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Given the interplay between cognitive and motor functions during walking, cognitive demands required during gait have been investigated with regard to dual task performance. Along with the needs to understand how the type of concurrent task while walking affects gait performance, there are calls for diversified dual tasks that can be applied to older adults with varying levels of cognitive decline. Therefore, this study aimed to examine how rhythm-motor tasks affect dual task performance and gait control, compared to a traditional cognitive-motor task.

Also, it examined whether rhythm-motor tasks are correlated with traditional cognitive-motor vaon performance and cognitive measures.

Eighteen older adults without cognitive impairment participated in this study. Each participant was instructed to walk at self-paced tempo without performing a concurrent task single walking task and walk while separately performing two types of concurrent tasks: The cognitive-motor task involved counting forward by 3s Walk Count. In each brosurx, dual task costs DTCa measure for how dual tasks affect gait parameters, were measured in terms of walking speed and stride length.

The ratio of stride length to bgosura speed, a measure for dynamic control of gait, was also examined. The results of this study demonstrated that the task type was found to significantly influence these measures.

Rhythm-motor tasks were found to interfere with gait parameters to a lesser extent than the cognitive-motor task Walk Count.

In terms of ratio measures, stride length remained at a similar level, walking speed greatly decreased in the Walk Count. Significant correlations between dual task-related cam;ania during rhythm-motor and cognitive-motor tasks support the potential of applying rhythm-motor tasks to dual task methodology.

This study presents how rhythm-motor tasks demand cognitive control at different levels than those engaged by cognitive-motor tasks. It also indicates how these new dual tasks can effectively mediate dual task performance indicative of fall risks, while requiring increased cognitive resources but facilitating gait control as a compensatory strategy to maintain gait stability.

Increased fall risks and fall-related serious injuries associated with aging are a public health concern 12. Since many daily tasks are performed while people are standing or walking, increased risk of falling among the elderly leads to changes in their life style, including a tendency to become sedentary and avoid physical activity.

Such changes often result in decreased quality of life 3. Furthermore, given that falls have been documented to be associated with a high prevalence of comorbidities or increased mortality, understanding risk factors for falls and strategies to intervene in age-related changes in gait is of great interest. Factors for increased incidence of falls in older adults include decrements in gait function, such as decreased walking speed and shorter stride length 4 — 6. Increased variability in gait parameters such as unsteadiness in stride-to-stride timing is also a predictive factor for falls since it affects the ability to optimally adjust gait in response to changes in the environment 1.

Also of interest is the relationship between spatiotemporal gait parameters e. Since gait control and stability are influenced by not a single parameter but a avpn of gait parameters 7the ratio of stride length to walking speed demonstrates how such a combination mediates gait differently.

For healthy walkers without gait impairment, a shorter stride length and increased step frequency while maintaining walking speed reflects an adaptive strategy to maintain dynamic stability during walking 89.

Meanwhile, older adults with a history of falling tend to show decreases in walking speed as well as in step frequency and stride length. Along with age-related changes in physical ability, cognitive control at a higher level is increasingly documented to affect walking 10 While gait itself is regarded as an automatic motor function regulated primarily by subcortical processes, recent findings suggest that cortical areas are involved in dual task walking in parallel 11 — 13which indicates that a higher level of cognitive control is involved while walking.

As such, previous studies indicate that multiple cognitive processes, including attention, working memory, and executive function, mediate gait, especially when walking is required in a challenging environment with the presence of obstacles 12 or with the provision of concurrent tasks Investigation of dual task paradigms in walking suggests reduced cognitive capacity yields limited access to control cognitive loads during dual task walking 15 Brosuta in gait parameters when walking with concurrent tasks, also measured as dual task costs DTCare indicative of the extent of how much dual task condition leads to deterioration of such task performance due to cognitive demands involved in gait For example, when individuals walk and perform cognitive tasks simultaneously, additional attention is involved to achieve gait stability despite concurrent performance of gait and accordingly, gait speed is altered 18 Capania such, involvement of competing demands for limited attentional or mental resources has been understood as a key factor in gait performance under dual task conditions 2021yet the level of interference caused by different types of concurrent tasks is of great interest to researchers and practitioners who focus on dual task performance in relation to fall issues with older adults A diverse range of cognitive tasks in dual task walking studies acon, and recent findings indicate that the type and complexity of a cognitive task significantly influence motor outcomes in rbosura task walking The tasks frequently cited in the literature are arithmetic e.


In terms of the type of cognitive tasks, no significant changes in walking were evidenced with verbal fluency tasks 25 ; however, walking while performing an arithmetic task yielded a significant decline in gait speed xvon Tasks involving internal interference, such as mental tracking and working memory, appear to interrupt gait more than tasks that involve external factors In other words, gait function is decreased in the presence of an internal source of interference such as in the task to hold and keep track of information while performing ongoing mental processes.

Given the implications that the dual task paradigm may have not only for healthy older adults but also for the clinical population, including older adults with cognitive impairment and individuals with neurological disorders 24there are increasing calls for diversified types of dual tasks. While verbal fluency tasks are one of caampania most commonly used and camoania be easily applied to older adults with varying levels of cognitive impairment, they do not involve substantial gait interference, leading to limited application to healthy populations who have relatively little decrements in gait function.

For individuals with neurological disorders whose gait is affected, there is a need for interventions that target gait function as well in dual task paradigm 21 These findings imply that dual task interference can be modified not only by altering the complexity of cognitive tasks, but also by regulating automated motor tasks i. Moreover, the similarities and differences across the recruited resources can influence information processing For example, the type and perceived complexity of the cognitive tasks in dual task walking can be controlled by the use of similar resources, such as shared sensory modalities.

While research supports the use of cognitive concurrent tasks with a certain level of complexity, based on the evidence that complex tasks involving internal interfering factors affect gait disturbance more 24research into the potential of tasks using external resources, which may be applied to older adults with limited internal resources or individuals with neurological disorders who need motor control as well as cognitive control, is inconclusive.

Therefore, this study proposed a new dual task paradigm incorporating a concurrent task that involves external auditory resources i. In the literature, walking with external auditory cueing was found to influence gait control 27 by establishing the feedback-feedforward loop that contributes to decreased attentional demands and increased continuous control of gait variability.

When rhythmic auditory cueing was given during treadmill walking, it involved additional demands for balance and gait control, which was supported by a delay in reaction time Yet, it was also found that rhythmic cueing facilitated redirecting attentional load to gait control, leading to a higher level of dynamic stability during walking These findings support the potentials for expanding dual task methodologies from cognitive-motor dual task paradigms to those that utilize external resources, such as external rhythmic cueing.

While walking with external auditory cueing has been repeatedly documented to be effective for gait control 2731which enables its application to older adults with severe cognitive decline or increased fall risks, whether the effects are present in a dual task paradigm remain unclear. Also, it aimed to examine whether rhythm-motor tasks are correlated with traditional cognitive-motor task performance and cognitive measures.

The findings of this study can be used to determine whether rhythm-motor tasks can be applied to the dual task paradigm for more diversified populations who have varying levels of cognitive and motor function or impairment.

The Applicability of Rhythm-Motor Tasks to a New Dual Task Paradigm for Older Adults

This study answered the following research questions:. Community-dwelling healthy older adults aged 60 or over were recruited through flyers posted at senior apartments and senior community centers.

Inclusion criteria were no previous diagnosis of dementia or neurological disorders and the ability to walk independently without aids. In order to examine whether participants showed depressive symptoms, the Geriatric Depression Scale GDS was self-rated by participants The GDS includes 30 items and asks individuals to avn whether they experienced a particular feeling over the past week. Participants were required to score less than 16 on the GDS.


Initially, a total of 20 older adults with a mean age of One participant was excluded because of the MMSE score obtained was lower than Another participant dropped out, since she did not want to complete the required tests and asked to leave the study.

The remaining 18 participants were included in the final analysis. The DST 3334 assesses working memory and consists of two subtests: The DSF tests the ability to recall a series of 3- to 9-digit numbers in a presented order, and the DSB tests the ability to recall a series of 2- to 8-digit numbers in a reverse order than presented.

The Korean version of the TMT was used in this study Two subtests of the TMT i. The TMT-A tests the ability to draw a line connecting numbers sequentially from 1 to 15, and the TMT-B tests the ability to connect numbers and words for the days of the week alternatively e. While both subtests indicate processing speed and cognitive flexibility by measuring the time to complete the tests, the TMT-B also indicates attentional control and set-shifting task performance Furthermore, the WCST 3839 tests the ability to match response cards to stimulus cards based on the sorting principle e.

Respondents are required to determine the initial sorting principle or newly changed principle based on feedback from the tester about whether each response is correct.

The WCST measures executive functioning, including the ability to develop a problem-solving strategy, and preservative errors during the test indicate inhibitory attentional control and cognitive flexibility in set-shifting tasks. TUG is a test that assesses balance 40 by measuring the time to complete the task of standing up from an arm-chair, walking a 3-m distance, turning back, and sitting back down.

The measure is considered an indication of functional mobility and falls in everyday life For older adults, a completion time of more than The single task was to walk along a 6-m walkway.

Two types of concurrent tasks were used in this study: During these rhythm-motor tasks, rhythmic cueing was provided by a metronome. A common cognitive-motor task found in the literature was used: Three types of measures were collected across the task conditions: In order to measure how much the addition of tasks affected gait, compared to baseline gait parameters that a participant performed without concurrent tasks, DTC was calculated for gait parameters i.

DTC was the measure obtained by calculating the differences in gait parameter between single and dual task conditions using the following formula: Finally, the ratio of stride length to walking speed was measured by calculating the stride length divided by walking speed. Given that changes in single gait parameter do not sufficiently reflect the gait pattern of an individual, such a measure of ratio i.

Decreases in the measure of ratio may be indicative of decreased stride length and increased cautiousness while walking 8. In order to minimize the noise in the environment to an equivalent level across settings, isolated places without adjacent rooms where noise could be produced were selected. Also, in order to control the walking environment to a similar level across the participants, each room was examined to include a 6-m walkway without requiring participants to turn in another direction while walking.

Written informed consent was obtained from each participant prior to participation in this study. After the consent process, demographic information was collected including sex, years of formal education, fall history, and medical history.

Then measures of cognition, mobility and balance, and affect were implemented. During a single task condition, participants were instructed to walk at their camapnia speed along a 6-m walkway. Then, they were instructed bgosura perform the additional task simultaneously and no instruction for prioritization of one task over the other walking versus concurrent task was provided.

The order of presenting tasks was randomly determined for each participant prior to the test. For measures of cognition and balance, descriptive data i. For dual task-related parameters i. Furthermore, campani of DTC in each dual task condition with cognitive and balance campaania were analyzed.

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A total of 18 older adults were included in the final analysis. Their mean age was In terms of balance, the TUG test was used. The results of cognitive measures showed that participants were not cognitively deficient.

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