Cognitive-motor Dual-task Training Research Articles

A Nonpharmacologic Treatment for Anxiety in Older Adults Based on Cognitive-Motor Training With Response-Generated Feedback.

Simultaneous combinations of cognitive and physical exercises (cognitive-motor dual-task training [CMDT]) are more effective than physical and cognitive training alone in counteracting the decline of older adults and promoting physical and psychological well-being. The CMDT can be particularly effective in improving cognitive and functional abilities. Here, we validated an innovative nonpharmacologic intervention for anxiety and general well-being in older people by combining CMDT and response-generated feedback (RGF) principles. As outcomes, anxiety, cognitive functions, and functional mobility were evaluated. In addition, electroencephalographic methods were employed to investigate the neural basis of the possible intervention effects. Thirty older adults were divided into an experimental group trained using a CMDT + RGF protocol and a control group using the CMDT only. The CMDT + RGF consisted of the simultaneous execution of whole-body exercises, cognitive tasks that were realized using interactive devices, and continuous feedback on every response. Results showed decreased anxiety and increased response speed in the experimental group, and both groups improved their functional ability and response accuracy after the intervention. According to electroencephalographic results, both groups showed an increase in the bilateral prefrontal cortex anticipatory activity, but the experimental group also showed a further increase in the left prefrontal cortex and in the premotor areas anticipatory functions. This study confirms the effectiveness of the proposed intervention on anxiety by adopting a nonpharmacology treatment that could affect public and individual health costs by proposing an alternative approach to expensive medications and psychotherapy and could significantly improve older adults' quality of life.

Testing a Multicomponent Training Designed to Improve Sprint, Agility and Decision-Making in Elite Basketball Players.

This study tested if, in elite basketball players' training, the integration of a cognitive component within a multi-component training (MCT) could be more effective than an MCT with motor components only to improve both physical and cognitive skills. To this purpose, we designed an MCT focussed on sprint and agility incorporating a cognitive-motor dual-task training (CMDT) focussed on decision-making speed. Specific tests on sprint, agility and decision-making, and event-related potential (ERP) during the latter test were evaluated before and after the intervention. Thirty elite basketball players were recruited and divided into an experimental group executing CMDT integrated into the MCT and a control group performing the motor MCT (without cognitive components). The MCT with CMDT session was performed by four athletes simultaneously that executed different circuits. One circuit was the CMDT which was realized using interactive devices. Results on physical performance showed that only the experimental group improved in sprint and agility and also shortened response time in the decision-making test. At the neural level, the experimental group only shows an increase in the P3 ERP component, which has been associated with a series of post-perceptual cognitive functions, including decision-making. In conclusion, CMDT implemented within an MCT, likely stimulating more than physical training cortical plasticity, could be more effective than a motor MCT alone in improving the physical and cognitive skills of elite basketball players in five weeks only.

Sex Differences in Cognitive-Motor Dual-Task Training Effects and in Brain Processing of Semi-Elite Basketball Players

In the current study, we aimed at evaluating the possible sex differences in cognitive-motor dual-task training (CMDT) effects on the sport and cognitive performance of semi-elite basketball athletes. Moreover, we investigated the CMDT effects on proactive brain processing using event-related potential (ERP) analysis. Fifty-two young basketball athletes (age 16.3 years) were randomly assigned into an experimental (Exp) group performing the CMDT, and a control (Con) group executing standard motor training. Before and after a 5-week training intervention, participants' motor performance was evaluated using dribbling tests. Cognitive performance was assessed by measuring response time and accuracy in a discrimination response task (DRT). Brain activity related to motor and cognitive preparation was measured through the Bereitschaftspotential (BP) and the prefrontal negativity (pN) ERP components. The CMDT involved the simultaneous execution of dribbling exercises and cognitive tasks which were realized using interactive technologies on the court. Results showed that both groups had some enhancements from pre- to post-tests, but only the Exp group enhanced in the dribbling exercise. In the DRT after the CMDT, females performed faster than males in the Exp group. All groups, except for the Con group of males, performed the DRT more accurately after the training. According to the ERP results, in the Exp group of males and in Exp and Con group of females, we found an increase in pN amplitude (associated with better accuracy); in the Exp group of females and in Exp and Con group of males, we found an increase in BP (associated with better response time). In conclusion, the present study endorsed the efficacy of the proposed CMDT protocol on both the sport and cognitive performance of semi-elite basketball players and showed that the neural basis of these benefits may be interpreted as sex-related compensatory effects.

Measured and Perceived Exercise Intensity During the Performance of Single-Task, Cognitive-Motor Dual-Task, and Exergame Training: Transversal Study

The physical and cognitive loads borne during exergaming may differ from more conventional cognitive-motor dual-task trainings. The aim of this pilot transversal study was to compare objectively measured and perceived exercise intensity during exergame, cognitive-motor dual-task, and single-task training sessions. We recruited apparently healthy young adults who carried out one session of each type of training: exergaming, cognitive-motor dual-tasking, and single-tasking. We used a custom-made exergame as support. The sessions lasted 30 minutes, were spaced at least 24 hours apart, and took place in random order for each group of 4 participants. We used heart rates to assess exercise intensity and the modified Borg scale to assess perception of intensity. In all, 16 apparently healthy young participants carried out all sessions. There was no difference between the different types of training in mean heart rates (P=.27), peak heart rates (P=.50), or Borg scale scores (P=.40). Our custom-made exergame's objectively measured and perceived physical load did not differ between cognitive-motor dual-task and single-task training. As a result, our exergame can be considered to be as challenging as more traditional physical training. Future studies should be conducted in older adults with or without cognitive impairments and incorporate an assessment of cognitive performance.

Feasibility and potential cognitive impact of a cognitive-motor dual-task training program using a custom exergame in older adults: A pilot study.

Dual-task training may be relevant and efficient in the context of active aging. An issue in training programs lies in enhancing the adherence of participants. This can potentially be improved using games as support. We designed and developed a custom interactive exergame in this way. The objective of this pilot study was to explore the potential use of this exergame and the feasibility of our intervention, including the level of safety and adherence. The result's trends on cognitive and motor capacities, as well as on the level of motivation for physical activity, fear of falling, and quality of life of participants, were also explored. Older adults aged 65 years or older were recruited and realized 30 min of supervised training in groups of 4, 2-3 times a week for 12 weeks. Exercises consisted of incorporated cognitive and motor dual tasks, with an increased difficulty over the weeks. Our program's safety, engagement, attendance, and completion levels were evaluated. Participants' postural control in single-task and dual-task conditions, as well as their performances in mental inhibition, flexibility, working memory, mobility, and postural control, and their levels of motivation for physical activity, fear of falling, and quality of life were also assessed. We realized a per protocol statistical analysis with a p-value set at 0.05. Thirty-nine participants (aged 84.6 ± 8.5 years) were recruited. No adverse events, and 89% adherence, 88% attendance, and 87% completion rates were observed. A potentially significant effect of our exergame on working memory in single-task conditions and on the cognitive aspect of dual-task conditions was also observed. We observed no differences in other parameters. Our exergame seemed feasible and safe and was enjoyed by participants, mainly due to the gamification of our training program. Moreover, our exergame may be efficient for cognitive training in older adults, as well as for the maintenance of motor functions, motivation for physical activity, fear of falling, and quality of life levels. This constitutes the first step for our solution with interesting results that need to be further studied.

Specific effect of a cognitive-motor dual-task training on sport performance and brain processing associated with decision-making in semi-elite basketball players

ObjectivesIn this study, we aimed at evaluating the effects of cognitive-motor dual-task training (CMDT) on sport-specific athletic performance and cognitive functions of semi-elite basketball players. Further, we investigated the CMDT effects on reactive brain processing by employing event-related potential (ERP) analysis. Design: A randomized controlled trial was conducted including 52 young semi-elite basketball players (28 females mean age 16.3 ± 1.1 years) who were randomly assigned into an experimental (Exp) group executing the CMDT and a control (Con) group performing standard motor training. Method: Athletes’ sport-specific performance was evaluated with dribbling tests before and after a five-week training. Cognitive performance was assessed by measuring speed and accuracy in a discrimination response task. Brain activity associated with sensory processing, selective attention, and decision-making was measured through the P1, N1, and P3 components. The CMDT consisted of simultaneous execution of dribbling exercises and cognitive tasks which were realized using interactive devices located around the athlete on the basket court. Data were submitted to a mixed analysis of variance. Results: Both groups showed some improvements from pre-to post-tests, but the Exp group improved basket-specific performance by 13% more than the Con group; in addition, the cognitive performance also improved more in the Exp group (25.8% in accuracy and 5.4% response speed). According to the EEG results, training did not affect sensory processing and attentional processing which were equally increased after both kinds of training; however, decision-making processes were specifically affected by the experimental training. Conclusions: This study confirmed the effectiveness of the proposed CMDT protocol on both sport-specific and cognitive performance of basketball players and showed that the neural basis of these benefits may be mediated by more intense decisional processing allowing faster connection between sensory encoding and response execution.

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

Simultaneous dual- or multitasking training has been used in manifold ways to improve cognitive-motor performance in different age groups. Dual task (DT) training is assumed to improve both, single task (ST) motor and cognitive performance, but particularly, performance under dual tasking conditions. Further, DT interventions have been shown to be beneficial for motor skill learning and cognitive performance as well as academic achievements in children and adolescents. The aim of this scoping review was to summarize current evidence on different cognitive-motor interventions that practice motor and cognitive performance simultaneously in children and adolescents and to identify training regimes that are most effective to improve cognitive or motor performance in this target group. MethodsFour electronic databases were searched (Pubmed, MEDLINE, Web of Science and APA Psycinfo) until May 2021. Following the PRISMA guidelines, title, abstract, and full-text screening as well as quality assessment was done by two independent reviewers. Studies were eligible if they (1) were published in English or German language, (2) accessible as a full-text version, (3) included at least one group of children or adolescents with a mean age of 4 to 21 years, (4) used dual-tasks as part of the intervention, (5) conducted one or more training sessions, and (6) reported at least one cognitive or motor outcome. The main outcome measures were cognitive and motor as well as cognitive-motor DT performance. Due to the heterogeneity in the characteristics of the included studies, we designed this review as a scoping review. ResultsSeven studies met the inclusion criteria (n = 543, age four to 14 years, 47.1% female). One study reported two intervention experiments. Studies differed in sample size (20–189) as well as in type of training (specific or general DT training) and dose (frequency: one session/week to 110 sessions within 22 weeks). Overall, task-specific improvements in physical and cognitive functions were found, but not consistently across all interventions. Two interventions out of five interventions that measured motor performance demonstrated improvement in that domain, especially in balance. Three out of five interventions that measured cognitive functions found improved cognition. Only one study examined DT performance post training but failed to gain significant improvements in comparison to a control group. Studies only occasionally integrated training principles like individualization or progression in the design of their intervention. DiscussionThe results indicate that DT training interventions may improve physical and/or cognitive functions in children and adolescents. Best practice recommendations for training regimes cannot be derived as outcomes differed a lot and were not systematically assessed across studies. Future studies should integrate more principles of training monitoring and aspects like individualization and progression to provide ideal training control and achieve better DT training results. Further, more high-quality trials are needed that adhere to the previous concepts. PsycINFO classification2340 Cognitive Processes2820 Cognitive & Perceptual Development.3720 Sports

Exergame and cognitive-motor dual-task training in the healthy elderly (INCOME): a study protocol

Background: Ageing is associated with a decrease in cognitive, motor, and dual-task capacities, leading to a possible loss in autonomy. Cognitive-motor dual-task training is known to be effective on these functions but suffers from low adherence level. On this point, exergames seem to be a promising solution. We aim to evaluate the effects of a new customized exergame on cognitive and motor capabilities in the elderly. Methods: Thirty-nine elderly persons (65 years old or above) will carry out 30 minutes of cognitive-motor dual-task training through our exergame, 3 times a week for 12 weeks. We will assess postural control under single and dual-task conditions (stabilometric platform), mental inhibition (Stroop test), mental flexibility (Trail Making Test), working memory (N-Back), mobility (Timed Up-and-Go), balance (Berg Balance Scale), fear of falling (Falls Efficacy Scale), quality of life (EuroQol), city exploration, and tracked (Armband®) or self-reported (QAPPA) physical activity level. Lastly, we will assess the safety (adverse events appearance) and the adhesion (compliance, drop-out, motivation) levels of this intervention. These evaluations will take place after the training protocol and after a 3-month follow-up. Discussion: This pilot study is expected to bring positive gains for the participants, as well as exploration of current knowledge gaps in the literature.

Effect of Cognitive-motor Dual Task Training on Balance Function and Daily Living Ability in Stroke Patients

Effect of Cognitive-motor Dual Task Training on Balance Function and Daily Living Ability in Stroke Patients

Neural Correlates of Single-Task Versus Cognitive-Motor Dual-Task Training

Single-task and cognitive-motor dual-task training (CMDT) has been extensively studied for the post-stroke function rehabilitation. However, little is known about the difference between the brain activities when these two types of tasks are being implemented. Therefore, neural correlates of single-cognitive/motor-task training (SCT/SMT) versus CMDT are investigated in this study. Specifically, a pure mathematical problem-solving task and a pure cycling task were designed for the SCT and SMT paradigms, respectively. For the CMDT, subjects should perform these two tasks simultaneously. Electroencephalography signals acquired during performing these two types of training are used to analyze the brain dynamic properties by event-related potential and event-related (de-)synchronization analyses. It can be seen from the results that compared with the SCT, theta event-related synchronization can be increased significantly by the CMDT (frontal theta: <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p$ </tex-math></inline-formula> -value <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$= 5.44e-05 &lt; 0.0001$ </tex-math></inline-formula> and temporal theta: <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$p$ </tex-math></inline-formula> -value <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$= 9.18e-06 &lt; 0.0001$ </tex-math></inline-formula> ) and, meanwhile, the mu and central beta event-related desynchronization induced by the CMDT is significantly lower than that induced by the SMT (mu: p-value <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$= 2.28e-06 &lt; 0.0001$ </tex-math></inline-formula> and central beta: p-value <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$= 4.37e-06 &lt; 0.0001$ </tex-math></inline-formula> ). Therefore, it is proved in this study that the SMT can induce higher motor neural engagement than the CMDT and, meanwhile, compared with the SCT, higher cognitive neural activity can be induced by the CMDT, which can be explained by that the multitask coordination induces more neural activities. In addition, it is found that more attention has been paid on the relatively difficult task during the dual-task training. Therefore, the difficulty level of each task in the CMDT paradigm can be designed subject specific to implement the personalized training.

Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT.

The aim was to compare the effectiveness of dual-task training (DTT) compared to single mobility training (SMT) on dual-task walking, mobility and cognition, in persons with Multiple Sclerosis (pwMS). Forty pwMS were randomly assigned to the DTT or SMT groups. The DTT-group performed dual-task exercises using an interactive tablet-based application, while the SMT-group received conventional walking and balance exercises. Both interventions were supervised and identical in weeks (8) and sessions (20). Nine cognitive-motor dual-task conditions were assessed at baseline, after intervention and at 4-weeks follow-up (FU). The dual-task cost (DTC), percentage change of dual-task performance compared to single-task performance, was the primary outcome. Mobility and cognition were secondarily assessed. Mixed model analyses were done with group, time and the interaction between group and time as fixed factors and participants as random factors. Significant time by group interactions were found for the digit-span walk and subtraction walk dual-task conditions, with a reduction in DTC (gait speed) for the DTT maintained at FU. Further, absolute dual-task gait speed during walking over obstacles only improved after the DTT. Significant improvements were found for both groups in various motor and cognitive measures. However, the DTT led to better dual-task walking compared to the SMT.

Effects of cognitive-motor dual-task training combined with auditory motor synchronization training on cognitive functioning in individuals with chronic stroke: A pilot randomized controlled trial.

Background:Preservation and enhancement of cognitive function are essential for the restoration of functional abilities and independence following stroke. While cognitive-motor dual-task training (CMDT) has been utilized in rehabilitation settings, many patients with stroke experience impairments in cognitive function that can interfere with dual-task performance. In the present study, we investigated the effects of CMDT combined with auditory motor synchronization training (AMST) utilizing rhythmic cues on cognitive function in patients with stroke.Methods:The present randomized controlled trial was conducted at a single rehabilitation hospital. Thirty patients with chronic stroke were randomly divided an experimental group (n = 15) and a control group (n = 15). The experimental group received 3 CMDT + AMST sessions per week for 6 weeks, whereas the control group received CMDT only 3 times per week for 6 weeks. Changes in cognitive function were evaluated using the trail making test (TMT), digit span test (DST), and stroop test (ST).Results:Significant differences in TMT-A and B (P = .001, P = .001), DST-forward (P = .001, P = .001), DST-backward (P = .000, P = .001), ST-word (P = .001, P = .001), and ST-color (P = .002, P = .001) scores were observed in both the control and experimental groups, respectively. Significant differences in TMT-A (P = .001), DST-forward (P = .027), DST-backward (P = .002), and ST-word (P = .025) scores were observed between the 2 groups. Performance speed on the TMT-A was faster in the CMDT + AMST group than in the CMDT group. Moreover, DST-forward and DST-backward scores were higher in the CMDT + AMST group than in the CDMT group. Although ST-color results were similar in the 2 groups, ST-word scores were higher in the CMDT + AMST group than in the CMDT group.Conclusion:This finding indicates that the combined therapy CMDT and AMST can be used to increase attention, memory, and executive function for people with stroke.

The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial.

[Purpose] This study investigates whether cognition, balance and dual task performance in institutionalized older adults improves by a virtual reality dual task training. [Subjects and Methods] Randomized controlled trial; Twenty institutionalized older adults with mild cognitive impairment (13 female, 7 male; average age, 87.2 ± 5.96 years) were randomized to the intervention (i.e. Virtual reality dual-task training using the BioRescue) or control group (no additional training). The intervention group took part in a 6-week training program while the elderly in the control group maintained their daily activities. Balance was measured with the Instrumented Timed Up-and-Go Test with and without a cognitive task. The Observed Emotion Rating Scale and Intrinsic Motivation Inventory were administered to evaluate the emotions and motivation regarding the exergaming program. [Results] The intervention group improved significantly on the total Timed Up-and-Go duration and the turn-to-sit duration during single-task walking in comparison to the control group who received no additional training. Participants found the virtual reality dual task training pleasant and useful for their concentration, memory and balance. Pleasure and alertness were the two emotions which were mostly seen during the intervention. [Conclusion] The BioRescue is a pleasant and interesting treatment method, well suited for institutionalized older adults in need of lifelong physical therapy.

The effect of cognitive-motor dual-task training on cognitive function and plasma amyloid β peptide 42/40 ratio in healthy elderly persons: a randomized controlled trial.

BackgroundPhysical activity reduces the incidence and progression of cognitive impairment. Cognitive-motor dual-task training, which requires dividing attention between cognitive tasks and exercise, may improve various cognitive domains; therefore, we examined the effect of dual-task training on the executive functions and on plasma amyloid β peptide (Aβ) 42/40 ratio, a potent biomarker of Alzheimer’s disease, in healthy elderly people.MethodsTwenty-seven sedentary elderly people participated in a 12-week randomized, controlled trial. The subjects assigned to the dual-task training (DT) group underwent a specific cognitive-motor dual-task training, and then the clinical outcomes, including cognitive functions by the Modified Mini-Mental State (3MS) examination and the Trail-Making Test (TMT), and the plasma Aβ 42/40 ratio following the intervention were compared with those of the control single-task training (ST) group by unpaired t-test.ResultsAmong 27 participants, 25 completed the study. The total scores in the 3MS examination as well as the muscular strength of quadriceps were equally improved in both groups after the training. The specific cognitive domains, “registration & recall”, “attention”, “verbal fluency & understanding”, and “visuospatial skills” were significantly improved only in the DT group. Higher scores in “attention”, “verbal fluency & understanding”, and “similarities” were found in the DT group than in the ST group at post-intervention. The absolute changes in the total (8.5 ± 1.6 vs 2.4 ± 0.9, p = 0.004, 95 % confidence interval (CI) 0.75―3.39) and in the scores of “attention” (1.9 ± 0.5 vs −0.2 ± 0.4, p = 0.004, 95 % CI 2.25―9.98) were greater in the DT group than in the ST group. We found no changes in the TMT results in either group. Plasma Aβ 42/40 ratio decreased in both groups following the training (ST group: 0.63 ± 0.13 to 0.16 ± 0.03, p = 0.001; DT group: 0.60 ± 0.12 to 0.25 ± 0.06, p = 0.044), although the pre- and post-intervention values were not different between the groups for either measure.ConclusionsCognitive-motor dual-task training was more beneficial than single-task training alone in improving broader domains of cognitive functions of elderly persons, and the improvement was not directly due to modulating Aβ metabolism.

Dual-Task Training for Balance and Mobility in a Person With Severe Traumatic Brain Injury

Attentional impairments following severe traumatic brain injury (TBI) are common and can lead to decreased functional mobility and balance, as well as deficits in previously automatic movements such as walking and stair climbing. The purpose of this case study was to determine the feasibility and potential value of incorporating a cognitive-motor dual-task training program into physical therapy for a patient with a severe TBI. The patient was a 26-year-old woman who sustained a severe TBI during a motor vehicle accident 46 days prior to physical therapy evaluation. On the 8-level Rancho Los Amigos Cognitive Function Scale, her functioning was classified as level IV. She had impairments in attention, functional mobility, and balance, all of which limited her ability to participate in activities of daily living. : Physical therapy was provided over 26 days within the inpatient rehabilitation setting. Interventions included mobility tasks such as walking, balancing, and stair climbing. Mobility training was paired with specific secondary cognitive and motor tasks. Dual-task training may have contributed to improvements on outcome measures designed to test divided attention including the Walking While Talking Test and Trail Making Test and a greater rate of improvement in walking speed and time to descend stairs when compared to the baseline phase. Addition of cognitive-motor dual-task training to standard physical therapy in the inpatient rehabilitation setting appears to be feasible and may have value for improving function in individuals with severe TBI. (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A41) for more insights from the authors.