The method
10 min
According to physiotherapist Josefa Domingos, and speech language pathologist John Dean, dual task interference is a problem in aging and several neurological diseases, for the following reasons:
Most daily life activities require people to perform one or more tasks at once1, such as talking and walking, or talking on the phone and deciding when to safely cross a busy road.
Difficulties in performing two tasks at the same time will impact people’s independence1.
Particularly, in Parkinson’s, these difficulties have been associated with loss of balance and an increased risk of falls1.
These challenges can all, understandably, negatively impact daily life and social interaction.
Improving dual-task performance in people with Parkinson’s is an emerging area of interest2.
What can we do?
Increasing research suggests that non-pharmacological interventions, such as physical and cognitive training, have shown to benefit people with Parkinson's in both physical and cognitive outcomes8.
Combining interventions may be a new potential method of treatment.
Dual or multitasking is commonly defined as ‘the capacity to simultaneously perform two or more tasks during transfers, ambulation and other gait-related activities’.
As such, dual or multitasking refers to training individuals to be able to perform simultaneously two or more tasks. Each of these tasks can be performed independently, measured separately and can have distinct goals8.
There are three main reasons why therapists usually use dual-task training in clinical practice6:
to improve dual task performance in daily activities;
to enhance learning by making activities progressively more complex;
to enhance motivation and engagement.
Evidence
Initial research in five people with mild to moderate Parkinson’s (mean age of 61 with a mean of 3.5 years with Parkinson’s) concluded that, in these patients, 30 minutes once a week for three weeks of multiple-task gait training was feasible3, and led to sustained benefits in terms of multiple-task walking velocity, levels of fatigue and anxiety. Later, Brauer and Morris4 showed, in a study with 20 people with Parkinson’s, that training could increase step length when walking under dual task conditions.
More recently, a randomised clinical trial involving 121 people with early to mid-stage Parkinson’s showed that dual task gait improved when compared with a control period without training5. The study implemented two dual-task training programmes, one with consecutive training and one with concurrent (i.e. integrated) dual-task training delivered in the home setting.
Both training modes had a similar effect on dual-task gait, and benefits were retained after a 12-week follow-up. No significant change in fall risk occurred in both training modes and showed favourable compliance rates. These findings support adoption of dual-task training in clinical practice.5
Entrenadores
Josefa Domingos
Josefa Domingos es una psicoterapeuta especializada en enfermedad de Parkinson con 15 años de experiencia trabajando exclusivamente con personas con Parkinson y otros trastornos del movimiento. Es formadora, clínica e investigadora, y está actualmenteterminando su doctorado sobre Consideraciones sobre el Ejercicio en Enfermedad de Parkinson en la Universidad de Radboud (Países Bajos), bajo la supervisión del Prof. Bas Bloem. Es también la actual Coordinadora Nacional de Salud de la Asociación de Parkinson Protuguesa (APDPk), miembro ejecutivo de la Asociación Europea de Parkinson (EPDA) y coordinadora del grupo de trabajo sobre rehabilitación de la SociedadPortuguesa de Trastornos del movimiento (SPDMov).
John Dean
John Dean, M.A., CCC-SLP, es logopeda especialista en tratar la enfermedad de Parkinson y otros síntomas asociados desde 2007. Además de su trabajo clínico, ha estado involucrado en numerosos proyectos relacionados con el Parkinson, incluyendo el desarrollo de redes de rehabilitación multidisciplinarias para una compañía de saludEstadounidense a nivel nacional; es el fundador de los premios a empresas emergentes basadas en la generación de tecnología para personas con Parkinson; y trabaja desde hace ya tiempo como Director de la Estrategia y Tecnología Sanitarias en la Fundación Davis Phinney, organización sin ánimo de lucro. Actualmente lidera Triad Health AI, unastart-up enfocada en ofrecer tareas de ejercicios duales usandoaltavoces inteligentes.
1. Kelly V at all. A Review of Dual-Task Walking Deficits in People with Parkinson’s Disease: Motor and Cognitive Contributions, Mechanisms, and Clinical Implications. Parkinsons Dis. 2012;2012:918719.
2. Ghai S at all. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clin Interv Aging. 2017; 12: 557–577.
3. Canning, C. G., Ada, L., & Woodhouse, E. (2008). Multiple-task walking training in people with mild to moderate Parkinson’s disease: a pilot study. Clinical Rehabilitation, 22(3), 226–233.
4. Brauer, S. Morris, M., (2009) Can people with Parkinson’s disease improve dual tasking when walking?, Gait & Posture, Volume 31(2),229-233
5. Strouwen, C. , Molenaar, E. A., Münks, L. , Keus, S. H., Zijlmans, J. C., Vandenberghe, W. , Bloem, B. R. and Nieuwboer, A. (2017), Training dual tasks together or apart in Parkinson’s disease: Results from the DUALITY trial. Mov Disord., 32: 1201-1210.
6. Conradsson, D., Löfgren, N., Nero, H., Hagströmer, M., Ståhle, A., Lökk, J., & Franzén, E. (2015). The Effects of Highly Challenging Balance Training in Elderly With Parkinson’s Disease: A Randomized Controlled Trial. Neurorehabilitation and neural repair, 29(9), 827–836.
7. Ghai, S., Ghai, I., & Effenberg, A. O. (2017). Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clinical interventions in aging, 12, 557–577. 8. EPDA ExerciseCast. Available at: https://www.epda.eu.com/latest/resources/epda-exercisecast/ [Accessed: October 2023]
UK/BIAL/2023/030d
Date of preparation: October 2023