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Can dual-tasking help improve balance, mobility, and cognition?

This is an excerpt from ABLE Bodies Balance Training 2nd Edition With HKPropel Access by Sue M. Scott.

Dual Tasks

Dual tasks train the “automaticity” in automatic movement patterns. Automatic patterns, also called procedural motor programs, are learned from past experiences and stored by neurons in lower brain regions (basal ganglia and cerebellum), where motor patterns are generated and maintained automatically. These motor patterns done without conscious attention would otherwise task upper brain regions (prefrontal cortex). Walking, driving, opening doors, reaching for something in a cupboard, or standing up from a chair are all examples of automatic movement patterns. Consider driving while listening to the radio; this is a simple procedural skill, and you likely pay little attention to how you do it. But if you have ever found yourself turning down the radio so you could find an address, it means you needed to turn down one input (the music) so you could pay better attention to another input (finding the address).

Over time, automaticity can be compromised. Factors such as age and neurological diseases erode these systems. Simple tasks now take more conscious thought and attention. When automatic patterns begin to falter, they require conscious thought and attention; this means a little more of the limited cognitive reserves (upper brain resources) must be used.

For some older or frail adults, the loss of automaticity will begin to overwhelm their attention systems, and mistakes in mobility start to happen. Multitasking is almost impossible. Mistakes can mean falls, errors in driving, difficulty with ADLs, freezing of gait, and slowed walking speeds. Decreased walking speeds are associated with cognitive decline and greater risks for dementia (Collyer et al. 2022).

Dual task training may help restore some automaticity. Dual tasking involves pairing an automatic skill, say walking, with a distracting other type of task, such as talking, counting, or making big arm swings. The dual task is used to distract an individual from the desired automatic pattern, walking, making it more automatic. A successful distraction will help return the base skill to automatic control.

Helping individuals regain, maintain, and improve automaticity of movement with dual tasking has been shown to decrease falls and improve walking speed, cadence, balance, and motor skills (Chang et al. 2020; Li et al. 2020). The cognitive improvements that follow dual task training include better self-awareness, task awareness, problem-solving, set shifting, and memory (Becker 2022).

To further clarify, dual tasking and multi-tasking are not the same. Multi-tasking is repeatedly switching attention between two or more tasks. Dual tasks are two skills done simultaneously. Each skill has a different goal that can be done separately. What’s key is that the two tasks activate different areas of the brain. That is, one task activates upper brain regions for thinking and attention, while the other task stimulates actions from lower brain regions responsible for automatic or procedural movements. For example, pair walking (normally an automatic skill) with a secondary (distracting) task like counting backward by threes (that uses conscious thought or a goal). The goal when using dual tasks is to strengthen procedural movement skills in order to reduce loads on cognitive and attentional centers.

Dual tasks may comprise an easy verbal task (reciting a nursery rhyme) or a more difficult physical task (tossing a ball hand to hand). Tasks can be visual (select or ignore a target), auditory (respond or ignore a sound), or cognitive, such as simple math or Stroop types of challenges that use inhibition (Go, Go, No Go). Dual tasks can be novel and fun (juggling scarves) or something more functional (giving directions to someone’s home). One of my new favorite dual tasks is to use basic signs from American Sign Language. Check out Jacob Weiss’ HandEyeBody Academy for lots of fun and novel dual tasks.

When dual tasks are practiced with procedural movements, the procedural motor tasks become easier and more automatic. This improves the flow and coordination of movement, preserves cognitive resources, and reduces fall risks (Becker 2022). Readers will learn more ways to use dual tasks in chapter 8 on balance and mobility.

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