What Is Dual Tasking in Occupational Therapy? 

If you are new to Dual Tasking, take this AOTA-Approved Dual Tasking CE Course to better understand the concepts. 

Helpful Resource: Simple Ways to Add Dual Tasking into your Occupational Therapy Treatment

Dual tasking sounds complicated, but the basic idea is simple.

A true dual task happens when a person performs two separate tasks at the same time, and each task has its own goal and can be measured independently (McIsaac et al., 2015).

For example:

• Walking while answering questions
• Standing while naming items in a category
• Sorting medication while listening for a timer
• Navigating obstacles while remembering directions
• Reaching for objects while counting backward

Dual tasking matters because everyday life almost never happens one task at a time.

People walk while talking. They prepare food while monitoring children. They cross the street while watching traffic. They carry groceries while navigating stairs. They listen to instructions while moving through a crowded environment.

After a stroke, brain injury, Parkinson’s disease, multiple sclerosis, dementia, or another neurological condition, these previously automatic combinations may suddenly become difficult.

The person may still be able to perform each task separately.

They can walk.

They can answer a question.

But when they try to walk and answer the question at the same time, one or both tasks begin to break down.

That breakdown is called dual-task interference.

What Is Dual-Task Interference?

Dual-task interference occurs when performance gets worse because two tasks are competing for the person’s attention or processing capacity.

The change may appear in the motor task.

The person may:

• Walk more slowly
• Shorten their steps
• Lose balance
• Stop moving
• Use more compensatory movement
• Miss an obstacle
• Need more physical assistance

The change may also appear in the cognitive task.

The person may:

• Stop talking
• Forget the instructions
• Lose their place
• Make more errors
• Respond slowly
• Repeat themselves
• Abandon one part of the task

Sometimes both tasks decline.

This is why a patient may look safe in a quiet therapy room but struggle in a grocery store, kitchen, classroom, or busy hallway.

The single task did not reveal the full problem.

The combined task did.

Not Everything That Looks Like Dual Tasking Is a True Dual Task

Walking while carrying a full glass of water is often called a motor-motor dual task. However, McIsaac, Lamberg, and Muratori argued that this may actually be a complex single task rather than a true dual task (McIsaac et al., 2015).

Why?

Because walking and stabilizing the glass work together toward one shared goal:

Move the water from one location to another without spilling it.

The two actions cannot be separated very easily. The way the person holds the glass directly changes how they walk, position the trunk, and control the body.

A true dual task has two distinct goals.

For example:

Walk to the other side of the room while naming as many animals as possible.

The walking task has one goal.

The word-generation task has another.

Each can be measured separately.

This distinction matters because therapists should know what they are actually testing.

A complex functional activity can still be very valuable. It simply may not meet the strict research definition of dual tasking.

Looking for more dual tasking intervention ideas? Check out cognitive intervention resources. 

Everyday Examples of Dual Tasking

True dual tasks may include:

• Walking while having a conversation
• Standing while remembering a shopping list
• Navigating stairs while answering a question
• Crossing a room while scanning for a specific sign
• Folding laundry while planning the next household task
• Walking through a store while comparing prices
• Completing exercises while following changing verbal commands
• Preparing a meal while responding to a timer
• Moving through a hallway while remembering directions

Complex single tasks may include:

• Carrying a tray while walking
• Pushing a shopping cart through a store
• Transporting a laundry basket
• Pouring a drink without spilling
• Carrying a child while moving through the home

Both categories matter in occupational therapy.

The difference is whether the therapist is studying two independent tasks or one complex activity with several connected parts.

Two Main Types of Dual Tasking

Dual-task activities are often described as cognitive-motor or motor-motor.

Cognitive-Motor Dual Tasking

A cognitive-motor dual task combines a movement task with a thinking task.

Examples include:

• Walking while naming words in a category
• Standing while recalling a sequence
• Reaching while answering questions
• Navigating obstacles while subtracting by threes
• Completing a transfer while explaining the safety steps
• Walking while remembering a short list
• Balancing while following changing commands

These activities may challenge:

• Attention
• Working memory
• Processing speed
• Inhibition
• Cognitive flexibility
• Language
• Visual scanning
• Decision-making
• Motor control
• Balance

Motor-Motor Dual Tasking

A true motor-motor dual task combines two independent movement tasks.

Examples may include:

• Tapping one foot while drawing a shape
• Walking while texting
• Stepping to targets while completing a separate hand pattern
• Maintaining one arm movement while performing a different leg movement
• Throwing a ball while following an unrelated stepping sequence

Motor-motor tasks may compete for:

• Visual attention
• Limb coordination
• Motor planning
• Timing
• Spatial processing
• Postural control
• Response selection

Research has not consistently shown that one type is always more difficult than the other.

Some studies have found more interference from a manual motor task. Others have found greater interference from a cognitive task. The result often depends on the exact tasks, the person, and the outcome being measured (O’Shea et al., 2002; Asai et al., 2014; McIsaac et al., 2015).

For example, one task pairing may reduce walking speed, while another increases stride variability.

This is why we should stop asking:

Is motor-motor or cognitive-motor dual tasking harder?

The better question is:

Which resources do these two tasks require, and where does this patient’s performance begin to break down?

Member Resources: 

• Dual Tasking Assessments and Interventions 
• Dual Tasking Ideas for Groups

Why Can’t the Brain Just Do Both Tasks?

Researchers have proposed several explanations.

1. Capacity-Sharing Theory

This is the easiest theory to understand.

Imagine that the person has a limited amount of attention available.

One task uses part of it.

The second task uses more.

When the combined demand becomes greater than the person’s available capacity, performance declines.

For example, walking may usually require little conscious attention.

After a neurological injury, walking may require much more attention because the person must consciously think about balance, foot placement, posture, and safety.

When a conversation is added, there may not be enough capacity available to manage both tasks well.

2. Multiple Resource Theory

Multiple Resource Theory suggests that attention is not one single bucket.

Instead, the nervous system has several partially separate processing resources.

Tasks may use different:

• Sensory channels
• Response systems
• Processing stages
• Types of information

For example, one task may be primarily visual and spatial.

Another may be auditory and verbal.

According to this theory, tasks interfere more when they compete for the same resources (Wickens, 2008).

A visual scanning task and a visually guided walking task may compete heavily because both depend on visual-spatial processing.

Walking while listening to a simple verbal instruction may create less interference because the tasks rely on somewhat different channels.

This is not a perfect rule, but it gives therapists a useful way to analyze task demands.

3. Central Bottleneck Theory

The central bottleneck theory suggests that some parts of information processing cannot happen at exactly the same time.

The brain may receive two pieces of information, but response selection becomes crowded.

One response has to wait while the other is selected.

This creates a delay known as the psychological refractory period (Pashler, 1994).

In very simple language:

The brain may notice both tasks, but it cannot always decide on two separate responses at the exact same moment.

This may explain why people hesitate, freeze, stop walking, or respond slowly when two demands occur very close together.

4. Task-Switching and Personal Strategy

People do not all manage multiple tasks in the same way.

Some people block tasks. They focus on one task for a period and then shift to the other.

Some rapidly switch back and forth.

Others group their responses and attempt to respond to both demands close together.

These strategies may affect speed, accuracy, and fatigue. They may also change depending on whether the tasks use similar or different resources (Brüning et al., 2020).

This means therapists should observe not only whether performance declines, but also how the person tries to manage the demands.

Member Resource: Attention Resource and How Alternating Attention Feels Under Cognitive Load

Helpful Resource Page: Trouble Multi-Tasking

Why Dual Tasking Matters in Neurological Rehabilitation

Many everyday movements are normally automatic.

A healthy adult does not usually need to consciously plan every step while walking across a room.

After neurological injury or disease, that automaticity may be reduced.

The person may need to consciously think about:

• Taking a large enough step
• Clearing the foot
• Shifting weight
• Maintaining posture
• Turning
• Avoiding obstacles
• Controlling speed
• Staying balanced

That leaves fewer resources available for conversation, memory, navigation, or decision-making.

This is commonly seen in people with:

• Stroke
• Parkinson’s disease
• Brain injury
• Multiple sclerosis
• Dementia
• Cerebellar disorders
• Vestibular dysfunction
• Age-related cognitive and motor changes (Go to Functional Cognition Resource Page)

Dual-task performance may reveal problems that are hidden during simple testing.

A person may score well on a brief cognitive screen while seated in a quiet room. 

The same person may become confused when medication management, movement, interruptions, and time pressure occur together.

That is why dual tasking is closely connected to functional cognition.

The question is not only whether the person can think.

The question is whether they can think while doing what real life requires.

Adrianna Brown, MS, OTR/L and I discuss this in our blog article, ' When the Scores Don't Match the Person: Using Activity Analysis to Bridge Cognitive Capacity and Functional Performance'

Examples of Dual Tasking in Occupational Therapy

Occupational therapy practitioners can use dual-task training to connect cognitive, sensory, motor, emotional, and environmental demands.

Cognitive-Motor Examples

• Walking while recalling a short grocery list
• Standing while naming items required for a morning routine
• Reaching into cabinets while following two-step directions
• Completing a transfer while explaining the safety sequence
• Folding laundry while sorting items by person and location
• Navigating obstacles while remembering room numbers
• Preparing food while responding to a timer
• Carrying household items while answering safety questions

Motor-Motor Examples

• Completing a stepping pattern while manipulating objects
• Maintaining a lower-extremity rhythm while completing a hand task
• Moving through obstacles while texting
• Reaching to targets while completing a separate foot-tapping pattern
• Alternating upper- and lower-body sequences with independent goals

Complex Functional Tasks

• Carrying a glass through the kitchen
• Moving a laundry basket between rooms
• Pushing a grocery cart while reaching for products
• Carrying a tray while navigating around furniture
• Transporting supplies during a work simulation

Again, complex single tasks are not lesser tasks.

They are simply classified differently.

Dual Tasking Is Not Just “Walking While Counting”, Interventions Can and Should go Beyond this Common Practice

Walking while counting backward is popular because it is easy to set up. But it is not appropriate for every person or every goal. Just because something is common does not make it best practice for your patient. 

A secondary cognitive task can involve:

• Working memory
• Planning
• Language
• Inhibition
• Visual attention
• Auditory attention
• Decision-making
• Sequencing
• Problem-solving
• Prospective memory

The therapist should select the secondary task based on what the patient actually needs.

• A person returning to grocery shopping may need visual scanning and working memory.
• A teacher may need divided attention, verbal processing, and environmental monitoring.
• A parent may need to move safely while listening for a child and planning the next task.
• A patient managing medication may need prospective memory, sequencing, and error detection.

Counting by threes may reveal interference and help engage/excite that area of the brain (which is great!), but it does not automatically represent the occupation the patient needs to return to.

How to Grade Dual-Task Activities

Dual-task training should not begin by making everything difficult at once.

Start by understanding each task separately.

• Can the patient safely complete the motor task alone?
• Can they complete the cognitive task alone?
• What happens then the two are combined?

Then change one variable at a time.

You can grade the motor task by changing:

• Speed
• Distance
• Surface
• Base of support
• Amount of upper-extremity support
• Direction changes
• Obstacles
• Object weight
• Assistance level

You can grade the cognitive task by changing:

• Number of instructions
• Response speed
• Memory length
• Familiarity
• Distraction
• Need for inhibition
• Need for switching
• Amount of problem-solving

You can also change task priority.

You may tell the patient:

• Focus on walking safely
• Keep both tasks equally accurate
• Prioritize the memory task
• Switch priorities when cued

This gives you valuable information about how the patient allocates attention.

Coordination and Sensory Integration

Dual-task performance is not only about cognition.

Coordination and sensory processing often affect how well the person can manage combined demands.

A patient may need to integrate:

• Vision
• Proprioception
• Vestibular input
• Touch
• Auditory information
• Body position
• Movement timing

Examples include:

Obstacle navigation with visual or auditory cues

The person must process the cue, identify the obstacle, plan the response, and maintain balance.

Hand-eye coordination activities

The person tracks a moving target, times the movement, and controls force and accuracy.

Sequential movement patterns

The person watches or hears a sequence, remembers it, plans the movement, and performs it in the correct order.

These activities may address:

• Praxis
• Body awareness
• Spatial orientation
• Working memory
• Motor planning
• Executive function
• Postural control

Dual Tasking and Interdisciplinary Care

Dual tasking does not belong to one rehabilitation profession.

Occupational therapy practitioners, physical therapy practitioners and speech-language pathologists may all address cognitive-motor performance from different professional perspectives.

Physical therapy may use dual-task training during gait, mobility, balance, and movement interventions.

Speech-language pathology may address language, attention, memory, executive function, and communication during functional activities.

Occupational therapy may combine movement and cognition within meaningful occupations, roles, routines, and environmental demands.

There will be overlap.

That is not automatically a problem.

Cognition does not become irrelevant simply because the person is moving.

Movement does not become irrelevant simply because the task is cognitive.

The person needs both systems to work together.

Interdisciplinary collaboration may include:

• Using the same safety language
• Reinforcing shared strategies
• Coordinating task progression
• Identifying which task declines first
• Sharing observations across settings
• Connecting impairment-level work to daily function

The goal should be collaboration, not competition.

At the same time, every profession should be clear about its reasoning, scope, and contribution.

The Occupational Therapy Role

Occupational therapy practitioners are particularly well positioned to study dual-task performance because we analyze the interaction between the person, task, environment, habits, roles, and desired occupations.

We do not only ask:

Can the patient walk while counting?

We ask:

• Can the patient move safely while preparing breakfast?
• Can they follow a morning routine while managing distractions?
• Can they carry laundry while remembering where it belongs?
• Can they navigate a store while finding and comparing products?
• Can they return to work while handling interruptions?
• Can they monitor a child while completing household tasks?

The occupational therapy practitioner can identify exactly where performance breaks down.

The problem may involve:

• Attention
• Memory
• Processing speed
• Balance
• Strength
• Sensory processing
• Motor planning
• Emotional regulation
• Environmental distraction
• Poor task organization

The intervention should target the specific breakdown.

Case Example

Client Profile

A 58-year-old client with early Parkinson’s disease reports difficulty managing household tasks.

Strength and basic mobility have improved.

However, the client:

• Loses track of multistep activities
• Forgets to turn off appliances
• Becomes less stable when talking
• Stops walking when asked a question
• Has difficulty switching between tasks
• Becomes overwhelmed when the environment is busy

Step 1: Test Tasks Separately

First, evaluate the components.

Can the client:

• Stand safely without an added task?
• Walk across the kitchen?
• Recall the steps of meal preparation?
• Identify stove-safety strategies?
• Shift attention between two instructions?

This helps establish whether the difficulty is present during the single task or appears mainly when demands are combined.

Step 2: Introduce a Simple Dual Task

The client may begin by standing at the counter while recalling three meal-preparation steps.

The therapist observes:

• Balance
• Response time
• Accuracy
• Movement quality
• Need for cues
• Signs of fatigue

Step 3: Increase Functional Complexity

The activity may progress to:

• Reaching for ingredients while following the sequence
• Walking between the refrigerator and counter while remembering two items
• Responding to a timer while preparing food
• Identifying a safety error during the activity
• Resuming the task after an interruption

Step 4: Teach a Strategy

The therapist may introduce:

• A written checklist
• Verbal self-talk
• A stove-shutoff routine
• Environmental organization
• A pause-and-plan strategy
• A timer or reminder system

Step 5: Practice Carryover

The client practices the strategy during a realistic meal-preparation task.

The goal is not merely to improve performance during a therapy exercise.

The goal is to help the client safely manage a meaningful household occupation.

Continue Learning With Us

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Helpful Dual Tasking References

1. Norman, D. A. (1975). On data-limited and resource-limited processes. Cognitive Psychology, 7(1), 44–64. 
2. McIsaac, T. L., Lamberg, E. M., & Muratori, L. M. (2015). Building a framework for a dual task taxonomy. BioMed Research International, 2015, Article 591475. https://doi.org/10.1155/2015/591475  
3. Pashler, H. (1994). Dual-task interference in simple tasks: Data and theory. Psychological Bulletin, 116(2), 220–244. 
4. Bruya, B., & Tang, Y.-Y. (2018). Is attention really effort? Revisiting Daniel Kahneman's influential 1973 book Attention and Effort. Frontiers in Psychology, 9, Article 1133. https://doi.org/10.3389/fpsyg.2018.01133 
5. Wickens, C. D. (2008). Multiple resources and mental workload. Human Factors, 50(3), 449–455. https://doi.org/10.1518/001872008X288394 
6. Brüning, J., Mückstein, M., & Manzey, D. (2020). Multitasking strategies make the difference: Separating processing-code resources boosts multitasking efficiency when individuals prefer to interleave tasks in free concurrent dual tasking. Journal of Experimental Psychology: Human Perception and Performance, 46(12), 1411–1433. https://doi.org/10.1037/xhp0000865  
7. Friedman, N. P., Miyake, A., Corley, R. P., Young, S. E., DeFries, J. C., & Hewitt, J. K. (2006). Not all executive functions are related to intelligence. Psychological Science, 17(2), 172-179. 
8. Ruthruff, E., Pashler, H. E., & Klaassen, A. (2001). Processing bottlenecks in dual-task performance: Structural limitation or strategic postponement? Psychonomic Bulletin & Review, 8(1), 73-80. 
9. Toba, M. N., Seidel Malkinson, T., Howells, H., Mackie, M.-A., & Spagna, A. (2024). Same, same but different? A multi-method review of the processes underlying executive control. Neuropsychology Review, 34, 418–454. https://doi.org/10.1007/s11065-023-09577-4 
10. de Barros, G. M., Melo, F., Domingos, J., Oliveira, R., Silva, L., Fernandes, J. B., & Godinho, C. (2021). The effects of different types of dual tasking on balance in healthy older adults. Journal of Personalized Medicine, 11(9), Article 933. https://doi.org/10.3390/jpm11090933  
11. Miyake, A., & Friedman, N. P. (2012). The nature and organization of individual differences in executive functions: Four general conclusions. Current Directions in Psychological Science, 21(1), 8–14. https://doi.org/10.1177/0963721411429458 
12. Friedman, N. P., & Miyake, A. (2004). The relations among inhibition and interference control functions: A latent-variable analysis. Journal of Experimental Psychology: General, 133(1), 101–135. https://doi.org/10.1037/0096-3445.133.1.101 
13. Ehsani, H., Mohler, M. J., O'Connor, K., Zamrini, E., Tirambulo, C., & Toosizadeh, N. (2019). The association between cognition and dual-tasking among older adults: The effect of motor function type and cognition task difficulty. Clinical Interventions in Aging, 14, 659–669.  
14. Norman, D. A. (1968). Toward a theory of memory and attention. Psychological Review, 75(6), 522–536. 
15. Strobach, T., Wendt, M., & Janczyk, M. (2018). Editorial: Multitasking: Executive functioning in dual-task and task switching situations. Frontiers in Psychology, 9, Article 108. https://doi.org/10.3389/fpsyg.2018.00108