This would be extremely useful to assess this in stroke survivors so protocols could be written to address any problems found. At first I couldn't even walk and talk at the same time. Now I can walk, talk and use the cell phone most of the time, except for this very bad blunder.
Splatting on the steps of Westminster Abbey
The latest here:
Virtual reality‐based assessment of cognitive‐locomotor interference in healthy young adults
Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 53 (2021)
Abstract
Background
A recent literature review emphasized the importance of assessing dual-task (DT) abilities with tasks that are representative of community ambulation. Assessing DT ability in real-life activities using standardized protocols remains difficult. Virtual reality (VR) may represent an interesting alternative enabling the exposure to different scenarios simulating community walking. To better understand dual-task abilities in everyday life activities, the aims of this study were (1) to assess locomotor and cognitive dual-task cost (DTC) during representative daily living activities, using VR, in healthy adults; and 2) to explore the influence of the nature and complexity of locomotor and cognitive tasks on DTC.
Methods
Fifteen healthy young adults (24.9 ± 2.7 years old, 8 women) were recruited to walk in a virtual 100 m shopping mall corridor, while remembering a 5-item list (DT condition), using an omnidirectional platform and a VR headset. Two levels of difficulty were proposed for the locomotor task (with vs. without virtual agent avoidance) and for the cognitive task (with vs. without items modification). These tasks were also performed in single task (ST) condition. Locomotor and cognitive DTC were measured by comparing performances in ST and DT conditions. Locomotor performance was characterized using walking speed, walking fluidity, and minimal distance between the participant and the virtual agent during avoidance. Cognitive performance was assessed with the number of items correctly recalled. Presence of DTC were determined with one-sample Wilcoxon signed-rank tests. To explore the influence of the tasks’ complexity and nature on DTC, a nonparametric two-way repeated measure ANOVA was performed.
Results
No locomotor interference was measured for any of the outcomes. A cognitive DTC of 6.67% was measured (p = .017) while participants performed simultaneously both complex locomotor and cognitive tasks. A significant interaction between locomotor task complexity and cognitive task nature (p = .002) was identified on cognitive DTC.
Conclusions
In challenging locomotor and cognitive conditions, healthy young adults present DTC in cognitive accuracy, which was influenced by the locomotor task complexity task and the cognitive task nature. A similar VR-based protocol might be used to investigate DT abilities in older adults and individuals with a stroke.
Background
In everyday life activities, people are frequently engaged in situations involving the concurrent execution of locomotor and cognitive tasks, i.e. dual task (DT). Several studies have demonstrated that performing a cognitive task while walking may result in performance deterioration in one or both tasks [1,2,3,4]. Different theories suggest that dual-task interferences (DTI) may occur as a result of attentional limitations, but it may reflect a broad variety of underlying mechanisms or processes. The central bottleneck theory postulates that central processes might operate sequentially; processing for the second task must consequently be postponed [5]. From a different perspective, the central capacity sharing theory suggests that both tasks must share, in parallel, the limited processing capacity available [6, 7].
In most studies documenting DT performances, interference in at least one of the executed tasks was observed, regardless of the studied population [8,9,10,11]. However, personal factors seem to influence DTI magnitude. For instance, age-related sensorimotor and cognitive decline, as well as neurological lesions are known to have a detrimental impact on performance when multiple tasks are executed simultaneously [12,13,14,15,16]. Older adults tend to present greater locomotor and/or cognitive performance decrements in dual-task conditions than younger adults, but smaller decrements than age-matched persons with neurological disorders [12].
In addition to personal factors, the complexity of the locomotor task and the nature of the cognitive task might have an impact on the magnitude of the performance decrements [1, 8, 12, 13, 17,18,19,20,21,22]. For instance, some studies observed that DT cognitive performances were worse during walking tasks involving obstacle avoidance than during simple locomotor tasks [1, 18]. Furthermore, in a meta-analysis, Al-Yahya et al. [12] suggested that cognitive tasks involving internal interfering factors (e.g. mental tracking) seem to disturb walking speed and cadence more than those involving external interfering factors (e.g. reaction time). These observations highlighted the necessity of taking into account the nature and complexity of both locomotor and cognitive tasks for an accurate understanding and interpretation of the DTI.
Dual-task phenomenon was extensively documented, but only a few studies have used cognitive and locomotor tasks representing daily activities. Indeed, commonly used cognitive tasks are adapted from traditional neuropsychological assessments, such as the Stroop test or serial subtractions [23]. Existing literature reflects upon the ecological validity of those executive function assessments. Those assessments seemed inconsistent with the executive functions solicited when performing daily activities [24]. Regarding the locomotor task, participants were most frequently asked to walk forward over a short distance, without any mobile obstacles in most dual-task studies [12, 23].
Moreover, it is important to consider the potential impact of the environment in dual-task assessment. Recent studies have observed differences in locomotor performance between a real-world environment, with high level of distractors, and a quiet hallway, with low level of distractors [25, 26]. Indeed, walking in the community represents a complex activity requiring physical abilities, such as minimal speed, endurance, as well as the ability to negotiate physical environmental demands [27,28,29]. Everyday community mobility is also known to solicit cognitive functions, especially executive functions and attention [3]. Given the influence of the executed tasks and the environment on DT performance, DT assessment while walking should be performed using cognitive and locomotor tasks that are representative of community ambulation in everyday life.
However, it is difficult to assess dual-task ability, in real-life activities and environment, using standardized and replicable protocols. To overcome this issue, virtual reality (VR) represents an interesting alternative in order to expose individuals with disabilities to different scenarios simulating community walking [30]. The acceptability and feasibility of using VR-based assessment and training have been previously demonstrated in diverse populations with physical limitations [30,31,32]. In regard to dual-task assessment, this technology may enable the development of standard DT assessment protocols in meaningful simulated environments [30]. Moreover, difficulty of the tasks and environmental distractors can be controlled in VR [33]. Given the latest advancements in technology, some VR systems are now low-cost and easy to use facilitating their adoption in clinical practice.
The aims of this study were: (1) to assess locomotor and cognitive dual-task costs in activities that are representative of daily living, using virtual reality, in healthy adults; and (2) to explore the influence of the nature and complexity of cognitive and locomotor tasks on DTC.
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