Balance rehabilitation and dual-task ability in older adults

Background/PurposeRecent evidence suggests that an impaired ability to allocate attention to balance during dual-task situations is a powerful predictor of falls. Increased difficulty under dual-task conditions may result from cognitive or motor impairments or both. The extent to which interventions should be directed at cognitive or motor impairments is unclear. The goal of this study was to examine the extent to which standard balance rehabilitation improves dual-task ability.MethodsA retrospective chart review of patients without vestibular or neurological disorders who were referred to physical therapy for disequilibrium was performed. Patients were assessed initially and at discharge for balance-related confidence, gait speed, fall risk, sensory integration, and dual-task ability. Balance rehabilitation involved weekly sessions plus home training for strengthening, endurance, center of gravity control training, multisensory training and postural strategy training. Specific dual-task training was not included.ResultsAverage age was 75.8 ± 7.5 years, with 49% of participants being female. Participants improved significantly in all outcome measures, including measures of dual-task ability (p < 0.05). Percent improvement from initial to discharge assessment was significantly greater for balance confidence, fall risk and sensory integration than dual-task ability.ConclusionStandard balance rehabilitation significantly improved all measures of gait and balance, including dual-task measures; however, measures of dual-task ability did not improve to the same extent. Improvements of underlying motor impairments may not adequately address impaired dual-task ability.