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International audience; Visuospatial memory (VSM) performance depends on intrinsic (biopsychosocial parameters) and extrinsic (space) factors. We aimed at characterizing the determinants of VSM performance according to space. Young healthy adults, 20 males and 41 females (23 ± 3 years old), were assessed for VSM performance through a pathway learning task, in reaching (eCorsi Block Tapping task) and walking space (Virtual Walking Corsi Task). We evaluated psychosocial factors through seven questionnaires - Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Fatigue Severity Scale, Profile of the Mood States, 2nd edition, short version, Coping Inventory for Stressful Situations, Measurement of Ambiguity Tolerance, Motives for Physical Activities Measure-Revised, mental rotation capabilities and locomotor characteristics (physical activity level through embedded trackers and the International Physical Activity Questionnaire, and gait parameters). The most explanatory biopsychosocial determinants of VSM performance were i) mental rotation capabilities and fatigue indicator in reaching space, and ii) mental rotation capabilities and physical activity level (tracked active energy expenditure only) in walking space. These results suggest that specific parameters should be preferred for the evaluation and strengthening of VSM capabilities in both reaching or walking spaces.

Purpose: To date, the effects of dual-task training on balance underlying cognitive function remain unclear. Therefore, this study was to verify the effects of cognitive–physical dual-task training on balance and executive function in community-dwelling older adults with a history of falls. Method: Fifty-eight participants were randomly allocated to the experimental group (EG) receiving cognitive–physical dual-task training (n = 29) or to the control group (CG) receiving functional balance training (n = 29). After 12 sessions for 6 weeks, the One Leg Standing Test (OLST), the Timed UP and Go (TUG), and part B of the Trail-Making Test (TMT-B) were implemented to examine static and dynamic balance and executive function. Results: After the 12 sessions, the EG showed a greater improvement in the OLST (p < 0.001; η2 = 0.332), the TUG (p < 0.001; η2 = 0.375), and the TMT-B (p < 0.001; η2 = 0.224) compared to the CG. Conclusion: These results indicate that dual-task training is clinically beneficial to improving static and dynamic balance as well as executive function in older adults with a history of falls. These findings shed new light on a clinical implication that executive function should be considered in balance training for older adults.

The purpose of this study was to investigate changes in dynamic balance and gross motion function when dual-task training was performed on an unstable support surface by children with spastic diplegia. The subjects of this study were 14 children (experimental group n=7, control group n=7) who were medical diagnosed with spastic diplegia. Both groups were administered treatment for 30 min, 2 times a week for 8 weeks, with the experimental group performing dual-task exercise in which cognitive tasks related to daily living were performed while maintaining balance on an unstable surface, and the control group being administered neurodevelopmental treatment. Balance and gross motor function Assessments were conducted before intervention and after 8 weeks of intervention. Wilcoxon signed-rank test was performed to analyze changes in balance, gross motor function in the group, and the Mann-Whitney test was conducted to compare the differences between the two groups before and after intervention. The results showed that there was a statistically significant difference in both groups when balance in a sitting position and gross motor function (P

Background The number of patients with cognitive impairment increases as the population becomes older. This perspective may persist a burden on health care systems unless considered new options of prevention and treatment. The aim of this meta-synthesis is to analyze different systematic reviews on the effectiveness of dual-task training (DTT) on cognition and motor function of different people. Methods A systematic search of systematic reviews published until October 2019 was conducted in PubMed/Medline, Scopus and Cochrane databases addressing studies which investigated the effect of DTT compared to control or other intervention on cognitive functions of healthy or unhealthy individuals. Three steps were followed to retrieve studies: reading title, abstract and full text. Checklist Assessing the Methodological Quality of Systematic Reviews (AMSTAR) was used to assess the quality of selected articles. Results In terms of quality of evidence, according to AMSTAR, 62.5 % of the reviews were rated as being “low” and 37.5 % were graded as “moderate” quality. Two main themes were identified among the studies’ outcomes: Improvement on mobility performance or postural stability; and beneficial effect on cognitive function. In terms of effect size, there were reported an important variation, having more significant results for findings involving mobility and modest effect for findings regarding cognitive function. Conclusion People with different clinical conditions could benefit from dual-task training. The benefits may encompass general cognitive functions, memory, physical performance, gait and balance, to name a few aspects.

Background People with dementia progressively lose cognitive and functional abilities. Interventions promoting exercise and activity may slow decline. We developed a novel intervention to promote activity and independence and prevent falls in people with mild cognitive impairment (MCI) or early dementia. We successfully undertook a feasibility randomised controlled trial (RCT) to refine the intervention and research delivery. We are now delivering a multi-centred RCT to evaluate its clinical and cost-effectiveness. Methods We will recruit 368 people with MCI or early dementia (Montreal Cognitive Assessment score 13–25) and a family member or carer from memory assessment clinics, other community health or social care venues or an online register (the National Institute for Health Research Join Dementia Research). Participants will be randomised to an individually tailored activity and exercise programme delivered using motivational theory to promote adherence and continued engagement, with up to 50 supervised sessions over one year, or a brief falls prevention assessment (control). The intervention will be delivered in participants’ homes by trained physiotherapists, occupational therapists and therapy assistants. We will measure disabilities in activities of daily living, physical activity, balance, cognition, mood, quality of life, falls, carer strain and healthcare and social care use. We will use a mixed methods approach to conduct a process evaluation to assess staff training and delivery of the intervention, and to identify individual- and context-level mechanisms affecting intervention engagement and activity maintenance. We will undertake a health economic evaluation to determine if the intervention is cost-effective. Discussion We describe the protocol for a multi-centre RCT that will evaluate the clinical and cost-effectiveness of a therapy programme designed to promote activity and independence amongst people living with dementia. Trial registration ISRCTN, ISRCTN15320670. Registered on 4 September 2018.

Background: Parkinson disease (PD) is characterized by motor and non-motor symptoms that affect patients’ functions, especially while performing dual-tasks a critical factor in everyday living. However, many controversies exist about the benefits of dual-task training in patients with PD. Objectives: This study assessed the efficacy of motor and cognitive dual-task training in improving balance and gait parameters in people with idiopathic PD. Materials & Methods: A single-blind controlled trial was conducted on PD patients living in Guilan Province of Iran, in 2018-2019. A total of 30 PD patients (Hoehn and Yahr stage II-III while on medication) were assigned to the cognitive dual-task training group (n=10), motor dual-task training group (n=10), and single-task control group (n=10). All groups received 30 sessions of different exercises for 10 consecutive weeks. The patients’ balance and some spatiotemporal gait parameters were respectively assessed with timed up and go test and HD VideoCam-Kinovea before and after training and then 1 month later. Results: Both dual-task and single-task trainings improved the outcome measures (timed up and go test (F=535.54; P=0.000), stride length (F=87.41; P=0.00), stride time (F=102.11; P=0.00), cadence (F=286.36; P=0.00), swing time (F=48.90; P=0.00), and stance time (F=40.56; P=0.00)). These improvements were maintained at 1-month follow-up, although the effect slightly reduced. No significant differences were found between the study groups (P>0.05). Conclusion: Motor/cognitive dual-task training and single-task training were found to be significantly and equally effective in improving balance and gait parameters in people with PD.

Objective: To evaluate the effects of dual-task training on static and dynamic balance in patients with multiple sclerosis. Data sources: PubMed/MEDLINE, EMBASE, Scopus, and PEDro databases were searched from inception to March 1, 2021. Methods: This study was conducted in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers assessed studies for inclusion and extracted data. We used the Physiotherapy Evidence Database scale to evaluate the methodological quality and the risk-of-bias. Randomized clinical trial data were pooled for the meta-analysis. The effect sizes and 95% confidence interval (CI) were calculated by random-effect models. Egger regression and Begg-Mazumdar rank correlation test were used for publication bias. Results: A total of 13 studies involving 584 patients (42.3 ± 9 years mean ± SD; 377 females) met the inclusion criteria for the systematic review, while nine were included in the meta-analysis. People who received dual-task training interventions showed significant improvements in the Timed Up & Go test 0.44 [(95% CI = 0.22; 0.65), P-valueConclusion: The findings from the current meta-analysis support dual-task training as a beneficial therapy for improving dynamic balance and functional mobility in patients with multiple sclerosis. The limited number of studies that investigated static balance performance after dual-task training do not currently allow us to draw a conclusion about any possible improvements in this ability.

This article focuses on an eHealth application, CogniViTra, to support cognitive and physical training (i.e., dual-task training), which can be done at home with supervision of a health care provider. CogniViTra was designed and implemented to take advantage of an existing Platform of Services supporting a Cognitive Health Ecosystem and comprises several components, including the CogniViTra Box (i.e., the patient terminal equipment), the Virtual Coach to provide assistance, the Game Presentation for the rehabilitation exercises, and the Pose and Gesture Recognition to quantify responses during dual-task training. In terms of validation, a functional prototype was exposed in a highly specialized event related to healthy and active ageing, and key stakeholders were invited to test it and share their insights. Fifty-seven specialists in information-technology-based applications to support healthy and active ageing were involved and the results and indicated that the functional prototype presents good performance in recognizing poses and gestures such as moving the trunk to the left or to the right, and that most of the participants would use or suggest the utilization of CogniViTra. In general, participants considered that CogniViTra is a useful tool and may represent an added value for remote dual-task training. This study has received funding from the European Union under the AAL programme through project CogniViTra (Grant No. AAL-2018-5-115-CP), with national funding support from FCT, ISCIII, and FNR. This presentation reflects the authors’ views, and neither AAL nor the National Funding Agencies are responsible for any use that may be made of the information.

International audience; This overview aims to summarize the effectiveness of cognitive-motor dual-task and exergame interventions on cognitive, physical and dual-task functions in healthy older adults, as well as the feasibility, safety, adherence, transfer and retention of benefits of these interventions. We searched for systematic reviews or meta-analyses assessing the effects of cognitive-motor dual-task and exergame interventions on cognitive, physical and dual-task functions in cognitively healthy older adults through eight databases (CDSR (Cochrane), MEDLINE (PubMed), Scopus, EMBASE, CINAHL, PsycINFO, ProQuest and SportDiscus). Two reviewers performed the selection, data extraction and risk of bias evaluation independently (PROSPERO ID: CRD42019143185). Eighteen reviews were included in this overview. Overall, positive effects of cognitive-motor dual-task interventions on cognitive, physical and dual-task functions, as well as exergames on cognitive functions only, were observed in cognitively healthy older adults. In contrast, the effects of exergames on physical functions are more controversial, and their effects on dual-task functions have not been studied. The feasibility, safety, adherence, transfer and retention of benefits for both intervention types are still unclear. Future studies should follow more rigorous methodological standards in order to improve the quality of evidence and provide guidelines for the use of cognitive-motor dual-task and exergame interventions in older adults.

International audience; Ageing is associated with cognitive decline, ranging from normal to mild cognitive impairment or dementia. This leads to physical and cognitive impairments, which are risk factors for loss of autonomy. Therefore, cognitive and physical training are important for cognitively impaired older adults. The combination of both may represent an efficiency advantage. This overview aims to summarize the effectiveness of cognitive-motor dual-task (CMDT) interventions on cognitive, physical and dual-task functions in cognitively impaired older adults, as well as the safety, adherence, and retention of benefits of these interventions. We searched for systematic reviews or meta-analyses assessing the effects of CMDT interventions on cognitive or physical functions in older adults with mild cognitive impairment or dementia through eight databases (CDSR (Cochrane), MEDLINE, Scopus, EMBASE, CINAHL, PsycINFO, ProQuest and SportDiscus). Two reviewers independently performed the selection, data extraction and risk of bias evaluation. Nine reviews were included in this overview. CMDT interventions were found to be more effective than active control groups on cognitive and physical functions in older adults with cognitive impairment, irrespective of intervention dose and modalities; no information on dual-task functions was available. Retention of benefits, adherence, need for supervision and safety are still unclear. These results should be interpreted with caution, considering the low average methodological quality of included reviews. Future intervention research should follow more rigorous methodological standards and focus on other forms of CMDT.

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive–motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N–N intervals, SDNN; root mean square of successive R–R interval differences, RMSSD; and absolute power of high-frequency band (0.15–0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8–12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR2 = 0.035, RMSSD p = 0.017 one-tailed, ΔR2 = 0.012, and HF power p = 0.011 one-tailed, ΔR2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures., Frontiers in Aging Neuroscience, 12, ISSN:1663-4365

Walking is a common activity among older adults. Fallers were discovered to have a higher propensity to conscious motor processing (reinvestment) than age-matched non-fallers, leading to movement disruption, possibly by constraining or interfering with automatic motor control mechanisms. However, gait rehabilitation programs by implicit motor learning methodologies may ameliorate reinvestment propensity while improving gait ability in older adults. One hundred and five older adults, with moderate to high risk of falling, will be recruited from different community centres in Hong Kong to investigate the effect of single-task, dual-task and analogy training (implicit motor learning methodologies) on walking during rehabilitation in the context of reinvestment propensity, balance, walking ability and fear of falling. Participants will be randomly allocated and received 12 training sessions in either a Single-task Walking Group (STWG), a Dual-task Walking Group (DTWG) or an Analogy Walking Group (AGWG). Reinvestment propensity, walking ability, balance and fear of falling will be assessed by the Chinese version Movement Specific Reinvestment Scale (MSRS-C), 10-meter Walk Test, Tinetti Balance Assessment Tool, Timed ‘Up & Go’ Test (TU&G), Berg Balance Scale (BBS) and 13-item Falls Efficacy Scale (FES-13), respectively at baseline before training (T0), just after completion of all training sessions (T1), and 6 months after completion of all training sessions (T2). Participants' number of falls between T1 and T2 will also be recorded. The results could establish a solid foundation for further development and implementation of a novel and effective gait rehabilitation program in fall prevention for older adults at risk of falling. Keywords: Single-task training, Dual-task training, Analogy training, Gait rehabilitation, Older adults

The ability to effectively execute compensatory steps is critical for preventing accidental falls, and consequently stepping training is an essential ingredient of fall prevention programs. In this paper, we propose a concept for stepping training that aims to maximize training effects by taking into account recent research evidence and a precise dosing of training ingredients. The concept addresses motor as well as cognitive falls-related aspects, it is suitable for individual as well as group based training, and it does not require costly equipment. Theory and evidence behind all of the training principles is reviewed, and an example of an exercise protocol is described in detail. Participants are presented with stepping patterns which they have to memorize and implement on a mat. In order to enable investigation of dose-response effects, the difficulty level systematically and gradually increases session by session based on four principles: execution speed, pattern complexity, pattern length and execution in dual-/multi-tasking conditions. The presented concept can be used as a framework for the development of further prevention and/or rehabilitation stepping exercise programs. Further studies using this exercise regimen or modified versions of it are encouraged.

[Purpose] The aim of this study was to evaluate the influence of using a selected dual-task training program to improve postural stability in infantile hemiparesis. [Subjects and Methods] Thirty patients participated in this study; patients were classified randomly into two equal groups: study and control groups. Both groups received conventional physical therapy treatment including mobility exercises, balance exercises, gait training exercises, and exercises to improve physical conditioning. In addition, the study group received a selected dual-task training program including balance and cognitive activities. The treatment program was conducted thrice per week for six successive weeks. The patients were assessed with the Biodex Balance System. These measures were recorded two times: before the application of the treatment program (pre) and after the end of the treatment program (post). [Results] There was a significant improvement for both groups; the improvement was significantly higher in the study group compared to the control group. [Conclusion] The selected dual-task training program is effective in improving postural stability in patients with infantile hemiparesis when added to the conventional physical therapy program.

Background: Dual tasking constitutes a large portion of most activities of daily living; in real-life situations, people need to not only maintain balance and mobility skills, but also perform other cognitive or motor tasks at the same time. Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective: To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods: CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results: The adherence rate was 91%. DTT was perceived as "somewhat difficult" (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions: CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS. The study was partially funded by an unrestricted educational grant from Novartis Pharma AG to Rehabilitation in Multiple Sclerosis, Swedisch PROMOBILIA foundation, and Flemish MS Liga. The authors would like to thank Marijke Vandermaesen for assistance in the development of CMI-APP. Tacchino, A (corresponding author), Italian Multiple Sclerosis Fdn, Sci Res Area, Via Operai 40, I-16149 Genoa, Italy. andrea.tacchino@aism.it

Background Randomized controlled trials (RCTs) provide the highest level of scientific evidence, but successful participant recruitment is critical to ensure the external and internal validity of results. This study describes the strategies associated with recruiting older adults at increased falls risk residing in retirement villages into an 18-month cluster RCT designed to evaluate the effects of a dual-task exercise program on falls and physical and cognitive function. Methods Recruitment of adults aged ≥65 at increased falls risk residing within retirement villages (size 60–350 residents) was initially designed to occur over 12 months using two distinct cohorts (C). Recruitment occurred via a three-stage approach that included liaising with: 1) village operators, 2) independent village managers, and 3) residents. To recruit residents, a variety of different approaches were used, including distribution of information pack, on-site presentations, free muscle and functional testing, and posters displayed in common areas. Results Due to challenges with recruitment, three cohorts were established between February 2014 and April 2015 (14 months). Sixty retirement villages were initially invited, of which 32 declined or did not respond, leaving 28 villages that expressed interest. A total of 3947 individual letters of invitation were subsequently distributed to residents of these villages, from which 517 (13.1%) expressions of interest (EOI) were received. Across three cohorts with different recruitment strategies adopted there were only modest differences in the number of EOI received (10.5 to 15.3%), which suggests that no particular recruitment approach was most effective. Following the initial screening of these residents, 398 (77.0%) participants were deemed eligible to participate, but a final sample of 300 (58.0% of the 517 EOI) consented and was randomized; 7.6% of the 3947 residents invited. Principal reasons for not participating, despite being eligible, were poor health, lack of time and no GP approval. Conclusion This study highlights that there are significant challenges associated with recruiting sufficient numbers of older adults from independent living retirement villages into an exercise intervention designed to improve health and well-being. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613001 161718. Date registered 23rd October 2013.

[Purpose] The purpose of this research is to take a look at the influences of the dual task training on the hand function and the balance ability of the stroke patients. [Subjects and Methods] The dual task training was applied to 2 stroke hemiplegia patients. The dual task training had been carried out for 30 minutes by each session for 5 days a week for 3 weeks. The evaluations had been carried out 5 times for 3 weeks before and after the intervention. And the changes of the hand function had been measured by using the box and block test. And, for the changes of the balancing ability, the Berg Balance Scale was used. [Results] Both the hand function and the balancing ability of the subjects were improved after the dual task training. [Conclusion] Through the results of the research, it was able to confirm that the dual task training is effective for the enhancements of the hand function and the balancing ability of the stroke patients.

Objectives Dual-task (DT) performance is common to most activities of daily living and difficulties in DT activities may reduce quality of life in older adults. This study investigated the effect of DT training in a sample of older adults. Methods Sixty older adults (mean = 74.4 ± 3.1 years) participated in the study. Twenty-two older adults were included in the control (CG), 19 in the single-task (ST) training and 19 in DT training group. ST group received balance and walking training twice a week for16 weeks, while DT training group performed the same training with additional motor tasks. Data were gathered on 6 m timed walk (6MTW), timed up and go test (TUG) and four square step test (FSST). DT conditions required participants to complete 6MTW, TUG and FSST, either (i) while carrying a glass of water or (ii) while carrying a ball on a round tray. Results A significant Group x Time interaction was found in TUG ( F [2,57] = 29.5; p η 2 = 0.51) and in FSST (F [2,57] = 23.2; p 0.01; partial η 2 = 0.44). After intervention DT showed better scores in overall TUG (mean difference = 1.21 s [95% CI, 0.82–1.60]; p p Conclusion Our results suggested that 16 weeks of motor DT training, using motor additional tasks as manipulation of common objects of everyday life, could improve mobility in older age.

[Purpose] The purpose of this study was to determine the effects of training using dual tasks on balance ability in stroke patients. [Subjects] Forty stroke patients were divided into a dual-task training group (N = 20) and a single task training group (N = 20) randomly. [Methods] The subjects in the single-task traing group stood in a comfortable position, faced a therapist, then threw a Swiss ball back and forth. They then performed balance training in which they raised and lowered their ankles while facing forward or moved objects from one table to another. The DTG performed dual tasks, which involved performing a task on an unstable surface using a balance pad. Both groups received training 30 min per day, five times per week, for eight weeks. [Results] The DTG showed significant increases in weight distribution rate, anterior limit of stability, posterior limit of stability, and BBS scores compared with the STG. [Conclusion] According to the results of this study, dual-task training and single-task training were effective in improving balance in stroke patients, dual task training is more effective for increasing balance ability.

This thesis is an investigation of the feasibility of training protocols to alter dual-task performance in complex environments. The performance of a cognitive task during whole body movements is well established to cause performance decrements in either one of, or both tasks. Furthermore, these performance decrements are amplified as tasks become more challenging and in certain special populations, such as older adults. Research groups have developed training protocols to examine the possibility of reducing dual-task interference effects. However, it is currently unknown if training will transfer to improvements in more complex environments. The current thesis is composed of four experiments. The first experiment was designed to better understand the effects of structural interference on the concurrent performance of an obstacle avoidance task. Results from this experiment demonstrated larger dual-task interference effects on a concurrent obstacle crossing task in the presence of structural interference, indicating the selection of a cognitive task to pair with obstacle crossing has a major influence on performance outcomes. Experiments II & III examined different durations and compositions of training protocols in young adults designed to alter performance on a complex test of dual task performance (a concurrent obstacle crossing and auditory Stroop task). In Experiments II & III, dual-task training protocols composed of performing simultaneous walking and cognitive tasks were observed to increase minimum trail foot clearance in young adults, indicating a potentially more cautious obstacle crossing strategy following training. Conversely, in Experiment III, the training program based on computer-game based training did not alter obstacle crossing strategies to the same magnitude. Finally, the fourth experiment applied the most effective training protocol from the previous studies to a population of community dwelling older adults. Results from the experiment indicated older adult participants exposed to walking based dual-task training did not alter obstacle clearance values, but instead walked more slowly during the dual-task test following training, indicating an alteration to allow more time to implement an obstacle crossing strategy. Collectively, the results of this dissertation indicate that dual-task performance is largely modulated by the tasks included in the experimental protocol. Furthermore, the effects induced by a walking based dual-task training protocol to performance on a concurrent obstacle crossing and auditory Stroop test depend on the population tested.

© 2015 Elsevier Ireland Ltd. Background: Gait abnormalities and vascular disease risk factors are associated with cognitive impairment in aging. Objective: To determine the impact of group-based exercise and dual-task training on gait and vascular health, in active community-dwelling older adults without dementia. Methods: Participants [n = 44, mean (SD) age: 73.5 (7.2) years, 68% female] were randomized to either intervention (exercise + dual-task; EDT) or control (exercise only; EO). Each week, for 26 weeks, both groups accumulated 50 or 75 min of aerobic exercise from group-based classes and 45 min of beginner-level square stepping exercise (SSE). Participants accumulating only 50 min of aerobic exercise were instructed to participate in an additional 25 min each week outside of class. The EDT group also answered cognitively challenging questions while performing SSE (i.e., dual-task training). The effect of the interventions on gait and vascular health was compared between groups using linear mixed effects models. Results: At 26 weeks, the EDT group demonstrated increased dual-task (DT) gait velocity [difference between groups in mean change from baseline (95% CI): 0.29 m/s (0.16-0.43), p < 0.001], DT step length [5.72 cm (2.19-9.24), p = 0.002], and carotid intima-media thickness [0.10 mm (0.003-0.20), p = 0.04], as well as reduced DT stride time variability [8.31 coefficient of variation percentage points (-12.92 to -3.70), p < 0.001], when compared to the EO group. Conclusions: Group-based exercise combined with dual-task training can improve DT gait characteristics in active older adults without dementia.

Falls are a major public health concern with at least one third of people aged 65 years and over falling at least once per year, and half of these will fall repeatedly, which can lead to injury, pain, loss of function and independence, reduced quality of life and even death. Although the causes of falls are varied and complex, the age-related loss in muscle power has emerged as a useful predictor of disability and falls in older people. In this population, the requirements to produce explosive and rapid movements often occurs whilst simultaneously performing other attention-demanding cognitive or motor tasks, such as walking while talking or carrying an object. The primary aim of this study is to determine whether dual-task functional power training (DT-FPT) can reduce the rate of falls in community-dwelling older people. The study design is an 18-month cluster randomised controlled trial in which 280 adults aged ≥65 years residing in retirement villages, who are at increased risk of falling, will be randomly allocated to: 1) an exercise programme involving DT-FPT, or 2) a usual care control group. The intervention is divided into 3 distinct phases: 6 months of supervised DT-FPT, a 6-month ‘step down’ maintenance programme, and a 6-month follow-up. The primary outcome will be the number of falls after 6, 12 and 18 months. Secondary outcomes will include: lower extremity muscle power and strength, grip strength, functional assessments of gait, reaction time and dynamic balance under single- and dual-task conditions, activities of daily living, quality of life, cognitive function and falls-related self-efficacy. We will also evaluate the cost-effectiveness of the programme for preventing falls. The study offers a novel approach that may guide the development and implementation of future community-based falls prevention programmes that specifically focus on optimising muscle power and dual-task performance to reduce falls risk under ‘real life’ conditions in older adults. In addition, the ‘step down’ programme will provide new information about the efficacy of a less intensive maintenance programme for reducing the risk of falls over an extended period. Australian New Zealand Clinical Trials Registry: ACTRN12613001161718 . Date registered 23 October 2013.