Cognitive Training and Dual-task Ability in Older Adults
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 34
- Locations
- 2
- Primary Endpoint
- Change Scores in Timed up and go With Cognitive Task
Study Overview
Brief Summary
The first goal of this study is to examine the extent to which the inclusion of dual-task practice to standard balance rehabilitation results in greater benefits to dual-task ability. The second goal of this study is to examine the extent to which the addition of cognitive training following balance rehabilitation results in greater benefits to dual-task ability.
Detailed Description
Historically, degradation of balance control in older adults has been attributed to impairments of the motor and/or sensory systems. As a result, therapy has focused on motor and sensory impairments. However, evidence suggests that an impaired ability to allocate attentional resources to balance during dual-task situations is a powerful predictor of falls. Despite this fact, few studies have examined whether interventions can improve older adults' dual-task ability. The goal of this study is to develop effective interventions to improve ability to allocate attention to balance and gait under dual-task conditions.
Older adults (n = 44) who have been referred to physical therapy (PT) for gait or balance impairments who have dual-task impairment will be randomized to receive either standard balance rehabilitation or balance rehabilitation with dual-task practice. Following PT, subjects will receive cognitive training (CT), either speed of processing or generalized cognitive training. Primary outcomes are ability to walk while performing four different cognitive tasks of varying difficulty. Assessment will occur at baseline, post-PT, post-CT.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 60 Years to 89 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Inclusion criteria include:
- •> 60 years of age
- •documented balance or mobility problems
- •dual-task impairment (timed up and go with subtraction task > 15 s)
Exclusion Criteria
- •Exclusion criteria include:
- •cognitive impairment (> 2 errors on Short Portable Mental Status Questionnaire41)
- •progressive medical issues that would impact mobility (e.g., Parkinson's disease).
Arms & Interventions
Balance rehabilitation + dual-tasking
Balance rehabilitation will involve a structured framework of balance activities that require increasing levels of complexity and multimodal stimuli and response demands with the addition of cognitive tasks, (e.g., counting backwards or reciting lists) to be added when the participant can safely perform the primary balance or gait task.
Intervention: Balance rehabilitation + dual-tasking (Behavioral)
Standard balance rehabilitation
Standard balance rehabilitation will involve a structured framework of balance activities that require increasing levels of complexity and multimodal stimuli and response demands.
Intervention: Standard balance rehabilitation (Behavioral)
Cognitive training (speed of processing)
Speed of processing cognitive training involves systematically increasing the complexity of visual tasks. Task demands are increased by reducing stimulus duration, adding visual or auditory distractors, increasing number of concurrent tasks or increasing the visual field.
Intervention: Cognitive training (speed of processing) (Behavioral)
Cognitive training (general cognition)
General cognitive training involves systematic training of 14 key cognitive abilities, including visual scanning, response time, eye-hand coordination, spatial perception, and working memory. Initial starting point is determined by the software using baseline evaluation.
Intervention: Cognitive training (general cognition) (Behavioral)
Outcomes
Primary Outcomes
Change Scores in Timed up and go With Cognitive Task
Time Frame: baseline and 6 weeks
Timed up and go test (TUG) has three conditions: no secondary task (TUG), cognitive (TUGc) and manual dual-tasks (TUG-m). Time to complete the task with the cognitive task was recorded as a primary outcome measure. Time greater than 15 s for TUG-c indicates impaired dual-task ability.
Secondary Outcomes
- Change Scores in Sensory Organization Test (SOT)(baseline and 6 weeks)
- Change Scores in Activities-specific Balance-related Confidence(baseline and 6 weeks)
- Change Scores in Preferred Gait Speed(baseline and 6 weeks)
- Change Scores in Walk While Talk Test With Verbal Fluency Task(baseline and 6 weeks)
- Change Scores in Dynamic Gait Index(baseline and 6 weeks)