Title: Dual-tasking and aging—About multiple perspectives and possible implementations in interventions for the elderly

 Reference:

Varela-Vásquez, L. A., Minobes-Molina, E., & Jerez-Roig, J. (2020). Dual-task exercises in older adults: A structured review of current literature. Journal of frailty, sarcopenia and falls, 5(2), 31–37. https://doi.org/10.22540/JFSF-05-031

Introduction

Dual tasking, the simultaneous performance of a motor and a cognitive task, is an increasingly significant focus in understanding the interplay between motor and cognitive functions. This review aims to explore how dual tasking impacts the elderly and how clinicians can best support their patients through targeted interventions.

Understanding Dual Tasking

Dual tasking is the performance of two tasks simultaneously, typically involving a motor task (e.g., walking) and a cognitive task (e.g., talking or carrying an object). Research indicates that both motor and cognitive components are significantly affected when performed together, especially in the aging population. As we age, physiological processes such as gait and postural control deteriorate, making dual tasking more challenging and potentially hazardous.

Gait and Cognitive Tasks

A 2007 study by Shumway-Cook involving 1,227 participants aged 20 to 95 revealed that those 65 and older experienced reduced walking speeds when engaged in dual tasking. This highlights the importance of not just focusing on stride length but also the efficiency of functional ambulation when additional tasks are involved, such as walking while talking or carrying objects.

Cognitive Overload in Aging

According to Yogev-Seligmann et al. (2005), as people age, walking transitions from an automated and rhythmic motor task to a more cognitively demanding activity. This shift underscores the need for occupational therapy practitioners to address both motor and cognitive components in their interventions to improve everyday functionality for older adults.

 Neural Activation During Dual Tasking

The review identified various brain regions activated during dual tasking, including the inferior frontal gyrus, the orbitofrontal cortex, and the anterior cingulate gyrus. These areas are crucial for decision-making and managing competing stimuli, which are vital for executing dual tasks efficiently. Understanding these neural activations helps in designing interventions that target specific cognitive processes during dual tasking.

Psychological Refractory Period (PRP)

The concept of the psychological refractory period (PRP) is crucial in dual tasking. It refers to the delay in response to a second stimulus when a first stimulus is still being processed. This bottleneck effect is particularly relevant when considering the slower reaction times in older adults during dual-tasking. For example, a delay in response to a phone ringing while navigating a complex turn illustrates the PRP effect, highlighting the need for interventions that account for these processing delays.

Practical Interventions for Dual Tasking in the Elderly

Based on the review, several effective dual-tasking interventions can be implemented:

1. Stepping Exercises: Incorporating stepping tasks with cognitive elements can improve both gait and cognitive functions.
2. Balance Training: Balance exercises that include dual tasking components, such as standing on one leg while performing a cognitive task, can enhance stability and reduce fall risk.
3. Combined Strength, Agility, and Balance Training: These exercises address multiple systems simultaneously, improving overall functional performance.
4. Dance and Video Game Training: These engaging activities can integrate motor and cognitive tasks, making them effective and enjoyable for patients.

Key Components for Effective Dual Tasking Interventions

1. Incorporate Balance Training: Balance exercises integrated into dual tasking have shown significant improvements in gait and postural control.
2. Utilize Attention Strategies: Employing various attention strategies, such as alternating attention tasks, can enhance dual tasking abilities.
3. Variable Priority Instructions: Changing instructions during tasks can lead to long-term improvements in both motor and cognitive performance.
4. Leverage Video Game Technology: Ensure that video games used for interventions incorporate both motor and cognitive components for maximal benefit.
5. Music-Based Rhythmic Training: Utilizing rhythm and music in dual tasking exercises can significantly improve gait, balance, and reduce fall risk.

Conclusion

Dual tasking interventions are crucial for addressing the complex interplay between motor and cognitive functions in the elderly. By understanding the underlying neural mechanisms and employing targeted strategies, clinicians can significantly improve the functional abilities and quality of life of their older patients. Integrating these interventions into regular practice not only addresses immediate motor deficits but also enhances cognitive resilience, promoting a more holistic approach to elderly care.

Discussion Questions

1. How can you apply the insights from dual tasking studies to your specific patient population?
2. Can you identify any patients who might benefit from dual tasking interventions?
3. How has your understanding of brain activation during dual tasking influenced your approach to designing interventions?

By incorporating dual tasking principles into clinical practice, we can better support the aging population in maintaining their independence and improving their overall quality of life.