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

Abstract

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

Keywords: balance; cerebrovascular; cognitive; dual-task; fall; fear of falling; gait; motor; older adult; walking speed.

Figure A1

Example of a walkable led floor representation during an easy, medium, or difficult DTT Walking Stroop task. See Table A3 for more details. A figure was reproduced, with the permission of the authors, from Figure 1B–D in Clinical interventions in Aging, Walking Stroop carpet: an innovative dual-task concept for detecting cognitive impairment, Clinical Interventions in Aging 2013, 8, 317–328 by Perrochon et al. [27].

Figure 1

Dual-task room: five screens; one walkable led floor 4.5 m × 1.5 m; one audio/video controller console.

Figure 2

Outcome performance after different training protocols. (A) POMA-B, (B) POMA-G, (C) POMA total, (D) FES-I, (E) 6-MWT, (F) Gait speed. * Significant intra-group difference p < 0.01. Abbreviations: MixT: combined motor and cognitive training; DTT: motor-cognitive dual-task training; POMA tot: Tinetti Performance Oriented Mobility Assessment total score; POMA-B: POMA balance; POMA-G: POMA gait; FES-I: Falls Efficacy Scale-International; 6-MWT (m): 6-min walk test (meters).