Balance Training and Multi-Task Performance in Seniors

Abstract

Age-related impairment in gait patterns when simultaneously performing cognitive (CI) and/or motor (MI) interference tasks are associated with an increased risk of falling in seniors. The objective of this study was to investigate the impact of balance training (BT) on walking performance with and without concurrently performing a CI and/or MI task in seniors. Twenty healthy women (n=14) and men (n=6) were assigned to either an intervention (n=11, age 71.9±4.8 yrs) or a control group (n=9, age 74.9±6.3 yrs). The intervention group conducted a six week BT (3/week). Pre and post tests included the assessment of stride-to-stride variability during single (walking), dual (CI or MI+walking), and triple (CI+MI+walking) task walking on an instrumented walkway. BT resulted in statistically significant reductions in stride time variability under single (p=0.02, Δ34.8%) but not dual or triple-task walking. Significant improvements in the MI task (p=0.05, Δ39.1%), but not in the CI task were found while walking. Findings showed that improved performance during single-task walking did not transfer to walking under dual or triple-task conditions suggesting multi-task BT as an alternative training modality. Improvement of the secondary motor but not cognitive task may indicate the need for the involvement of motor and particularly cognitive tasks during BT.

Key words

elderly - gait - attentional demand - cognitive/motor interference - treatment

References

• 1 Beauchet O, Annweiler C, Dubost V, Allali G, Kressig RW, Bridenbaugh S, Berrut G, Assal F, Herrmann FR. Stops walking when talking: a predictor of falls in older adults?.  Eur J Neurol. 2009;  16 786-795
• 2 Beauchet O, Dubost V, Aminian K, Gonthier R, Kressig RW. Dual-task-related gait changes in the elderly: does the type of cognitive task matter?.  J Mot Behav. 2005;  37 259-264
• 3 Beauchet O, Dubost V, Herrmann FR, Kressig RW. Stride-to-stride variability while backward counting among healthy young adults.  J Neuroeng Rehabil. 2005;  2 26
• 4 Besser MP, Kmieczak K, Schwartz L, Snyderman M, Wasko J, Selby-Silverstein L. Representation of temporal spatial gait parameters using means in adults without impairment.  Gait Posture. 1999;  9 113
• 5 Cohen J. (ed). Statistical Power for the Behavioral Sciences. Hillsdale, NJ: Erlbaum; 1988
• 6 Dubost V, Kressig RW, Gonthier R, Herrmann FR, Aminian K, Najafi B, Beauchet O. Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults.  Hum Mov Sci. 2006;  25 372-382
• 7 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.  Behav Res Methods. 2007;  39 175-191
• 8 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state” A practical method for grading the cognitive state of patients for the clinician.  J Psychiatr Res. 1975;  12 189-198
• 9 Fraizer EV, Mitra S. Methodological and interpretive issues in posture-cognition dual-tasking in upright stance.  Gait Posture. 2008;  27 271-279
• 10 Gollhofer A. Proprioceptive training: considerations for strength and power production. In: Komi PV (ed). Strength and Power in Sport. Oxford: Blackwell Publishing; 2003: 331-342
• 11 Granacher U, Gollhofer A, Strass D. Training induced adaptations in characteristics of postural reflexes in elderly men.  Gait Posture. 2006;  24 459-466
• 12 Granacher U, Gruber M, Gollhofer A. The impact of sensorimotor training on postural control in elderly men.  Deut Z Sportmed. 2009;  12 16-22
• 13 Gruber M, Gruber SB, Taube W, Schubert M, Beck SC, Gollhofer A. Differential effects of ballistic versus sensorimotor training on rate of force development and neural activation in humans.  J Strength Cond Res. 2007;  21 274-282
• 14 Harriss DJ, Atkinson G. International Journal of Sports Medicine – Ethical Standards in Sport and Exercise Science Research.  Int J Sports Med. 2009;  30 701-702
• 15 Hausdorff JM, Edelberg HK, Mitchell SL, Goldberger AL, Wei JY. Increased gait unsteadiness in community-dwelling elderly fallers.  Arch Phys Med Rehabil. 1997;  78 278-283
• 16 Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study.  Arch Phys Med Rehabil. 2001;  82 1050-1056
• 17 Hu MH, Woollacott MH. Multisensory training of standing balance in older adults: II. Kinematic and electromyographic postural responses.  J Gerontol A Biol Sci Med Sci. 1994;  49 M62-M71
• 18 Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, Vuori I. Fall-induced injuries and deaths among older adults.  JAMA. 1999;  281 1895-1899
• 19 Kempen GI, Todd CJ, van Haastregt JC, Zijlstra GA, Beyer N, Freiberger E, Hauer KA, Piot-Ziegler C, Yardley L. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory.  Disabil Rehabil. 2007;  29 155-162
• 20 Kressig RW, Beauchet O. Guidelines for clinical applications of spatio-temporal gait analysis in older adults.  Aging Clin Exp Res. 2006;  18 174-176
• 21 Kressig RW, Herrmann FR, Grandjean R, Michel JP, Beauchet O. Gait variability while dual-tasking: fall predictor in older inpatients?.  Aging Clin Exp Res. 2008;  20 123-130
• 22 Laessoe U, Hoeck HC, Simonsen O, Voigt M. Residual attentional capacity amongst young and elderly during dual and triple task walking.  Hum Mov Sci. 2008;  27 496-512
• 23 Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RM. Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial.  Osteoporos Int. 2007;  18 419-425
• 24 Maki BE, McIlroy WE. Cognitive demands and cortical control of human balance-recovery reactions.  J Neural Transm. 2007;  114 1279-1296
• 25 Pashler H. Dual-task interference in simple tasks: data and theory.  Psychol Bull. 1994;  116 220-244
• 26 Pellecchia GL. Dual-task training reduces impact of cognitive task on postural sway.  J Mot Behav. 2005;  37 239-246
• 27 Rochat S, Martin E, Piot-Ziegler C, Najafi B, Aminian K, Bula CJ. Falls self-efficacy and gait performance after gait and balance training in older people.  J Am Geriatr Soc. 2008;  56 1154-1156
• 28 Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention.  Age Ageing. 2006;  35 ((Suppl 2)) ii37-ii41
• 29 Silsupadol P, Lugade V, Shumway-Cook A, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Training-related changes in dual-task walking performance of elderly persons with balance impairment: A double-blind, randomized controlled trial.  Gait Posture. 2009;  29 634-639
• 30 Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial.  Arch Phys Med Rehabil. 2009;  90 381-387
• 31 Silsupadol P, Siu KC, Shumway-Cook A, Woollacott MH. Training of balance under single- and dual-task conditions in older adults with balance impairment.  Phys Ther. 2006;  86 269-281
• 32 Snijders AH, van de Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly people: clinical approach and classification.  Lancet Neurol. 2007;  6 63-74
• 33 Steadman J, Donaldson N, Kalra L. A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients.  J Am Geriatr Soc. 2003;  51 847-852
• 34 Taube W, Gruber M, Beck S, Faist M, Gollhofer A, Schubert M. Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation.  Acta Physiol (Oxf). 2007;  189 347-358
• 35 Tideiksaar R. Preventing falls: how to identify risk factors, reduce complications.  Geriatrics. 1996;  51 43-55
• 36 Tinetti ME, Richman D, Powell L. Falls efficacy as a measure of fear of falling.  J Gerontol A Biol Sci Med Sci. 1990;  45 239-243

Correspondence