Citation

McCulloch KL, Buxton E, Hackney J, Lowers S. J. Head Trauma Rehabil. 2010; 25(3): 155-163.

Affiliation

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

Copyright

(Copyright © 2010, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0b013e3181dc82e7

PMID

20473089

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.

Language: en