Objective-To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment.Design-A double-blind, randomized controlled trial. Setting-University research laboratory.Participants-Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS), and/or walked with a self-selected gait speed of 1.1m/s or less.Interventions-Participants were randomly assigned to 1 of 3 interventions: single-task training; dual-task training with fixed-priority instruction; and dual-task training with variable-priority instruction. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks.Main Outcome Measures-Gait speed under single-task and dual-task conditions were obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training.Results-Participants in all groups improved on the BBS (P<.001, effect size [ES]=.72), and walked significantly faster after training (P=.02, ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instruction and dualtask training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57 and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instruction group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001, ES=.61).Reprint requests to Patima Silsupadol, PT, PhD, Dept of Physical Therapy, The Faculty of Associated Medical Sciences, Chiang Mai University, 110 Intawarorot Rd, Sripoom, Chiang Mai, Thailand, 50200, psilsupa@gmail.com.. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. Conclusions-Dual-task training is effective in improving gait speed under dual-task conditions in elderly with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect. NIH Public Access KeywordsAging; Attention; Rehabilitation Among older adults, impairment in the control of balance under dual-task conditions is a common occurrence. Because impaired dual-task balance performance predicts adverse outcomes such as falls, 1-3 and declines in both cognitive and physical function, [4][5][6] interventions that improve dual-task balance performance are a critica...

The purpose of this study was to compare the efficiency of three different balance training strategies in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance of older adults with balance impairment. Elderly individuals with balance impairment, age 65 and older, were randomly assigned to one of three individualized training programs: singletask (ST) balance training; dual-task training with fixed-priority (FP) instruction; and dual-task training with variable-priority (VP) instruction. Balance control during gait, under practiced and novel conditions, was assessed by calculating the center of mass and ankle joint center inclination angles in the frontal plane. A smaller angle indicated better balance performance. Other outcomes included gait velocity, stride length, verbal reaction time, and rate of response. All measures were collected at baseline and the end of the 4-week training. Results indicated that all training strategies were equally effective (P > .05) at improving balance performance (smaller inclination angle) under single-task contexts. However, the VP training strategy was more effective (P = .04) in improving both balance and cognitive performance under dual-task conditions than either the ST or the FP training strategies. Improved dual-task processing skills did not transfer to a novel dual-task condition. Results support Kramer et al.'s proposal that VP training improves both single-task automatization and the development of task-coordination skills.

Background and Purpose. Traditionally, rehabilitation programs emphasize training balance under single-task conditions to improve balance and reduce risk for falls. The purpose of this case report is to describe 3 balance training approaches in older adults with impaired balance. Case Descriptions. Three patients were randomly assigned to 1 of 3 interventions: (1) single-task balance training, (2) dual-task training under a fixed-priority instructional set, and (3) dual-task training under a variable-priority instructional set. Outcomes. The patients who received balance training under dual-task conditions showed dual-task training benefits; these training benefits were maintained for 3 months. The patient who received variable-priority training showed improvement on novel dual tasks. Discussion. Older adults may be able to improve their balance under dual-task conditions only following specific types of balance training. This case report gives insight on how this intervention might be combined with more traditional physical therapy intervention. [Silsupadol P, Siu KC, Shumway-Cook A, Woollacott MH. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther. 2006;86:269–281.]