Cognitive Training and Dual-task Ability

VA Office of Research and Development

Status: Completed

Conditions: Gait Disorder

Treatments: Behavioral: Cognitive training (general cognition); Behavioral: Standard balance rehabilitation; Behavioral: Balance rehabilitation + dual-tasking; Behavioral: Cognitive training (speed of processing)

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT01895608

E7614-P

Details and patient eligibility

About

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.

Full 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.

Enrollment: 34 patients

Sex: All

Ages: 60 to 89 years old

Volunteers: Accepts Healthy Volunteers

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).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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34 participants in 4 patient groups

Balance rehabilitation + dual-tasking

Experimental group

Description:

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.

Treatment:

Behavioral: Balance rehabilitation + dual-tasking

Standard balance rehabilitation

Active Comparator group

Description:

Standard balance rehabilitation will involve a structured framework of balance activities that require increasing levels of complexity and multimodal stimuli and response demands.

Treatment:

Behavioral: Standard balance rehabilitation

Cognitive training (speed of processing)

Experimental group

Description:

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.

Treatment:

Behavioral: Cognitive training (speed of processing)

Cognitive training (general cognition)

Active Comparator group

Description:

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.

Treatment:

Behavioral: Cognitive training (general cognition)