Dual-Task Flashcards
What is dual tasking?
Concurrent performance of two tasks that can be performed independently, measured separately, and have distinct goals
Increasingly prevalent in modern life
What is dual tasking not?
A complex series of task (e.g., making coffee)
A complex single task (e.g., riding a bike with a backpack on)
What does dual tasking require?
Task performance requires interaction between action, cognition, and sensory systems
Interference is detrimental and more prevalent
Facilitation may exist and can be used as a therapeutic agent
What is cognitive-motor interference?
Occurs when simultaneous (dual-task) performance of a cognitive and a motor task results in deterioration of performance in one or both tasks, relative to performance of each task separately (single-task performance)
Can occur between two motor tasks or two cognitive tasks
How will dual taking impact performance?
Focus is interference of one (primary) task due to concurrent performance of a secondary task, leading to performance deterioration of:
Primary task, Secondary task or both
Dual-task cost: reduced performance in the dual task condition
What are some factors that can influence dual tasking?
Measurement of single task performance is crucial (ex: walking time during TUG-DT)
Instructions are critical: task priority
Safety cost may bias performance
Task characteristics
Why is dual talking important?
Predictive of function in the real world (associated with falls risk)
Provides important insights into patient’s cognitive and motor function
Provides avenues for education for patient safety
What are the three theories for dual tasking?
Attentional capacity
Attention allocation
Structural interference
What are some aspects/”nature” of attention?
Focused
Sustained
Selective
Alternating
Divided
What does attention allocation refer too?
Common resources (other than attention) are needed for each task, so resources allocated to one task cause poor performance on the other
What does attention capacity refer too?
A set amount of attention (pie) is allowed and we give more attention to as task when we’re early in practice or non skilled. As we practice and improved out attention can shift to the secondary task
What are the processes required for dual tasking?
Processes relevant for both multitasking domains, dual-task-specific, and task-switching-specific processes
What do we need to keep in mind when designing a dual tasking program?
Identify patient-specific impairments in single and dual task
Understand patient-specific contextual deficits: individual goals, settings, and participation/ patient roles
Understand personalities, psychological, and cognitive factors related to the patient
Salience is crucial for transfer to real life
When do we test for dual tasking?
ENSURE SAFETY
Establish baseline prior to interventions (clear deficits in single and dual task conditions)
Re-examination to determine improvement
- Re-testing in similar conditions
Transfer to real world—in patient’s environment
Examples of dual task measures
Walking While Talking (WWT) or Stops Walking While Talking
Walking and Remembering Test (WART)
Cognitive Timed Up and Go (C-TUG)
Patient-specific, environment-specific testing
Describe the WWT exam
Ambulate 20 feet, turn, and return
- WWT-simple: walking while reciting the alphabet aloud
- WWT-complex: walking while reciting alternate letters of the alphabet aloud
Scoring: time needed to complete the distance
- 20 seconds or longer for WWT-simple: high specificity for identifying falls
- 33 seconds or longer for WWT-complex: high specificity for identifying falls
What are the types of TUG tests?
TUG: normal
Cognitive TUG: complete TUG while counting backward by 3s from a randomly selected number b/w 20 and 100
Manual: complete TUG while holding a cup filled with water
How do we document dual tasks?
Goal is to identify dual-task tolerance in a task specific manner
Document: both motor and secondary task cognitive or motor
Identify:
* Deficits in single task conditions
* Deficits in dual task conditions
* Establishing the level of dual-task intolerance using dual-task cost
* Identify number and type of errors and strategies of compensation
What is the relevance of dual task training?
ADLs: independence in mobility and stability with efficiency
Fall prevention, Hygiene, Personal/community relationships, Vocation, and Recreation
What are the 7 principles of training
- Specificity
- Repetition
- Intensity
- Establishing goals: function
- Motivation: autonomy, modify expectation of success
- Consider motor, perceptual, and cognitive deficits
- Consider personality
How can you improve motivation for the patient?
Share results of testing including interpretation
Answer questions and relieve concerns
Prioritize and ensure safety
Patient goals: crucial
Foster autonomy (choices, established RPE, progression, HEP)
Use VR if possible
Safety and dual tasking
Safety is important.
Identifying dual-task intolerance
Awareness of dual-task intolerance
Understanding significance of distractors and their effects on mobility and stability
Providing compensatory strategies and training
Modify environment for safety
Train caregivers
What does the evidence say?
Current evidence for the efficacy of dual-task training compared with single-task training is mixed at best.
- Disparities in motor and cognitive tasks used for testing and training
- Disparities in specificity and intensity of training
- Test-retest learning
- Individual differences are not considered
