Effects of single- vs. dual-task training on balance performance under dual-task conditions in older adults with balance impairment: A randomized, controlled trial
Silsupadol, Patima, 1975-
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Silsupadol, Patima, 1975-
Among older adults, an impaired ability to maintain balance while simultaneously performing cognitive tasks is a common occurrence. Because poor dual-task balance performance is associated with increased fall risk and a decline in cognitive function, interventions to improve dual-task balance performance are needed. Although traditional rehabilitation programs emphasizing training balance under single-task conditions are effective in improving single-task balance performance, it is not known whether single-task training generalizes to balance control under dual-task contexts. Moreover, the effectiveness of approaches to training balance under dual-task conditions is not known. Thus, the purposes of this study were to determine whether elderly individuals with balance impairment can improve their balance performance under dual-task conditions; to investigate whether training balance under single-task conditions generalizes to balance control during dual-task contexts; and to evaluate the effect of instructional set on dual-task balance performance. Specifically, the efficiency of three different training strategies was examined in an effort to understand the mechanisms underlying training-related changes in dual-task balance performance. Twenty-three elderly adults with balance impairment were randomly assigned to 1 of 3 interventions: single-task balance training (ST); dual-task training with fixed-priority instruction (FP); and dual-task training with variable-priority instruction (VP). Clinical and laboratory measures were obtained at baseline and after training. In addition, selected clinical outcomes were repeated after the second week of training to examine interim balance change and at twelve weeks post training to test retention. Results indicate that dual-task training was effective in improving balance under dual-task conditions in the 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 was an important factor for improvement in dual-task performance. The VP instructional set offered advantages over the FP instructional set in terms of the degree of improvement, the rate of learning, and the retention of the dual-task training effect. The dual-task processing skills learned during training were not transferred to novel dual-task conditions. Lastly, the training benefits acquired during VP training could be the result of both automatization of the individual task and the development of task-coordination skills.