Effect of Dual-Task Motor-Cognitive Training in Preventing Falls in Vulnerable Elderly Cerebrovascular Patients: A Pilot Study

Abstract

Falling is a frequent and major clinical problem among older adults, as well as in patients with chronic cerebrovascular diseases (CVD). At present, sequential (mixed) and simultaneously (dual-task) motor-cognitive trainings are the best approaches to affording patients more autonomy in their everyday motor independence while reducing fall risks and consequences. The objective of this study was to evaluate the efficacy of an advanced and innovative dual-task motor-cognitive rehabilitation program on fall risks in vulnerable older persons with chronic CVD. To this purpose, 26 consecutive older fallers with chronic CVD were recruited, and completed a mixed motor-cognitive or a dual-task motor-cognitive training program. Each patient also underwent two test evaluations to assess balance, gait, fear of falling, and walking performance at pre-and post-intervention. We found that our experimental motor-cognitive dual-task rehabilitation program could be an effective method to improve walking balance, gait, walking speed, and fear of falling, while reducing the risk of falls in older people with chronic CVD. Furthermore, results show that the simultaneous motor-cognitive training is more effective than the sequential motor-cognitive training. Therefore, our study brings innovative data, which can contribute positively to the management of this population.

Influence of Speech and Cognitive Load on Balance and Timed up and Go

“…It is important to train the subjects in dual tasks in order to get situations as close as possible to real life. This dual-task training improves walking ability [ 44 ] and balance [ 45 ] and is more effective than sequential training [ 46 ] in elderly subjects with different impairments. However, the exact modalities are yet to be determined [ 24 ].…”

The Effect of Dual-Task Motor-Cognitive Training in Adults with Neurological Diseases Who Are at Risk of Falling

“…Inclusion criteria were the following: age ≥ 18 years; at least 5 years of formal education; risk of falling (total POMA, Tinetti Performance Oriented Mobility Assessment, score ≤ 20 and/or at least one fall in the previous year, in line with previous studies [ 24 , 25 ]).…”

“…All patients were trained during fifteen sessions of an individual, experimental dual-task rehabilitation program (i.e., simultaneous motor/cognitive tasks, 40 min/day, 3 days/week for 5 weeks). The intervention program was carried out in a dual-task room [ 24 ], i.e., the same as that previously used and described in detail in Spanò et al, 2022 [ 24 ]. Briefly, each DTT session consisted of the simultaneous administration of motor and cognitive tasks and included: (1) the first part of the protocol (i.e., 1/3 of the time of each training session) concerning the use of sensory carpets with different surfaces (medium density smooth, sandy and cobbled) and a video projector; (2) a second part of the protocol concerning the use of a walkable led floor and five video projectors (see Spanò et al, 2022 [ 24 ] for a detailed description).…”

“…In this regard, several dual-task trainings have been shown to improve gait performance and to reduce the risk of falling in some neurological disorders, such as Parkinson’s disease and stroke [ 20 , 21 , 22 , 23 , 24 ]. Furthermore, in a recent pilot study [ 24 ] we demonstrated that our advanced and innovative dual-task, motor-cognitive training (DTT) is an effective method for improving walking balance, gait and walking speed, as well as reducing the fear of falling in patients with chronic CVD.…”

“…In light of these observations, the aim of this study was to explore and compare the effect of our DTT program [ 24 ] in adult patients at risk of falling with CVD, PD, TBI and other neurological conditions (OND).…”