions. StartReact is the acceleration of reaction times by a startling stimulation (a startling acoustic stimulus was applied in 25% of trials), attributed to the startling stimulus directly releasing a pre-prepared movement. If dual-task costs are due to a lowered state of preparation, we expected trials both with and without an accompanying startling stimulus to be delayed compared to the single-task condition, whereas we expected only trials without a startling stimulus to be delayed if a bottleneck in response initiation would underlie dual-task costs. Reaction times of the manual squeezing task in the flexor digitorum superficialis and extensor carpi radialis muscle were significantly delayed (approx. 20 ms) when walking compared to the seated position. A startling acoustic stimulus significantly decreased reaction times of the squeezing task (approx. 60 ms) both when walking and sitting. Dual-task costs during walking are, therefore, likely the result of lowered task preparation because of competition for attentional resources.
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Vitorio, Rodrigo, Samuel Stuart, and Martina Mancini. "Executive Control of Walking in People With Parkinson’s Disease With Freezing of Gait." Neurorehabilitation and Neural Repair 34, no. 12 (2020): 1138–49. http://dx.doi.org/10.1177/1545968320969940.
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Background Walking abnormalities in people with Parkinson’s disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory prefrontal executive control. Indirect measures of automaticity of walking (eg, step-to-step variability and dual-task cost) suggest that freezing of gait (FoG) may be associated with reduced automaticity of walking. However, the influence of FoG status on actual prefrontal cortex (PFC) activity during walking remains unclear. Objective To investigate the influence of FoG status on automaticity of walking in people with PD. Methods Forty-seven people with PD were distributed into 2 groups based on FoG status, which was assessed by the New Freezing of Gait Questionnaire: PD−FoG (n = 23; UPDRS-III = 35) and PD+FoG (n = 24; UPDRS-III = 43.1). Participants walked over a 9-m straight path (with a 180° turn at each end) for 80 seconds. Two conditions were tested off medication: single- and dual-task walking (ie, with a concomitant cognitive task). A portable functional near-infrared spectroscopy system recorded PFC activity while walking (including turns). Wearable inertial sensors were used to calculate spatiotemporal gait parameters. Results PD+FoG had greater PFC activation during both single and dual-task walking than PD−FoG ( P = .031). There were no differences in gait between PD−FoG and PD+FoG. Both groups decreased gait speed ( P = .029) and stride length ( P < .001) during dual-task walking compared with single-task walking. Conclusions These findings suggest that PD+FoG have reduced automaticity of walking, even in absence of FoG episodes. PFC activity while walking seems to be more sensitive than gait measures in identifying reduction in automaticity of walking in PD+FoG.
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Ozkul, Cagla, Arzu Guclu-Gunduz, Kader Eldemir, et al. "Dual-Task Cost and Related Clinical Features in Patients With Multiple Sclerosis." Motor Control 25, no. 2 (2021): 211–33. http://dx.doi.org/10.1123/mc.2020-0035.
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This study aimed to investigate the dual-task cost of both motor and cognitive performances in patients with multiple sclerosis (PwMS) and in healthy controls and to determine their relationships with clinical features in PwMS. The participants performed motor tasks (postural stability, walking, and manual dexterity) and cognitive tasks (mental tracking and verbal fluency) under single- and dual-task conditions. The results showed that postural stability under dual-task conditions did not change, whereas walking and manual dexterity deteriorated, regardless of the concurrent cognitive task, in PwMS (median Expanded Disability Status Scale score: 1) and the healthy controls. Verbal fluency decreased during postural stability, whereas it increased during walking, and it was maintained during manual dexterity in both groups. Mental tracking did not change during walking; it declined during manual dexterity in both groups. Mental tracking during postural stability deteriorated in PwMS, while it did not change in the healthy controls. In general, dual-task costs were associated with baseline performances of tasks rather than clinical features. Therefore, baseline performances of both tasks should be increased for improving dual-task performance in PwMS.
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Kaplan, Rini I., Nishaat Mukadam, Jaimie Girnis, et al. "65 Neuroscience in the Everyday World: Lateralization of Brain Activity During Dual-Task Walking." Journal of the International Neuropsychological Society 29, s1 (2023): 472–73. http://dx.doi.org/10.1017/s135561772300615x.
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Objective:Functional near-infrared spectroscopy (fNIRS) is a non-invasive functional neuroimaging method that takes advantage of the optical properties of hemoglobin to provide an indirect measure of brain activation via task-related relative changes in oxygenated hemoglobin (HbO). Its advantage over fMRI is that fNIRS is portable and can be used while walking and talking. In this study, we used fNIRS to measure brain activity in prefrontal and motor region of interests (ROIs) during single- and dual-task walking, with the goal of identifying neural correlates.Participants and Methods:Nineteen healthy young adults [mean age=25.4 (SD=4.6) years; 14 female] engaged in five tasks: standing single-task cognition (serial-3 subtraction); single-task walking at a self-selected comfortable speed on a 24.5m oval-shaped course (overground walking) and on a treadmill; and dual-task cognition+walking on the same overground course and treadmill (8 trials/condition: 20 seconds standing rest, 30 seconds task). Performance on the cognitive task was quantified as the number of correct subtractions, number of incorrect subtractions, number of self-corrected errors, and percent accuracy over the 8 trials. Walking speed (m/sec) was recorded for all walking conditions. fNIRS data were collected on a system consisting of 16 sources, 15 detectors, and 8 short-separation detectors in the following ROIs: right and left lateral frontal (RLF, LLF), right and left medial frontal (RMF, LMF), right and left medial superior frontal (RMSF, LMSF), and right and left motor (RM, LM). Lateral and medial refer to ROIs’ relative positions on lateral prefrontal cortex. fNIRS data were analyzed in Homer3 using a spline motion correction and the iterative weighted least squares method in the general linear model. Correlations between the cognitive/speed variables and ROI HbO data were applied using a Bonferroni adjustment for multiple comparisons.Results:Subjects with missing cognitive data were excluded from analyses, resulting in sample sizes of 18 for the single-task cognition, dual-task overground walking, and dual-task treadmill walking conditions. During dual-task overground walking, there was a significant positive correlation between walking speed and relative change in HbO in RMSF [r(18)=.51, p<.05] and RM [r(18)=.53, p<.05)]. There was a significant negative correlation between total number of correct subtractions and relative change in HbO in LMSF ([r(18)=-.75, p<.05] and LM [r(18)=-.52, p<.05] during dual-task overground walking. No other significant correlations were identified.Conclusions:These results indicate that there is lateralization of the cognitive and motor components of overground dual-task walking. The right hemisphere appears to be more active the faster people walk during the dual-task. By contrast, the left hemisphere appears to be less active when people are working faster on the cognitive task (i.e., serial-3 subtraction). The latter results suggest that automaticity of the cognitive task (i.e., more total correct subtractions) is related to decreased brain activity in the left hemisphere. Future research will investigate whether there is a change in cognitive automaticity over trials and if there are changes in lateralization patterns in neurodegenerative disorders that are known to differentially affect the hemispheres (e.g., Parkinson’s disease).
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Wong, Pei-Ling, Yea-Ru Yang, Shih-Fong Huang, and Ray-Yau Wang. "Effects of Transcranial Direct Current Stimulation Followed by Treadmill Training on Dual-Task Walking and Cortical Activity in Chronic Stroke: A Double-Blinded Randomized Controlled Trial." Journal of Rehabilitation Medicine 55 (March 21, 2023): jrm00379. http://dx.doi.org/10.2340/jrm.v55.5258.
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Objective: To explore the effects of transcranial direct current stimulation followed by treadmill training on dual-task gait performance and contralesional cortical activity in chronic stroke patients.Methods: Forty-five chronic stroke participants were randomized into 3 groups: a bilateral transcranial direct current stimulation and treadmill training group; a cathodal transcranial direct current stimulation and treadmill training group; and a sham transcranial direct current stimulation and treadmill training group for 50 min per session (20 min transcranial direct current stimulation followed by 30 min treadmill training), 3 sessions per week for 4 weeks. Outcome measures included cognitive dual-task walking, motor dual-task walking, walking performance, contralesional cortical activity, and lower-extremity motor control.Results: The cathodal transcranial direct current stimulation + treadmill training group showed significantly greater improvements in cognitive dual-task walking speed than the other groups (p cathodal vs sham = 0.006, p cathodal vs bilateral = 0.016). In the cathodal transcranial direct current stimulation + treadmill training group the silent period duration increased significantly more than in the other groups (p < 0.05). Changes in motor evoked potentials in the cathodal transcranial direct current stimulation + treadmill training group were greater than those in the sham transcranial direct current stimulation + treadmill training group (p < 0.05). No significant changes were observed in the bilateral transcranial direct current stimulation + treadmill training group.Conclusion: Cathodal transcranial direct current stimulation followed by treadmill training is an effective intervention for improving cognitive dual-task walking and modulating contralesional cortical activity in chronic stroke. No beneficial effects were observed after bilateral transcranial direct current stimulation and treadmill training.LAY ABSTRACTDual-task walking is essential for daily functioning, both at home and socially. This study explored the effects of transcranial direct current stimulation followed by treadmill training on dual-task gait performance and contralesional cortical activity in chronic stroke patients. A total of 45 chronic stroke patients were randomized to 1 of 3 groups: a bilateral transcranial direct current stimulation and treadmill training group, a cathodal transcranial direct current stimulation and treadmill training group, or a sham transcranial direct current stimulation and treadmill training group for 50 min per session, 3 sessions per week for 4 weeks. Cognitive dual-task walking, motor dual-task walking, walking performance, contralesional cortical activity, and lower-extremity motor control of the affected side were measured before and after the intervention. The results show that cathodal transcranial direct current stimulation followed by treadmill training is an effective intervention for improving cognitive dual-task walking and modulating contralesional cortical activityin individuals with chronic stroke.
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Bishnoi, Alka, Roee Holtzer, and Manuel E. Hernandez. "Brain Activation Changes While Walking in Adults with and without Neurological Disease: Systematic Review and Meta-Analysis of Functional Near-Infrared Spectroscopy Studies." Brain Sciences 11, no. 3 (2021): 291. http://dx.doi.org/10.3390/brainsci11030291.
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(1) Functional near-infrared spectroscopy (fNIRS) provides a useful tool for monitoring brain activation changes while walking in adults with neurological disorders. When combined with dual task walking paradigms, fNIRS allows for changes in brain activation to be monitored when individuals concurrently attend to multiple tasks. However, differences in dual task paradigms, baseline, and coverage of cortical areas, presents uncertainty in the interpretation of the overarching findings. (2) Methods: By conducting a systematic review of 35 studies and meta-analysis of 75 effect sizes from 17 studies on adults with or without neurological disorders, we show that the performance of obstacle walking, serial subtraction and letter generation tasks while walking result in significant increases in brain activation in the prefrontal cortex relative to standing or walking baselines. (3) Results: Overall, we find that letter generation tasks have the largest brain activation effect sizes relative to walking, and that significant differences between dual task and single task gait are seen in persons with multiple sclerosis and stroke. (4) Conclusions: Older adults with neurological disease generally showed increased brain activation suggesting use of more attentional resources during dual task walking, which could lead to increased fall risk and mobility impairments. PROSPERO ID: 235228.
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Tsang, Charlotte Sau Lan, Doris Yin Kei Chong, and Marco Yiu Chung Pang. "Cognitive-motor interference in walking after stroke: test–retest reliability and validity of dual-task walking assessments." Clinical Rehabilitation 33, no. 6 (2019): 1066–78. http://dx.doi.org/10.1177/0269215519828146.
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Objective: To explore the reliability and validity of a series of dual-task mobility assessments among individuals post-stroke. Design: Observational study with repeated measures. Setting: University laboratory. Participants: Thirty community-dwelling individuals with chronic stroke. Interventions: Not applicable. Main Measures: Each of the two mobility tasks (1-minute level-ground walking with and without obstacle-negotiation) was performed concurrently with each of the eight cognitive tasks (auditory Stroop test, serial subtraction, shopping list recall and category naming at two difficulty levels). Walking distance and obstacle hitting rate (OHR) indicated dual-task mobility performance. Number of correct responses (NCR) indicated cognitive performance. Reaction time was additionally measured for the auditory Stroop test. Construct validity was examined by correlations between the dual-task assessments. The dual-task assessments were repeated within 7–14 days for test–retest reliability. Results: Excellent test–retest reliability in walking distance and OHR was found (intraclass correlation coefficient, ICC(3,1) = 0.891–0.984, P < 0.05). Moderate to excellent reliability was found in NCR and reaction time (ICC(3,1) = 0.480–0.911, P < 0.01). Correlations between walking distance were excellent ( rs = 0.840–0.985, P < 0.01). Correlations of NCR and reaction time between low- and high-level cognitive tasks were mostly moderate to excellent ( rs = 0.515–0.793, P < 0.01). Generally no significant correlations were found in NCR between the dual-task assessments with different cognitive domains. Conclusion: The dual-task walking assessments are reliable and valid for evaluating cognitive-motor interference in community-dwelling individuals post-stroke. The lack of correlations between the tasks of different cognitive domains indicates the need of using different cognitive domains in dual-task walking assessment post-stroke.
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Gagné, Marie-Ève, Bradford J. McFadyen, Isabelle Cossette, et al. "Alterations in dual-task walking persist two months after mild traumatic brain injury in young adults." Journal of Concussion 3 (January 2019): 205970021987829. http://dx.doi.org/10.1177/2059700219878291.
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Objectives To compare dual-task performance involving different cognitive-locomotor combinations between healthy controls and participants with sub-acute mild traumatic brain injury (mTBI) and to correlate dual-task performances to history of prior head injuries. Methods Eighteen participants having recently sustained mTBI and 15 controls performed nine dual-tasks combining locomotor (level-walking, narrow obstacle, deep obstacle) and cognitive (Stroop task, Verbal fluency, Counting backwards) tasks. Previous history of concussion was also investigated. Results Slower gait speeds were observed in the mTBI group compared to controls during both single and dual-tasks. Longer response times to cognitive tasks in the mTBI group further suggested the presence of residual impairments two months following injury. No combination of dual-task was more sensitive. Correlations were observed between history of mTBI and several measures of dual-task performance, underlying the need to further consider the effects of multiple injuries in relation to dual-task walking. Conclusion Dual-tasks using simultaneously locomotor and cognitive functions represent an ecological way for clinicians to detect residual, but subtle, alterations post-mTBI. History of previous mTBI needs to be considered as a personal characteristic which may influence dual-task walking performance.
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Leone, Carmela, Francesco Patti, and Peter Feys. "Measuring the cost of cognitive-motor dual tasking during walking in multiple sclerosis." Multiple Sclerosis Journal 21, no. 2 (2014): 123–31. http://dx.doi.org/10.1177/1352458514547408.
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Purposeful, safe locomotion requires higher-level cortical processes, to meet the real-life demands of walking while performing concurrent cognitive tasks (e.g. recalling a shopping list or attending to a conversation). The assessment of walking and a secondary cognitive task under these ‘dual tasking’ conditions may represent a more valid outcome measure in multiple sclerosis (MS), by examining the occurrence and magnitude of the cognitive-motor interference of walking. This topical review provides a state-of-the-art overview of research into dual-tasking during walking in persons with MS, based on 14 recent papers. Studies consistently demonstrate a slowing of ambulation under dual tasking, regardless of the cognitive task demand, the stage of the disease and the disability level. The reciprocal effect of walking on the cognitive tasks was rarely assessed. We present our main findings, highlight the different factors contributing to dual-task deficits, identify methodological shortcomings and offer recommendations for constructing dual-tasking paradigms useful in clinical practice and research.
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Brennan, Alexandra C., and Scott P. Breloff. "THE EFFECT OF VARIOUS CELL PHONE RELATED ACTIVITIES ON GAIT KINEMATICS." Journal of Musculoskeletal Research 22, no. 03n04 (2019): 1950011. http://dx.doi.org/10.1142/s0218957719500118.
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Background: With cell phone use and ownership on the rise, daily circumstances often require individuals to divide attentional resources between walking and a cell phone-related task. This division of attention has been found to detrimentally effect task performance, making pedestrian cell phone usage an increasing safety concern. However, most studies have investigated the impact of dual-tasks on situational awareness and few have focused on tasks other than texting. Therefore, this study aimed to investigate the effect of various cell phone-related tasks on lower limb kinematics during walking. Methods: Fourteen healthy, college-aged subjects completed gait analysis trials in five walking conditions, one single-task walking condition and four dual task conditions: Walk+Converse, Walk+Read (Simple), Walk+Read (Difficult), and Walk+Text. Subjects’ movements were recorded with a motion capture system and peak sagittal plane lower extremity joint angles, gait velocity, and stride length were calculated. Results: Of the eight kinematic outcome measures analyzed, all but one revealed some significant (p < 0.05) differences between dual-task walking conditions. Gait velocity and stride length both decreased due to the addition of the dual tasking, with the magnitude of the reduction becoming more apparent with the increased difficulty of the cell phone-based task. Conclusion: This study supports a fundamental change to gait kinematics in response to cell phone use while walking, with the magnitude of impact being directly related to the complexity of the secondary task. The significant changes to gait kinematics in complex dual-task situations could present a threat to balance.
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Schniepp, Roman, Raimund Trabold, Alexander Romagna, et al. "Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days." Journal of Neurosurgery 126, no. 1 (2017): 148–57. http://dx.doi.org/10.3171/2015.12.jns151663.
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OBJECTIVE The determination of gait improvement after lumbar puncture (LP) in idiopathic normal-pressure hydrocephalus (iNPH) is crucial, but the best time for such an assessment is unclear. The authors determined the time course of improvement in walking after LP for single-task and dual-task walking in iNPH. METHODS In patients with iNPH, sequential recordings of gait velocity were obtained prior to LP (time point [TP]0), 1–8 hours after LP (TP1), 24 hours after LP (TP2), 48 hours after LP (TP3), and 72 hours after LP (TP4). Gait analysis was performed using a pressure-sensitive carpet (GAITRite) under 4 conditions: walking at preferred velocity (STPS), walking at maximal velocity (STMS), walking while performing serial 7 subtractions (dual-task walking with serial 7 [DTS7]), and walking while performing verbal fluency tasks (dual-task walking with verbal fluency [DTVF]). RESULTS Twenty-four patients with a mean age of 76.1 ± 7.8 years were included in this study. Objective responder status moderately coincided with the self-estimation of the patients with subjective high false-positive results (83%). The extent of improvement was greater for single-task walking than for dual-task walking (p < 0.05). Significant increases in walking speed were found at TP2 for STPS (p = 0.042) and DTVF (p = 0.046) and at TP3 for STPS (p = 0.035), DTS7 (p = 0.042), and DTVF (p = 0.044). Enlargement of the ventricles (Evans Index) positively correlated with early improvement. Gait improvement at TP3 correlated with the shunt response in 18 patients. CONCLUSIONS Quantitative gait assessment in iNPH is important due to the poor self-evaluation of the patients. The maximal increase in gait velocity can be observed 24–48 hours after the LP. This time point is also best to predict the response to shunting. For dual-task paradigms, maximal improvement appears to occur later (48 to 72 hours). Assessment of gait should be performed at Day 2 or 3 after LP.
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McCulloch, K. L., T. E. Shubert, and C. A. Giuliani. "WALKING DUAL TASK PERFORMANCE IN OLDER ADULTS." Journal of Geriatric Physical Therapy 29, no. 3 (2006): 132. http://dx.doi.org/10.1519/00139143-200612000-00041.
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Kreska-Korus, Agnieszka, Nikola Chmura, and Małgorzata Młynarczyk. "Factors infulencing gait in dual-task walking." Egészségtudományi Közlemények 13, no. 1 (2023): 44–53. http://dx.doi.org/10.32967/etk.2023.013.
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Gait with an additional task commonly occurs in everyday life, e.g., simultaneously walking and talking on the phone. The dual-task paradigm (comparison of task performance efficiency under single-task conditions and simultaneous performance of both tasks) has found application in gait research. It is a test that allows assessing the quality of gait in clinical settings but also lets us analyse the quality of gait under the conditions of everyday life. It also allows the identification of people at risk of falling. A review of the available literature and research conducted at the Central Laboratory of Motion Analysis at AWF Krakow has been made, which may be useful for identifying factors that increase the risk of falls.
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Morgan, Sara J., Brian J. Hafner, and Valerie E. Kelly. "The effects of a concurrent task on walking in persons with transfemoral amputation compared to persons without limb loss." Prosthetics and Orthotics International 40, no. 4 (2015): 490–96. http://dx.doi.org/10.1177/0309364615596066.
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Background:Many people with lower limb loss report the need to concentrate on walking. This may indicate increased reliance on cognitive resources when walking compared to individuals without limb loss.Objective:This study quantified changes in walking associated with addition of a concurrent cognitive task in persons with transfemoral amputation using microprocessor knees compared to age- and sex-matched controls.Study design:Observational, cross-sectional study.Methods:Quantitative motion analysis was used to assess walking under both single-task (walking alone) and dual-task (walking while performing a cognitive task) conditions. Primary outcomes were walking speed, step width, step time asymmetry, and cognitive task response latency and accuracy. Repeated-measures analysis of variance was used to examine the effects of task (single-task and dual-task) and group (transfemoral amputation and control) for each outcome.Results:No significant interactions between task and group were observed (all p > 0.11) indicating that a cognitive task did not differentially affect walking between groups. However, walking was slower with wider steps and more asymmetry in people with transfemoral amputation compared to controls under both conditions.Conclusion:Although there were significant differences in walking between people with transfemoral amputation and matched controls, the effects of a concurrent cognitive task on walking were similar between groups.Clinical relevanceThe addition of a concurrent task did not differentially affect walking outcomes in people with and without transfemoral amputation. However, compared to people without limb loss, people with transfemoral amputation adopted a conservative walking strategy. This strategy may reduce the need to concentrate on walking but also contributed to notable gait deviations.
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Kreska-Korus, Agnieszka, Karolina Ryś, and Wiktoria Buczan. "Dual-task walking and falls in the elderly." Egészségtudományi Közlemények 13, no. 1 (2023): 34–43. http://dx.doi.org/10.32967/etk.2023.012.
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Dual-task walking is a common activity in everyday life. The dual-task paradigm is a procedure in experimental psychology that involves examining the performance of two tasks separately and simultaneously, allowing researchers to determine the extent to which different mental abilities compete for information-processing resources in the brain. This information can help identify whether tasks interfere with each other. This study aimed to analyse publications, gather knowledge on gait with an additional task, and determine the impact of dual-task conditions on gait parameters among the elderly. In October 2022, we conducted a comprehensive review of available literature in databases such as Pubmed, Cochrane, and Google Scholar, as well as research carried out at the Central Laboratory of Motion Analysis of the University of Physical Education in Krakow. We identified 11 publications on dual-task gait in the elderly, focusing exclusively on healthy individuals. Studies on the effects of training on dual-task gait were not included in our analysis. Research conducted to date in older adults has shown that dual-task conditions have a negative effect on gait speed, step frequency, gait cycle time, and gait variability indices, among other parameters.
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Alberts, Jay L., Ryan D. Kaya, Kathryn Scelina, et al. "Digitizing a Therapeutic: Development of an Augmented Reality Dual-Task Training Platform for Parkinson’s Disease." Sensors 22, no. 22 (2022): 8756. http://dx.doi.org/10.3390/s22228756.
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Augmented reality (AR) may be a useful tool for the delivery of dual-task training. This manuscript details the development of the Dual-task Augmented Reality Treatment (DART) platform for individuals with Parkinson’s disease (PD) and reports initial feasibility, usability, and efficacy of the DART platform in provoking dual-task interference in individuals with PD. The DART platform utilizes the head-mounted Microsoft HoloLens2 AR device to deliver concurrent motor and cognitive tasks. Biomechanical metrics of gait and cognitive responses are automatically computed and provided to the supervising clinician. To assess feasibility, individuals with PD (N = 48) completed a bout of single-task and dual-task walking using the DART platform. Usability was assessed by the System Usability Scale (SUS). Dual-task interference was assessed by comparing single-task walking and walking during an obstacle course while performing a cognitive task. Average gait velocity decreased from 1.06 to 0.82 m/s from single- to dual-task conditions. Mean SUS scores were 81.3 (11.3), which placed the DART in the “good” to “excellent” category. To our knowledge, the DART platform is the first to use a head-mounted AR system to deliver a dual-task paradigm and simultaneously provide biomechanical data that characterize cognitive and motor performance. Individuals with PD were able to successfully use the DART platform with satisfaction, and dual-task interference was provoked. The DART platform should be investigated as a platform to treat dual-task declines associated with PD.