Abstract
Background: Walking while performing cognitive and motor tasks simultaneously interferes with gait performance and may lead to falls in older adults with mild cognitive impairment (MCI). Executive function, which seems to play a key role in dual-task gait performance, can be improved by combined physical and cognitive training. Virtual reality (VR) has the potential to assist rehabilitation, and its effect on physical and cognitive function requires further investigation. The purpose of this study was to assess the effects of VR-based physical and cognitive training on executive function and dual-task gait performance in older adults with MCI, as well as to compare VR-based physical and cognitive training with traditional combined physical and cognitive training.Method: Thirty-four community-dwelling older adults with MCI were randomly assigned into either a VR-based physical and cognitive training (VR) group or a combined traditional physical and cognitive training (CPC) group for 36 sessions over 12 weeks. Outcome measures included executive function [Stroop Color and Word Test (SCWT) and trail making test (TMT) A and B], gait performance (gait speed, stride length, and cadence) and dual-task costs (DTCs). Walking tasks were performed during single-task walking, walking while performing serial subtraction (cognitive dual task), and walking while carrying a tray (motor dual task). The GAIT Up system was used to evaluate gait parameters including speed, stride length, cadence and DTCs. DTC were defined as 100 * (single-task gait parameters − dual-task gait parameters)/single-task gait parameters.Results: Both groups showed significant improvements in the SCWT and single-task and motor dual-task gait performance measures. However, only the VR group showed improvements in cognitive dual-task gait performance and the DTC of cadence. Moreover, the VR group showed more improvements than the CPC group in the TMT-B and DTC of cadence with borderline significances.Conclusion: A 12-week VR-based physical and cognitive training program led to significant improvements in dual-task gait performance in older adults with MCI, which may be attributed to improvements in executive function.
Highlights
Performing activities of daily living (ADLs) requires the ability to perform multiple cognitive and physical tasks simultaneously
Subjects in the Virtual reality (VR) group participated in a 60-min, VR-based physical and cognitive training each visit, three times a week for 12 weeks
We found significant improvements in executive function (SCWT), single-task gait performance and motor dual-task gait performance in both groups
Summary
Performing activities of daily living (ADLs) requires the ability to perform multiple cognitive and physical tasks simultaneously. Dual tasking destabilizes gait performance, especially for those with impaired cognitive function, which may lead to falls (Springer et al, 2006). A previous study reported that older adults with mild cognitive impairment (MCI) showed significant decreases in gait velocity, increases in stride time and increases in stride time variability when changing from a single to a dual task (Muir et al, 2012). Executive function, which seems to play a key role in dual-task gait performance, can be improved by combined physical and cognitive training. The purpose of this study was to assess the effects of VR-based physical and cognitive training on executive function and dual-task gait performance in older adults with MCI, as well as to compare VR-based physical and cognitive training with traditional combined physical and cognitive training
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