The study aims to examine the effect of single-task, dual-task and analogy training during gait rehabilitation on conscious motor processing propensity, balance, walking ability and fear of falling by older adults at risk of falling in Hong Kong. One-hundred and five healthy older adults will be recruited from elderly community centres in Hong Kong by convenience sampling. They will be randomly assigned into 3 groups (i.e., single-task walking group (active control group), dual-task walking group and analogy walking group). Participants in different groups will have training sessions (about 45 minutes each) three times per week for 4 weeks in a group of 5 participants. A total of 12 sessions will be completed by each participant. All training sessions will be conducted by experienced Hong Kong registered Physiotherapists. In each training session, all groups will have warm-up (5 minutes), balance training (5 minutes), body transport training (5 minutes), body transport with hand manipulation training (5 minutes), walking training with various difficulties in a 10 meters walkway with different instructions in different walking groups (20 minutes) and cool down (5 minutes). Participants in the different groups will receive different instructions during walking training. Well- developed single-task (explicit), dual-task and analogy instructions will be utilized in the single-task walking group, dual-task walking group and analogy walking group, respectively. Each participant will undergo assessment sessions (total 3 assessment sessions) before training at baseline (T0), just after completion of all training sessions (T1) and 6 months after completion of all training sessions (T2). In the baseline assessment, a structural questionnaire will be used to ask for demographics, detailed history of fall incident, detailed medical history, social history and social-economic status of the participants. A battery of assessments will be done to assess physical and cognitive abilities of the participants in all assessment sessions. Single-task walking ability, dual-task walking ability, functional gait and balance assessment, cognitive function, fearing of falling and propensity for conscious motor processing. All participants will also be asked to record their number of falls prospectively at the time between T1 (completion of all training sessions) and T2 (6 months after completion of all training sessions) using a calendar. The number of falls within the 6-month follow- up period will then be collected.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
105
In each training session, all groups will have warm-up (5 minutes), balance training (5 minutes), body transport training (5 minutes), body transport with hand manipulation training (5 minutes), walking training with various difficulties in a 10 meters walkway with Single-task Training instructions (20 minutes) and cool down (5 minutes).
In each training session, all groups will have warm-up (5 minutes), balance training (5 minutes), body transport training (5 minutes), body transport with hand manipulation training (5 minutes), walking training with various difficulties in a 10 meters walkway with Dual-task Training instructions (20 minutes) and cool down (5 minutes).
In each training session, all groups will have warm-up (5 minutes), balance training (5 minutes), body transport training (5 minutes), body transport with hand manipulation training (5 minutes), walking training with various difficulties in a 10 meters walkway with Analogy Training instructions (20 minutes) and cool down (5 minutes).
The HKJC Building for Interdisciplinary Research
Hong Kong, Hong Kong
RECRUITINGBaseline propensity for conscious motor processing
The Chinese version Movement Specific Reinvestment Scale (MSRS-C) (Masters et al., 2005; Wong et al., 2015a; Wong et al., 2015b). The MSRS-C includes two sub-scales: Conscious motor processing and Movement self-consciousness. The scores for both sub-scales ranges from 5-30. A higher score indicate a higher propensity for conscious motor processing.
Time frame: Before the start of training
Change from baseline propensity for conscious motor processing upon completion of training
The Chinese version Movement Specific Reinvestment Scale (MSRS-C) (Masters et al., 2005; Wong et al., 2015a; Wong et al., 2015b). The MSRS-C includes two sub-scales: Conscious motor processing and Movement self-consciousness. The scores for both sub-scales ranges from 5-30. A higher score indicate a higher propensity for conscious motor processing.
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline propensity for conscious motor processing at 6 months after the completion of training
The Chinese version Movement Specific Reinvestment Scale (MSRS-C) (Masters et al., 2005; Wong et al., 2015a; Wong et al., 2015b). The MSRS-C includes two sub-scales: Conscious motor processing and Movement self-consciousness. The scores for both sub-scales ranges from 5-30. A higher score indicate a higher propensity for conscious motor processing.
Time frame: 6 months after the completion of Training
Baseline single-task walking ability
10 meters comfortable and fast walking speed (Bohannon, 1997)
Time frame: Before the start of training
Change from baseline single-task walking ability upon completion of training
10 meters comfortable and fast walking speed (Bohannon, 1997)
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline single-task walking ability at 6 months after the completion of training
10 meters comfortable and fast walking speed (Bohannon, 1997)
Time frame: 6 months after the completion of Training
Baseline dual-task walking ability
10 meters comfortable and fast walking speed with concurrent verbal or visual-spatial dual-tasks of auditory stroop task (Siu, Catena, Chou, van Donkelaar, \& Woollacott, 2008) or clock test (Plummer-D'Amato, Altmann, Saracino, Fox, Behrman, \& Marsiske, 2008)
Time frame: Before the start of training
Change from baseline dual-task walking ability upon completion of training
10 meters comfortable and fast walking speed with concurrent verbal or visual-spatial dual-tasks of auditory stroop task (Siu, Catena, Chou, van Donkelaar, \& Woollacott, 2008) or clock test (Plummer-D'Amato, Altmann, Saracino, Fox, Behrman, \& Marsiske, 2008)
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline dual-task walking ability at 6 months after the completion of training
10 meters comfortable and fast walking speed with concurrent verbal or visual-spatial dual-tasks of auditory stroop task (Siu, Catena, Chou, van Donkelaar, \& Woollacott, 2008) or clock test (Plummer-D'Amato, Altmann, Saracino, Fox, Behrman, \& Marsiske, 2008)
Time frame: 6 months after the completion of Training
Baseline Tinetti Balance Assessment Tool score
Tinetti Balance Assessment Tool (Tinetti, 1986).
Time frame: Before the start of training
Change from baseline Tinetti Balance Assessment Tool score upon completion of training
Tinetti Balance Assessment Tool (Tinetti, 1986)
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline Tinetti Balance Assessment Tool score at 6 months after the completion of training
Tinetti Balance Assessment Tool (Tinetti, 1986)
Time frame: 6 months after the completion of Training
Baseline Timed 'Up & Go' Tests time
Timed 'Up \& Go' Tests (TU\&G(Podsiadlo \& Richardson, 1991)
Time frame: Before the start of training
Change from baseline Timed 'Up & Go' Tests time upon completion of training
Timed 'Up \& Go' Tests (TU\&G(Podsiadlo \& Richardson, 1991)
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline Timed 'Up & Go' Tests time at 6 months after the completion of training
Timed 'Up \& Go' Tests (TU\&G(Podsiadlo \& Richardson, 1991)
Time frame: 6 months after the completion of Training
Baseline Berg Balance Scale score
Berg Balance Scale (BBS) (Berg, Wood Dauphinee, Williams \& Gayton, 1989)
Time frame: Before the start of training
Change from baseline Berg Balance Scale score upon completion of training
Berg Balance Scale (BBS) (Berg, Wood Dauphinee, Williams \& Gayton, 1989)
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline Berg Balance Scale score at 6 months after the completion of training
Berg Balance Scale (BBS) (Berg, Wood Dauphinee, Williams \& Gayton, 1989)
Time frame: 6 months after the completion of Training
Cognitive function
The Chinese version Mini-Mental State Examination (MMSE-C) (Folstein et al., 1975; Chiu et al., 1994). A mark of 24 or above out of 30 is required to meet the inclusion criteria.
Time frame: Before the start of training
Baseline fear of falling
Fall Efficacy Scale (FES-13) (Tinetti, Richman, \& Powell L, 1990; Tinetti, Leon, Doucette \& Parker, 1994; Hellström \& Lindmark, 1999). The FES-13 score ranges from 16-64. A higher score indicates greater fear of falling.
Time frame: Before the start of training
Change from baseline fear of falling upon completion of training
Fall Efficacy Scale (FES-13) (Tinetti, Richman, \& Powell L, 1990; Tinetti, Leon, Doucette \& Parker, 1994; Hellström \& Lindmark, 1999). The FES-13 score ranges from 16-64. A higher score indicates greater fear of falling.
Time frame: Upon completion of 12 Training Sessions (4 weeks of training)
Change from baseline fear of falling at 6 months after the completion of training
Fall Efficacy Scale (FES-13) (Tinetti, Richman, \& Powell L, 1990; Tinetti, Leon, Doucette \& Parker, 1994; Hellström \& Lindmark, 1999). The FES-13 score ranges from 16-64. A higher score indicates greater fear of falling.
Time frame: 6 months after the completion of Training
Number of falls between T1 and T2 (post training to 6 months after completion of training)
Record of the the number of falls prospectively at the time between T1 (completion of all training sessions) and T2 (6 months after completion of all training sessions) using a calendar.
Time frame: 6 months after the completion of Training
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