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Dr. Okun

Post of the Week: Dual Tasking and Parkinson

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Dear forum members,


This interesting study looked at what happens with dual tasking (doing two things at once). The spin of the study was that the authors looked at how the instructions impacted the outcome.



Parkinsons Dis. 2012;2012:671261. doi: 10.1155/2012/671261. Epub 2012 Dec 29.

The effects of instructions on dual-task walking and cognitive task performance in people with Parkinson's disease.




Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific Street, P.O. Box 356490, Seattle, WA 98125, USA.



Gait impairments are prevalent among people with Parkinson's disease (PD). Instructions to focus on walking can improve walking in PD, but the use of such a cognitive strategy may be limited under dual-task walking conditions, when walking is performed simultaneously with concurrent cognitive or motor tasks. This study examined how dual-task performance of walking and a concurrent cognitive task was affected by instructions in people with PD compared to healthy young and older individuals. Dual-task walking and cognitive task performance was characterized under two sets of instructions as follows: (1) focus on walking and (2) focus on the cognitive task. People with PD and healthy adults walked faster when instructed to focus on walking. However, when focused on walking, people with PD and young adults demonstrated declines in the cognitive task. This suggests that dual-task performance is flexible and can be modified by instructions in people with PD, but walking improvements may come at a cost to cognitive task performance. The ability to modify dual-task performance in response to instructions or other task and environmental factors is critical to mobility in daily life. Future research should continue to examine factors that influence dual-task performance among people with PD.

PMID: 23326758 [PubMed] Free PMC Article

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Dr Okun,

I found this to be quite interesting. Your thoughts?



The relevance of dual-task walking to everyday ambulation is widely acknowledged, and numerous studies have demonstrated that dual-task interference can significantly impact recovery of functional walking in people with neurological disorders. The magnitude and direction of dual-task interference is influenced by the interaction between the two tasks, including how individuals spontaneously prioritize their attention. Therefore, to accurately interpret and characterize dual-task interference and identify changes over time, it is imperative to evaluate single and dual-task performance in both tasks, as well as the tasks relative to each other. Yet, reciprocal dual-task effects (DTE) are frequently ignored. The purpose of this perspective paper is to present a framework for measuring treatment effects on dual-task interference, specifically taking into account the interactions between the two tasks and how this can provide information on whether overall dual-task capacity has improved or a different attentional strategy has been adopted. In discussing the clinical implications of using this framework, we provide specific examples of using this method and provide some explicit recommendations for research and clinical practice.



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When people with Parkinson try to dual task they tend to worsen and sometimes fall or get into uncomfortable situations.  How we give directions in dual tasking and also which dual tasks we use could be important.  Dr. Altman and Hass at UF studied this and actually found recumbent cycling could improve some features while dual tasking!

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