The Effects of Integrated Single- and Dual-Task Training on Automaticity and Attention Allocation in Parkinson's Disease: A Secondary Analysis From a Randomized Trial
The Effects of Integrated Single- and Dual-Task Training on Automaticity and Attention Allocation in Parkinson's Disease: A Secondary Analysis From a Randomized Trial
复制标题
DOI：
10.1037/neu0000496
复制
发表时间：
2019-02-01
期刊：
影响因子：
2.4
通讯作者：
Franzen, Erika
中科院分区：
文献类型：
--
作者：
Lofgren, Niklas;Conradsson, David;Franzen, Erika
目的：帕金森病（PwPD）患者表现出运动和认知任务的自动性受损，当暴露于双重任务情况时，优先级策略不明确。然而，没有随机试验研究了训练对这一人群的自动性和优先策略的影响。本研究旨在探讨训练对PwPD患者步态自动性和认知加工的影响，以及步态和认知任务之间的注意分配。方法：100名PwPD被随机分配到10周的挑战性步态和平衡训练（包括单任务和双任务条件）或对照组（照常护理）。结果测量是步态和认知参数的绝对双任务干扰（单任务和双任务之间的差异）。比较两组之间基线和随访之间的差异。使用Mann-Whitney U检验评估潜在差异。显著性水平设定为p = 0.05。非参数效应量的方向和大小被用来研究注意分配。结果：未发现任何步态参数的组间差异。训练组显著改善了认知任务的双任务干扰。组间效应量的方向表明，训练组主要分配注意力的认知任务，而对照组似乎优先步态。结论：挑战性训练可以提高步行过程中认知加工的自动性。这可能对在社区安全行走的能力产生有益的影响，从而提高这一人群的独立性和生活质量。这项研究首次发现，同时进行行走和认知任务的挑战性训练对帕金森病患者的影响，并表明训练改善了认知任务的表现，而不是步态。这意味着，训练使帕金森病患者在行走时注意周围环境，从而降低了在社区行走时发生跌倒事故的风险。
Objective: People with Parkinson's disease (PwPD) demonstrate impaired automaticity of motor and cognitive tasks, with unclear prioritization strategies when exposed to dual-task situations. However, no randomized trials have investigated the effects of training on automaticity and prioritization strategies in this population. The purpose of this study was to investigate the effects of training on the automaticity of gait and cognitive processing in PwPD and the allocation of attention between gait and a cognitive task. Method: One-hundred PwPD were randomized to 10 weeks of challenging gait and balance training (including single and dual-task conditions) or to a control group (care as usual). Outcome measure was the absolute dual-task interference (difference between single- and dual-tasks) for gait and cognitive parameters. Differences between baseline and follow-up were compared between the groups. The Mann-Whitney U test was used to assess potential differences. Significance level was set to p = .05. The direction and magnitude of nonparametric effect sizes were used to investigate attention allocation. Results: No significant between-groups differences were found regarding any gait parameter. The training group significantly improved the dual-task interference of the cognitive task. The direction of between-groups effect sizes indicated that the training group primarily allocated attention to the cognitive task, whereas the control group appeared to prioritize gait. Conclusions: The results indicate that challenging training can improve automaticity of cognitive processing during walking. This may have a beneficiary effect on the ability to ambulate safely in the community, thereby improving independence and the quality of life in this population.This study provides the first findings regarding how challenging training entailing the simultaneous performance of walking and cognitive tasks affect people with Parkinson's disease and suggests that the training improved the performance on a cognitive task rather than gait. This implies that the training enabled people with Parkinson's disease to pay attention to the surrounding environment while walking, thereby reducing the risk of fall accidents when walking in the community.