The effect of dual task training on postural control of young and older adults

Abstract

Research has shown that a lack of postural control during standing, particularly a failure to use the reactive balance strategy to regain equilibrium, is a leading cause of falls for older individuals. However, most previous fall prevention research has focused solely on the motor aspect of the balance system while ignoring cognitive influence. Thus, the current thesis highlights and provides novel evidence by addressing essential gaps and limitations in the literature related to dual task assessment and training and how they influence postural control in different age ranges. This thesis aimed to examine the effect of novel dual task training on different age groups postural control and dual task cost. In order to achieve this aim, three studies were conducted. The first study was a systematic review and meta-analysis aimed at reviewing the effect of a specific or general exergame DT training on postural control among older adults over 65 (Chapter 3). Both DT training has been shown to enhance cognitive, balance, and dual task performance in most of the studies. The study concluded no significant difference between the specific and general exergame training for these performances. The other two studies were conducted to measure the effect of novel interventions on young and older adults (Chapters 5 and 6). Both studies were a quasi-experimental design with pre-and post-testing. The studies compared two types of DT training with different goals: Cognitive Dual task Training (CDT) and Balance Dual task Training (BDT). Both DT training were unsupervised and used exergames three times a week for two months. The BDT focused on training and enhancing the ankle strategy. In contrast, CDT aimed to improve specific cognitive domains such as working memory, reaction time, mental tracking and decision-making under the dual task paradigm. These studies found that the BDT was more effective in enhancing hand reaching activity, balance stability and limit (LOS) of stability in young and older adults. Conversely, the CDT group showed better cognitive task outcomes for both younger and older participants. Also, BDT resulted in an overall reduction in dual task cost in static balance and LOS for younger and older participants, respectively. In contrast, CDT resulted in an overall increase in DTC. In addition, CDT and BDT decreased walking time in Time Up and Go test by 0.5 seconds, indicating that DT training assisted to reduce the walking time factor of risk of falls among older adults over 65.Finally, both DT training showed a high adherence rate of over 93% of training sessions among young and older participants. In conclusion, completing the current thesis has resulted in new knowledge about the effect of different types of DT training on individual responses to dual task elements (i.e. a cognitive or balance task) and postural control. In addition, selecting a proper assessment tool can help objectively measure DT training’s influence on postural control. Using unsupervised exergame DT training is feasible to reduce the risk factors for falls among older adults.