认知注意力、平衡功能双重任务训练对预防老年人跌倒的临床研究

目的:探讨认知注意力、平衡功能双重任务训练对预防老年人跌倒的作用。方法:选取有提高平衡能力预防跌倒意愿的老年人60例,随机分为2组各30例,观察组进行认知注意力、平衡功能双重任务训练;对照组进行常规平衡功能训练。训练前后均采用平衡功能检测训练系统评定平衡功能,用连线测试评定认知注意力。结果:治疗4周后,观察组在面向前睁眼及闭眼状态模式下前后平均摆幅、左右平均摆幅、重心轨迹长、矩形面积、外周面积及连线测试所用时间均较治疗前及对照组明显下降(P0.05),单位面积轨迹长及连线正确率较治疗前及对照组明显提高(P0.05);对照组仅重心轨迹长和外周面积均较治疗前明显下降(P0.05),其余参数治疗前后比较差异无统计学意义。结论:认知注意力、平衡功能双重任务训练效果明显,对预防老年人跌倒有正向作用。     

音乐认知与运动的双重任务训练对脑梗死患者的临床疗效

目的:探讨音乐认知与运动的双重任务训练对脑梗死患者的临床疗效。方法:选取上海市杨浦区中心医院(同济大学附属杨浦医院)2020年6月至2021年6月收治的脑梗死患者98例作为研究对象,依照1∶1形式分为对照组和观察组各49例。对照组采取常规护理,观察组应用音乐认知与运动的双重任务训练干预。比较两组患者护理前后音乐认知评估情况、运动功能及健康状况调查量表评分。结果:干预前,两组患者各项量表评分比较差异均无统计意义(均P>0.05);干预后,对照组音乐认知评估量表情况比观察组差,差异有统计学意义(P<0.05);观察组运动功能比对照组高,差异有统计学意义(P<0.05);对照组健康状况调查量表评分低于观察组,差异有统计学意义(P<0.05)。结论:对于脑梗死患者应用音乐认知与运动双重任务训练干预,可提升患者音乐认知功能,改善运动情况,提升患者健康情况,利于预后。     

认知双重任务训练对青年人动态平衡的影响

目的:探讨认知平衡双重任务训练与常规平衡训练对提高动态平衡能力的作用。方法:选取年龄在20~25岁之间的健康青年人20名,随机分为2组各10例,观察组进行认知、平衡双重任务训练;对照组进行常规平衡功能训练。训练前后采用动态平衡测试仪评定其动态平衡能力,用连线测试评定其认知注意力。结果:训练2周后,在感觉统合测试(SOT)中观察组SOT综合得分及第5、6项测试得分均明显高于训练前及对照组(P0.05,0.01),训练前后观察组第1、2、3、4项得分及对照组各项得分差异无统计学意义;在重心稳定极限测试中,观察组反应时较训练前明显降低(P0.05),移动速度、端点行程距离、最大偏移距离及方向控制能力较训练前明显提高(P0.05,0.01),对照组在训练后移动速度、端点行程距离及最大偏移距离较训练前明显提高(P0.05,0.01),而在反应时和方向控制方面训练前后差异无统计学意义,2组间比较差异无统计学意义。结论:认知双重任务训练可以提高青年人的动态平衡能力,且效果优于单任务平衡训练。     

早期认知障碍患者的认知功能和双重任务步态的临床研究

目的:探索早期认知障碍患者双重任务下步态参数与认知功能之间的关系.方法:本研究共纳入轻度认知障碍者(MCI)20例,主观认知下降者(SCD)34例,认知功能正常者(NC)24例,均采用三维运动捕捉系统及建模仿真分析软件进行单任务及双重任务下步态参数(步长、步速、步频、步态周期)的采集与分析.结果:双重任务下 MCI 组...     

双重任务行走步态分析预测短暂性脑缺血发作患者认知功能障碍的发生

目的 寻找简便易行且敏感、有效地预测短暂性脑缺血发作(TIA)患者认知功能障碍发生的方法,以便及时干预TIA患者认知功能障碍的发生和进展。 方法 选取首次发病,且可独立自主行走的TIA患者36例［蒙特利尔认知评估量表（MoCA）评分不低于26分］,设为TIA患者组;另选取年龄、性别及受教育年限与TIA患者组相匹配的正常受试者36例设为作正常对照组。2组受试者均于入组后当天进行1次双重任务行走步态分析,并于入组12个月后对2组受试者进行MoCA量表评定。采用SPSS 22.0版统计学软件进行数据分析,通过诊断试验验证步态参数预测认知功能障碍的可靠性,并计算接受者操作特性曲线（ROC）下面积。 结果 入组后当天,异常步长的TIA患者的步长变异率分别与正常对照组和非异常步长的TIA患者比较,差异均有统计学意义（P<0.05）;异常平均步速的TIA患者的平均步速分别与正常对照组和非异常平均步速的TIA患者比较,差异均有统计学意义（P<0.05）。入组后当天,正常对照组行双重任务步行时的计算正确率为（90.72±8.72）%,而TIA患者组中异常步态患者和非异常步态组患者的计算正确率均显著低于正常对照组,差异均有统计学意义（P<0.05）,且异常步态患者的计算正确率显著低于非异常步态组患者,差异均有统计学意义（P<0.05）。入组12个月后,异常步态患者中MoCA评分<26分的患者例数与非异常步态患者中MoCA评分<26分的患者例数比较,差异有统计学意义（P<0.01）。计算参数ROC曲线下面积得出,步态参数中的步长变异率和平均步速均可预测12个月后TIA患者认知功能障碍的发生,差异有统计学意义(P<0.01)。 结论 双重任务行走步态分析可有效地预测TIA患者认知功能障碍的发生,较MoCA测试可更早发现异常。     

长期体育锻炼对青年人不同认知任务干扰时平衡能力的影响

摘要目的：探索青年人在不同认知任务干扰时的平衡表现,以及长期体育锻炼的调节效应。方法：测试有体育锻炼习惯组和无体育锻炼习惯组的健康青年人在不同认知任务干扰时的静态、动态平衡,并以分组变量（group）为主体间变量、多次平衡测试结果（task）为主体内变量进行单因素重复测量方差分析。结果：长期体育锻炼对计算、唱歌、书写干扰时的静态平衡、书写干扰时的静态左右对称平衡、唱歌干扰时的静态前后对称平衡以及计算干扰时的动态平衡具有积极的调节效应（P＜0.05）,且能够明显降低青年人受到相应认知任务干扰时的双任务成本（P＜0.05）,但是对计算干扰时的静态左右对称平衡、朗读干扰时的静态前后对称平衡以及计算和唱歌干扰时的动态左右对称平衡具有消极的调节效应（P＜0.05）。结论：长期体育锻炼对青年人在不同认知任务干扰时的动态和静态平衡表现都具有显著的调节效应。     

认知—运动双重任务训练对老年肌少症患者认知和肢体功能的影响

目的:观察认知—运动双重任务训练对老年肌少症患者认知和肢体功能的影响,探讨其在预防跌倒中的作用。方法:收集社区中经初步筛查拟诊患肌少症的老年人108例,分别至我院行双能X线吸收法(DXA)检查,以及握力、6m步行速度测定,最终将确诊的62例老年肌少症患者随机分为对照组21例、单纯运动训练组(STT组)21例,及双重任务训练组(DTT组)20例。对照组只接受常规营养支持治疗,STT组和DTT组在常规营养支持治疗基础上,分别予以单纯步行—抗阻训练和认知步行—抗阻训练(均为1次/天,45min/次,5天/周,共12周)。3组患者均在治疗前,治疗12周后行DXA检查并计算四肢骨骼肌质量指数(ASMI),同时采用蒙特利尔认知量表(MoCA)、起立步行测试(TUGT)、Tinetti平衡与步态量表(POMA)、修正版跌倒效能量表(M-FES)等进行评定。结果:治疗前,3组患者的ASMI、TUGT结果,及MoCA、POMA、M-FES等评分均无显著性差异(P0.05)。治疗12周后,STT组和DTT组患者的ASMI、TUGT结果及MoCA、POMA、M-FES评分均较治疗前显著改善(P0.01),同时STT组和DTT组各项指标较对照组有显著提高(P0.01)。且治疗12周后,DTT组较STT组的MoCA、POMA、M-FES评分也有明显提高(P0.05),但ASMI和TUGT水平无显著性差异(P0.05)。结论:认知—运动双重任务训练能更有效地改善老年肌少症患者认知和肢体功能。相较于单纯运动训练,认知—运动双重任务训练在预防老年肌少症患者跌倒方面可能更有优势。     

认知任务干扰脑卒中步态的前驱研究

目的:通过步态分析手段,探讨认知任务对脑卒中患者步态的影响,比较不同认知任务对步态影响的区别。方法:15例脑卒中患者参与本项研究。要求所有患者分别进行两种步行:自然状态下直线步行20m;步行的同时分别执行定向、记忆、计算和言语任务。采用Gaitwatch步态分析系统收集5次步行时的步态参数,包括步频、步幅、步速、双支撑相百分比和健侧摆动相百分比。结果:5组步频无显著性差异(F=1.972,P=0.169),5组步幅(F=13.142,P0.01)、步速(F=11.445,P=0.001)、双支撑相百分比(F=13.142,P0.01)和健侧摆动相百分比(F=11.000,P0.01)有显著性差异。与自然步行相比,4种认知任务时的步幅均显著降低,双支撑相百分比显著提高,定向任务和计算任务时的步速和健侧摆动相百分比显著降低。与计算任务相比,定向任务时的步幅、步速提高,双支撑相百分比降低;记忆任务时步幅、步速和健侧摆动相百分比提高,双支撑相百分比降低;言语任务时步幅和步速提高。结论:认知任务会降低脑卒中患者的步幅、步速和健侧摆动相百分比,延长双支撑相百分比,不同类型认知任务对步态的干扰不同。     

双重任务训练联合经颅直流电刺激对早期帕金森病患者平衡功能的影响

目的 观察双重任务训练(DTT)联合经颅直流电刺激(tDCS)对早期帕金森病(PD)患者平衡功能的影响。方法 选取符合标准的早期PD患者54例,随机分为DTT组、tDCS组和联合组,每组各18例。三组患者均予常规康复训练,DTT组进行运动-认知DTT,tDCS组采用tDCS刺激左侧DLPFC,联合组在DTT同时进行tDCS。于训练前和训练8周后,采用Tecnobody平衡测试系统和单双任务10 m步行测试评估动静态平衡控制能力及ABC量表评估活动信心。结果 训练前三组患者动静态平衡控制能力、单双任务步速及ABC量表评分差异均无统计学意义(P>0.05),经过8周训练,三组患者上述相关指标均较训练前明显改善(P<0.05);组间比较,tDCS组稳定极限、单双任务步速及ABC量表评分明显高于DTT组(P<0.05),睁、闭眼状态下运动轨迹面积均显著低于DTT组(P<0.05),联合组上述指标改善效果较其他两组更优,差异有统计学意义(P<0.05)。结论 DTT联合tDCS能有效改善早期帕金森病患者平衡控制能力,增强患者活动时维持平衡的信心,该联合训练方案值得在...     

双重任务训练对脑卒中后共济失调患者的平衡及步行能力的影响

目的:为了探索双重任务(DT)训练对脑卒中后共济失调患者的平衡及步行能力的影响.方法:40例脑卒中后共济失调患者随机分为DT组和单一任务(ST)组各20例,ST组接受常规运动训练,DT组在常规训练里的步行训练时接受DT训练.治疗前及治疗4周后对2组患者进行以下评定:单一任务模式的计时起立-走测试(TUG-S)、运动双重...     

Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer’s disease: simple versus dual task: a preliminary report

Background/Aims: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer’s disease (AD) patients. Methods: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20‐second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. Results: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. Conclusion: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.     

Different motor tasks impact differently on cognitive performance of older persons during dual task tests

Background

Dual task paradigm states that the introduction of a second task during a cognitive or motor performance results in a decreased performance in either task. Treadmill walk, often used in clinical applications of dual task testing, has never been compared to overground walk, to ascertain its susceptibility to interference from a second task. We compared the effects of overground and treadmill gait on dual task performance.

Methods

Gait kinematic parameters and cognitive performance were obtained in 29 healthy older adults (mean age 75 years, 14 females) when they were walking freely on a sensorized carpet or during treadmill walking with an optoelectronic system, in single task or dual task conditions, using alternate repetition of letters as a cognitive verbal task.

Findings

During overground walking, speed, cadence, step length stride length, and double support time (all with P value < 0.001) and cognitive performance (number of correct words, P < 0.001) decreased substantially from single to dual task testing. When subjects walked at a fixed speed on the treadmill, cadence decreased significantly (P = 0.005), whereas cognitive performance remained unaffected.

Interpretation

Both motor and cognitive performances decline during dual task testing with overground walking. Conversely, cognitive performance remains unaffected in dual task testing on the treadmill. In the light of current dual task paradigm, these findings may have relevant implication for our understanding of motor control, as they suggest that treadmill walk does not involve brain areas susceptible to interference from the introduction of a cognitive task.     

The dual task effect on gait in adults with intellectual disabilities: is it predictive for falls?

Purpose: Falling is an important health issue in adults with intellectual disabilities. Their cognitive and motor limitations may result in difficulties with dual tasking (walking and talking), which increases fall risk. Therefore, we assessed the dual task effect on gait in adults with intellectual disabilities, if this dual task effect is predictive for falls, and if this is more predictive than regular walking.

Method: Gait characteristics of 31 adults with intellectual disabilities without Down syndrome were assessed with the GAITRite at comfortable speed and during dual tasking (conversation). Falls were collected over a three-month follow-up period.

Results: During dual tasking, participants walked slower, with a lower cadence, increased stride time, and shorter stride lengths. They spend less time in swing and single support phase than at comfortable speed. Also swing and single support time became more variable. The dual task effect and walking at comfortable speed were not predictive for falls, although medium effect sizes were found.

Conclusions: Dual tasking affects gait in adults with intellectual disabilities. This is an important finding for safe community participation, and must be considered while interacting with adults with intellectual disabilities during daily activities. Possible negative consequences of distractors should be kept in mind. More research is needed to better understand the predictive value of gait for falls.

• Implications for Rehabilitation

• Having a conversation while walking affects the gait pattern of adults with intellectual disabilities, possible negative consequences of distractors should be kept in mind.

• The dual task effect on the width of the gait pattern and stride time variability had the largest effect sizes with future falls, this potential relationship should be kept in mind in clinical practice.

• The dual task effect on gait is important to consider with regard to safe community participation.

• Future studies are needed to better understand the predictive value of gait for falls, and for cutoff points to be used in clinical practice.

     

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

Background:

Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology.

Objective:

To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS.

Method:

The presence of frailty was verified by Fried''s Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite^(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson''s Correlation tests were administered.

Results:

The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001).

Conclusions:

Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population.     

Stroop范式和躯干控制双任务训练对老年脑卒中患者平衡功能的影响

目的:探讨Stroop范式和躯干控制双任务训练对老年脑卒中患者平衡功能的影响。方法:老年脑卒中患者40例,随机分成两组,其中对照组20例,进行常规的康复训练,观察组20例,在常规康复训练的基础上进行Stroop范式和躯干控制双任务训练。两组患者分别于训练前和训练4周后进行BBS、SOT、LOS、MoCA、认知注意力等评定。结果:与治疗前相比,观察组BBS、SOT综合得分、Ⅴ模式和Ⅵ模式得分、重心移动速度、端点行程、最大偏移、方向控制、Mo CA总分、视空间/执行功能、注意力和延迟记忆得分均有明显提高(P<0.05),反应时、连线用时、连线错误个数有明显下降(P<0.05);而对照组BBS、SOT综合得分、端点行程提高,反应时和错误数下降(P<0.05)。治疗后,观察组BBS、SOT综合得分、最大偏移、方向控制、连线用时、连线错误数、视空间/执行功能和注意力等指标显著优于对照组(P<0.05)。结论:Stroop范式和躯干控制双任务训练对提高老年脑卒中患者平衡功能有促进作用。