Dual-Tasking for Individuals with Lower Limb Amputation: Exploring the Relationship to Falls and Instrumental Activities of Daily Living

下肢截肢（LLA）的退伍军人，特别是那些由于血管病因，是在高风险下降。 这种高跌倒风险的部分原因可能是他们在走路时需要专注于每一步， 这使得添加并发任务（例如，携带物体）要求很高。日常活动通常 需要双重任务;因此，日常生活中双重任务表现的问题可能是高 患有血管障碍性LLA的个体的福尔斯次数。在老年人群体中，双重任务训练（即， 练习两个同时进行的任务）提高了模拟的双任务表现。改进双任务 性能可以降低每天活动期间的跌倒风险（例如，穿衣服，边洗边动 洗碗、打电话或叠衣服）。患有血管障碍性LLA的退伍军人需要计划来改善 日常活动表现，因为他们经常经历无数的合并症和医学复杂性 影响日常生活的参与。在制定双重任务培训计划之前， 需要在这一人群中检查与双任务绩效的关系。这一行的长远目标 研究的重点是在功能相关和生态相关的背景下实施新的双重任务干预。 有效的任务，退伍军人与血管障碍LLA。实现长期目标的初步步骤如下： 本研究采用观察性队列和并行混合方法设计，有三个目的：（1） 比较参与者在双任务步行过程中经历相互干扰的比例， 跌倒组（非跌倒与复发性跌倒），（2）确定双任务效应与自我报告的关系 参与日常生活活动，（3）定性探讨双重任务对自我报告的影响 秋季或接近秋季的双重任务场景。定量阶段（目标1 + 2）将确定如何 表现与福尔斯和参与日常生活活动有关（n=30例患有血管障碍性LLA的退伍军人）; 双任务将用基本行走步态和认知任务来测量，如通常用其他 老年人口。双任务表现将使用双任务效应来衡量，双任务效应计算 单任务和双任务条件之间步态和认知性能变化的差异。步行速度 （米/秒）将被测量，认知将基于连续减法（校正）进行量化 考虑总响应和错误的响应比率）。定性阶段（目标3）将吸引退伍军人 与LLA（n= 30），以探索潜在的认知和行为机制，有助于增加 福尔斯的风险。本CDA 1提案得到了来自母Merit试验的基础设施和资源的支持， 由主要导师领导。从这项研究中收集的数据将为双任务训练的发展提供信息 对患有血管障碍性LLA的退伍军人进行干预试验（未来的CDA 2研究）。在颁奖期间， 候选人将利用专门的研究时间来发展临床，研究和专业技能 作为一个独立的调查员，未来的角色是必不可少的。特别是候选人将发展更大 专长：研究设计和分析（定量和定性），退伍军人临床培训， LLA，行为干预和科学报告（书面和口头）。

Veterans with lower limb amputation (LLA), particularly those due to vascular etiology, are at high risk to fall. Part of this high fall risk could be due to their reported need to focus on each individual step when walking, which makes adding a concurrent task (e.g., carrying an object) highly demanding. Everyday activities typically require dual-tasking; therefore, problems with dual-task performance during daily life could account for the high number of falls for individuals with dysvascular LLA. In the older adult population, dual-task training (i.e., practicing two simultaneous tasks) improves simulated dual-task performance. Improving dual-task performance could reduce fall risk during every day activities (e.g., getting dressed, moving while washing dishes, talking on the phone, or folding laundry). Veterans with dysvascular LLA need programs to improve daily activity performance, as they often experience a myriad of comorbidities and medical complexities impacting participation in everyday life. Before a dual-task training program can be developed, preliminary relationships to dual-task performance need to be examined in this population. The long-term goal of this line of research is to implement novel dual-task interventions in the context of functionally relevant and ecologically valid tasks for Veterans with dysvascular LLA. The initial steps toward the long-term goal are proposed with this study, in three aims, using an observational cohort and concurrent parallel mixed-methods design: (1) compare the proportion of participants experiencing mutual interference during dual-task walking between fall groups (Non-fall vs. Recurrent Fall), (2) identify the relationships dual-task effects have with self-reported participation in activities of daily living, and (3) qualitatively explore the effects of dual-tasking on self-reported fall or near-fall dual-task scenarios. The quantitative phase (Aims 1 + 2) will identify how dual-task performance relates to falls and participation in activities of daily living (n=30 Veterans with dysvascular LLA); dual-tasking will be measured with basic walking gait and cognitive tasks, as typically measured with other older adult populations. Dual-task performance will be measured using dual-task effects, a calculation of the difference in gait and cognitive performance changes between the single and dual-task conditions. Gait speed (meters/second) will be measured and cognition will be quantified based on serial subtractions (corrected response ratio considering total responses and mistakes). The qualitative phase (Aim 3) will engage Veterans with LLA (n=up to 30) to explore underlying cognitive and behavioral mechanisms that contribute to increased risk for falls. This CDA1 proposal is supported by infrastructure and resources from a parent Merit trial that is led by the primary mentor. The data gathered from this study will inform the development of a dual-task training intervention trial (future CDA2 study) for Veterans with dysvascular LLA. During the award period, the candidate will capitalize on dedicated research time to develop clinical, research, and professional skills essential for a future role as a VA independent investigator. Specifically the candidate will develop greater expertise in: research design and analysis (quantitative and qualitative), clinical training for Veterans with LLA, behavioral interventions, and scientific presentation (written and oral).