Shaikhsulaiman, AAM; (2015) Effects of Dual (Cognitive) Tasking on Free Walking in Patients with a Peripheral Vestibular Disorder. Doctoral thesis , UCL (University College London).

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Abstract

This thesis examines the effect of dual tasking on dynamic balance in patients with unilateral peripheral vestibular disorders, both in indoor laboratory and in outdoor urban environments. A novel dual-tasking the functional gait assessment test (FGA) and an outdoor urban walking task around London Bridge using an accelerometer device were used to examine the effect of dual tasking on walking velocity and acceleration of various body segments. In addition, behavioural assessment using the dys-executive syndrome tests battery (BADs) was undertaken to assess participants’ cognitive abilities and their impact on performance under the dual task condition. The above measures were first applied to healthy participants assigned to young and old age groups (Chapter 3). Although both study groups had reduced FGA scores under the dual tasking condition, the older healthy group had significantly lower scores that may increase their risk of falls. The trunk medio-lateral (ML) acceleration was significantly reduced in older healthy adults, and the trunk attenuation rate (TAR) was reduced in dual tasking. Case control trials were carried out to compare the performance of patients diagnosed with unilateral peripheral vestibular disorders (UVD) relative to healthy age matched controls, while carrying indoor assessment (Chapter 4) and outdoor assessment tasks (Chapter 5). The addition of cognitive tasks adversely affected the FGA scores in both groups, though UVD group had a significantly higher risk of falls (in Chapter 4). Cognitive scores were significantly lower in the UVD group in three sub-tests of the BADs test battery. Walking velocity was significantly reduced in the patients group under single and dual task conditions (Chapter 5). Cognitive tasking resulted in significant reduction in the anterior-posterior (AP) and vertical (V) acceleration of the UVD group. ML head acceleration was significantly higher than ML Trunk Acceleration in UVD with dual tasking. In conclusion, our novel approach of implementing a dual tasking paradigm while walking in an outdoor environment showed that dual tasking interferes with postural stability. This will most likely put patients at risk of falls in multitasking situations commonly encountered in everyday life. This finding could be used to inform patient rehabilitation programmes currently in use.

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