Task Practice Interventions for Executive Function

Overseen By David Badre, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Brown University

Must not be taking: Brain related medications

Disqualifiers: Neurological, Psychiatric, Pregnancy, Implants, others

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

Compensation: Varies

Number of Visits: 12

Duration: 3 weeks

60 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this basic experimental clinical trial is to understand the effect of multitasking practice on the structure of neural representations of tasks in the human lateral prefrontal cortex and control brain regions. The main question it aims to answer is: What changes in neural representational structure predict improvements in multitasking behavior due to multitasking practice? Healthy human participants will learn two independent tasks, each mapping a set of stimuli to motor responses based on different rules. Participants will be randomized to one of two interventions. Participants assigned to the multitask practice intervention (MPI) will practice multitasking the two tasks over multiple days. Those assigned to the single-task practice intervention (SPI) will instead practice each task separately while controlling for the total number of practice opportunities associated with each task across the interventions. Both before and after the practice, the ability of all participants to perform both tasks simultaneously will be behaviorally measured using a well-established psychological refractory period (PRP) paradigm, and their neural representations will be measured using functional MRI while they perform the two tasks. Researchers will then compare improvements in multitasking behavior across the two groups, as well as changes in neural representational geometry of the tasks in the lateral prefrontal cortex and control brain regions, and test whether multitasking training is associated with specific changes in neural representations in the lateral prefrontal cortex.

Will I have to stop taking my current medications?

The trial excludes participants who use brain-related medications, so you may need to stop taking such medications to participate.

What data supports the effectiveness of the treatment Multitask Practice Intervention (MPI) for improving executive function?

Research suggests that interventions involving multitasking and cognitive training can improve executive functions, such as planning and problem-solving, especially in individuals with brain injuries. Studies have shown that training which combines cognitive tasks with physical activities can enhance dual-tasking abilities, although more research is needed to confirm these findings. ^{1 2 3 4 5}

Is the Task Practice Intervention for Executive Function safe for humans?

The research articles reviewed do not provide specific safety data for Task Practice Interventions, but they focus on the improvement of cognitive and motor skills through practice, which generally suggests a low risk of harm. These interventions are typically non-invasive and involve training tasks that are unlikely to pose significant safety concerns. ^{6 7 8 9 10}

How does the Multitask Practice Intervention (MPI) differ from other treatments for executive function issues?

The Multitask Practice Intervention (MPI) is unique because it involves training individuals to perform multiple tasks simultaneously, which can enhance executive function by improving attentional control and cognitive flexibility. This approach contrasts with traditional single-task training, which focuses on one task at a time and may not offer the same level of improvement in handling complex, real-life situations. ^{5 11 12 13 14}

Research Team

David Badre, PhD

Principal Investigator

Brown University

Eligibility Criteria

This trial is for individuals with ADHD, healthy subjects interested in executive function, and those who can perform tasks based on different rules. Participants will be trained to multitask or single-task over multiple days.

Inclusion Criteria

My vision is normal or corrected to normal.

Exclusion Criteria

I am taking medication for a brain condition.

Injury to the participant by a metallic object or foreign body (e.g., BB, bullet, shrapnel, etc.)

Left handedness

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (phone call)

Baseline Assessment

Baseline evaluations of multitasking behavior and neural representations in lateral PFC with fMRI

4 weeks

4 visits (in-person)

Treatment

Participants receive either single-task or multitask practice treatment over multiple sessions

3 weeks

3 visits (in-person)

Endline Assessment

Endline evaluations of multitasking behavior and neural representations in lateral PFC with fMRI

4 weeks

4 visits (in-person)

Follow-up

Participants are monitored for changes in neural representations and multitasking behavior

4 weeks

Treatment Details

Interventions

• Multitask Practice Intervention (MPI)
• Single-task Practice Intervention (SPI)

Trial Overview The study tests how practicing multitasking versus single tasks affects the brain's task management. It measures changes in behavior and brain activity using psychological tests and fMRI before and after practice sessions.

Participant Groups

Group I: Multitask Practice Experimental Treatment 1 Intervention

Group II: Single Task Practice Active Control 1 Intervention

Who Is Running the Clinical Trial?

Brown University

Lead Sponsor

Trials

480

Recruited

724,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

Metacognitive strategy instruction (MSI) has been shown to significantly improve everyday functional problems in young to middle-aged adults with traumatic brain injury (TBI), based on a systematic review of 15 studies, including 5 randomized control trials.

While immediate outcomes from MSI were better than control interventions, there was not enough data to assess long-term maintenance effects or to make recommendations for children or older adults with TBI.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intervention for executive functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. Kennedy, MR., Coelho, C., Turkstra, L., et al.[2018]

A 5-week cognitive-motor dual-tasking training program showed improvement in dual-task performance for individuals with acquired brain injury, particularly in a task that combined walking with a cognitive task, involving 19 participants in total (10 in the treatment group and 9 in the control group).

Participants reported a perceived improvement in their dual-tasking abilities in daily life, although the study had limitations such as a small sample size and lack of blinding, which may affect the reliability of the findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. Evans, JJ., Greenfield, E., Wilson, BA., et al.[2009]

The multicontext approach effectively improved functional performance in an adult with executive dysfunction following a traumatic brain injury, even though there was no increase in self-awareness of deficits.

This case study highlights the importance of using varied contexts to help individuals generalize learned strategies, providing valuable insights for clinicians working with patients who have significant awareness and executive function challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Application of the Multicontextual Approach in Promoting Learning and Transfer of Strategy Use in an Individual with TBI and Executive Dysfunction. Toglia, J., Goverover, Y., Johnston, MV., et al.[2014]

Cognitive-motor dual-task training (DTT) and single-task cognitive training (STT) both showed improvements in different aspects of executive functions in participants over 65 years old, with DTT enhancing control and inhibition of reactions and STT improving abstract thinking and categorization.

Neither training method resulted in improvements in attention, indicating that while both types of training can benefit executive functions, they may not address attention-related challenges.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The cognitive and cognitive-motor training contribution to the improvement of different aspects of executive functions in healthy adults aged 65 years and above-A randomized controlled trial. Wiśniowska, J., Łojek, E., Chabuda, A., et al.[2022]

A self-instructional procedure that involved verbalizing plans before and during tasks significantly improved planning abilities and reduced off-task behaviors in a client with executive functioning impairments after a traumatic brain injury over an eight-week training period.

The training not only enhanced the client's self-control ratings in everyday behaviors but also demonstrated that these improvements could generalize to real-life situations with extended practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Planning disorder after closed head injury: a case study. Cicerone, KD., Wood, JC.[2019]

Practice in dual-task situations can significantly reduce performance impairment caused by interference between tasks, as certain cognitive processes become more automatic over time.

Improvements in dual-task performance are linked to enhanced executive control skills and better allocation of attention resources, allowing individuals to manage simultaneous tasks more effectively.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mechanisms of Practice-Related Reductions of Dual-Task Interference with Simple Tasks: Data and Theory. Strobach, T., Torsten, S.[2020]

The study reviews how training can optimize different types of executive functions, such as Shifting, Inhibition, Updating, and Dual tasking, which are crucial for performing complex tasks effectively.

It introduces the Efficient Task Instantiation (ETI) model, suggesting that practice enhances dual-task performance by improving how task information is organized in working memory, highlighting the cognitive mechanisms behind these improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice-related optimization and transfer of executive functions: a general review and a specific realization of their mechanisms in dual tasks. Strobach, T., Salminen, T., Karbach, J., et al.[2021]

Dual-task (DT) training, which combines cognitive and motor tasks, shows potential benefits for improving physical and cognitive functions in children and adolescents, as evidenced by a review of seven studies involving 543 participants aged 4 to 14 years.

While some interventions demonstrated improvements in balance and cognitive performance, the results were inconsistent, highlighting the need for more structured training principles and higher-quality studies to better assess the effectiveness of DT training.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of cognitive-motor dual task training on cognitive and physical performance in healthy children and adolescents: A scoping review. Wollesen, B., Janssen, TI., Müller, H., et al.[2022]

In a study with 25 young adult participants, those who had limited practice on a speech task experienced significant dual-task interference when also performing a visuomotor task, indicating that practice amount affects task performance.

Participants who received extended practice showed minimal dual-task interference, suggesting that increased familiarity with a task can enhance performance even when multitasking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice Mediates Bidirectional Dual-Task Interference When Performing a Novel Sequential Nonword Repetition Task. Whitfield, JA., Holdosh, SR.[2021]

A new e-health device for assessing dual-tasking abilities in Multiple Sclerosis (MS) patients was tested on 184 individuals and proved reliable, allowing meaningful assessments in just 6 minutes.

The device's results correlated well with important clinical measures like disease severity and processing speed, making it a promising tool for routine neuropsychological evaluations in MS and potentially other neurological disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

On the Reliability of Examining Dual-Tasking Abilities Using a Novel E-Health Device-A Proof of Concept Study in Multiple Sclerosis. Böttrich, N., Mückschel, M., Dillenseger, A., et al.[2020]

Cognitive-physical dual-task training significantly improved executive function in older adults with mild cognitive impairment, as evidenced by better performance on the Trail Making Test Part B compared to single-cognitive training.

The dual-task training also resulted in decreased activity in the prefrontal cortex during cognitive testing, suggesting a more efficient use of cognitive resources, although it did not translate to improvements in daily living activities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Cognitive-Physical Dual-Task Training on Executive Function and Activity in the Prefrontal Cortex of Older Adults with Mild Cognitive Impairment. Park, JH.[2023]

The process-based multi-task adaptive cognitive training (P-bM-tACT) program significantly improved executive function and other cognitive domains in older adults with mild cognitive impairment (MCI) over a 10-week period, with effects maintained for 3 months after training.

The program was well-received, demonstrating a high adherence rate of 83.4%, indicating its acceptability as a viable intervention for enhancing cognitive function in the community.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transferability and sustainability of process-based multi-task adaptive cognitive training in community-dwelling older adults with mild cognitive impairment: a randomized controlled trial. Zhao, X., Ji, C., Zhang, C., et al.[2023]

A study involving 84 healthy older adults showed that multi-domain cognitive training, which included inhibition, visuomotor function, and spatial navigation, led to greater improvements in attentional control compared to single-domain training over 50 sessions.

Participants with initially lower cognitive performance benefited the most from the training, and these improvements were maintained at a 6-month follow-up, suggesting that multi-domain training can effectively enhance cognitive functions important for daily life in older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-domain training enhances attentional control. Binder, JC., Martin, M., Zöllig, J., et al.[2019]

This meta-analysis of 49 studies involving older adults (over 60 years) found that process-based training for executive function and working memory significantly improved performance on both trained and near-transfer tasks compared to control groups.

While the training showed smaller far-transfer effects, these were still significant, indicating that such cognitive training can benefit older adults in various cognitive tasks, regardless of the type of training or duration.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Making working memory work: a meta-analysis of executive-control and working memory training in older adults. Karbach, J., Verhaeghen, P.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Intervention for executive functions after traumatic brain injury: a systematic review, meta-analysis and clinical recommendations. [2018]

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

Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness. [2009]

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

Application of the Multicontextual Approach in Promoting Learning and Transfer of Strategy Use in an Individual with TBI and Executive Dysfunction. [2014]

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

The cognitive and cognitive-motor training contribution to the improvement of different aspects of executive functions in healthy adults aged 65 years and above-A randomized controlled trial. [2022]

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

Planning disorder after closed head injury: a case study. [2019]

6. Poland pubmed.ncbi.nlm.nih.gov

Mechanisms of Practice-Related Reductions of Dual-Task Interference with Simple Tasks: Data and Theory. [2020]

7. Germany pubmed.ncbi.nlm.nih.gov

Practice-related optimization and transfer of executive functions: a general review and a specific realization of their mechanisms in dual tasks. [2021]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Effects of cognitive-motor dual task training on cognitive and physical performance in healthy children and adolescents: A scoping review. [2022]

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

Practice Mediates Bidirectional Dual-Task Interference When Performing a Novel Sequential Nonword Repetition Task. [2021]

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

On the Reliability of Examining Dual-Tasking Abilities Using a Novel E-Health Device-A Proof of Concept Study in Multiple Sclerosis. [2020]

11. Korea (South) pubmed.ncbi.nlm.nih.gov

Effects of Cognitive-Physical Dual-Task Training on Executive Function and Activity in the Prefrontal Cortex of Older Adults with Mild Cognitive Impairment. [2023]

12. England pubmed.ncbi.nlm.nih.gov

Transferability and sustainability of process-based multi-task adaptive cognitive training in community-dwelling older adults with mild cognitive impairment: a randomized controlled trial. [2023]

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

Multi-domain training enhances attentional control. [2019]

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

Making working memory work: a meta-analysis of executive-control and working memory training in older adults. [2022]