A divided-attention timed stepping accuracy task as a procedural learning intervention improves balance and functional performance in healthy older adults
For both healthy individuals and individuals at high risk of falling, certain environments, such as a dual-task situation, require more resources than others to prevent a loss of balance. Stepping assessment tasks can be used to predict falls, and it has been suggested that impaired voluntary stepping may be a contributing factor to falls (Lord & Fitzpatrick, 2001). In this research, a stepping task was used not as an assessment, but as a therapeutic intervention. The purpose of this research was to determine how training with a task that provides a procedural learning environment can affect balance and functional outcomes. The divided-attention timed stepping accuracy task required participants to step to and from 16 targets in a random order as quickly and accurately as possible. The physical stepping task was performed simultaneously with a cognitive information-processing task that involved attending to verbal cues to determine the next target while visually monitoring the environment to ensure accuracy requirements were met. Training sessions lasted approximately 30 min and were performed three times per week for 6 weeks. In experiment 1, a single-case experimental design, an individual with a 4 year history of an incomplete cervical spinal cord injury demonstrated improvements in balance, endurance, and functional tasks. In experiment 2, a pretest, posttest control group design, healthy older adults aged 65 years and above had significant improvements in the areas of balance, divided-attention performance, functional task performance, endurance and strength. In experiment 1, it was hypothesized that a procedural learning environment had been established and this was substantiated in experiment 2. The results from experiment 2 indicate that strength and endurance may have accounted for some of the improvements seen, but there is sufficient evidence that much of the improvement could be accounted for by procedural learning. In experiment 2, training resulted in simultaneous improvements in both the physical and cognitive aspects of the task. This research has immediate clinical applications and future studies may substantiate other potential clinical applications.
motor learning, implicit learning, physical therapy, training, strengthening
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