title: Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial.
abstract: OBJECTIVE
  To compare the effect of 3 different approaches to balance training on dual-task balance performance in older adults with balance impairment.
  
  
  METHODS
  A double-blind, randomized controlled trial.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Older adults (N=23) with balance impairment (mean age, 74.8y). They scored 52 or less on the Berg Balance Scale (BBS) and/or walked with a self-selected gait speed of 1.1m/s or less.
  
  
  METHODS
  Participants were randomly assigned to 1 of 3 interventions: single-task training, dual-task training with fixed-priority instructions, and dual-task training with variable-priority instructions. Participants received 45-minute individualized training sessions, 3 times a week for 4 weeks.
  
  
  METHODS
  Gait speed under single-task and dual-task conditions was obtained at baseline, the second week, the end of training, and the twelfth week after the end of training. Other measures, including the BBS and the Activities-specific Balance Confidence (ABC) Scale, were collected at baseline and after training.
  
  
  RESULTS
  Participants in all groups improved on the BBS (P<.001; effect size [ES]=.72), and walked significantly faster after training (P=.02; ES=.27). When a cognitive task was added, however, only participants who received dual-task training with fixed-priority instructions and dual-task training with variable-priority instructions exhibited significant improvements in gait speed (P<.001, ES=.57; and P<.001, ES=.46, respectively). In addition, only the dual-task training with variable-priority instructions group demonstrated a dual-task training effect at the second week of training and maintained the training effect at the 12-week follow-up. Only the single-task training group showed a significant increase on the ABC after training (P<.001; ES=.61).
  
  
  CONCLUSIONS
  Dual-task training is effective in improving gait speed under dual-task conditions in elderly participants with balance impairment. Training balance under single-task conditions may not generalize to balance control during dual-task contexts. Explicit instruction regarding attentional focus is an important factor contributing to the rate of learning and the retention of the dual-task training effect.
authors.affiliation: Department of Physical Therapy, The Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. psilsupa@gmail.com
authors.forename: Patima
authors.initials: P
authors.lastname: Silsupadol
authors.forename: Anne
authors.initials: A
authors.lastname: Shumway-Cook
authors.forename: Vipul
authors.initials: V
authors.lastname: Lugade
authors.forename: Paul
authors.initials: P
authors.lastname: van Donkelaar
authors.forename: Li-Shan
authors.initials: LS
authors.lastname: Chou
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mayr
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Woollacott
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D015897:Comorbidity; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D015577:Geriatric Assessment; D006801:Humans; D007206:Individuality; D008297:Male; D004856:Postural Balance; D012678:Sensation Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D013647:Task Performance and Analysis; D016896:Treatment Outcome