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J Head Trauma Rehabil. 2010 May-Jun;25(3):155-63. doi: 10.1097/HTR.0b013e3181dc82e7.

Balance, attention, and dual-task performance during walking after brain injury: associations with falls history.

Author information

1
Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina 27599, USA. karen mcculloch@med.unc.edu

Abstract

OBJECTIVE:

To examine the relationship between balance, attention, and dual-task performance in individuals with acquired brain injury.

DESIGN:

Cross-sectional study.

SETTING:

Rehabilitation center and supported living program.

PARTICIPANTS:

Twenty-four individuals aged 18 to 58 years (mean = 39 years) with acquired brain injury who were able to ambulate 40 ft with (29%) or without an assistive device. Fifty-eight percent were independent community ambulators. Fifty-four percent had fallen in the past 6 months; and 42% reported feeling unsteady with standing or walking.

INTERVENTIONS:

Participants completed a battery of balance, attention, and dual-task assessments.

MAIN OUTCOME MEASURES:

Balance: Berg Balance Scale (BBS), Four Square Step Test (FSST), High Level Mobility Assessment Test (HiMAT); Attention: Symbol Digit Modalities Test (SDMT), Moss Attention Rating Scale (MARS), modified for a single test session; and a walking dual-task assessment, the Walking and Remembering Test.

RESULTS:

Mean scores: BBS, 48 of 56; FSST, 19.6 seconds; HiMAT, 20 of 54; SDMT, 30 correct; and MARS, 80. Dual-task costs were observed with variable patterns across subjects: 48% demonstrated primarily motor slowing, 9% had reduced cognitive accuracy without motor slowing, and 35% demonstrated decrements in both tasks. Subjects with a falls history had more impaired balance (HiMAT, BBS, and FSST, all P <.026) but were not significantly different in dual-task performance or attention measures.

CONCLUSIONS:

The test battery matched the range of motor and cognitive abilities of the sample. Balance was more strongly related to falls history than measures of attention or dual-task performance. Injury chronicity may have allowed some subjects to develop strategies to optimize dual-task performance. Alternatively, motor slowing in dual-task conditions may be an adaptive strategy, allowing performance of multiple tasks with reduced safety risk. Further investigation in this area is warranted to clarify the utility of dual-task methods in identifying falls risk after brain injury.

PMID:
20473089
DOI:
10.1097/HTR.0b013e3181dc82e7
[Indexed for MEDLINE]

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