O controle postural vem sendo estudado há algum tempo com o intuito de entender o complexo funcionamento do sistema de controle postural, além de servir para evitar quedas em idosos. As quedas são eventos que ocorrem em aproximadamente um terço da população idosa e podem levar a consequências muito graves, o que dá importância para o tema. A dupla-tarefa com interferência cognitivo-motora pode afetar o desempenho dos idosos na tarefa de manter o equilíbrio e aumentar o risco de quedas. Logo, o objetivo desse estudo foi avaliar o efeito de tarefas cognitivas sobre o desempenho em tarefas de controle motor estático e dinâmico em adultas jovens (n=25) e idosas caidoras (n=20) e não-caidoras (n=21). Foram avaliados o controle postural estático em dois tipos de superfície (estável e instável) e também o desempenho na tarefa de marcha com transposição de obstáculos, durante dois tipos de tarefas cognitivas (teste de Stroop e contagem regressiva em etapas de três). ANOVAs de dois fatores foram usadas para avaliar as diferenças entre grupos e condições. O equilíbrio estático foi melhor para jovens em comparação com idosas, que não diferiram entre caidoras e não-caidoras. A tarefa de contagem regressiva piorou o equilíbrio, principalmente nas idosas. Na tarefa de ultrapassagem de obstáculos, a velocidade das idosas caidoras foi menor, mesmo sem tarefa cognitiva, sendo que a tarefa cognitiva influenciou o desempenho das idosas não-caidoras e jovens. As distâncias verticais na transposição do obstáculo foram maiores para o grupo de idosas caidoras, diferente do esperado, denotando uma segurança maior na tarefa nesses indivíduos e uma menor chance de cair nesses indivíduos. É possível que esse resultado seja relacionado ao medo de cair nesses idosas, o que levou os mesmos a realizarem uma tarefa mais cautelosa na transposição do obstáculo. Com relação às distâncias horizontais, as jovens afastaram mais o pé do obstáculo, denotando maior capacidade nessa tarefa que idosas não-caidoras e caidoras, não havendo efeito da tarefa cognitiva. Os resultados indicam que o desempenho em tarefas de controle postural estático e dinâmico é pior em idosas, sem grandes diferenças entre caidoras e não-caidoras. Na tarefa de transposição do obstáculo, as idosas optaram por uma tarefa mais cautelosa, mesmo quando nenhuma tarefa cognitiva era solicitada, ao passo que a tarefa cognitiva levou as jovens a realizar estratégia semelhante. O medo de cair que acomete o idoso pode ter levado a estratégias mais cautelosas. Conclui-se que o as tarefas cognitivas afetam o desempenho no controle postural estático em jovens e idosas e afetam o desempenho da tarefa dinâmica em jovens, principalmente. Durante a execução da tarefa de marcha com obstáculo, as idosas assumiram uma estratégia mais segura, possivelmente pelo medo de cair. Somente o teste de contagem regressiva aplicou demanda cognitiva suficiente para afetar a realização das tarefas motoras, enquanto que o teste de Stroop ajudou a tarefa motora em alguns casos. / Postural control has been studied in the last years to understand the hard behavior of the postural control system and to find ways to prevent falls in elderly. One third of the elderly people experiences falls during the live and falls can lead to serious consequences, being an important issue to study. Cognitive-motor interference in dual-task conditions can affect balance tasks performance on elderly and increase the risk of falls. Thus, this study aims to evaluate the effect of cognitive tasks on static and dynamic motor control tasks performances in young women (n = 25) and fallers (n = 20) and non-fallers (n = 21) older women. Static postural control in two surface conditions (stable and unstable) and obstacle negotiation task during walking were evaluated, while the subjects were performing two different cognitive tasks (Stroop task and counting backwards on steps of three) and without any cognitive task. Were performed ANOVAs with two factor to test differences between groups and conditions. Static balance was better in younger compared to old-aged, and non-fallers and fallers did not differ between themselves. Counting backward cognitive task impaired the balance especially in elderly. During obstacles negotiation tasks, the mean velocity was lower for fallers than the other groups, even without cognitive task. Cognitive tasks impaired performance of non-fallers and younger groups. Vertical distances on obstacle negotiation were higher for the fallers group, different than we expected. It means that this group performs the task safer than the others perform and has lower chance of falling. It is possible that these results are related to the elderly fear of falling, which led them to conduct a more cautious task during obstacle negotiation. Regarding to horizontal distances, young people distance more their foot from obstacle, showing increased capacity in this task than non-fallers and fallers, with no effect of cognitive task. Results indicate that static and dynamic performance on postural control tasks is worse in the elderly, without many differences between fallers and non-fallers. In obstacle negotiation task, elderly have opted for a more cautious task, even when no cognitive task was requested, while the cognitive tasks lead young people to perform similar strategy. Fear of falling that affect elderly people has led them to take more cautious strategies. We conclude that the cognitive tasks affect static postural control performances in young and old groups and affect dynamic task performance mainly in the young group. During the obstacle negotiation task, elderly have taken a safer strategy, possibly due to fear of falling in this task. Only the counting backwards task applied a sufficient cognitive demand to affect the proposed motor tasks while the Stroop task improved the performances for some variables.

O controle postural vem sendo estudado há algum tempo com o intuito de entender o complexo funcionamento do sistema de controle postural, além de servir para evitar quedas em idosos. As quedas são eventos que ocorrem em aproximadamente um terço da população idosa e podem levar a consequências muito graves, o que dá importância para o tema. A dupla-tarefa com interferência cognitivo-motora pode afetar o desempenho dos idosos na tarefa de manter o equilíbrio e aumentar o risco de quedas. Logo, o objetivo desse estudo foi avaliar o efeito de tarefas cognitivas sobre o desempenho em tarefas de controle motor estático e dinâmico em adultas jovens (n=25) e idosas caidoras (n=20) e não-caidoras (n=21). Foram avaliados o controle postural estático em dois tipos de superfície (estável e instável) e também o desempenho na tarefa de marcha com transposição de obstáculos, durante dois tipos de tarefas cognitivas (teste de Stroop e contagem regressiva em etapas de três). ANOVAs de dois fatores foram usadas para avaliar as diferenças entre grupos e condições. O equilíbrio estático foi melhor para jovens em comparação com idosas, que não diferiram entre caidoras e não-caidoras. A tarefa de contagem regressiva piorou o equilíbrio, principalmente nas idosas. Na tarefa de ultrapassagem de obstáculos, a velocidade das idosas caidoras foi menor, mesmo sem tarefa cognitiva, sendo que a tarefa cognitiva influenciou o desempenho das idosas não-caidoras e jovens. As distâncias verticais na transposição do obstáculo foram maiores para o grupo de idosas caidoras, diferente do esperado, denotando uma segurança maior na tarefa nesses indivíduos e uma menor chance de cair nesses indivíduos. É possível que esse resultado seja relacionado ao medo de cair nesses idosas, o que levou os mesmos a realizarem uma tarefa mais cautelosa na transposição do obstáculo. Com relação às distâncias horizontais, as jovens afastaram mais o pé do obstáculo, denotando maior capacidade nessa tarefa que idosas não-caidoras e caidoras, não havendo efeito da tarefa cognitiva. Os resultados indicam que o desempenho em tarefas de controle postural estático e dinâmico é pior em idosas, sem grandes diferenças entre caidoras e não-caidoras. Na tarefa de transposição do obstáculo, as idosas optaram por uma tarefa mais cautelosa, mesmo quando nenhuma tarefa cognitiva era solicitada, ao passo que a tarefa cognitiva levou as jovens a realizar estratégia semelhante. O medo de cair que acomete o idoso pode ter levado a estratégias mais cautelosas. Conclui-se que o as tarefas cognitivas afetam o desempenho no controle postural estático em jovens e idosas e afetam o desempenho da tarefa dinâmica em jovens, principalmente. Durante a execução da tarefa de marcha com obstáculo, as idosas assumiram uma estratégia mais segura, possivelmente pelo medo de cair. Somente o teste de contagem regressiva aplicou demanda cognitiva suficiente para afetar a realização das tarefas motoras, enquanto que o teste de Stroop ajudou a tarefa motora em alguns casos. / Postural control has been studied in the last years to understand the hard behavior of the postural control system and to find ways to prevent falls in elderly. One third of the elderly people experiences falls during the live and falls can lead to serious consequences, being an important issue to study. Cognitive-motor interference in dual-task conditions can affect balance tasks performance on elderly and increase the risk of falls. Thus, this study aims to evaluate the effect of cognitive tasks on static and dynamic motor control tasks performances in young women (n = 25) and fallers (n = 20) and non-fallers (n = 21) older women. Static postural control in two surface conditions (stable and unstable) and obstacle negotiation task during walking were evaluated, while the subjects were performing two different cognitive tasks (Stroop task and counting backwards on steps of three) and without any cognitive task. Were performed ANOVAs with two factor to test differences between groups and conditions. Static balance was better in younger compared to old-aged, and non-fallers and fallers did not differ between themselves. Counting backward cognitive task impaired the balance especially in elderly. During obstacles negotiation tasks, the mean velocity was lower for fallers than the other groups, even without cognitive task. Cognitive tasks impaired performance of non-fallers and younger groups. Vertical distances on obstacle negotiation were higher for the fallers group, different than we expected. It means that this group performs the task safer than the others perform and has lower chance of falling. It is possible that these results are related to the elderly fear of falling, which led them to conduct a more cautious task during obstacle negotiation. Regarding to horizontal distances, young people distance more their foot from obstacle, showing increased capacity in this task than non-fallers and fallers, with no effect of cognitive task. Results indicate that static and dynamic performance on postural control tasks is worse in the elderly, without many differences between fallers and non-fallers. In obstacle negotiation task, elderly have opted for a more cautious task, even when no cognitive task was requested, while the cognitive tasks lead young people to perform similar strategy. Fear of falling that affect elderly people has led them to take more cautious strategies. We conclude that the cognitive tasks affect static postural control performances in young and old groups and affect dynamic task performance mainly in the young group. During the obstacle negotiation task, elderly have taken a safer strategy, possibly due to fear of falling in this task. Only the counting backwards task applied a sufficient cognitive demand to affect the proposed motor tasks while the Stroop task improved the performances for some variables.

O controle postural vem sendo estudado há algum tempo com o intuito de entender o complexo funcionamento do sistema de controle postural, além de servir para evitar quedas em idosos. As quedas são eventos que ocorrem em aproximadamente um terço da população idosa e podem levar a consequências muito graves, o que dá importância para o tema. A dupla-tarefa com interferência cognitivo-motora pode afetar o desempenho dos idosos na tarefa de manter o equilíbrio e aumentar o risco de quedas. Logo, o objetivo desse estudo foi avaliar o efeito de tarefas cognitivas sobre o desempenho em tarefas de controle motor estático e dinâmico em adultas jovens (n=25) e idosas caidoras (n=20) e não-caidoras (n=21). Foram avaliados o controle postural estático em dois tipos de superfície (estável e instável) e também o desempenho na tarefa de marcha com transposição de obstáculos, durante dois tipos de tarefas cognitivas (teste de Stroop e contagem regressiva em etapas de três). ANOVAs de dois fatores foram usadas para avaliar as diferenças entre grupos e condições. O equilíbrio estático foi melhor para jovens em comparação com idosas, que não diferiram entre caidoras e não-caidoras. A tarefa de contagem regressiva piorou o equilíbrio, principalmente nas idosas. Na tarefa de ultrapassagem de obstáculos, a velocidade das idosas caidoras foi menor, mesmo sem tarefa cognitiva, sendo que a tarefa cognitiva influenciou o desempenho das idosas não-caidoras e jovens. As distâncias verticais na transposição do obstáculo foram maiores para o grupo de idosas caidoras, diferente do esperado, denotando uma segurança maior na tarefa nesses indivíduos e uma menor chance de cair nesses indivíduos. É possível que esse resultado seja relacionado ao medo de cair nesses idosas, o que levou os mesmos a realizarem uma tarefa mais cautelosa na transposição do obstáculo. Com relação às distâncias horizontais, as jovens afastaram mais o pé do obstáculo, denotando maior capacidade nessa tarefa que idosas não-caidoras e caidoras, não havendo efeito da tarefa cognitiva. Os resultados indicam que o desempenho em tarefas de controle postural estático e dinâmico é pior em idosas, sem grandes diferenças entre caidoras e não-caidoras. Na tarefa de transposição do obstáculo, as idosas optaram por uma tarefa mais cautelosa, mesmo quando nenhuma tarefa cognitiva era solicitada, ao passo que a tarefa cognitiva levou as jovens a realizar estratégia semelhante. O medo de cair que acomete o idoso pode ter levado a estratégias mais cautelosas. Conclui-se que o as tarefas cognitivas afetam o desempenho no controle postural estático em jovens e idosas e afetam o desempenho da tarefa dinâmica em jovens, principalmente. Durante a execução da tarefa de marcha com obstáculo, as idosas assumiram uma estratégia mais segura, possivelmente pelo medo de cair. Somente o teste de contagem regressiva aplicou demanda cognitiva suficiente para afetar a realização das tarefas motoras, enquanto que o teste de Stroop ajudou a tarefa motora em alguns casos. / Postural control has been studied in the last years to understand the hard behavior of the postural control system and to find ways to prevent falls in elderly. One third of the elderly people experiences falls during the live and falls can lead to serious consequences, being an important issue to study. Cognitive-motor interference in dual-task conditions can affect balance tasks performance on elderly and increase the risk of falls. Thus, this study aims to evaluate the effect of cognitive tasks on static and dynamic motor control tasks performances in young women (n = 25) and fallers (n = 20) and non-fallers (n = 21) older women. Static postural control in two surface conditions (stable and unstable) and obstacle negotiation task during walking were evaluated, while the subjects were performing two different cognitive tasks (Stroop task and counting backwards on steps of three) and without any cognitive task. Were performed ANOVAs with two factor to test differences between groups and conditions. Static balance was better in younger compared to old-aged, and non-fallers and fallers did not differ between themselves. Counting backward cognitive task impaired the balance especially in elderly. During obstacles negotiation tasks, the mean velocity was lower for fallers than the other groups, even without cognitive task. Cognitive tasks impaired performance of non-fallers and younger groups. Vertical distances on obstacle negotiation were higher for the fallers group, different than we expected. It means that this group performs the task safer than the others perform and has lower chance of falling. It is possible that these results are related to the elderly fear of falling, which led them to conduct a more cautious task during obstacle negotiation. Regarding to horizontal distances, young people distance more their foot from obstacle, showing increased capacity in this task than non-fallers and fallers, with no effect of cognitive task. Results indicate that static and dynamic performance on postural control tasks is worse in the elderly, without many differences between fallers and non-fallers. In obstacle negotiation task, elderly have opted for a more cautious task, even when no cognitive task was requested, while the cognitive tasks lead young people to perform similar strategy. Fear of falling that affect elderly people has led them to take more cautious strategies. We conclude that the cognitive tasks affect static postural control performances in young and old groups and affect dynamic task performance mainly in the young group. During the obstacle negotiation task, elderly have taken a safer strategy, possibly due to fear of falling in this task. Only the counting backwards task applied a sufficient cognitive demand to affect the proposed motor tasks while the Stroop task improved the performances for some variables.

Background Individuals with Parkinson’s disease (PD), Alzheimer’s disease (AD), multiple sclerosis (MS), and stroke experience various cognitive and motor impairments, which can negatively affect their ability to complete daily activities such as walking and talking. Walking and talking or dual-task walking often leads to a decline in performance in one or both tasks, which is called dual-task cost. This dual-task cost seems to be more pronounced in individuals with neurological conditions compared to age-matched healthy individuals, possibly due to disease-associated impairments. While the results of neuroimaging studies are inconsistent, several studies have found structural or functional brain changes that might contribute to a decrease in dual-task walking performance in people with neurological disorders. Research question/objective The objective of this study was to systematically review peer-reviewed articles that examined the neural correlates of cognitive-motor dual-task interference in people with neurological conditions. The primary aim was to identify brain areas or measures that might underlie dual-task walking performance of people with MS, stroke, AD, and PD. The secondary aim was to compare their dual-task performance with other groups such as healthy individuals. Methods A systematic review of the literature was conducted, following PRISMA guidelines, on Medline, Embase, and Scopus databases. Studies were included if they examined dual-task walking performance and associated structural or functional brain changes in adults with stroke, MS, PD, and AD. Studies were first screened using a title and abstract and then full-text review was performed. The quality of each study was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist and then the data regarding cognitive and motor performance during dual- versus single task conditions and brain imaging were extracted. The findings were grouped according to neurological condition and then by imaging technique. Results After screening, 23 studies were selected to be included in this review. The majority (90%) showed a decline in dual-task walking performance compared to single-walking in people with neurological conditions and this decline was greater than healthy individuals. Most structural imaging studies (75%) reported a significant positive correlation between lower brain structural integrity and poorer dual-task walking performance. Specifically, the striatum regions including pedunculopontine nucleus and hippocampus in PD demonstrated this positive correlation. In MS, the supplementary motor area showed a positive correlation. In terms of functional brain changes, 60% observed an increase in prefrontal cortex activity during dual tasking in people with PD and stroke, which was associated with decreased performance in most cases (n = 3) while some found an association with maintained performance (n = 2). Further, people with MS and stroke both showed a significant relationship between a higher supplementary motor area activity and poor dual-task walking performance. Conclusions This systematic review identified several structural and functional neural correlates of dual-task walking in people with PD, MS, and stroke and has facilitated a better understanding of neural basis of dual-task interference in people with neurological conditions. However, the relationship between the brain and behavioural outcomes is complicated and various factors may influence neural correlates, such as individuals’ characteristics (e.g., neural reserve, age), the nature of cognitive task used, and presentation modality (e.g., visual).

A broad understanding of motor control has been achieved through research performed on upper extremity reaching, walking on level ground, and static balance. Though invaluable insights have been achieved under these testing paradigms, inherent limitations result in less being known regarding functional movement in weight-bearing. Gait studies require large numbers of consecutive steps to achieve high reliability, static balance is limited to the goal of no movement, and upper extremity reaching lacks insights into feedback from the vestibular system. Here we describe (and provide a supplemental video of) a system for testing and training the performance of a weight-bearing, visuomotor task in the form of a mini-squat according to a sinusoidal trace on a screen. In this work, we determined that by altering both task movement rate and resistance at the knee, a hierarchy of difficulty was achieved at all ages. As age increases, there is a velocity-error tradeoff; speed of movement is attempted to be maintained while error is sacrifieced. When introducing an unexpected force perturbation (rapid release of the resistance of the squat for less than a second), older adults who are least able to match the frequency of the task experience the greatest error and velocity rates during the perturbation. This exposes a possible deficit in the feedback control system of even healthy older adults, where future studies may determine if early intervention to prevent such changes may prevent future injury and disability. When older and younger adults learned to perform the visuomotor task while performing a simultaneous cognitive task, learning was slowed as complexity of the cognitive task increased. In older adults, a difficult cognitive task inhibited acquisition of the squatting task with no apparent improvement in trial error nor coherence. Upon retesting of the motor task, there was no difference between dual-task and single-task trained ability to consolidate the motor task in both age groups, though those that trained under a dual-task condition were more able to automate the motor task as measured by a smaller dual-task cost. This may indicate that dual-task training leads to freeing cognitive resources from attending to a functional movement so that they may attend to other tasks such as what may be happening in the environment. Finally, executive function as measured by the Flanker Test, explained 80% of the variability of final day visuomotor error, being a possible prognostic factor for dual-task interventions. Future directions will determine if increased automaticity of a mini-squat will lead improvement to overall improved functional mobility and reduced lower extremity injuries when functioning in a busy community.

The thesis evaluates the effect of four-week home therapy using stabilometric platform Nintendo Wii Balance Board and tablet with integrated software HomeBalance in patients with brain injury. Software HomeBalance has been developed for the treatment of balance disorders and cognitive function. Manipulating the platform and the tablet may also develop grip and handling abilities of hand, both will be evaluated in this work as well. The theoretical part describes new trends in rehabilitation of cognitive-motor interference, dual-task therapy and therapy using technological equipments. Methods: A total of 9 subjects underwent four weeks of therapy using a therapeutic set HomeBalance. The control group of 12 subjects received therapy without any technological equipment. Patients participated in the initial examination, home therapy and final examination. As an evaluation of the therapy Mini-BESTest, Timed Up and Go test, Montreal cognitive assessment, 9- hole peg test, and also two games from HomeBalance software and questionnaire assessing satisfaction with therapy have been used. Results: After treatment the whole group improved in only two tests evaluated: in Mini- BESTest and the time of diagnostic scene in HomeBalance software. The research group had statistically better results in both tests...