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Improving cognitive-motor dual tasking after brain injury.
INS (International Neuropsychological Society) Conference, Bilbao, July 2007
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Objective: People who have suffered brain injury frequently complain of difficulties with dual-tasking. We examined whether the ability to walk and carry out additional cognitive tasks (akin to walking and talking) could be improved by a specifically designed training programme. Participants and Methods: The study was a randomised controlled trial of a five-week cognitive-motor dual-tasking training programme. Twenty participants with evidence of dual¬tasking difficulties arising from neurological injury or illness were randomly allocated to treatment or control groups. The training programme involve exercises in walking with gradually increasing secondary cognitive demands carried out twice per day, five days per week. Outcome measures included tests of cognitive-cognitive, cognitive-motor and motor¬-motor task combinations as well as a questionnaire relating to everyday dual-tasking. Results: The training programme was viewed positively by participants, and there was a good compliance rate. Participants reported increased awareness of dual tasking demands in everyday life. Analysis of variance showed evidence of improvement as a result of training in performance on primary outcome measures where those measures were very close in format to training conditions, but little evidence of generalisation to other measures of cognitive¬motor, cognitive-cognitive or motor-motor dual task combinations. There was some evidence that treatment group participants felt that their dual-tasking performance in everyday life was improved after the intervention. Conclusions: This study suggests that functionally oriented interventions where training is close in form to everyday behaviour might improve cognitive-motor dual-tasking such as walking and talking. Although methodological constraints limit the extent of conclusions that can be drawn, the findings have implications for rehabilitation, particularly in relation to mobility in attentionally demanding and potentially dangerous situations such as busy urban environments.