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

患有下肢截肢(LLA)的退伍军人，特别是那些因血管病因而跌倒的退伍军人，摔倒的风险很高。 这种高跌倒风险的部分原因可能是因为据报道，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，携带对象)要求很高。日常活动通常 需要同时处理两项任务；因此，日常生活中的双重任务表现问题可能是导致高 血管功能障碍患者的跌倒次数。在老年人口中，双重任务训练(即， 练习两个同时执行的任务)可以提高模拟双重任务的性能。改进双重任务 在日常活动中(例如，穿衣服、洗澡时移动)，运动可以降低跌倒的风险 洗碗、打电话或叠衣服)。患有LLA血管障碍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疗复杂性 影响日常生活的参与。在可以开发双重任务培训计划之前，初步 在这一人群中，需要研究与双重任务绩效的关系。这条线路的长期目标是 研究的重点是在与功能相关和生态相关的背景下实施新的双重任务干预 对于患有血管LLA障碍的退伍军人来说是有效的任务。迈向长期目标的初步步骤如下所示 本研究采用观察队列和并行混合方法设计，有三个目的：(1) 比较参与者在双重任务行走过程中遇到相互干扰的比例 跌倒组(不跌倒与反复跌倒)，(2)确定双重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和2)将确定如何同时处理两项任务 表现与跌倒和参与日常生活活动有关(n=30名患有血管功能障碍的退伍军人)； 双重任务将用基本的行走步态和认知任务来衡量，通常用其他 老年人口。双任务绩效将使用双任务效应来衡量，计算 在单任务和双任务条件下，步态和认知表现的差异发生变化。步态速度 (米/秒)将被测量，认知将基于序列减法被量化(已更正 考虑到全部答复和错误的答复比率)。定性阶段(目标3)将吸引退伍军人 与LLA(n=30)一起探索有助于提高 有跌倒的风险。此CDA1提案由基础设施和来自父Merit试验的资源支持，该试验 由主要导师领导。本研究收集的数据将为双任务训练的发展提供参考 退伍军人LLA血管功能障碍的干预试验(未来CDA2研究)。在颁奖期内， 应聘者将利用专门的研究时间来发展临床、研究和专业技能 对将来作为退伍军人管理局独立调查员的角色至关重要。具体地说，候选人将发展出更大的 专长：研究设计和分析(定量和定性)，退伍军人临床培训 LLA、行为干预和科学陈述(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).