Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value?
Rizzo J A,Bogardus S T,Leo-Summers L,Williams C S,Acampora D,Inouye S K
Medical care
INTRODUCTION:Delirium, or acute confusional state, is a common and serious occurrence among hospitalized older persons. Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year, involving more than 17.5 million hospital days and accounting for more than $4 billion (1994 dollars) of Medicare expenditures. A 40% reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention (MTI) strategy to prevent delirium, compared with subjects receiving usual hospital care.1 Before recommending that this preventive strategy be implemented in clinical practice, however, the cost implications must be thoroughly examined as well. METHODS:The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients. Hospital charge and cost-to-charge ratio data are linked to a database of 852 subjects, who were treated with MTI or usual care. Multivariable regression methods were used to help isolate the impact of MTI on hospital costs. These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention. RESULTS:The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium, but not among subjects at high risk. When MTI intervention costs were included, MTI had no significant effect on overall health care costs in the intermediate risk cohort, but raised overall costs in the high risk group. CONCLUSIONS:Because the MTI prevented delirium in the intermediate risk group without raising costs, the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium. In contrast, the results suggest that the MTI is not cost effective for subjects at high risk.
Fear of Falling in People With Multiple Sclerosis: Which Clinical Characteristics Are Important?
Khalil Hanan,Al-Shorman Alham,El-Salem Khalid,Abdo Nour,Alghwiri Alia A,Aburub Aseel,Shalabi Sarah,Al-Mustafa Firas
Physical therapy
BACKGROUND:Fear of falling (FOF) is an important risk indicator for health-related outcomes and quality of life in patients with multiple sclerosis (MS). However, factors associated with FOF in MS are not well investigated. OBJECTIVES:This study was done to explore predictors of FOF in this population. METHODS:Seventy relapsing remitting patients with MS were evaluated. Fear of falling was assessed using the Fall Efficacy Scale-International (FES-I). Motor outcomes included: 30-second chair stand test (30s-CST), Berg Balance Scale (BBS), 10-Meter Walk Test (10MWT), and 6-Minute Walk Test (6MWT). Cognitive status was determined using the Montréal Cognitive Assessment (MOCA) and Symbol Digit Modalities Test (SDMT). Affective factors including depression, fatigue, and sleep were also assessed using the Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), and Pittsburgh Sleep Quality Index (PSQI), respectively. RESULTS:Fear of falling was significantly correlated with all motor and affective measures used. However, a stepwise regression found that only BBS from motor measures, MOCA from cognitive measures, and sleep disorders from affective factors were significantly predictive of the FOF. CONCLUSIONS:Fear of falling in patients with MS is multifactorial and includes motor and nonmotor factors. Thus, therapies that aim to reduce risk of falling in this population should address motor functions, cognitive abilities, and sleep quality.
10.1093/ptj/pzx044
Benefits of a Dual-Task Training on Motor and Cognitive Functions in Community-Dwelling Older Adults: A Controlled Clinical Trial.
American journal of physical medicine & rehabilitation
OBJECTIVE:The aim of the study is to verify the effects of a 3-mo dual-task training on motor and cognitive functions in community-dwelling older adults. DESIGN:In this prospective, single-blinded, controlled clinical trial, a total of 40 participants were allocated to either the experimental or the control (no-exercise) group. The intervention program consisted of a combination of motor and cognitive exercises conducted twice a week on nonconsecutive days. The main outcome measures were postural stability, mobility, fear of falling, and cognitive functions. Multiple analyses of variance were used to assess the impact of the dual-task training. Effect sizes (η 2 p) were reported. Significance was set at 5%. RESULTS:Compared with the control group, participants who underwent the dual-task training showed positive outcomes in terms of postural stability (η 2 p = 0.298, P = 0.020), mobility (η 2 p = 0.285, P = 0.003), and cognitive functions (η 2 p = 0.536, P = 0.001). No significant differences were observed between the groups in terms of the fear of falling ( P = 0.566). CONCLUSIONS:Three-month dual-task training was beneficial for postural control, mobility, and cognitive functions in community-dwelling older adults. Based on the present findings, healthcare professionals should consider incorporating dual-task training into clinical practice.
10.1097/PHM.0000000000002352
Feasibility and potential cognitive impact of a cognitive-motor dual-task training program using a custom exergame in older adults: A pilot study.
Frontiers in aging neuroscience
Introduction:Dual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result's trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored. Methods:Older adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2-3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program's safety, engagement, attendance, and completion levels were evaluated. Participants' postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a -value set at 0.05. Results:Thirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters. Discussion:Our exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.
10.3389/fnagi.2023.1046676
Mild Stroke, Serious Problems: Limitations in Balance and Gait Capacity and the Impact on Fall Rate, and Physical Activity.
Neurorehabilitation and neural repair
BACKGROUND:After mild stroke persistent balance limitations may occur, creating a risk factor for fear of falling, falls, and reduced activity levels. To investigate whether individuals in the chronic phase after mild stroke show balance and gait limitations, elevated fall risk, reduced balance confidence, and physical activity levels compared to healthy controls. METHODS:An observational case-control study was performed. Main outcomes included the Mini-Balance Evaluation Systems Test (mini-BEST), Timed Up and Go (TUG), 10-m Walking Test (10-MWT), and 6-item version Activity-specific Balance Confidence (6-ABC) scale which were measured in 1 session. Objectively measured daily physical activity was measured for 7 consecutive days. Fall rate in daily life was recorded for 12 months. Individuals after a mild stroke were considered eligible when they: (1) sustained a transient ischemic attack or stroke longer than 6 months ago, resulting in motor and/or sensory loss in the contralesional leg at the time of stroke, (2) showed (near-) complete motor function, that is, ≥24 points on the Fugl-Meyer Assessment-Lower Extremity (range: 0-28). RESULTS:Forty-seven healthy controls and 70 participants after mild stroke were included. Participants with stroke fell more than twice as often as healthy controls, had a 2 point lower median score on the mini-BEST, were 1.7 second slower on TUG, 0.6 km/h slower on the 10-MWT, and had a 12% lower 6-ABC score. Intensity for both total activity (8%) as well as walking activity (6%) was lower in the participants with stroke, while no differences were found in terms of duration. CONCLUSIONS:Individuals in the chronic phase after a mild stroke demonstrate persistent balance limitations and have an increased fall risk. Our results point at an unmet clinical need in this population.
10.1177/15459683231207360
Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture.
World journal of clinical cases
BACKGROUND:Elderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures, and are prone to negative emotions, which affect treatment compliance. AIM:To evaluate the effects of evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fractures. METHODS:A total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups ( = 60 each) according to different nursing methods. The basic rehabilitation methods of the two groups were consistent, but patients in the intervention group received evidence-based nursing interventions at the same time. Differences between groups in the scores of motion phobia, pain fear, rehabilitation training compliance, self-efficacy, nursing satisfaction, and hip joint function were compared before and after the intervention. RESULTS:Before the intervention, there were no statistically significant differences in motion phobia and pain fear scores between the groups (all > 0.05). However, motion phobia scores at 1 wk after intervention initiation ( < 0.05), and pain fear scores at 1 wk and 2 wk after intervention initiation (all < 0.05), were significantly lower in the intervention group than in the routine group. On the first day of intervention, there was no significant difference in rehabilitation treatment compliance between the groups ( > 0.05); however, at 2 wk after intervention initiation, rehabilitation compliance was significantly better in the intervention group than in the routine group ( < 0.05). Before the intervention, there were no statistically significant differences in the scores for the two self-efficacy dimensions (overcoming difficulties and rehabilitation exercise self-efficacy) and the total self-efficacy score between the groups (all > 0.05). After 2 wk of intervention, the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group (all < 0.05). At 3 and 6 mo after surgery, hip function as evaluated by the Harris hip score, was significantly better in the intervention group than in the routine group ( < 0.05). Additionally, overall nursing satisfaction was significantly higher in the intervention group than in the routine group ( < 0.05). CONCLUSION:Evidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery, and improve rehabilitation treatment compliance and patient self-efficacy, which promote hip function recovery.
10.12998/wjcc.v10.i10.3069
Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: a preliminary investigation.
You Joshua H,Shetty Anand,Jones Tawaih,Shields Kimberli,Belay Yordanos,Brown Deborah
NeuroRehabilitation
The present study highlights the effects of the dual-task cognitive-gait intervention (CGI) on working memory and gait functions in older adults with a history of falls. Thirteen older adults with a history of falls were recruited from local community centers and randomly stratified into either the control (n = 5) or experimental (n = 8) group. The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor (walking) and cognitive (memory recall) task whereas the control group received a placebo treatment (walking with simple music). The intervention was provided 30 minutes per session, over a 6-week period. Memory measures included a combination of word recall and arithmetic task. Gait function measures included velocity and center of pressure (COP) stability. Non-parametric tests were used at p < 0.05. The experimental group showed a greater memory performance than the control (p < 0.05). However, no significant intervention-related changes in gait velocity and stability were observed. Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition.
10.3233/NRE-2009-0468
Functional brain changes following cognitive and motor skills training: a quantitative meta-analysis.
Patel Ronak,Spreng R Nathan,Turner Gary R
Neurorehabilitation and neural repair
BACKGROUND:Functional neuroimaging is increasingly used in rehabilitation research to map the neural mechanisms subserving training targets. These data can inform intervention design and improve evaluation of treatment outcomes. Reliable neural markers may provide standard metrics of treatment impact and allow consideration of behavioral outcomes in the context of functional brain changes. OBJECTIVE:To identify common patterns of functional brain changes associated with training across a diverse range of intervention protocols. Reliable brain changes could inform development of candidate neural markers to guide intervention research. METHODS:Taking a quantitative meta-analytic approach, we review the functional neuroimaging studies of cognitive and motor skills training interventions in healthy young adults (N = 38). RESULTS:Reliable decreases in functional brain activity from pretraining to posttraining were observed in brain regions commonly associated with cognitive control processes, including lateral prefrontal, left anterior inferior parietal lobule, and dorsal anterior cingulate cortex. Training-related increases were observed in the medial prefrontal cortex and posterior cingulate and angular gyrus, core regions of the default network. Activity within the subcortical striatum also showed reliable increases pretraining to posttraining. CONCLUSIONS:These data suggest that altered engagement of large-scale, spatially distributed cortical brain networks and subcortical striatal brain regions may serve as candidate neural markers of training interventions. The development of reliable metrics based on activity and functional connectivity among large-scale brain networks may prove fruitful in identifying interactions between domain-general and -specific changes in brain activity that affect behavioral outcomes.
10.1177/1545968312461718
Brain activity associated with Dual-task performance of Ankle motor control during cognitive challenge.
Peters Sue,Eng Janice J,Liu-Ambrose Teresa,Borich Michael R,Dao Elizabeth,Amanian Ameen,Boyd Lara A
Brain and behavior
INTRODUCTION:Skilled Ankle motor control is frequently required while performing secondary cognitively demanding tasks such as socializing and avoiding obstacles while walking, termed "Dual tasking." It is likely that Dual-task performance increases demand on the brain, as both motor and cognitive systems require neural resources. The purpose of this study was to use functional MRI to understand which brain regions are involved in resolving Dual-task interference created by requiring high levels of Ankle motor control during a cognitive task. METHODS:Using functional MRI, brain activity was measured in sixteen young adults during performance of visually cued Ankle plantar flexion to a target (Ankle task), a cognitive task (Flanker task), and both tasks simultaneously (Dual task). RESULTS:Dual-task performance did not impact the Ankle task (p = 0.78), but did affect behavior on the Flanker task. Response times for both the congruent and incongruent conditions during the Flanker task were significantly longer (p < 0.001, p = 0.050, respectively), and accuracy for the congruent condition decreased during Dual tasking (p < 0.001). Activity in 3 brain regions was associated with Dual-task Flanker performance. Percent signal change from baseline in Brodmann area (BA) 5, BA6, and the left caudate correlated with performance on the Flanker task during the Dual-task condition (R = 0.261, p = 0.04; R = -0.258, p = 0.04; R = 0.303, p = 0.03, respectively). CONCLUSIONS:Performance of Ankle motor control may be prioritized over a cognitive task during Dual-task performance. Our work advances Dual-task research by elucidating patterns of whole brain activity for Dual tasks that require Ankle motor control during a cognitive task.
10.1002/brb3.1349
A multimodal approach integrating cognitive and motor demands into physical activity for optimal mental health: Methodological issues and future directions.
Progress in brain research
Physical activity is known for its positive effects on cognition and affect, with existing literature suggesting that these mental health benefits may be optimally experienced by incorporating cognitive and motor demands during physical activity (PA). However, the existing body of literature lacks a comprehensive guideline for designing the qualitative characteristics of a PA program. Accordingly, this narrative review aimed to (1) provide a working two-dimension model that operationally defines the cognitive and motor demands involved in PA and the rationale for systematically studying these qualitative aspects of PA, (2) identify methods to assess the cognitive and motor demands of PA and address associated methodological issues, and (3) offer potential future directions for research on the cognitive and motor aspects of PA in support of the development of PA programs designed to maximize PA-induced cognitive and affective benefits. We anticipate this article to inform the need for future research and development on this topic, aiming to create clear, evidence-based guidelines for designing innovative and effective PA interventions.
10.1016/bs.pbr.2024.05.011
Early neurodevelopment in the offspring of women enrolled in a randomized controlled trial assessing the effectiveness of a nutrition + exercise intervention on the cognitive development of 12-month-olds.
Journal of developmental origins of health and disease
Experimental data on the effects of lifestyle interventions on fetal neurodevelopment in humans remain scarce. This study assessed the impact of a pregnancy nutrition+exercise intervention on offspring neurodevelopment at 12 months of age. The Be Healthy in Pregnancy (BHIP) randomized controlled trial (RCT) randomly assigned pregnant persons with stratification by site and body mass index (BMI) to bi-weekly nutrition counselling and high dairy protein diet, walking goal of 10,000 steps/day plus usual prenatal care (UPC; intervention group) or UPC alone (control group). This study examined a subset of these mothers (> 18 years, singleton pregnancy, BMI <40 kg/m, and enrolled by ≤12 weeks gestation) and their infants (intervention = 42, control = 32), assessing cognition, language, motor, social-emotional, and adaptive functioning at 12 months using the third edition (BSID-III) as the outcome measure. We also examined if maternal factors (prepregnancy BMI, gestational weight gain (GWG)) moderated associations. Expressive language (MD = 9.62, 95% CI = (9.05-10.18), = 0.03, ƞ = 0.07) and general adaptive composite (GAC) scores (MD = 103.97, 95% CI = (100.31-107.63), = 0.04, ƞ = 0.06) were higher in infants of mothers in the intervention group. Effect sizes were medium. However, mean cognitive, receptive language, motor, and social-emotional scale scores did not differ between groups. A structured and monitored nutrition+exercise intervention during pregnancy led to improved expressive language and general adaptive behavior in 12-month-olds, but not cognitive, receptive language, motor, or socioemotional functioning. While these experimental data are promising, further research is needed to determine the clinical utility of nutrition+exercise interventions for optimizing infant neurodevelopment.
10.1017/S204017442300020X
Video game and motor-cognitive dual-task training could be suitable treatments to improve dual-task interference in older adults.
Bagheri Hossein,Khanmohammadi Roya,Olyaei Gholamreza,Talebian Saeed,Reza Hadian Mohammad,Najafi Marziyeh
Neuroscience letters
The objective of study was to investigate the effects of video game training in comparison with traditional motor-cognitive dual-task training on dual-task interference in older adults. Sixty older adults were allocated to the video game (intervention group) or the motor-cognitive dual-task training (control group). The outcome measures were dual-task cost (DTC) of linear metrics (Standard deviation (SD) of amplitude and velocity) and DTC of nonlinear metrics (approximate entropy, Lyapunov and correlation dimension) acquired from postural sway time series from both the mediolateral (ML) and anteroposterior (AP) directions. The results revealed in both groups, dual-task cost of SD of amplitude and velocity as well as Lyapunov were significantly decreased in post-training and follow-up compared with pre-training (p < 0.017), while there was no significant difference between the groups. Video game and motor-cognitive dual-task training could be recommended as suitable treatments to improve dual-task interference.
10.1016/j.neulet.2021.136099
Combining Virtual Reality Motor Rehabilitation With Cognitive Strategy Use in Chronic Stroke.
The American journal of occupational therapy : official publication of the American Occupational Therapy Association
IMPORTANCE:Rehabilitation interventions for chronic stroke are largely impairment based, with results confined to the level of impairment instead of function. In contrast, cognitive strategy training interventions have demonstrated clinically meaningful improvements in functional outcomes. Integration of these approaches has yet to be explored. OBJECTIVE:To evaluate acceptability, recruitment, and retention rate and determine which outcome measures best capture the effect of the intervention. DESIGN:Single-group, pre-post design. SETTING:Research laboratory. PARTICIPANTS:Adults with chronic stroke and hemiparesis (N = 10). INTERVENTION:A 12-wk intervention integrating cognitive strategy training with upper extremity motor training. Two weekly sessions used Kinect-based virtual reality to encourage high numbers of upper extremity movement repetitions. The third weekly session focused on the use of cognitive strategies with practice of client-centered goals. OUTCOMES AND MEASURES:Upper extremity motor performance was measured with the Fugl-Meyer Assessment. Occupational performance on trained and untrained goals was measured via the Performance Quality Rating Scale and the Canadian Occupational Performance Measure. Outcome data were gathered preintervention, postintervention, and at 3-mo follow-up. RESULTS:The intervention was perceived as acceptable. Recruitment rate was 15%, and retention rate was 100%. Large effects were found on outcomes of upper extremity motor performance, occupational performance, and participation at follow-up. CONCLUSION AND RELEVANCE:MetacogVR is feasible for adults with chronic stroke. The effect of MetacogVR is best captured through measures of upper extremity motor performance, occupational performance, and participation. WHAT THIS ARTICLES ADDS:Traditional, impairment-based approaches to chronic stroke rehabilitation may require integration with cognitive-strategy training to affect performance on meaningful goals.
10.5014/ajot.2019.030130
Task order choices in cognitive and perceptual-motor tasks: The cognitive-load-reduction (CLEAR) hypothesis.
VonderHaar Rachel L,McBride Dawn M,Rosenbaum David A
Attention, perception & psychophysics
A core question in the study of the dynamics of cognition is how tasks are ordered. Given two tasks, neither of which is prerequisite for the other and neither of which brings a clearly greater reward, which task will be done first? Few studies have addressed this question, though recent work has suggested one possible answer, which we here call the cognitive-load-reduction (CLEAR) hypothesis. According to the CLEAR hypothesis, there is a strong drive to reduce cognitive load (to "clear one's mind"). Given two tasks, one of which is more cognitively demanding than the other, the more cognitively demanding task will tend to be done first. We tested this prediction using a novel method inviting participants to freely choose when to perform each of c = 5, 10, or 15 items per category in item-generation tasks relative to b = 10 box-moving tasks. The box-moving tasks were cognitively undemanding relative to the item generation tasks, whose cognitive difficulty presumably grew with c. A full half of our n = 122 participants chose to complete all of the c tasks before performing any of the b tasks, and most other participants chose to complete a majority of the c tasks before any of the b tasks. This result is consistent with the CLEAR hypothesis. Speed on the box-moving task decreased the later the category-generation task was completed, supporting another CLEAR prediction. The general method used here provides direction for future work on task order choices in cognitive and perceptual-motor tasks.
10.3758/s13414-019-01754-z
Motor imagery and action observation: cognitive tools for rehabilitation.
Mulder Th
Journal of neural transmission (Vienna, Austria : 1996)
Rehabilitation, for a large part may be seen as a learning process where old skills have to be re-acquired and new ones have to be learned on the basis of practice. Active exercising creates a flow of sensory (afferent) information. It is known that motor recovery and motor learning have many aspects in common. Both are largely based on response-produced sensory information. In the present article it is asked whether active physical exercise is always necessary for creating this sensory flow. Numerous studies have indicated that motor imagery may result in the same plastic changes in the motor system as actual physical practice. Motor imagery is the mental execution of a movement without any overt movement or without any peripheral (muscle) activation. It has been shown that motor imagery leads to the activation of the same brain areas as actual movement. The present article discusses the role that motor imagery may play in neurological rehabilitation. Furthermore, it will be discussed to what extent the observation of a movement performed by another subject may play a similar role in learning. It is concluded that, although the clinical evidence is still meager, the use of motor imagery in neurological rehabilitation may be defended on theoretical grounds and on the basis of the results of experimental studies with healthy subjects.
10.1007/s00702-007-0763-z
Effect of interactive cognitive motor training on gait and balance among older adults: A randomized controlled trial.
Kao Ching-Chiu,Chiu Huei-Ling,Liu Doresses,Chan Pi-Tuan,Tseng Ing-Jy,Chen Ruey,Niu Shu-Fen,Chou Kuei-Ru
International journal of nursing studies
BACKGROUND:Aging is a normal degenerative process that results in a decline in the gait and balance performance of older adults. Interactive cognitive motor training is an intervention that integrates cognitive and motor tasks to promote individuals' physical and cognitive fall risk factors. However, the additive effects of the interactive cognitive motor training on objective quantitative data and comprehensive descriptions of gait and balance warrants further investigation. OBJECTIVES:To investigate the effect of interactive cognitive motor training on older adults' gait and balance from immediate to long-term time points. DESIGN:A double-blind randomized control trial. SETTINGS:Four senior service centers and community service centers in Taiwan. PARTICIPANTS:62 older adults who met the inclusion criteria. METHODS:The study participants were older adults without cognitive impairment, and they were randomly allocated to the experimental group or active control group. In both groups, older adults participated in three sessions of 30-min training per week for a total of 8 weeks, with the total number of training sessions being 24. The primary outcome was gait performance, which was measured using objective and subjective indicators. iWALK was used as an objective indicator to measure pace and dynamic stability; the Functional Gait Assessment was employed as a subjective indicator. The secondary outcome was balance performance, which was measured using iSWAY. A generalized estimating equation was used to identify whether the results of the two groups differ after receiving different intervention measures; the results were obtained from immediate to long-term posttests. RESULTS:Stride length in the pace category of the experimental group improved significantly in immediate posttest (p = 0.01), 3-month follow-up (p = 0.01), and 6-month follow-up (p = 0.04). The range of motion of the leg exhibited significant improvement in immediate posttest (p = 0.04) and 3-month follow-up (p = 0.04). The Functional Gait Assessment result indicated that statistically significant improvement was observed in immediate posttest (p = 0.02) and 12-month follow-up (p = 0.01). The results of balance performance showed that the experimental group attained statistically significant improvement in centroid frequency in the immediate posttest (p = 0.02). CONCLUSIONS:The research results validated that the 24 sessions of the interactive cognitive motor training intervention significantly improved gait and balance performance. Future studies should extend the sample to communities to promote the gait and balance performance of community-dwelling older adults without cognitive impairment and reduce their risk of falling and developing gait-related diseases.
10.1016/j.ijnurstu.2018.03.015
The effects of cognitive versus motor concurrent task on gait in individuals with transtibial amputation, transfemoral amputation and in a healthy control group.
Gait & posture
BACKGROUND:Lower limb amputation causes difficulties in mobility together with motor and sensory loss. Challenging situations such as concurrent tasks cause gait parameters to deteriorate. Understanding the effect of concurrent tasks on gait is important for the rehabilitation of amputees. RESEARCH QUESTION:Are the effects of concurrent cognitive and motor tasks on gait parameters at fixed speed different in individuals with transtibial amputation, or transfemoral amputation compared to healthy individuals? METHODS:The gait parameters were evaluated of 20 individuals with transtibial amputation, 13 individuals with transfemoral amputation and 20 healthy individuals while walking on a motorized treadmill under single task (ST), cognitive dual task (CDT) and motor dual task (MDT) conditions. The self-selected comfortable velocity, which was determined in the single-task gait, was used in all three walking tests. RESULTS:ST, CDT and MDT gait parameters of individuals with transtibial amputation, transfemoral amputation and healthy individuals were significantly different (p < 0.01). Covariance of step length variability increased in amputees when walking under MDT (p < 0.05). The dual task cost (DTC) for all the gait parameters was similar in all three groups (p > 0.05). The motor DTC of covariance of step length was greater than cognitive DTC (p < 0.05). SIGNIFICANCE:Individuals with lower limb amputation have the capacity to walk with cognitive and motor tasks without changing velocity on the treadmill, but concurrent motor tasks cause an increase in gait variability. The results of this study suggest that there is an increase in gait variability especially with motor tasks, which may cause a higher risk of falling. Trial number: NCT04392466 (clinicaltrials.gov).
10.1016/j.gaitpost.2021.10.036
The effect of acute exercise on cognitive and motor inhibition - Does fitness moderate this effect?
Psychology of sport and exercise
BACKGROUND:Given the extensive evidence on improvements in cognitive inhibition immediately following exercise, and the literature indicating that cognitive and motor inhibitory functions are mediated by overlapping brain networks, the aim of this study was to assess, for the first time, the effect of moderate intensity acute aerobic exercise on multi-limb motor inhibition, as compared to cognitive inhibition. METHOD:Participants were 36 healthy adults aged 40-60 years old (mean age 46.8 ± 5.7), who were randomly assigned to experimental or control groups. One-to-two weeks following baseline assessment, participants were asked to perform a three-limb (3-Limb) inhibition task and a vocal version of the Stroop before and after either acute moderate-intense aerobic exercise (experimental group) or rest (control). RESULTS:Similar rates of improvement were observed among both groups from baseline to the pre-test. Conversely, a meaningful, yet non-significant trend was seen among the experimental group in their pretest to posttest improvement in both cognitive and motor tasks. In addition, exploratory analysis revealed significant group differences in favor of the experimental group among highly fit participants on the 3-Limb task. A significant correlation was indicated between the inhibition conditions, i.e., choice in the motor inhibition and color/word (incongruent) in the cognitive inhibition, especially in the improvement observed following the exercise. DISCUSSION:Moderate-intensity acute aerobic exercise is a potential stimulator of both multi-limb motor inhibition and cognitive inhibition. It appears that high-fit participants benefit from exercise more than low-fit people. Additionally, performance on behavioral tasks that represent motor and cognitive inhibition is related. This observation suggests that fitness levels and acute exercise contribute to the coupling between cognitive and motor inhibition. Neuroimaging methods would allow examining brain-behavior associations of exercise-induced changes in the brain.
10.1016/j.psychsport.2022.102344
Coordination between motor and cognitive tasks in dual task gait.
Smeeton Nicholas J,Wrightson James,Varga Matyas,Cowan Rhiannon,Schafer Lisa
Gait & posture
BACKGROUND:Dual Task (DT) paradigms are frequently used by researchers and clinicians to examine the integrity of motor processes in many movement disorders. However, the mechanism of this interaction is not fully understood. Therefore, the aim of this study was to examine the within-stride interactions between cognitive and motor processes during dual task gait (DT). RESEARCH QUESTION:Do healthy young adults coordinate gait with secondary task processing? If so, is cognitive task processing capability associated with the coordination observed? METHODS:Nineteen healthy young adults walked for two minutes on a motorized treadmill whilst counting backwards in sevens from three-digit numbers. The coordination of calculation verbalizations with gait parameters were assessed across six phases of the gait cycle. Mid verbalization time points (VER) were used as points of high cognitive processing of the dual task and compared with the end of the verbalizations (VER) as points of low cognitive processing. RESULTS:VER and VER did not systematically occur in any phase of the gait cycle. However, 10/19 and 9/19 participants showed non-random distributions of verbalizations for VER and VER time points respectively (p < 0.01), indicating that these walkers coordinated gait with the cognitive task. Analysis of subgroups of Verbalization Coordinators and Non-Coordinators showed slower verbalization response durations (VRD) for VER Coordinators compared to VER Non-Coordinators, indicating that VER Coordinators found the cognitive tasks more demanding. No differences were found in VRD for VER Coordinators and VER Non-Coordinators. SIGNIFICANCE:It was found that cognitive processing is coordinated with gait phases in some but not all healthy young adults during DT gait. When demands on cognitive processes are high, healthy young adults coordinate cognitive processing with phases of gait. Analysis of within-stride coordination may be of use for studying clinical conditions where gait and attentional cognition performance breaks down.
10.1016/j.gaitpost.2021.01.012
Effects of exergames and cognitive-motor dual-task training on cognitive, physical and dual-task functions in cognitively healthy older adults: An overview.
Ageing research reviews
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.
10.1016/j.arr.2020.101135
The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review.
Schoene Daniel,Valenzuela Trinidad,Lord Stephen R,de Bruin Eling D
BMC geriatrics
BACKGROUND:It is well-known physical exercise programs can reduce falls in older people. Recently, several studies have evaluated interactive cognitive-motor training that combines cognitive and gross motor physical exercise components. The aim of this systematic review was to determine the effects of these interactive cognitive-motor interventions on fall risk in older people. METHODS:Studies were identified with searches of the PubMed, EMBASE, and Cochrane CENTRAL databases from their inception up to 31 December 2013. Criteria for inclusion were a) at least one treatment arm that contained an interactive cognitive-motor intervention component; b) a minimum age of 60 or a mean age of 65 years; c) reported falls or at least one physical, psychological or cognitive fall risk factor as an outcome measure; d) published in Dutch, English or German. Single case studies and robot-assisted training interventions were excluded. Due to the diversity of populations included, outcome measures and heterogeneity in study designs, no meta-analyses were conducted. RESULTS:Thirty-seven studies fulfilled the inclusion criteria. Reporting and methodological quality were often poor and sample sizes were mostly small. One pilot study found balance board training reduced falls and most studies reported training improved physical (e.g. balance and strength) and cognitive (e.g. attention, executive function) measures. Inconsistent results were found for psychological measures related to falls-efficacy. Very few between-group differences were evident when interactive cognitive-motor interventions were compared to traditional training programs. CONCLUSIONS:The review findings provide preliminary evidence that interactive cognitive-motor interventions can improve physical and cognitive fall risk factors in older people, but that the effect of such interventions on falls has not been definitively demonstrated. Interactive cognitive-motor interventions appear to be of equivalent efficacy in ameliorating fall risk as traditional training programs. However, as most studies have methodological limitations, larger, high-quality trials are needed.
10.1186/1471-2318-14-107
The interplay between cognitive and motor functioning in healthy older adults: findings from dual-task studies and suggestions for intervention.
Schaefer Sabine,Schumacher Vera
Gerontology
Reaching late adulthood is accompanied by losses in physical and mental resources, but lifestyle choices seem to have a considerable influence on the aging trajectory. This review deals with the interplay between cognitive and motor functioning in old age, focusing on two different lines of research, namely (a) dual-task studies requiring participants to perform a cognitive and a motor task simultaneously, and (b) intervention studies investigating whether increases in physical fitness also lead to improvements in cognitive performance. Dual-task studies indicate that healthy older adults show greater performance reductions in both domains than young adults when performing a cognitive and a motor task simultaneously. In addition, older adults often tend to protect their motor functioning at the expense of the cognitive task when the situation involves a threat to balance. This can be considered an adaptive behavior since fall-related injuries can have severe consequences. Fitness intervention studies which increased the aerobic fitness of previously sedentary older adults have demonstrated impressive performance improvements in the cognitive domain, especially for tasks involving executive control processes. These findings are interesting in light of cognitive intervention studies, which often fail to find significant transfer effects to tasks that have not been trained directly. The authors argue that future research should compare the effects of cognitive and aerobic fitness interventions in older adults, and they present a study design in which cognition and fitness are trained sequentially as well as simultaneously. Finally, methodological issues involved in this type of research and potential applications to applied settings are discussed.
10.1159/000322197
Immediate and short-term effects of single-task and motor-cognitive dual-task on executive function.
PloS one
OBJECTIVES:Executive function plays an important role in our daily life and can be affected by both single task (acute aerobic exercise or cognitive training) and dual-task (acute motor-cognitive training) interventions. Here we explored the immediate and short-term effect on executive function to texted whether dual-task interventions are more effective at promoting executive function. METHODS:Forty-six young men were recruited (mean age: 20.65 years) and assigned randomly to aerobic exercise (n = 15), cognitive training (n = 15), or dual-task (n = 16) groups. Executive functions were assessed before, immediately after, and 30 min after intervention using Go/No-go, 2-back, and More-Odd-Shifting tests. RESULTS:Working memory function improved after all three interventions (significant Time effect, F(2,86) = 7.05, p = 0.001). Performance on the 2-back test was significantly better immediately after dual-task intervention (p = 0.038) and the response time was shorter (p = 0.023). Performance on the More-Odd-Shifting test improved over time (significant Time effect, F(2,86) = 30.698, p = 0.01), both immediately after the dual-task intervention (p = 0.015), and 30 min later (p = 0.001). Shifting-test performance was also better immediately after (p = 0.005) and 30 min after (p < 0.001) aerobic exercise. CONCLUSION:Executive function was enhanced by single-task (acute aerobic exercise or cognitive training) and dual-task interventions. The effect continued for 30 min after both the single-task aerobic exercise and the dual-task intervention. For short-term intervention, the dual-task was not more effective than either of the single tasks.
10.1371/journal.pone.0290171
Motor and cognitive outcomes of cerebello-spinal stimulation in neurodegenerative ataxia.
Brain : a journal of neurology
Cerebellar ataxias represent a heterogeneous group of disabling disorders characterized by motor and cognitive disturbances, for which no effective treatment is currently available. In this randomized, double-blind, sham-controlled trial, followed by an open-label phase, we investigated whether treatment with cerebello-spinal transcranial direct current stimulation (tDCS) could improve both motor and cognitive symptoms in patients with neurodegenerative ataxia at short and long-term. Sixty-one patients were randomized in two groups for the first controlled phase. At baseline (T0), Group 1 received placebo stimulation (sham tDCS) while Group 2 received anodal cerebellar tDCS and cathodal spinal tDCS (real tDCS) for 5 days/week for 2 weeks (T1), with a 12-week (T2) follow-up (randomized, double-blind, sham controlled phase). At the 12-week follow-up (T2), all patients (Group 1 and Group 2) received a second treatment of anodal cerebellar tDCS and cathodal spinal tDCS (real tDCS) for 5 days/week for 2 weeks, with a 14-week (T3), 24-week (T4), 36-week (T5) and 52-week follow-up (T6) (open-label phase). At each time point, a clinical, neuropsychological and neurophysiological evaluation was performed. Cerebellar-motor cortex connectivity was evaluated using transcranial magnetic stimulation. We observed a significant improvement in all motor scores (scale for the assessment and rating of ataxia, international cooperative ataxia rating scale), in cognition (evaluated with the cerebellar cognitive affective syndrome scale), in quality-of-life scores, in motor cortex excitability and in cerebellar inhibition after real tDCS compared to sham stimulation and compared to baseline (T0), both at short and long-term. We observed an addon-effect after two repeated treatments with real tDCS compared to a single treatment with real tDCS. The improvement at motor and cognitive scores correlated with the restoration of cerebellar inhibition evaluated with transcranial magnetic stimulation. Cerebello-spinal tDCS represents a promising therapeutic approach for both motor and cognitive symptoms in patients with neurodegenerative ataxia, a still orphan disorder of any pharmacological intervention.
10.1093/brain/awab157
Common Mechanisms of Learning in Motor and Cognitive Systems.
The Journal of neuroscience : the official journal of the Society for Neuroscience
Rapid progress in our understanding of the brain's learning mechanisms has been accomplished over the past decade, particularly with conceptual advances, including representing behavior as a dynamical system, large-scale neural population recordings, and new methods of analysis of neuronal populations. However, motor and cognitive systems have been traditionally studied with different methods and paradigms. Recently, some common principles, evident in both behavior and neural activity, that underlie these different types of learning have become to emerge. Here we review results from motor and cognitive learning, relying on different techniques and studying different systems to understand the mechanisms of learning. Movement is intertwined with cognitive operations, and its dynamics reflect cognitive variables. Training, in either motor or cognitive tasks, involves recruitment of previously unresponsive neurons and reorganization of neural activity in a low dimensional manifold. Mapping of new variables in neural activity can be very rapid, instantiating flexible learning of new tasks. Communication between areas is just as critical a part of learning as are patterns of activity within an area emerging with learning. Common principles across systems provide a map for future research.
10.1523/JNEUROSCI.1505-23.2023
The effects of exercise intervention on cognition and motor function in stroke survivors: a systematic review and meta-analysis.
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
BACKGROUND:Cognitive impairment was a common sequela among stroke survivors, and exercise intervention was a promising non-pharmacological treatment modality for it. PURPOSE:To explore the effects of exercise intervention programs on cognitive and motor function in patients with cognitive impairment after stroke. STUDY DESIGN:Systematic review and meta-analysis. METHODS:Seven online databases (PubMed, Embase, Cochrane Library, Web of Science, Scopus, PsycInfo, and SPORTDiscus) were searched from their inception to 10 February 2022. Randomised controlled trials (RCTs) comparing the effects of exercise with non-exercise rehabilitation, using the Montreal Cognitive Assessment, Addenbrooke's Cognitive Examination, Mini-Mental State Examination, Trial Making Test, Upper and Lower Extremity Fugl-Meyer Assessment, Berg Balance Scale, and Barthel Index, were selected. Calculations for each assessment were performed for the overall effect and the therapy of interest, taking into account the effect of stroke severity or stimulus parameters. RESULTS:Twelve RCTs involving 975 participants and investigating nine different types of exercise interventions were included. The results were not affected by participant characteristics or reactive balance outcomes. Our results emphasise the importance of lightweight and operable aerobic exercises. Exercise itself had a high potential to improve cognitive impairment and motor function after stroke. CONCLUSIONS:Exercise had significant positive effects on alleviating cognitive and motor impairments after stroke.
10.1007/s10072-023-06636-9
Dual-task training on cognition and resistance training improved both balance and working memory in older people.
Norouzi Ebrahim,Vaezmosavi Mohammad,Gerber Markus,Pühse Uwe,Brand Serge
The Physician and sportsmedicine
: With increasing age, declines in executive functions and basic motor skills such as posture control, muscle strength, and balance performance have been observed. However, no intervention has focused on enhancing both executive functions and balance performance concomitantly. Accordingly, the aim of the present study is to investigate whether and to what extent two different dual-task interventions improved both working memory and balancing. Specifically, we examined whether either a motor-cognitive dual task training (mCdtt) or a motor-motor dual-task training (mMdtt) impacted more favorably on working memory and on balance performance among a sample of older adults.: A total of 60 older males (mean age: 68.31 years; SD = 3.83) were randomly assigned either to the mCdtt, the mMdtt or to control condition. Balance performance and working memory performance were tested at baseline, four weeks later at study completion, and again 12 weeks later at follow-up.: Balance and working memory improved from baseline to post-intervention and to follow-up (significant Time effect), but more so in the mCdtt compared to the mMdtt condition (significant Time × Group interaction). Further, compared to the mMdtt condition, higher scores were observed in the mCdtt condition (significant Group effect).: Dual-task interventions improved both balance performance and working memory, but more so if cognitive performance was specifically trained along with resistance training.
10.1080/00913847.2019.1623996
Cognitive and physical impact of cognitive-motor dual-task training in cognitively impaired older adults: An overview.
Gallou-Guyot Matthieu,Mandigout Stéphane,Combourieu-Donnezan Laure,Bherer Louis,Perrochon Anaick
Neurophysiologie clinique = Clinical neurophysiology
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.
10.1016/j.neucli.2020.10.010