Concurrent performance of a cognitive and dynamic obstacle avoidance task: influence of dual-task training

The effect of visual sensory interference during multitask obstacle crossing in younger and older adults

When older adults step over obstacles during multitasking, their performance is impaired; the impairment results from central and/or sensory interference. The purpose was to determine if sensory interference alters performance under low levels of cognitive, temporal, and gait demand, and if the change in performance is different for younger versus older adults. Participants included 17 younger adults (20.9±1.9 years) and 14 older adults (69.7±5.4 years). The concurrent task was a single, simple reaction time (RT) task: depress button in response to light cue. The gait task was stepping over an obstacle (8 m walkway) in three conditions: (1) no sensory interference (no RT task), (2) low sensory interference (light cue on obstacle, allowed concurrent foveation of cue and obstacle), or (3) high sensory interference (light cue away from obstacle, prevented concurrent foveation of cue and obstacle). When standing, the light cue location was not relevant (no sensory interference). An interaction (sensory interference by task, p<0.01) indicated that RT was longer for high sensory interference during walking, but RT was not altered for standing, confirming that sensory interference increased RT during obstacle approach. An interaction (sensory interference by age, p<0.01) was observed for foot placement before the obstacle: With high sensory interference, younger adults placed the trail foot closer to the obstacle while older adults placed it farther back from the obstacle. The change increases the likelihood of tripping with the trail foot for younger adults, but with the lead limb for older adults. Recovery from a lead limb trip is more difficult due to shorter time for corrective actions. Overall, visual sensory interference impaired both RT and gait behavior with low levels of multitask demand. Changes in foot placement increased trip risk for both ages, but for different limbs, reducing the likelihood of balance recovery in older adults.

Walking (and talking) the plank: dual-task performance costs in a virtual balance-threatening environment

We evaluated the effects of engaging in extemporaneous speech in healthy young adults while they walked in a virtual environment meant to elicit low or high levels of mobility-related anxiety. We expected that mobility-related anxiety imposed by a simulated balance threat (i.e., virtual elevation) would impair walking behavior and lead to greater dual-task costs. Altogether, 15 adults (age = 25.6 ± 4.7 yrs, 7 women) walked at their self-selected speed within a VR environment that simulated a low (ground) and high elevation (15 m) setting while speaking extemporaneously (dual-task) or not speaking (single-task). Likert-scale ratings of cognitive and somatic anxiety, confidence, and mental effort were evaluated and gait speed, step length, and step width, as well as the variability of each, was calculated for every trial. Silent speech pauses (> 150 ms) were determined from audio recordings to infer the cognitive costs of extemporaneous speech planning at low and high virtual elevation. Results indicated that the presence of a balance threat and the inclusion of a concurrent speech task both perturbed gait kinematics, but the virtual height illusion led to increased anxiety and mental effort and a decrease in confidence. The extemporaneous speech pauses were longer on average when walking, but no effects of virtual elevation were reported. Trends toward interaction effects arose in self-reported responses, with participants reporting more comfort walking at virtual heights if they engaged in extemporaneous speech. Walking at virtual elevation and while talking may have independent and significant effects on gait; both effects were robust and did not support an interaction when combined (i.e., walking and talking at virtual heights). The nature of extemporaneous speech may have distracted participants from the detrimental effects of walking in anxiety-inducing settings.

A Review of Factors Associated with Voice Problems in the Fitness Instructor Population

There is a high prevalence of reported dysphonia symptomology in the fitness instructor population. This is concerning as these reported symptoms of dysphonia, aphonia, and vocal fatigue can significantly compromise quality of life. The purpose of this review is to explore key factors that may contribute to voice problems in the fitness instructor population. Voicing with concurrent phonation and exercise may be influenced by (1) the increased cardiovascular requirement during exercise, (2) the increased cognitive load associated with dual tasking, (3) the altered hydration state associated with prolonged exercise, and (4) the phonatory dose associated with continued voicing with loud background music. This manuscript will explore the literature on these key factors (ie, phonatory dose, dehydration, metabolic bioenergetics, cognitive load, and psychosocial stress) as they pertain to fitness instructors.

What Is the Role of Sustained Visual Attention in the Maintenance of Postural Control in Young Adults?

Dual tasks requiring sustained visual attention and upright stance are common, yet their impact on standing balance is not well understood. We investigated the role of visual attention in the maintenance of postural control, using the multiple-object tracking (MOT) task. Healthy young adults (n = 12) performed the MOT task at three object movement speeds while seated or standing. MOT performance was assessed using tracking capacity (k). Metrics calculated to assess mediolateral (ML) and anterior-posterior (AP) postural control included: maximum difference between CoM and CoP position (CoM-CoP Max), root mean square distance for center of pressure and center of mass position (CoP and CoM RMS distance), and correlation between CoM and CoP time series signals (CoM/CoP correlation). As predicted, k decreased significantly as object movement speed increased for both standing and seated conditions. Object movement speed also significantly affected AP CoM-CoP Max in seated conditions (p = .021) and AP CoM/CoP correlation for standing conditions (p = .002). The results demonstrate utility of the MOT task in understanding the role of visual attention in postural control, even though healthy young adults were able to compensate for the addition of a sustained visual attention task, with minimal deficits to postural control.

Multi-tasking deteriorates trunk movement control during and after obstacle avoidance

Dynamic and cognitive multi-tasking might affect balance and walking negatively and increase risk of falling. Trunk movement control is critical for balance maintenance and fall-prevention. The impact of multi-tasking on trunk movement control has not been thoroughly studied. In a challenging dynamic multi-tasking condition such as walking and obstacle avoidance, presence of a cognitive task not only increases risk of tripping but also may increase risk of falling by deteriorating trunk control. Our objective was to investigate the impacts of a challenging dynamic and cognitive multi-tasking condition (walking + obstacle avoidance + cognitive task) on trunk kinematics and kinetics and compare those with other joints/segments. Trunk, pelvis, hip, knee, and ankle kinematics and kinetics of 12 young adults were compared between joints/segments and conditions. During walking and obstacle avoidance (dynamic multi-tasking), the trunk had the largest normalized increase in peak flexion angle and extension torque compared to walking, among the other joints/segments. The presence of a cognitive task during walking and obstacle avoidance (dynamic and cognitive multi-tasking) did not impact any of the joints/segments biomechanics except the trunk peak extension torque that was increased. Furthermore, trunk kinematics showed the largest residual differences (post-effects) in 3 cycles after obstacle avoidance compared to walking. The presence of a cognitive task (dynamic and cognitive multi-tasking) did not impact the post-effects of obstacle avoidance on any joints/segments except the trunk with its residual difference from normal walking further increased. These results suggest that a cognitive task deteriorates trunk control and interferes with the ability to regain normal trunk biomechanics after obstacle avoidance. In summary, the trunk requires the largest biomechanical adjustments in a challenging dynamic and cognitive multi-tasking condition where there is a risk of falling. Our study provides baseline results suggesting that trunk control demands more attention and is more negatively affected by dynamic and cognitive multi-tasking. Our results raise a concern for elderly population as their trunk control is already impaired and common daily multi-tasking could further deteriorate their trunk control and increase fall risk.

Dual-task interference as a function of varying motor and cognitive demands

Multitasking is a critical feature of our daily lives. Using a dual-task paradigm, this experiment explored adults’ abilities to simultaneously engage in everyday motor and cognitive activities, counting while walking, under conditions varying the difficulty of each of these tasks. Motor difficulty was manipulated by having participants walk forward versus backward, and cognitive difficulty was manipulated by having participants count forward versus backward, employing either a serial 2 s or serial 3 s task. All of these manipulations were performed in single-task conditions (walk only, count only) and dual-task conditions (walk and count simultaneously). Both motor performance variables (cycle time, stride length, walking velocity) and cognitive variables (counting fluency, counting accuracy) were assessed in these conditions. Analyses of single-task conditions revealed that both motor and cognitive manipulations predictably influenced performance. Analyses of dual-task performance revealed influences of motor and cognitive factors on both motor and cognitive performance. Most centrally, dual-task costs (normalized difference between single- and dual-task conditions) for motor variables revealed that such costs occurred primarily for temporal or spatiotemporal gait parameters (cycle time, walking velocity) and were driven by cognitive manipulations. Dual-task cost analyses for cognitive measures revealed negative dual-task costs, or dual-task benefits, for cognitive performance. Finally, the effects of dual-task manipulations were correlated for motor and cognitive measures, indicating dual-task performance as a significant individual difference variable. These findings are discussed with reference to theories of attentional allocation, as well as the possible role of auditory–motor entrainment in dual-task conditions.

Effects of fixed versus variable task prioritization during short-term dual task practice on motor and cognitive task performance in young adults

OBJECTIVE

It has been shown that variable compared to fixed task prioritization during dual task practice more effectively improves motor (i.e., postural control) and cognitive (i.e., memory) performance in older adults. However, it is unclear whether this finding is also valid in young adults. Thus, the present study examined the effect of fixed (allocate equal priority on both tasks) versus variable (vary priority between both tasks) priority during short-term motor-cognitive dual task practice on single and dual task performance in healthy young adults (age range: 20-30 years).

RESULTS

During two days of practice, significant improvements of motor (i.e., balance task: reduced root mean square error; p < 001, η_p² = .72) and cognitive (i.e., arithmetic task: increased serial three subtractions; p < .001, η_p² = .78) task performance were observed and that was irrespective of group ("fixed priority" and "variable priority"). Further, the statistical analysis of post-practice single and dual task performance revealed no significant differences between groups, irrespective of task (i.e., motor or cognitive). This indicates that in young as opposed to old adults, single and dual task performance improvements are independent of task prioritization (i.e., fixed or variable priority) during short-term motor-cognitive dual task practice.

Dual Tasking during Trip Recovery and Obstacle Clearance among Young, Healthy Adults in Human Factors Research

Trip-induced falls are extremely common in ergonomic settings. Such situations can lead to fatal or non-fatal injuries, affecting the workers’ quality of life and earning capacity. Dual tasking (DT) is a leading cause of trips and ineffective obstacle clearance among workers. DT increases their attentional demand, challenging both postural control and concurrent secondary tasks. As the human brain has limited attentional processing capacity, even young, healthy adults need to prioritize duties during DT. This article aimed to analyze these secondary task types and their applications in recent trip-related studies conducted on young, healthy adults. An extensive review of the recent trip-related literature was performed to provide a condensed summary of the dual tasks used. In previous trip-related literature, distinct types of secondary tasks were used. The choice of the concurrent task must be made vigilantly depending on the occupation, environmental context, available resources, and feasibility. DT can be used as a tool to train workers on selective attention, which is a lifesaving skill in ergonomic settings, especially in the occupations of roofers, construction workers, or truck drivers. Such training can result in successful obstacle clearance and trip recovery skills, which eventually minimizes the number of falls at the workplace.

Cognitive and motor task performance under single- and dual-task conditions: effects of consecutive versus concurrent practice

The concurrent execution of two or more tasks simultaneously results in performance decrements in one or both conducted tasks. The practice of dual-task (DT) situations has been shown to decrease performance decrements. The purpose of this study was to investigate the effects of consecutive versus concurrent practice on cognitive and motor task performance under single-task (ST) and DT conditions. Forty-five young adults (21 females, 24 males) were randomly assigned to either a consecutive practice (INT consecutive) group, a concurrent practice (INT concurrent) group or a control (CON) group (i.e., no practice). Both INT groups performed 2 days of acquisition, i.e., practicing a cognitive and a motor task either consecutively or concurrently. The cognitive task required participants to perform an auditory stroop task and the number of correct responses was used as outcome measure. In the motor task, participants were asked to stand on a stabilometer and to keep the platform as close to horizontal as possible. The time in balance was calculated for further analysis. Pre- and post-practice testing included performance assessment under ST (i.e., cognitive task only, motor task only) and DT (i.e., cognitive and motor task simultaneously) test conditions. Pre-practice testing revealed no significant group differences under ST and DT test conditions neither for the cognitive nor the motor task measure. During acquisition, both INT groups improved their cognitive and motor task performance. The post-practice testing showed significantly better cognitive and motor task values under ST and DT test conditions for the two INT groups compared to the CON group. Further comparisons between the two INT groups revealed better motor but not cognitive task values in favor of the INT consecutive practice group (ST: p = 0.022; DT: p = 0.002). We conclude that consecutive and concurrent practice resulted in better cognitive (ST condition) and motor (ST and DT test conditions) task performance than no practice. In addition, consecutive practice resulted in superior motor task performance (ST and DT test conditions) compared to concurrent practice and is, therefore, recommended when executing DT practice schedules.

Effects of Motor Versus Cognitive Task Prioritization During Dual-Task Practice on Dual-Task Performance in Young Adults

Background: Previous studies have reported positive effects of concurrent motor and cognitive task practice compared to motor or cognitive task practice only on dual-task performance in young adults. Knowledge about the effect of motor vs. cognitive task prioritization during practice on dual-task performance remains unclear and has not been investigated in depth so far. Thus, we examined the effects of motor task compared to cognitive task prioritization during dual-task practice on motor-cognitive performance in healthy young adults.

Methods: Healthy young adults were randomly assigned to dual-task (DT; i.e., concurrent motor and cognitive practice) or single-task (ST; i.e., motor or cognitive task practice only) practice groups. In DT practice, subjects were instructed to either prioritize the motor or the cognitive task. The motor task required subjects to keep a stabilometer in a horizontal position. The cognitive task involved serial three subtractions. Outcome variables were the root-mean-square error (RMSE) for the motor task and the total number of correct calculations for the cognitive task. All participants practiced for 2 consecutive days under their respective treatment condition and were tested under DT condition 24 h later (i.e., retention on day 3) without providing instructions on task prioritization.

Results: Irrespective of prioritization (i.e., prioritize the motor task or the cognitive task), the DT practice groups similarly improved their DT motor and cognitive task performance. The ST groups also improved motor or cognitive performance depending on their respective training contents (i.e., motor practice improved RMSE and cognitive practice improved number of correct calculations but not vice versa).

Conclusion: We conclude that DT compared to ST practice is well-suited to improve DT performance, irrespective of task-prioritization. DT but not ST practice resulted in an improved modulation of both domains (i.e., motor and cognitive) during DT performance. Our findings might be explained by freeing up central resources following DT practice that can be used to effectively perform the concurrent execution of motor and cognitive processing demands. However, this process is not further enhanced by the prioritized task domain.

Improvements in Obstacle Clearance Parameters and Reaction Time Over a Series of Obstacles Revealed After Five Repeated Testing Sessions in Older Adults

The purpose of this study was to investigate obstacle clearance and reaction time parameters when crossing a series of six obstacles in older adults. A second aim was to examine the repeated exposure of this testing protocol once per week for 5 weeks. In total, 10 older adults (five females; age: 67.0 ± 6.9 years) walked onto and over six obstacles of varying heights (range: 100-200 mm) while completing no reaction time, simple reaction time, and choice reaction time tasks once per week for 5 weeks. The highest obstacles elicited the lowest toe clearance, and the first three obstacles revealed smaller heel clearance compared with the last three obstacles. Dual tasking negatively impacted obstacle clearance parameters when information processing demands were high. Longer and less consistent time to completion was observed in Session 1 compared with Sessions 2-5. Finally, improvements in simple reaction time were displayed after Session 2, but choice reaction time gradually improved and did not reach a plateau after repeated testing.

Do perturbation-evoked responses result in higher reaction time costs depending on the direction and magnitude of perturbation?

To date, little work has focused on whether cognitive-task interference during postural response execution is influenced by the direction and/or magnitude of the perturbation applied. Hypothetically, the increased difficulty associated with a backward loss of balance could necessitate increased allocation of cognitive resources to counteract destabilizing forces. The current study investigated these relationships using a paradigm in which individuals performed a cognitive task (auditory Stroop task during quiet stance; baseline condition). In certain trials, a translation of the support surface was concurrently evoked (magnitude: small or large; direction: forward or backward) which required a postural response to maintain balance. Ten healthy young adults completed four blocks of these experimental trials (26 randomized trials/block). Postural stability during balance recovery was evaluated using the margin of stability (MoS), while Stroop task performance was based on reaction time cost (RTC) and differences between experimental conditions. Results showed no effect of perturbation direction on RTC, but there was an observed MoS increase at peak extrapolated center of mass excursion following a small perturbation evoked concurrently with the cognitive task. No effect of cognitive-task performance was detected for MoS during stepping strategies (followed large perturbations). Instead, increased RTC were observed relative to the fixed base of support responses. In general, young adults adopted a "posture-first" strategy, regardless of perturbation direction, reinforcing the importance of cognition in the maintenance of upright balance.

The effects of dual tasking on gait synchronization during over-ground side-by-side walking

Recent studies have shown that gait synchronization during natural walking is not merely anecdotal, but it is a repeatable phenomenon that is quantifiable and is apparently related to available sensory feedback modalities. However, the mechanisms underlying this phase-locking of gait have only recently begun to be investigated. For example, it is not known what role, if any, attention plays. We employed a dual tasking paradigm in order to investigate the role attention plays in gait synchronization. Sixteen pairs of subjects walked under six conditions that manipulated the available sensory feedback and the degree of difficulty of the dual task, i.e., the attention. Movement was quantified using a trunk-mounted tri-axial accelerometer. A gait synchronization index (GSI) was calculated in order to quantify the degree of synchronization of the gait pattern. A simple dual task resulted in an increased level of synchronization, whereas a more complex dual task lead to a reduction in synchronization. Handholding increased synchronization, compared to the same attention condition without handholding. These results indicate that in order for two walkers to synchronize, some level of attention is apparently required, such that a relatively complex dual task utilizes enough attentional resources to reduce the occurrence of synchronization.

Effects of Single Compared to Dual Task Practice on Learning a Dynamic Balance Task in Young Adults

Background: In everyday life, people engage in situations involving the concurrent processing of motor (balance) and cognitive tasks (i.e., “dual task situations”) that result in performance declines in at least one of the given tasks. The concurrent practice of both the motor and cognitive task may counteract these performance decrements. The purpose of this study was to examine the effects of single task (ST) compared to dual task (DT) practice on learning a dynamic balance task.

Methods: Forty-eight young adults were randomly assigned to either a ST (i.e., motor or cognitive task training only) or a DT (i.e., motor-cognitive training) practice condition. The motor task required participants to stand on a platform and keeping the platform as close to horizontal as possible. In the cognitive task, participants were asked to recite serial subtractions of three. For 2 days, participants of the ST groups practiced the motor or cognitive task only, while the participants of the DT group concurrently performed both. Root-mean-square error (RMSE) for the motor and total number of correct calculations for the cognitive task were computed.

Results: During practice, all groups improved their respective balance and/or cognitive task performance. With regard to the assessment of learning on day 3, we found significantly smaller RMSE values for the ST motor (d = 1.31) and the DT motor-cognitive (d = 0.76) practice group compared to the ST cognitive practice group but not between the ST motor and the DT motor-cognitive practice group under DT test condition. Further, we detected significantly larger total numbers of correct calculations under DT test condition for the ST cognitive (d = 2.19) and the DT motor-cognitive (d = 1.55) practice group compared to the ST motor practice group but not between the ST cognitive and the DT motor-cognitive practice group.

Conclusion: We conclude that ST practice resulted in an effective modulation of the trained domain (i.e., motor or cognitive) while only DT practice resulted in an effective modulation of both domains (i.e., motor and cognitive). Thus, particularly DT practice frees up central resources that were used for an effective modulation of motor and cognitive processing mechanisms.

Validation of simplified centre of mass models during gait in individuals with chronic stroke

BACKGROUND

The feasibility of using a multiple segment (full-body) kinematic model in clinical gait assessment is difficult when considering obstacles such as time and cost constraints. While simplified gait models have been explored in healthy individuals, no such work to date has been conducted in a stroke population. The aim of this study was to quantify the errors of simplified kinematic models for chronic stroke gait assessment.

METHODS

Sixteen individuals with chronic stroke (>6months), outfitted with full body kinematic markers, performed a series of gait trials. Three centre of mass models were computed: (i) 13-segment whole-body model, (ii) 3 segment head-trunk-pelvis model, and (iii) 1 segment pelvis model. Root mean squared error differences were compared between models, along with correlations to measures of stroke severity.

FINDINGS

Error differences revealed that, while both models were similar in the mediolateral direction, the head-trunk-pelvis model had less error in the anteroposterior direction and the pelvis model had less error in the vertical direction. There was some evidence that the head-trunk-pelvis model error is influenced in the mediolateral direction for individuals with more severe strokes, as a few significant correlations were observed between the head-trunk-pelvis model and measures of stroke severity.

INTERPRETATION

These findings demonstrate the utility and robustness of the pelvis model for clinical gait assessment in individuals with chronic stroke. Low error in the mediolateral and vertical directions is especially important when considering potential stability analyses during gait for this population, as lateral stability has been previously linked to fall risk.

Examining Transfer Effects of Dual-Task Training Protocols for a Complex Locomotor Task

Training protocols designed to improve dual-task performance of an obstacle crossing and auditory Stroop task (OBS+Stroop) were tested. In Experiment  1 , following baseline collection of OBS+Stroop trials, proximally related walking training was performed, and participants were then retested on the OBS+Stroop test. After training, participants adopted a more cautious obstacle crossing strategy, indicating a potentially safer navigation strategy. Transfer effects from distally related training were then examined (Experiment  2 ); a computer game training paradigm was examined using the same testing protocol as Experiment  1 . Computer training demonstrated improved dual-task performance on some measures, but did not induce a more cautious stepping strategy. Results indicate that dual-task training needs to be similar to targeted tasks to yield reliable, positive training outcomes.