title: Improving motor control in walking: a randomized clinical trial in older adults with subclinical walking difficulty.
abstract: OBJECTIVE
  To test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait.
  
  
  METHODS
  Single-blinded randomized clinical trial.
  
  
  METHODS
  University research laboratory.
  
  
  METHODS
  Adults (N=40) aged ≥65 years with gait speed >1.0m/s and impaired motor skill (figure-of-8 walk time >8s).
  
  
  METHODS
  The 2 interventions included a task-oriented motor learning and a standard exercise program; both interventions included strength training. Both lasted 12 weeks, with twice-weekly, 1-hour, physical therapist-supervised sessions.
  
  
  METHODS
  Two measures of the motor control of gait, gait variability and smoothness of walking, were assessed pre- and postintervention by assessors masked to the treatment arm.
  
  
  RESULTS
  Of 40 randomized subjects, 38 completed the trial (mean age ± SD, 77.1±6.0y). The motor learning group improved more than the standard group in double-support time variability (.13m/s vs .05m/s; adjusted difference [AD]=.006, P=.03). Smoothness of walking in the anteroposterior direction improved more in the motor learning than standard group for all conditions (usual: AD=.53, P=.05; narrow: AD=.56, P=.01; dual task: AD=.57, P=.04). Smoothness of walking in the vertical direction also improved more in the motor learning than standard group for the narrow-path (AD=.71, P=.01) and dual-task (AD=.89, P=.01) conditions.
  
  
  CONCLUSIONS
  Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA. Electronic address: jbrach@pitt.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Brach
authors.affiliation: Department of Physical Therapy, Des Moines University, Des Moines, IA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Lowry
authors.affiliation: Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Subashan
authors.initials: S
authors.lastname: Perera
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Hornyak
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: David
authors.initials: D
authors.lastname: Wert
authors.affiliation: Longitudinal Studies Section, National Institute on Aging, Baltimore, MD.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Studenski
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jessie M
authors.initials: JM
authors.lastname: VanSwearingen
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009048:Motor Skills / Q000502:physiology*; D055070:Resistance Training; D016037:Single-Blind Method; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: Aging; Exercise; Gait; Motor control; Rehabilitation