Objective-To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment.Design-A double-blind, randomized controlled trial. Setting-University research laboratory.Participants-Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS), and/or walked with a self-selected gait speed of 1.1m/s or less.Interventions-Participants were randomly assigned to 1 of 3 interventions: single-task training; dual-task training with fixed-priority instruction; and dual-task training with variable-priority instruction. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks.Main Outcome Measures-Gait speed under single-task and dual-task conditions were obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training.Results-Participants in all groups improved on the BBS (P<.001, effect size [ES]=.72), and walked significantly faster after training (P=.02, ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instruction and dualtask training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57 and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instruction group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001, ES=.61).Reprint requests to Patima Silsupadol, PT, PhD, Dept of Physical Therapy, The Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intawarorot Rd, Sripoom, Chiang Mai, Thailand, 50200, psilsupa@gmail.com.. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Conclusions-Dual-task training is effective in improving gait speed under dual-task conditions in elderly with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect. NIH Public Access KeywordsAging; Attention; Rehabilitation Among older adults, impairment in the control of balance under dual-task conditions is a common occurrence. Because impaired dual-task balance performance predicts adverse outcomes such as falls, 1-3 and declines in both cognitive and physical function, [4][5][6] interventions that improve dual-task balance performance are a critica...

The findings of this study suggest that concussion may have long-term observable and measurable effects on the control of gait stability.

The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment. Elderly individuals with balance impairment, age 65 and older, were randomly assigned to one of three individualized training programs: singletask (ST) balance training; dual-task training with fixed-priority (FP) instruction; and dual-task training with variable-priority (VP) instruction. Balance control during gait, under practiced and novel conditions, was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane. A smaller angle indicated better balance performance. Other outcomes included gait velocity, stride length, verbal reaction time, and rate of response. All measures were collected at baseline and the end of the 4-week training. Results indicated that all training strategies were equally effective (P > .05) at improving balance performance (smaller inclination angle) under single-task contexts. However, the VP training strategy was more effective (P = .04) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies. Improved dual-task processing skills did not transfer to a novel dual-task condition. Results support Kramer et al.'s proposal that VP training improves both single-task automatization and the development of task-coordination skills.

The purpose of this study was to determine how two different types of concurrent tasks affect gait stability in patients with concussion and how balance is maintained. Fourteen individuals suffering from a grade II concussion and 14 matched controls performed a single task of level walking and two types of concurrent tasks during level walking: a discrete reaction time task and a continuous sequential question and answer task. Common gait spatial/temporal measurements, whole-body center of mass motion, and the center of pressure trajectory were recorded. Concussed individuals demonstrated differences in gait while performing single-task level walking and while being challenged with a more difficult secondary task compared to normal controls. Concussed individuals adopted a slower, more conservative gait strategy to maintain stability, but still exhibited signs of instability with center of mass deviations in the coronal plane increasing by 13% during the question and answer dual-task and 26% more than control subjects. Trends of attentional deficits were present with the question and answer task, while the reaction time task seemed to help concussed individuals be more alert to their gait and stability. Recommendations for a sensitive testing protocol of deficits following concussion are explained.

Fractals have been very successful in quantifying the visual complexity exhibited by many natural patterns, and have captured the imagination of scientists and artists alike. Our research has shown that the poured patterns of the American abstract painter Jackson Pollock are also fractal. This discovery raises an intriguing possibility – are the visual characteristics of fractals responsible for the long-term appeal of Pollock's work? To address this question, we have conducted 10 years of scientific investigation of human response to fractals and here we present, for the first time, a review of this research that examines the inter-relationship between the various results. The investigations include eye tracking, visual preference, skin conductance, and EEG measurement techniques. We discuss the artistic implications of the positive perceptual and physiological responses to fractal patterns.