The Effects of Instructions on Dual-Task Walking and Cognitive Task Performance in People with Parkinson's Disease

Abstract

Gait impairments are prevalent among people with Parkinson's disease (PD). Instructions to focus on walking can improve walking in PD, but the use of such a cognitive strategy may be limited under dual-task walking conditions, when walking is performed simultaneously with concurrent cognitive or motor tasks. This study examined how dual-task performance of walking and a concurrent cognitive task was affected by instructions in people with PD compared to healthy young and older individuals. Dual-task walking and cognitive task performance was characterized under two sets of instructions as follows: (1) focus on walking and (2) focus on the cognitive task. People with PD and healthy adults walked faster when instructed to focus on walking. However, when focused on walking, people with PD and young adults demonstrated declines in the cognitive task. This suggests that dual-task performance is flexible and can be modified by instructions in people with PD, but walking improvements may come at a cost to cognitive task performance. The ability to modify dual-task performance in response to instructions or other task and environmental factors is critical to mobility in daily life. Future research should continue to examine factors that influence dual-task performance among people with PD.

Dual tasking in Parkinson’s disease: should we train hazardous behavior?

“…Informationprocessing, however, could still be flexibly allocated and reallocated among the two tasks [29]. Clinical studies in PD support this finding by showing that changing task prioritization consciously, that is, allocating attention to one task specifically, led to differences in task performance [30]. Next to structural limitations, attention thus seems to be a mediating factor determining the level of DT interference.…”

Do Cognitive and Physical Fatigue Tasks Enhance Pain, Cognitive Fatigue, and Physical Fatigue in People With Fibromyalgia?

“…Fibro fog is a subjective report of cognitive difficulties, such as mental confusion, memory difficulties, memory decline, or speech difficulties (), and could reflect both cognitive fatigue and/or cognitive performance. Performing both a physical fatigue task (PFT) and a cognitive fatigue task (CFT) simultaneously exacerbates both physical and cognitive performance when done as individual tasks in people with neurologic diseases (i.e., stroke, multiple sclerosis, and Parkinson's disease) (). However, it is unclear if a decrease in performance is observed in people with FM during a dual fatigue task (DFT) and if there are alterations in cognitive fatigue in people with FM.…”

The ability of people with Parkinson’s disease to modify dual-task performance in response to instructions during simple and complex walking tasks

“…For example, verbal instructions to focus on walking increase gait speed and stride length in persons with PD during single-task walking (Lehman et al 2005; Fok et al 2011). Instructions can also improve walking under simple dual-task walking conditions, such as walking in a straight line with a usual base of support (Kelly et al 2012a; Yogev-Seligmann et al 2012). However, the degree to which people with PD can modify walking in response to instructions under dual-task conditions may depend on walking task complexity (Morris et al 1996; Canning 2005; Lohnes and Earhart 2011).…”