Can people with Parkinson's disease improve dual tasking when walking?

BACKGROUND: Gait disorders in people with Parkinson's disease (PD) are accentuated when they perform another task simultaneously. This study examines whether practice enables people with PD to walk with large steps while performing added tasks, and to determine if training people with PD to walk with added working memory tasks leads to improvements in gait when walking and performing other tasks simultaneously.
METHODS: Walking patterns were recorded pre and post a 20min dual task training session in 20 people with PD. Participants performed a series of 10m walking trials under seven conditions: gait only, and with six different added tasks varying by task type (e.g. motor, cognitive), domain (e.g. postural, manual manipulation, language, calculation, auditory, visuospatial), and difficulty level. Dual task training aimed to improve step length while simultaneously undertaking a variety of language and counting working memory tasks that were different to those used in assessment.
RESULTS: Following training, step length increased when performing five of the six added tasks, indicating transfer of dual task training when walking occurred across task types and domains. Improvements in gait speed occurred in three of the six added tasks. When other gait variables were examined, such as step length variability, few improvements with training were found.
CONCLUSIONS: Training can lead to larger steps when walking under dual task conditions in people with PD. The gait variable emphasised during dual task training appears to be an important factor in enabling the transfer of training improvements across tasks. Copyright 2009 Elsevier B.V. All rights reserved.