Pupil diameter as a biomarker of effort in goal-directed gait.

Subjects' eye movement behavior related to cognitive effort during gait was measured as subjects walked to perform low and high cognitive load tasks. We found that all pupil diameter measures, fixation durations, and the proportion of blink duration changed significantly during gait as a function of task load. In contrast, the number of fixations, saccade durations and travel time did not change significantly as a function of task load. Findings showed that pupil diameter was the best predictor of task load during one's gait preceding the performance of the task. While other studies have demonstrated the importance of eye fixation characteristics during gait, our findings showed that eye measures related to pupil diameter were better at detecting cognitive load while walking to perform a task compared to eye fixation data. We also found that cognitive effort was not limited to just the performance of the task, but that it was also exerted during one's gait preceding the performance of the task. Therefore, the additional attention demand caused by an increase in task complexity may result in less attentional resources being available to adequately handle distractions (such as obstacle avoidance) while walking to perform the task. Consequently, this may increase the likelihood of falls in those individuals with lower attentional capacity.