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The Effects of Task Prioritization on Dual-Tasking Postural Control in Patients With Parkinson Disease Who Have Different Postural Impairments

Published:March 28, 2020DOI:https://doi.org/10.1016/j.apmr.2020.02.014

      Abstract

      Objective

      To investigate the effect of task prioritization on dual-task control in Parkinson disease (PD) associated with different postural impairments.

      Design

      Cross-sectional study. Participants were instructed to keep 2 interlocking rings apart and maintain balance in a tandem stance. Attention was focused on either stance stability (posture-focus strategy) or the interlocking rings (supraposture-focus strategy).

      Setting

      University research laboratory.

      Participants

      Fifteen patients with PD and less postural impairment and 15 patients with PD and more postural impairment (N=30).

      Interventions

      Not applicable.

      Main Outcome Measures

      Postural sway, postural determinism (%DET), ankle co-contraction, and ring-touching time.

      Results

      In the less-impairment group, the supraposture-focus strategy provided smaller postural sway and postural %DET compared with the posture-focus strategy. In the more-impairment group, task prioritization showed lower effect on both postural sway and postural %DET. The supraposture-focus strategy led to less ankle co-contraction than the posture-focus strategy in the more-impairment group, but task prioritization did not affect ankle co-contraction in the less-impairment group. In both groups, the supraposture-focus strategy led to less ring-touching time than the posture-focus strategy.

      Conclusions

      The supraposture-focus strategy provided better dual-task control than the posture-focus strategy in both PD groups. In the less-impairment group, the supraposture-focus strategy enhanced postural automaticity and postural stability. In the more-impairment group, the supraposture-focus strategy reduced ankle stiffness, owing to reduced muscle co-contraction.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), AP (anterior-posterior), CAI (co-activation index), CoP (center-of-pressure), DET (determinism), EMG (electromyography), MDS-UPDRS (MDS-sponsored Revision of the Unified Parkinson’s Disease Rating Scale), ML (medial-lateral), PD (Parkinson disease), PF (posture-focus), SF (supraposture-focus), RMS (root mean square)
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