Technology-Assisted Cognitive Motor Dual-Task Rehabilitation in Chronic Age-Related Conditions: Systematic Review

Abstract

Background Cognitive-motor dual-task (CMDT) is defined as the parallel processing of motor (eg, gait) and cognitive (eg, executive functions) activities and is an essential ability in daily life. Older adults living with frailty, chronic conditions (eg, neurodegenerative diseases), or multimorbidity pay high costs during CMDT. This can have serious consequences on the health and safety of older adults with chronic age-related conditions. However, CMDT rehabilitation can provide useful and effective therapies for these patients, particularly if delivered through technological devices. Objective This review aims to describe the current technological applications, CMDT rehabilitative procedures, target populations, condition assessment, and efficacy and effectiveness of technology-assisted CMDT rehabilitation in chronic age-related conditions. Methods We performed this systematic review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, on 3 databases (Web of Science, Embase, and PubMed). Original articles that were published in English; involved older adults (>65 years) with ≥1 chronic condition and/or frailty; and tested, with a clinical trial, a technology-assisted CMDT rehabilitation against a control condition were included. Risk of bias (Cochrane tool) and the RITES (Rating of Included Trials on the Efficacy-Effectiveness Spectrum) tool were used to evaluate the included studies. Results A total of 1097 papers were screened, and 8 (0.73%) studies met the predefined inclusion criteria for this review. The target conditions for technology-assisted CMDT rehabilitation included Parkinson disease and dementia. However, little information regarding multimorbidity, chronicity, or frailty status is available. The primary outcomes included falls, balance, gait parameters, dual-task performance, and executive functions and attention. CMDT technology mainly consists of a motion-tracking system combined with virtual reality. CMDT rehabilitation involves different types of tasks (eg, obstacle negotiation and CMDT exercises). Compared with control conditions, CMDT training was found to be pleasant, safe, and effective particularly for dual-task performances, falls, gait, and cognition, and the effects were maintained at midterm follow-up. Conclusions Despite further research being mandatory, technology-assisted CMDT rehabilitation is a promising method to enhance motor-cognitive functions in older adults with chronic conditions.

Multidimensional screening and intervention program for neurocognitive disorder in vascular and multimorbid outpatients: Study protocol for a randomized clinical trial

“…Similarly, a recent review underscored the lack of a standard and accurate methodology in rehabilitation programs [ 26 ]. However, despite advancements in diagnosis, the current trajectory of dementia care remains suboptimal, characterized by insufficient standardization and inefficiency [ 11 , 13 , 23 , 25 ].…”

“…Concerning the efficacy of different rehabilitation programs, we generally expect a greater efficacy of combined motor-cognitive interventions compared to solely motor-based interventions [ 26 ]. As for digital rehabilitation, while other studies have already highlighted the efficacy of digital approaches in cognitive rehabilitation [ 20 , 63 , 64 ], it remains to be further discussed whether its implementation proves more effective than the traditional paper-pencil approach [ 23 ]. This necessitates a rigorous examination of both methods using standardized protocols [ 65 ].…”

“…Moreover, novel technological methods and home-based interventions have been implemented within the framework of cognitive rehabilitation for patients with dementia [ 18 – 22 ]. A multidomain intervention could thus enhance cognitive functioning in elderly individuals with multiple morbidities [ 23 , 24 ].…”

The effects of cognitive-motor dual-task training on athletes’ cognition and motor performance

“…On the other hand, athletic rehabilitation research has been more focused on using CMDT for post-injury recovery. Much of the current evidence for the benefits of CMDT training, surprisingly, did not originate from athletic training research but rather from the fields of athletic rehabilitation and athletic practice ( Pang et al, 2018 ; Gallou-Guyot et al, 2020 ; Tuena et al, 2023 ). CMDT has shown promise in improving patients’ neuro-muscular functions and motor-cognitive abilities, aiding in the recovery of normal functions post-injury.…”