The Multiple Tasks Test - Development and normal strategies
The Multiple Tasks Test - Development and normal strategies
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DOI：
10.1016/s0966-6362(01)00141-2
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发表时间：
2001-12-01
期刊：
影响因子：
2.4
通讯作者：
Willemsen, MD
中科院分区：
文献类型：
--
作者：
Bloem, BR;Valkenburg, VV;Willemsen, MD
姿势和认知的同时挑战（“双重任务”）可能比姿势控制的单独组成部分的测试更好地预测福尔斯。我们描述了一种新的平衡测试（多任务测试，MTT），它（1）是基于多个（> 2）姿势组件的同时评估;（2）代表日常情况;（3）可以由临床医生应用。福尔斯的相关危险因素和实际跌倒情况（从帕金森病的前瞻性调查中确定）被用来设计类似于日常情况的功能测试（或姿势“组件”）。我们区分了“认知”成分（回答系列问题）和主要的“运动”成分（站起来，坐下，转身，行走，避开障碍物和触摸地板）。四个额外的组件包括携带一个空的或加载托盘，穿着鞋底滑和减少照明的鞋。这些组件组合起来，产生了八个独立的任务，这些任务的复杂性不断增加，并按顺序执行。第一个也是最简单的任务包括站起来，不受干扰地行走，转身和坐下。对于接下来的每一个任务，一个新的组件被添加到先前的、在其他方面相同的任务中。每项任务的所有组成部分都必须同时执行。错误被定义为犹豫（减慢性能）或块（完全停止），这是分别为执行运动和认知组件。没有强调执行速度，但对所有任务进行了测量。对50名年轻健康受试者（平均年龄27.6岁）和13名老年受试者（平均年龄62.0岁）进行MTT。为了研究学习效果，20名不同的年轻受试者（平均年龄21.0岁）按照复杂性逐渐降低的顺序接受了MTT。在接受MTT测试的受试者中，两个年龄组中有62%的人完成了所有八项任务，而在运动组件中没有任何错误。在出现错误的被试中，随着任务的复杂程度增加，出现运动错误的被试比例显著增加（F（1，7）= 2.66，P < 0.05）。这一增加在两组之间存在差异（组与任务的显著相互作用; F（1，7）= 3.07，P = 0.01），因为更多的老年受试者在最复杂的任务中产生运动错误。随着任务的复杂性，认知错误的增加甚至超过运动错误，这种增加在年轻受试者中最为明显（组与错误类型与任务的显著相互作用; F（1，1，7）= 3.85，P = 0.001）。只有8名年轻受试者（16%）和4名老年受试者（30.8%）在没有任何运动或认知错误的情况下进行了MTT，再次表明更多的年轻受试者犯了认知错误。在以相反顺序接受MTT的受试者中，运动错误比以复杂性增加顺序接受MTT的受试者更常见（F（1，7）= 5.90，P < 0.05），特别是在两个最困难的任务中。老年人完成所有任务的速度都比年轻人慢。我们的结论是MTT是一个新的平衡测试的基础上，类似于日常情况的多任务设计。健康受试者的表现揭示了正常姿势策略的有趣见解。对于复杂的姿势任务，健康的受试者有利于执行的认知组件（“姿势第一”的策略）的执行运动组件。年轻受试者比老年受试者更倾向于使用这种策略。运动技能的学习影响了接受MTT测试的受试者的表现，顺序是难度增加。进一步的研究必须确定MTT是否可用于评估
Simultaneous challenge of posture and cognition ('dual tasks') may predict falls better than tests of isolated components of postural control. We describe a new balance test (the Multiple Tasks Test, MTT) which (1) is based upon simultaneous assessment of multiple ( > 2) postural components; (2) represents everyday situations; and (3) can be applied by clinicians. Relevant risk factors for falls and actual fall circumstances (identified from a prospective survey in Parkinson's disease) were used to design functional tests (or postural 'components') that resembled everyday situations. We distinguished a 'cognitive' component (answering serial questions) from largely 'motor' components (standing up, sitting down, turning around, walking, avoiding obstacles, and touching the floor). Four additional components included carrying an empty or loaded tray, wearing shoes with slippery soles and reduced illumination. These components were combined to yield eight separate tasks of increasing complexity that were executed sequentially. The first and simplest task consisted of standing Up, undisturbed walking, turning around and sitting down. For each of the next tasks, a new component was added to the earlier and otherwise identical task. All components within each task had to be performed simultaneously. Errors were defined as Hesitations (slowed performance) or Blocks (complete cessation), which were scored separately for execution of motor and cognitive components. Speed of performance was not stressed, but was measured for all tasks. The MTT was administered to 50 Young healthy subjects (mean age 27.6 years) and 13 elderly subjects (mean age 62.0 years). To study learning effects, 20 different Young subjects (mean age 21.0 years) received the MTT in order of gradually decreasing complexity. For subjects who received the MTT in order of increasing difficulty, 62% in both age groups performed all eight tasks without any Errors in the motor components. Among those making Errors, the proportion of subjects that made motor Errors increased significantly as the tasks became more complex (F(1,7) = 2.66, P < 0.05). This increase differed across the two groups (significant interaction of Group by Task; F(1,7) = 3.07, P = 0.01) because more elderly subjects produced motor Errors during the most complex tasks. Cognitive Errors increased even more than motor Errors with task complexity, and this increase was most pronounced in young subjects (significant interaction of Group by Error Type by Task; F(1, 1,7) = 3.85, P = 0.001). Only eight young (16%) and four elderly subjects (30.8%) performed the MTT without any motor or cognitive Errors, again suggesting that more young subjects made cognitive Errors. Among subjects who received the MTT in reverse order, motor errors were more common than among subjects who received the MTT in order of increasing complexity (F(1,7) = 5.90, P < 0.05), particularly during the two most difficult tasks. The elderly performed all tasks slower than the young subjects. We conclude that the MTT is a new balance test based upon a multiple task design that resembles everyday situations. Performance by healthy subjects revealed interesting insights into normal postural strategies. For complex postural tasks, healthy subjects favour execution of motor components over execution of a cognitive component ('posture first' strategy). Young subjects were more inclined than elderly subjects to use this strategy. Motor learning influenced performance among subjects who received the MTT in order of increasing difficulty. Further Studies Must determine whether the MTT can be used to evaluat