Dual-Task Training for Falling

(Real-DTT Trial)

Overseen By Laura A Swink, PhD

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: Colorado State University

Disqualifiers: Dementia, Not fluent in English

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 10 sessions

36 Participants Needed

Trial Summary

What is the purpose of this trial?

Older adults have difficulty optimizing two tasks at once and typically experience greater interference than younger adults when dual-tasking, meaningful that there is greater decline in performance of at least one task when comparing single and dual-tasking. Difficulty dual-tasking may actually predict falls in community-dwelling older adults. Dual-task training has been shown to improve cognitive outcomes (attention, memory), motor outcomes (balance, gait), and dual-task performance in older adults; however, most dual-task training involves simulated tasks that do not reflect functional dual tasks in the real world. Greater dual-task improvements could be seen when training functionally specific tasks. One way to increase task specificity is to offer real-life, contextually-relevant, dual-task training embedded in instrumental activities of daily living (IADLs). Limited evidence exists for dual-task training interventions for older adults with T2DM; however there is early evidence of improvements in cognitive and motor effects with simulated dual-task training, which could translate to improved dual-task performance, reduced impact on everyday life, and reduced fall risk. Therefore, the purpose of this study is to assess feasibility, acceptability, and preliminary efficacy of a real-life dual-task training program for older adults at risk to fall.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Dual-Task Training for Falling is an effective treatment?

The available research shows that Dual-Task Training can improve balance and walking speed in older adults, which helps reduce the risk of falling. One study found that when older adults practiced dual-task exercises, they experienced improvements in balance and walking speed. Another study highlighted that dual-task training can enhance postural control, which is crucial for preventing falls. These findings suggest that Dual-Task Training is an effective treatment for reducing fall risk in older adults. ^{1 2 3 4 5}

What safety data exists for dual-task training for falling?

The research reviewed does not explicitly mention safety data for dual-task training. However, it suggests that dual-task training can improve balance and walking speed in older adults, potentially reducing the risk of falls. The studies reviewed focus on the effectiveness of dual-task training in improving physical and cognitive functions, which indirectly implies a positive safety profile if the training is properly structured and tailored to the individual's needs. ^{2 3 4 6 7}

Is Dual-Task Training a promising treatment for reducing falls?

Yes, Dual-Task Training is promising because it helps improve balance, walking speed, and cognitive skills, which can reduce the risk of falling, especially in older adults. ^{2 3 8 9 10}

Eligibility Criteria

This trial is for older adults who have trouble doing two things at once, which can increase their risk of falling. It aims to help them improve their ability to perform daily tasks that require attention and balance.

Inclusion Criteria

I have been identified as having a risk of falling.

I can walk around my home, with or without help from a device.

I am scheduled for occupational therapy with Covell Care to improve my daily living skills.

Exclusion Criteria

I have been diagnosed with dementia.

I am not fluent in English.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Ten real-life dual-task training sessions focusing on motor and cognitive components of instrumental activities of daily living with a licensed occupational therapist

10 sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Real-life Dual-Task Training

Trial Overview The study tests a 'Real-life Dual-Task Training' program designed to mimic everyday activities. The goal is to see if practicing these real-world dual-tasks can help reduce the likelihood of falls by improving cognitive and motor skills.

Participant Groups

Group I: Real-life Dual-Task Training Experimental Treatment 1 Intervention

Ten real-life dual-task training sessions with explicit focus on motor and cognitive components of instrumental activities of daily living. Training occurs with a licensed occupational therapist.

Who Is Running the Clinical Trial?

Colorado State University

Lead Sponsor

Trials

138

Recruited

38,200+

Findings from Research

In a study involving 30 older adults with balance impairments, both cognitive dual-task training and executive function training significantly improved gait parameters such as walking speed and stride length after 8 weeks of training.

The executive function training group showed greater improvements in limb symmetry and inter-coordination during walking compared to the cognitive dual-task training group, indicating it may be more effective for enhancing gait in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of dual task and executive training on pattern of gait in older adults with balance impairment: A Randomized controlled trial. Azadian, E., Torbati, HR., Kakhki, AR., et al.[2018]

Dual-task training (DTT) can improve both cognitive functions and physical performance, particularly in mobility and postural stability, based on a meta-synthesis of systematic reviews.

While the quality of evidence was mostly rated as low to moderate, the findings suggest that DTT may be beneficial for individuals with various clinical conditions, enhancing aspects like memory, gait, and balance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of dual-task training on cognition of people with different clinical conditions: An overview of systematic reviews. Pereira Oliva, HN., Mansur Machado, FS., Rodrigues, VD., et al.[2022]

Dual-task exercises (DT) have been shown to effectively improve balance and walking speed in older adults, which can help reduce the risk of falls.

The review identified that the effectiveness of dual-task training depends on specific characteristics, such as the type of cognitive-motor tasks used and the training modalities, with variable prioritization showing greater improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dual-task exercises in older adults: A structured review of current literature. Varela-Vásquez, LA., Minobes-Molina, E., Jerez-Roig, J.[2020]

A systematic review of 22 studies found that specific training interventions can effectively improve dual-task postural control in older adults, which is crucial for reducing fall risk.

The review highlighted that single-task training does not effectively transfer to dual-task performance, indicating the need for targeted dual-task training programs to enhance postural control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults. Agmon, M., Belza, B., Nguyen, HQ., et al.[2021]

A study involving 60 older adults (average age 74.4 years) found that 16 weeks of dual-task (DT) training significantly improved mobility, as measured by the Timed Up and Go (TUG) and Four Square Step Test (FSST), compared to control and single-task groups.

The DT training, which included additional motor tasks like carrying a glass of water or a ball, led to better performance in mobility tasks, indicating that incorporating everyday challenges into training can enhance functional abilities in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dual-task training in older adults: The effect of additional motor tasks on mobility performance. Brustio, PR., Rabaglietti, E., Formica, S., et al.[2019]

An 8-week dual-task training program, involving either cognitive tasks (mCdtt) or motor tasks (mMdtt), improved balance in older adults, with no significant differences in outcomes between the two types of training.

Both training methods were effective in enhancing balance, fear of falling, walking functionality, and muscle strength, suggesting that either approach can be beneficial for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do motor-cognitive and motor-motor dual task training effect differently balance performance in older adults? Akin, H., Senel, A., Taskiran, H., et al.[2022]

A study involving 60 community-dwelling older adults showed that both mixed dual-task training protocols improved mobility, cognitive function, and balance over 24 weeks, indicating their effectiveness in enhancing daily living skills.

No significant differences in gait performance were found between the training groups, suggesting that while dual-task training benefits overall function, it may not specifically enhance walking speed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial. Trombini-Souza, F., de Moura, VTG., da Silva, LWN., et al.[2023]

Training can significantly enhance dual-task performance in both older and younger adults, even when tasks require similar motor responses, suggesting that attentional control skills can be improved with practice.

The improvements in dual-task processing skills were not limited to the trained tasks, as participants also performed better with new task combinations, indicating a generalization of the training effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Training effects on dual-task performance: are there age-related differences in plasticity of attentional control? Bherer, L., Kramer, AF., Peterson, MS., et al.[2007]

Dual-task training (DTT) significantly improves gait parameters such as walking speed, stride length, and cadence, as well as balance and motor impairments in patients with Parkinson's disease, based on a meta-analysis of 17 randomized controlled trials involving 826 participants.

DTT is a safe intervention with no reported adverse effects, making it an effective therapy compared to single-task training and usual care for enhancing the quality of life in individuals with Parkinson's disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Dual-Task Training in Patients with Parkinson's Disease: A Systematic Review with Meta-Analysis. García-López, H., de Los Ángeles Castillo-Pintor, M., Castro-Sánchez, AM., et al.[2023]

A study involving 33 healthy older adults showed that cognitive-motor dual-task training improved cognitive accuracy during walking, especially for those with lower cognitive abilities, indicating enhanced cognitive efficiency regardless of the type of training (executive function, aerobic exercise, or gross motor abilities).

While dual-task gait speed showed only small improvements, the significant enhancement in cognitive accuracy suggests that various training methods can effectively strengthen cognitive performance in dual-task situations, which may help reduce the risk of cognitive impairment in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multiple routes to help you roam: A comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults. Downey, R., Bherer, L., Pothier, K., et al.[2022]

References

1. Netherlands pubmed.ncbi.nlm.nih.gov

The effect of dual task and executive training on pattern of gait in older adults with balance impairment: A Randomized controlled trial. [2018]

2. England pubmed.ncbi.nlm.nih.gov

The effect of dual-task training on cognition of people with different clinical conditions: An overview of systematic reviews. [2022]

3. Greece pubmed.ncbi.nlm.nih.gov

Dual-task exercises in older adults: A structured review of current literature. [2020]

4. New Zealand pubmed.ncbi.nlm.nih.gov

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults. [2021]

5. Netherlands pubmed.ncbi.nlm.nih.gov

Dual-task training in older adults: The effect of additional motor tasks on mobility performance. [2019]

6. Switzerland pubmed.ncbi.nlm.nih.gov

Do motor-cognitive and motor-motor dual task training effect differently balance performance in older adults? [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Training effects on dual-task performance: are there age-related differences in plasticity of attentional control? [2007]

9. United States pubmed.ncbi.nlm.nih.gov

Efficacy of Dual-Task Training in Patients with Parkinson's Disease: A Systematic Review with Meta-Analysis. [2023]

10. Switzerland pubmed.ncbi.nlm.nih.gov

Multiple routes to help you roam: A comparison of training interventions to improve cognitive-motor dual-tasking in healthy older adults. [2022]