Motor-Cognitive Dual-Task Training in Persons With Neurologic Disorders: A Systematic Review

I know when I first got out of the hospital I couldn't walk and talk at the same time. I got better.
https://journals.lww.com/jnpt/Fulltext/2015/07000/Motor_Cognitive_Dual_Task_Training_in_Persons_With.2.aspx

Fritz, Nora E. PT, DPT, NCS, PhD; Cheek, Fern M. MALS; Nichols-Larsen, Deborah S. PT, PhD

Journal of Neurologic Physical Therapy: July 2015 - Volume 39 - Issue 3 - p 142–153

doi: 10.1097/NPT.0000000000000090

Systematic Review

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Background and Purpose: Deficits in motor-cognitive dual tasks (eg, walking while talking) are common in individuals with neurologic conditions. This review was conducted to determine the effectiveness of motor-cognitive dual-task training (DTT) compared with usual care on mobility and cognition in individuals with neurologic disorders.
Methods: Databases searched were Biosis, CINAHL, ERIC, PsychInfo, EBSCO Psychological & Behavioral, PubMed, Scopus, and Web of Knowledge. Eligibility criteria were studies of adults with neurologic disorders that included DTT, and outcomes of gait or balance were included. Fourteen studies met inclusion criteria. Participants were subjects with brain injury, Parkinson disease (PD), and Alzheimer disease (AD). Intervention protocols included cued walking, cognitive tasks paired with gait, balance, and strength training and virtual reality or gaming. Quality of the included trials was evaluated with a standardized rating scale of clinical relevance.
Results: Results show that DTT improves single-task gait velocity and stride length in subjects with PD and AD, dual-task gait velocity and stride length in subjects with PD, AD, and brain injury, and may improve balance and cognition in those with PD and AD. The inclusion criteria of the studies reviewed limited the diagnostic groups included.
Discussion and Conclusions: While the range of training protocols and outcome assessments in available studies limited comparison of the results across studies motor-cognitive dual-task deficits in individuals with neurologic disorders appears to be amenable to training. Improvement of dual-task ability in individuals with neurologic disorders holds potential for improving gait, balance, and cognition.
Video Abstract available for additional insights from the authors (Supplemental Digital Content, http://links.lww.com/JNPT/A104).

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INTRODUCTION

Impairments in both mobility and cognition are common in many neurologic conditions, making previously automatic movements more attention demanding.¹ Divided attention, the ability to respond to multiple stimuli simultaneously,²,³ is frequently affected more than other domains (eg, sustained attention).⁴ Divided attention is necessary to successfully perform 2 tasks concurrently (ie, dual tasks), such as a cognitive and a motor task (eg, walking and talking). Deficits in divided attention and dual-task (DT) ability seem linked to impairments in functional mobility in traumatic brain injury,⁵,⁶ acquired brain injury,⁷ multiple sclerosis (MS),⁸,⁹ Parkinson disease (PD),¹⁰,¹¹ stroke,¹² and Alzheimer disease (AD).¹³

The addition of a cognitive task to mobility tasks to gait or balance has been shown to amplify gait variability in individuals with neurologic disorders. Indeed, under DT conditions, individuals with PD¹⁰ and MS⁸ significantly increased swing and stride time variability, compared with controls. During balance DTs, individuals with MS demonstrated greater postural sway¹⁴ and sway velocity variability¹⁵ compared with controls. Impairments in divided attention may prevent individuals from allotting appropriate attentional resources to balance and gait, reduce adaptability to challenging environments such as obstacles and uneven paths, and may contribute to fall risk in PD,¹⁰ AD,¹³ and MS.¹⁶

Despite documented deterioration in gait and balance under DT conditions, there are few intervention studies that address this deficit. Available studies are marked by variability of training type and duration. Case studies in mild¹⁷ and severe traumatic brain injury,¹⁸ utilizing dual-task training (DTT), have reported improvements in balance,¹⁷ gait speed,¹⁸ and DT tolerance.¹⁷,¹⁸ Similarly, DTT improved balance during cognitive activities to a greater extent than mobility training alone in healthy individuals.¹⁹ The purpose of this systematic review was to examine the literature to determine the effectiveness of DTT on mobility and cognition compared with usual care in individuals with neurologic disorders.(The purpose of the review should have been to identify the protocol that would correct for these problems)

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