Dual-task Performance Research Articles

Dual-Task Assessments for Predicting Future Falls in Neurologic Conditions: A Systematic Review.

This review investigated the ability of dual-task tests to predict falls in people with neurological disorders. Databases were searched to identify prospective cohort studies that analyzed dual-task testing and falls in people with neurological disorders. Reviewers screened studies for eligibility and extracted key information like participant characteristics, intervention details, outcome measures, and significant outcomes. Reviewers assessed methodological quality of eligible studies using the Standard Quality Assessment Criteria. Eighteen studies of strong methodological qualified with 1750 participants were included in the review. Dual-task performances were predictive of future falls in people with Huntington's disease, spinal cord injury, and moderate cognitive impairment, although only one independent study was included for each disability type. In people with stroke, 37% of eligible studies showed dual-task assessments to be predictive of future falls. No dual-task tests predicted prospective falling in people with Alzheimer's or Parkinson's disease. Complex dual tasks seemed to be more predictive of fall risk than simpler dual tasks. Results suggest that disability type, severity of disability, and task complexity play a role in the predictive ability of dual-task assessments and future falling in neurological disorders. Future studies may benefit from using this review to guide the design of effective dual-task assessments and fall interventions.

Cognitively enhanced tai chi improved cognition vs. tai chi or stretching at 24 wk in older adults with MCI or memory concerns.

Li F, Harmer P, Eckstrom E, et al. Clinical effectiveness of cognitively enhanced tai ji quan training on global cognition and dual-task performance during walking in older adults with mild cognitive impairment or self-reported memory concerns: a randomized controlled trial. Ann Intern Med. 2023;176:1498-1507. 37903365.

Speaking demands: concurrent visuomotor rotor pursuit tracking measures cognitive load for speech

ABSTRACT Purpose The purpose of this proof-of-principle study was to determine the extent to which concurrent tracking in a visuomotor rotor pursuit task is a feasible task for inferring the attentional load of clinical speaking tasks. The central predictions of the concurrent dual-task paradigm suggest that participants would exhibit performance change on a visuomotor rotor pursuit task during concurrent speech task performance, particularly when performing an attention-demanding speech task. Method Twenty-five participants performed common speech clinical assessment tasks that included syllable repetition, sentence repetition, counting forward by one, or serial subtraction by three, which requires a higher working memory load. All speech tasks were performed as a single-task and under dual-task conditions with a concurrent visuomotor rotor pursuit task. Results Compared to performing the attention-demanding visuomotor rotor pursuit task as a single-task, participants exhibited clear reductions in tracking accuracy (percent time-on-target) when performing under dual-task conditions with a concurrent speech task. A significantly greater reduction in tracking accuracy was observed during dual-task performance with a serial subtraction task than during the more automatic speaking tasks that involved repetition and counting forward. Conclusion These data suggest that dual-task performance of even repetitive speaking tasks introduces an attentional demand that is reflected in dual-task performance of a concurrent visuomotor rotor pursuit task and that this interference may be greater for speech tasks that require more cognitive resources.

Can transcranial direct current stimulation combined with interactive computerized cognitive training boost cognition and gait performance in older adults with mild cognitive impairment? a randomized controlled trial

BackgroundOlder adults with Mild Cognitive Impairment (MCI) are often subject to cognitive and gait deficits. Interactive Computerized Cognitive Training (ICCT) may improve cognitive function; however, the effect of such training on gait performance is limited. Transcranial Direct Current Stimulation (tDCS) improves cognition and gait performance. It remains unclear whether combining tDCS with ICCT produces an enhanced synergistic effect on cognition and complex gait performance relative to ICCT alone. This study aimed to compare the effects of tDCS combined with ICCT on cognition and gait performance in older adults with MCI.MethodTwenty-one older adults with MCI were randomly assigned to groups receiving either anodal tDCS and ICCT ( tDCS + ICCT ) or sham tDCS and ICCT ( sham + ICCT ). Participants played Nintendo Switch cognitive games for 40 min per session, simultaneously receiving either anodal or sham tDCS over the left dorsolateral prefrontal cortex for the first 20 min. Cognitive and gait assessments were performed before and after 15 training sessions.ResultsThe global cognition, executive function, and working-memory scores improved in both groups, but there were no significant interaction effects on cognitive outcomes. Additionally, the group × time interactions indicated that tDCS + ICCT significantly enhanced dual-task gait performance in terms of gait speed (p = 0.045), variability (p = 0.016), and dual-task cost (p = 0.039) compared to sham + ICCT.ConclusionThe combined effect of tDCS and ICCT on cognition was not superior to that of ICCT alone; however, it had a significant impact on dual-task gait performance. Administering tDCS as an adjunct to ICCT may thus provide additional benefits for older adults with MCI.Trial registrationThis trial was registered at http://www.clinicaltrials.in.th/ (TCTR 20,220,328,009).

Beyond traditional training: Integrating data from semi-immersive VR dual-task intervention in Parkinsonian Syndromes. A study protocol.

Completing cognitive and motor tasks simultaneously requires a high level of cognitive control in terms of executive processes and attentional abilities. Most of the daily activities require a dual-task performance. While walking, for example, it may be necessary to adapt gait to obstacles of the environment or simply participate in a conversation; all these activities involve more than one ability at the same time. This parallel performance may be critical in the cognitive or motor load, especially for patients with neurological diseases such as Parkinsonian Syndromes. Patients are often characterized by a crucial impairment in performing both tasks concurrently, showing a decrease in attention skills and executive functions, thus leading to increased negative outcomes. In this scenario, the accurate assessment of the components involved in dual-task performance is crucial, and providing an early specific training program appears to be essential. The objective of this protocol is to assess cognitive and motor components involved in dual-task performance and create a training program based on ecological activities focusing on executive and motor functions. Thus, we will employ Virtual Reality to provide semi-immersive, multisensory, ecological, standardized, and realistic experiences for rehabilitative purposes in patients with Parkinsonian Syndromes, considering its high prevalence in aging and the incidence of motor and cognitive dysfunctions in this population. Moreover, we propose to integrate the great amount of different data provided by dual-task and Virtual Reality system, using machine learning techniques. These integrations may increase the treatment's reliability in terms of better prognostic indexes and individualized training.

Train the paediatric colonoscopy trainer course: Assessment of perceived value in improving colonoscopy teaching practice.

Endoscopy teaching practice is variable, which inevitably affects the training provided. There is only one Train the Paediatric Colonoscopy Trainer (TPCT) course in the UK. Informal feedback has been positive, but its practical value has never been formally assessed. We aim to assess the practical value of the TPCT course and how attendees perceive their teaching practice compared to nonattendees. A questionnaire based on the TPCT course learning aims and objectives was distributed to two groups of consultant paediatric gastroenterologists who teach colonoscopy in the UK; those who had attended the course (participants) and those who had not (controls). The 41 completed responses were received. Overall, responses indicated participants of the TPCT course rated their confidence and knowledge in teaching practices as higher than controls (4.27 vs. 3.56 p = < 0.001). There was a statistically significant difference in all areas: set (4.21 vs. 3.71 p = 0.011), dialogue (4.29 vs. 3.55 p = < 0.001) and closure (4.37 vs. 3.6 p = < 0.001) with those who attended the TPCT course giving higher ratings. There was evidence of increased understanding of key concepts such as using standardised language, conscious competence, dual task interference and performance enhancing feedback. Attending a TPCT course results in a higher perceived level of knowledge in fundamental teaching principles and confidence in colonoscopy teaching skills.

Brain control of dual-task walking can be improved in aging and neurological disease.

The peak prevalence of multiple sclerosis has shifted into older age groups, but co-occurring and possibly synergistic motoric and cognitive declines in this patient population are poorly understood. Dual-task-walking performance, subserved by the prefrontal cortex, and compromised in multiple sclerosis and aging, predicts health outcomes. Whether acute practice can improve dual-task walking performance and prefrontal cortex hemodynamic response efficiency in multiple sclerosis has not been reported. To address this gap in the literature, the current study examined task- and practice-related effects on dual-task-walking and associated brain activation in older adults with multiple sclerosis and controls. Multiple sclerosis (n = 94, mean age = 64.76 ± 4.19years) and control (n = 104, mean age = 68.18 ± 7.01years) participants were tested under three experimental conditions (dual-task-walk, single-task-walk, and single-task-alpha) administered over three repeated counterbalanced trials. Functional near-infrared-spectroscopy was used to evaluate task- and practice-related changes in prefrontal cortex oxygenated hemoglobin. Gait and cognitive performances declined, and prefrontal cortex oxygenated hemoglobin was higher in dual compared to both single task conditions in both groups. Gait and cognitive performances improved over trials in both groups. There were greater declines over trials in oxygenated hemoglobin in dual-task-walk compared to single-task-walk in both groups. Among controls, but not multiple sclerosis participants, declines over trials in oxygenated hemoglobin were greater in dual-task-walk compared to single-task-alpha. Dual-task walking and associated prefrontal cortex activation efficiency improved during a single session, but improvement in neural resource utilization, although significant, was attenuated in multiple sclerosis participants. These findings suggest encouraging brain adaptability in aging and neurological disease.

Ab. No. 155 Effect of Brain Gym Exercises on Executive Functions and Dual –Task Performance in Person’s With Parkinson’s Disease

Introduction: Cognitive impairments are common in Parkinson’s disease, and one of the most noticeable features is dysfunction in the executive function. Because of these changes, performing dual tasks that require the person’s attention and concentration, tend to be more difficult to accomplish. Brain Gym exercise is an academic kinesiological program that stimulates various brain regions, with a particular emphasis on the corpus callosum, facilitating inter-hemisphere communication. In brain gym exercise participants engage in a wide variety of tasks that engage different aspects of cognitive and physical functioning. These exercises had shown to improve cognitive performance and fitness levels in active older adults. Considering this the study is conducted with an intent to find if there is any effect of brain gym exercises on executive function and dual task performance in the persons with Parkinson’s disease. Methods: 19 persons with Parkinson’s disease age between 50-75 years with stages I-III on Modified Hoehn and Yahr classification, who can identify the sequencing from 1-25 and A-Z and can walk for at least 9 m (30ft) with or without assistive device participated in the study. Institutional ethical committee approval and participants consent was obtained. Intervention comprising of 23 brain gym exercise, each exercise 3 times per session for 4 days a week for 2 weeks was given. Pre and post intervention Executive Function was assed using Delta Trail Making test and Dual Task Performance was assessed using Timed up and GO test – Cognition. Wilcoxon Signed Rank test was used to compare pre and post values of outcome measures and statistically significant difference was seen in both the outcome measures (with p value of 0.000) Conclusion: The study concluded that Brain gym exercises are effective in improving executive function, dual task performance and can be incorporated with conventional exercises in treatment of persons with Parkinson’s disease.

Locomotor-cognitive dual-tasking in children with developmental coordination disorder.

Children with Developmental Coordination Disorder (DCD) demonstrate deficits in predictive motor control and aspects of cognitive control compared with their typically developing (TD) peers. Adjustment to dynamic environments depends on both aspects of control and the deficits for children with DCD may constrain their ability to perform daily actions that involve dual-tasking. Under the assumption that motor-cognitive integration is compromised in children with DCD, we examined proportional dual-task costs using a novel locomotor-cognitive dual-task paradigm that enlisted augmented reality. We expect proportional dual-task performance costs to be greater for children with DCD compared to their TD peers. Participants were 34 children aged 6-12 years (16 TD, 18 DCD) who walked along a straight 12 m path under single- and dual-task conditions, the cognitive task being visual discrimination under simple or complex stimulus conditions presented via augmented reality. Dual-task performance was measured in two ways: first, proportional dual-task costs (pDTC) were computed for cognitive and gait outcomes and, second, within-trial costs (p-WTC) were measured as the difference on gait outcomes between pre- and post-stimulus presentation. On measures of pDTC, TD children increased their double-limb support time when walking in response to a dual-task, while the children with DCD increased their locomotor velocity. On p-WTC, both groups increased their gait variability (step length and step width) when walking in response to a dual-task, of which the TD group had a larger proportional change than the DCD group. Greater pDTCs on motor rather than cognitive outcomes were consistent across groups and method of dual-task performance measurement. Contrary to predictions, our results failed to support dramatic differences in locomotor-cognitive dual-task performance between children with DCD and TD, with both groups tending to priorities the cognitive over the motor task. Inclusion of a within-trial calculation of dual-task interference revealed an expectancy effect for both groups in relation to an impending visual stimulus. It is recommended that dual-task paradigms in the future continue to use augmented reality to present the cognitive task and consider motor tasks of sufficient complexity to probe the limits of performance in children with DCD.

Dual-Task Cost Effects on Static Posture Control Parameters and Choice Reaction Time in Individuals With and Without Intellectual Disabilities.

This study aimed to evaluate the effect of age and intellectual disability (ID) on postural balance parameters, dual-task cost (DTC), and choice reaction time (CRT). Fifty-eight individuals with ID and 55 peers without ID performed a postural stance balance task under two conditions: a single task with eyes open and dual task involving an additional cognitive task (light sequence). Four postural balance parameters (total displacement, total sway area, mediolateral, and anteroposterior dispersion), cost of the dual task ([DTC%] = [(single-task performance - dual-task performance)/single-task performance] × 100), and CRT were recorded, calculated, and analyzed. All postural control parameters reflected poorerperformance during the dual-task condition, nevertheless, DTC was significantly higher only in individuals with ID and only for the total sway area, F(1, 111) = 5.039, p = .027, and mediolateral dispersion, F(1, 111) = 6.576, p = .012. CRT was longer in individuals with ID compared with the individuals without ID, F(1, 111) = 94.979, p ≤ .001, while age did not have a significant effect on the DTC nor on the CRT, F(1, 111) = 0.074, p = .786. In conclusion, an additional cognitive task during the postural balance task had a detrimental effect on various postural balance parameters, leading to increased DTC in terms of total sway area, mediolateral dispersion, and prolonged CRT in individuals with ID.

Dual- and Single-Task Training in Older Adults With Age-Related Hearing Loss: A Randomized Controlled Study.

We aimed to investigate the effects of dual- and single-task training in older adults with age-related hearing loss. Intervention groups included single-, dual-task training, and control groups. The dual- and single-task trainings were held 2 days a week for 40min for a total of 10 sessions for 5 weeks. We evaluated physical, cognitive, and auditory functions, quality-of-life, balance, concerns about falling, independence in activities of daily living, and dual-task performance. A total of 42 patients fully participated in this study. Statistically significant differences were observed in chair stand, chair sit-and-reach, global cognitive function, and delayed recall between the intervention groups and control group (p < .05). There was no statistically significant difference in quality-of-life, balance, falling concerns, independence in activities of daily living, and dual-task performance between all groups (p > .05). In conclusion, single- and dual-task training had a positive effect on physical and cognitive functioning in older adults with age-related hearing loss.

Dual-Task Performance in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-Analysis.

Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS-I). The meta-analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06-1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD.

Is There an Association Between Self-Reported Dual-Task Performance and Fear of Falling in Older Adults?

Is there an association between self-reported dual-task performance and fear of falling in older adults? Fear of falling tends to increase with age and can negatively impact dual-task abilities, leading to potential declines in overall quality of life. Therefore, it becomes crucial to evaluate dual-task performance in older adults, particularly prior to the onset of fear of falling. This study aims to investigate the potential association between self-reported dual-task performance and fear of falling in older adults. A total of 51 individuals (19 females and 32 males) were recruited. The participants met the inclusion criteria were administered the Dual-Task Questionnaire (DTQ), Falls Efficiency Scale International, and Physical Activity Scale for the Elderly. Multiple linear regression was performed to predict DTQ scores based on age, body mass index, and Physical Activity Scale for the Elderly. A moderate positive correlation was found between Falls Efficiency Scale International scores and self-reported DTQ scores (r: .448, p: .001). Age, body mass index, and Physical Activity Scale for the Elderly were not found to be significant predictors of DTQ scores. Our study reveals a moderate positive association between fear of falling and self-reported dual-task performance in older adults. A direct relationship between physical activity performance, fear of falling, and self-reported dual-task performance was observed among older adults. Significance/Implications: Integrating self-reported measures like the DTQ in clinical evaluations can provide valuable insights into dual-task abilities of older adults.

Changes of neural coupling between cognitive and motor networks associated with dual-task performance in Parkinson's disease.

Although cognitive control is essential for efficient gait, the associations between cognitive and motor networks regarding gait in individuals with Parkinson's disease (PD) remain to be determined. Herein, we enrolled 28 PD and 28 controls to compare internetwork coupling among cognitive and motor networks and examine its relationship with single- and dual-task gait performance in PD. The dorsal attention network (DAN), left and right frontoparietal control networks (FPNs), sensorimotor network, and lateral motor network were identified using resting-state functional magnetic resonance imaging data. The time taken to complete a 10-m walk test during cognitive or physical dual-tasks in PD was calculated representing gait performance. We observed that the internetwork couplings between the DAN and motor networks and between the motor networks decreased whereas those between the left FPN and DAN and motor networks increased in PD compared to controls using a permutation test. There was no significant correlation between the internetwork couplings and single- and dual-task gait performance in PD. Nevertheless, improved cognitive dual-task performance showed a positive correlation with the DAN and left FPN coupling and a negative correlation with the DAN and lateral motor network coupling in a good performance group. The opposite relationship was observed in the poor cognitive dual-task performance group. Our findings suggest a neural mechanism of cognitive control on gait to compensate for reduced goal-directed attention in PD who maintain cognitive dual-task performance.

Cognitive CAMSA: an ecological proposal to integrate cognitive performance into motor competence assessment.

To profile the participants using a system of self-organizing maps (SOM) based on their motor and cognitive performance during a dual-task version of the Canadian Agility and Movement Skill Assessment (Cognitive CAMSA). A total of 169 secondary school students (39.3% girls) volunteered to participate. The original CAMSA, cognitive CAMSA, the Corsi and Digit Span tests were used to assess (a) motor competence, (b) motor competence with cognitive load, and (c) cognitive performance, respectively. SOMs and the k-means clustering algorithm were used to establish the adolescents' dual-task performance profiles. Including decision making based on verbal and visual cues in the original CAMSA significantly increased the participants' total scores but also the time required to complete the test, while the skill score remained unchanged. However, not all the participants showed changes in their performance in the same direction during the cognitive CAMSA. Person-centered analyses by SOMs and k-means clustering identified six performance profiles with variations in the cognitive, motor skill, and time scores (H5 = 146.15, H5 = 102.68, and H5 = 108.07, respectively; all p < 0.01). The cognitive CAMSA was shown to be a feasible field-motor test for assessing motor competence with a cognitive load in an ecological setting. Some of the profiles identified in the SOM approach represented adolescents with similar motor and cognitive performance in dual-task or single-task contexts, although other participants obtained high motor competence in single and dual-tasking while their cognitive performance declined or rose more in dual-task than in single task situations. The cognitive CAMSA emerges as a tool of great potential, applicable in educational and sports environments, to know subjects' characteristics and try to individualize the interventions accordingly with their dual-task profile.

Dual task impact on functional mobility and interaction of functional level and balance in patients with Duchenne muscular dystrophy

BackgroundDystrophin, a protein crucial for various brain regions governing higher-order functions like learning and memory is notably absent in individuals with Duchenne muscular dystrophy (DMD). This absence of dystrophin in the brain is believed to underlie cognitive challenges in DMD. Cognitive and motor challenges observed in DMD could potentially hinder the execution of dual tasks. Research questionIs there a significant correlation between dual-task performance, functional mobility, and balance in children with DMD? MethodThe study included 28 participants (14 DMD, 14 typical development). Timed Up and Go (TUG) test results were recorded for single and dual-task conditions (motor-motor, cognitive-motor). Functional level was assessed using Motor Function Measurement-32 (MFM-32), Brooke Upper Extremity Scale, and Vignos Scale. Balance was evaluated using Balance Master System and Pediatric Functional Reach Test (PFRT). ResultsSignificant differences in TUG test scores across conditions were observed in both DMD and typical development groups (p < 0.05). Children with DMD exhibited longer completion times compared to typical development children (p < 0.05). Among children with DMD, there was a significant correlation between TUG scores in different task conditions and balance assessment (p < 0.05, r = 0.571 to −0.819). Lower MFM-32 scores in DMD children were correlated with worse TUG performance across conditions (p < 0.05, r = 0.586 to −0.868). SignifianceThis study sheds light on the multifaceted nature of dual-tasking challenges in individuals with DMD, thereby contributing to a deeper understanding of the implications for rehabilitation strategies.

Older adults exhibit declines in instrumental activities of daily living during a virtual grocery shopping task

Introduction: The successful performance of instrumental activities of daily living (IADLs) is critical in maintaining independence for older adults. Traditional IADL questionnaires and performance-based assessments are time consuming, potentially unreliable, and fail to adequately consider the interplay between cognitive and motor performance in completing IADLs. The Cleveland Clinic Virtual Reality Shopping (CC-VRS) platform was developed to objectively quantify IADL performance through the characterization of cognitive, motor, and cognitive-motor function. The CC-VRS combines an immersive virtual grocery store with an omnidirectional treadmill to create a scenario in which the user physically navigates through a virtual environment. The primary aim of this project was to determine the known-group validity of the CC-VRS platform to characterize IADL performance in healthy older adults and young adults.Methods: Twenty healthy young (n = 10) and older (n = 10) adults completed the Basic and Complex CC-VRS scenarios. Position data from VR trackers on the hands, waist, and feet were used to quantify motor performance. Cognitive and dual-task performance were automatically calculated by the application during specific shopping sub-tasks.Results: Older adults exhibited significantly worse performance on multiple cognitive, motor, and dual-task outcomes of the CC-VRS (e. g., average walking speed, number of list activations, and stopping frequency).Discussion: The CC-VRS successfully discriminated IADL performance between young and healthy older adults. The complex realistic environment of the CC-VRS, combined with simultaneous evaluation of motor and cognitive performance, has the potential to more accurately characterize IADL performance by identifying subtle functional deficits that may precede neurological disease.

The effect of dual-task training on cognitive ability, physical function, and dual-task performance in people with dementia or mild cognitive impairment: A systematic review and meta-analysis

Objective To summarize the effect of dual-task training on cognitive, physical function, and dual-task performance in people with mild cognitive impairment or dementia. Data sources Embase, PEDro, PsycINFO, PubMed, CINAHL, The Cochrane Library, and a forward search conducted via Web of Science have been searched from inception to July 2023. Review methods Good-quality randomized controlled trials compared dual-task training with no/placebo intervention or single-task training among people with a primary diagnosis of mild cognitive impairment or dementia were included. The PEDro scale was used to evaluate the methodological quality of individual studies. The Grading of Recommendations, Assessment, Development and Evaluations system was adopted to appraise the quality of evidence for each outcome. Results Eighteen trials (1325 participants) were included, and 17 provided data for meta-analysis. Comparing with no intervention, dual-task training led to significant improvements on attention (mean difference (MD) = −20.66, 95%CI [−39.42, −1.90]), functional mobility (MD = −2.73; 95%CI [−3.98, −1.49]). Compared with single-task training, dual-task training had greater effects on overall cognitive function (standardized mean difference (SMD) = 0.29, 95%CI [0.09, 0.49]), balance (SMD = 0.78, 95%CI [0.40, 1.15]) and functional mobility (MD = −1.17; 95%CI [−1.77, −0.58]). Its effect on dual-task performance remains inconclusive due to the inconsistent results reported. Conclusion Low- to moderate-quality evidence supports that dual-task training has beneficial effects on cognitive function and physical function in individuals with dementia or mild cognitive impairment. The optimal training protocol of dual-task training on cognitive and physical functions, and dual-task performance remains uncertain. Well-designed, randomized studies with large enough sample sizes are warranted.

Immediate effects of multimodal cognitive therapy in mild cognitive impairment.

Current therapeutic evidence suggests limited efficacy of the cognitive and exercise training in mild cognitive impairment (MCI) on depression, anxiety, memory retention, comprehension, calculation, concentration, orientation, dual-task performance, and sleep disorders. Nevertheless, the immediate effects of multimodal cognitive therapy (MCT) have recently developed and its individual effects remains unknown in MCI. This study aimed to compare the immediate effects of MCT on cognitive and psychological measures between young healthy and older adults with MCI. Forty young healthy and older adults with MCI underwent immediate MCT (5 minutes each), including transcranial direct current stimulation (tDCS), light therapy, computerized cognitive therapy (CCT), robotic-assisted gait training (RAGT), core breathing exercises (CBE), and music therapy. Outcome measures included memory retention, comprehension, calculation, attention, orientation, dual-task performance, awareness, depression, anxiety, and sleep disorders. The Mann-Whitney U test and Friedman's test were used at P < 0.05. Significant differences in depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness were observed between the tDCS, CCT, and music therapy groups (P < 0.05). MCT was beneficial for mitigating depression, anxiety, memory retention, comprehension, calculation, attention, orientation, dual-task performance, and awareness.

Development of the Troop Readiness Evaluation With Augmented Reality Return-to-Duty (Troop READY) Platform to Aid in the Detection and Treatment of Military Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI) is prevalent in service members (SMs); however, there is a lack of consensus on the appropriate approach to return to duty (RTD). Head-mounted augmented reality technology, such as the HoloLens 2, can create immersive, salient environments to more effectively evaluate relevant military task performance. The Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) platform was developed to objectively quantify cognitive and motor performance during military-specific activities to create a comprehensive approach to aid in mTBI detection and facilitate appropriate RTD. The aim of this project was to detail the technical development of the Troop READY platform, the outcomes, and its potential role in the aiding detection and RTD decision-making post mTBI. The secondary aim included evaluating the safety, feasibility, and SM usability of the Troop READY platform. The Troop READY platform comprises three assessment modules of progressing complexity: (1) Static and Dynamic Mobility, (2) Rifle Qualification Test, and (3) Small Unit Operations Capacity-Room Breach/Clearing Exercise. The modules were completed by 137 active duty SMs. Safety was assessed through monitoring of adverse events. Feasibility was assessed using the self-directed module completion rate. Usability was measured using the Systems Usability Scale. No adverse events occurred. Completion rates of the three modules ranged from 98 to 100%. In terms of usability, the mean Systems Usability Scale score of all participants was 83.92 (13.95), placing the Troop READY platform in the good-to-excellent category. Objective motor and cognitive outcomes were generated for each module. The Troop READY platform delivers self-directed, salient assessment modules to quantify single-task, dual-task, and unit-based performance in SMs. The resultant data provide insight into SM performance through objective outcomes and identify specific areas of executive or motor function that may be slow to recover following mTBI.