The study of dual task interference has gained increasing attention in the literature for the past 35 years, with six MEDLINE citations in 1979 growing to 351 citations indexed in 2014 and a peak of 454 cited papers in 2013. Increasingly, researchers are examining dual task cost in individuals with pathology, including those with neurodegenerative diseases. While the influence of these papers has extended from the laboratory to the clinic, the field has evolved without clear definitions of commonly used terms and with extreme variations in experimental procedures. As a result, it is difficult to examine the interference literature as a single body of work. In this paper we present a new taxonomy for classifying cognitive-motor and motor-motor interference within the study of dual task behaviors that connects traditional concepts of learning and principles of motor control with current issues of multitasking analysis. As a first step in the process we provide an operational definition of dual task, distinguishing it from a complex single task. We present this new taxonomy, inclusive of both cognitive and motor modalities, as a working model; one that we hope will generate discussion and create a framework from which one can view previous studies and develop questions of interest.

Background: A decline in manual dexterity is a common phenomenon in elderly individuals. Often, simple daily activities such as handling coins and preparing meals become challenging. A substantial decline in manual dexterity may impact one’s ability to live independently. Thus, understanding the underlying causes of these impairments is essential. Considerable attention has been given to the regulation of fingertip forces during object grasp, lift and transport in the elderly. Objective: Here we review studies on fingertip force coordination in the elderly, with an emphasis on the relationship between the degree of change in elderly grip force control and the nature of the tasks performed. Methods: A literature search was performed using Medline, Pubmed, and Web of Science electronic databases covering studies from 1985 to 2009, inputting combinations of the following key words: grip force, grasp force, fingertip forces, precision grip, aging, elderly, and hand motor control. Results: Studies show a consistent elevation in grip force magnitudes that may easily lead to fatigue. These force increases may represent a compensation for increased skin slipperiness or a reduction in tactile information. In contrast, anticipatory grip force control (planning) remains relatively intact. Age-related changes in anticipatory control seem to emerge only during more complex tasks. Conclusion: The relationship between task complexity and degree of age-related changes suggests that results from simple, laboratory-based tasks may only partially explain impairments observed during the performance of activities of daily living, since the latter ones are typically more complex. A better understanding of impaired manual dexterity experienced by elderly individuals could be achieved by expanding experimental paradigms so that they more closely resemble the complexities encountered in functional daily tasks. Subsequently, these findings could be used in clinical settings to develop treatment approaches that consider grasp control in the context of behaviorally meaningful tasks.

An interesting feature of the muscular organization of the human hand is that the main flexors and extensors of the fingers are compartmentalized and give rise to multiple parallel tendons that insert onto all the fingers. Previous studies of motor-unit synchrony in extensor digitorum and flexor digitorum profundus indicated that synaptic input to motor neurons supplying these multitendoned muscles is not uniformly distributed across the entire pool of motor neurons but instead appears to be partially segregated to supply subsets of motor neurons that innervate different muscular compartments. Little is known, however, about the organization of the synaptic inputs to the motor neurons supplying another multitendoned finger muscle, the flexor digitorum superficialis (FDS). Therefore in this study, we estimated the extent of divergence of last-order inputs to FDS motor neurons by measuring the degree of short-term synchrony among motor units within and across compartments of FDS. The degree of synchrony for motor-unit pairs within the same digit compartment was nearly twofold that of pairs of motor units in adjacent compartments and more than fourfold that of pairs in nonadjacent compartments. Therefore like other multitendoned muscles of the hand, last-order synaptic inputs to motor neurons supplying the FDS appear to primarily supply subsets of motor neurons innervating specific finger compartments. Such an organization presumably enables differential activation of separate compartments to facilitate independent movements of the fingers.

This paper provides a narrative review of cognitive motor interference in neurodegeneration, including brain imaging findings specific to interference effects in neurodegenerative disease, and dual task assessment and intervention in Parkinson’s disease (PD), multiple sclerosis (MS), and Huntington’s disease (HD). In a healthy central nervous system the ability to process information is limited. Limitations in capacity to select and attend to inputs influence the ability to prepare and perform multiple tasks. As a result, the system balances demands, switching attention to the most task-relevant information as it becomes available. Limitations may become more apparent in persons with neurodegenerative diseases (ND) with system-specific impairments in PD, MS, and HD. These ND affect both cognitive and motor function and are thus particularly susceptible to dual task interference. Issues related to performer and task characteristics and implications of these findings for both the standard assessment of dual task abilities as well as development and evaluation of interventions aimed at improving dual task ability are discussed. In addition, we address the need for optimizing individualized assessment, intervention and evaluation of dual task function by choosing cognitive and motor tasks and measures that are sensitive to and appropriate for the individual’s level of function. Finally, we use current evidence to outline a 5-step process of clinical decision making that uses the dual task taxonomy as a framework for assessment and intervention.

We examined the coordination of multi-digit grasping forces as they developed during object grasping and lifting. Ten subjects with Parkinson's disease (PD; OFF and ON medication) and ten healthy age-matched control subjects lifted a manipulandum that measured normal forces at each digit and the manipulandum's position. The center of mass (CM) was changed from trial to trial in either a predictable (blocked) or unpredictable (random) order. All subjects modulated individual fingertip forces to counterbalance forces exerted by the thumb and minimize object tilt after lift-off. However, subjects with PD OFF exhibited an impaired ability to use anticipatory mechanisms resulting in less differentiated scaling of individual finger forces to the object CM location. Remarkably, these between-group differences in force modulation dissipated as subjects reached peak grip forces during object lift, although these occurred significantly later in subjects with PD OFF than controls and PD ON. Analysis of the tilt of the object during lift revealed all subjects had similar deviations of the object from the vertical, the direction of which depended on CM location. Thus these findings in subjects with PD indicate that: (a) PD-induced impairments in anticipatory force mechanisms appear to be greatly increased in multi-digit grasping as opposed to previous reports from two-digit grasping; (b) inaccurate scaling of fingertip force amplitude and sharing patterns before object lift is recovered during object lift; (c) the implementation of appropriate force amplitude and sharing among the digits during the lift occurs significantly later than for controls; (d) medication improves the temporal recovery of multi-digit force coordination. These results are discussed within the framework of PD-related deficits in sensorimotor integration and control of multi-degrees of freedom movement.