Experimental Brain Research

, Volume 226, Issue 1, pp 81–93 | Cite as

The contribution of postural control and bilateral coordination to the impact of dual tasking on gait

  • Galit Yogev-Seligmann
  • Nir Giladi
  • Leor Gruendlinger
  • Jeffrey M. HausdorffEmail author
Research Article


The simultaneous performance of a cognitive task while walking typically alters the gait pattern. In some populations, these alterations have been associated with an increased risk of falls, motivating study of this response from the clinical perspective. The mechanisms responsible for these effects are not fully understood. The concurrent requirement to control upright posture and stepping, a bilaterally coordinated rhythmic task, may be the cause of this so-called dual-tasking effect. To evaluate this possibility, the present study was designed to isolate the individual contribution of these two demands by assessing the effects of cognitive loading on standing (i.e., postural control without bilateral coordination of stepping), cycling (i.e., bilateral coordination similar to stepping, but with minimal postural demands), and walking. We also investigated the effects of aging and parkinsonism on the performance of these three tasks in response to cognitive loading, also referred to as a dual task. Twenty-one healthy young adults, 15 healthy older adults, and 18 patients with Parkinson’s disease were assessed while walking, standing, and cycling, with and without an additional cognitive load. In the young adults, the performance on the two motor tasks that involved bilateral coordination deteriorated significantly in response to the dual task, while standing was not impacted. Similar results, although less robust, were observed among the healthy older adults. In contrast, among the patients with Parkinson’s disease, the dual-task costs, i.e., the impact of the simultaneously performed cognitive task on the gait pattern, were high in all motor tasks. These findings suggest that walking is especially vulnerable to cognitive loading, in part, because of the unique sensitivity of bilateral coordination of limb movements to the effects of dual tasking.


Gait Cognitive loading Dual task Attention Parkinson’s disease Postural control Aging 



Coefficient of variation


Frontal assessment battery


Trail making test


Unified Parkinson’s Disease Rating Scale

Supplementary material

221_2013_3412_MOESM1_ESM.doc (80 kb)
Supplementary material 1 (DOC 80 kb)


  1. Bakker M, Verstappen CC, Bloem BR, Toni I (2007) Recent advances in functional neuroimaging of gait. J Neural Transm 114:1323–1331PubMedCrossRefGoogle Scholar
  2. Beauchet O, Dubost V, Aminian K, Gonthier R, Kressig RW (2005a) Dual-task-related gait changes in the elderly: does the type of cognitive task matter? J Mot Behav 37:259–264PubMedGoogle Scholar
  3. Beauchet O, Dubost V, Herrmann FR, Kressig RW (2005b) Stride-to-stride variability while backward counting among healthy young adults. J Neuroeng Rehabil 2:26PubMedCrossRefGoogle Scholar
  4. Ble A, Volpato S, Zuliani G, Guralnik JM, Bandinelli S, Lauretani F, Bartali B, Maraldi C, Fellin R, Ferrucci L (2005) Executive function correlates with walking speed in older persons: the InCHIANTI study. J Am Geriatr Soc 53:410–415PubMedCrossRefGoogle Scholar
  5. Bloem BR, Valkenburg VV, Slabbekoorn M, van Dijk JG (2001a) The multiple tasks test. Strategies in Parkinson’s disease. Exp Brain Res 137:478–486PubMedCrossRefGoogle Scholar
  6. Bloem BR, Valkenburg VV, Slabbekoorn M, Willemsen MD (2001b) The Multiple Tasks Test: development and normal strategies. Gait Posture 14:191–202PubMedCrossRefGoogle Scholar
  7. Bloem BR, Grimbergen YA, van Dijk JG, Munneke M (2006) The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci 251:87–90PubMedCrossRefGoogle Scholar
  8. Bond JM, Morris M (2000) Goal-directed secondary motor tasks: their effects on gait in subjects with Parkinson disease. Arch Phys Med Rehabil 81:110–116PubMedGoogle Scholar
  9. Bootsma-van der Wiel A, Gussekloo J, de Craen AJ, van Exel E, Bloem BR, Westendorp RG (2003) Walking and talking as predictors of falls in the general population: the Leiden 85-Plus Study. J Am Geriatr Soc 51:1466–1471PubMedCrossRefGoogle Scholar
  10. Camicioli R, Oken BS, Sexton G, Kaye JA, Nutt JG (1998) Verbal fluency task affects gait in Parkinson’s disease with motor freezing. J Geriatr Psychiatry Neurol 11:181–185PubMedGoogle Scholar
  11. Christensen LO, Johannsen P, Sinkjaer T, Petersen N, Pyndt HS, Nielsen JB (2000) Cerebral activation during bicycle movements in man. Exp Brain Res 135:66–72PubMedCrossRefGoogle Scholar
  12. Dault MC, Frank JS, Allard F (2001) Influence of a visuo-spatial, verbal and central executive working memory task on postural control. Gait Posture 14:110–116PubMedCrossRefGoogle Scholar
  13. de Bruin ED, Schmidt A (2010) Walking behaviour of healthy elderly: attention should be paid. Behav Brain Funct 6:59PubMedCrossRefGoogle Scholar
  14. Donoghue OA, Cronin H, Savva GM, O’Regan C, Kenny RA (2012) Effects of fear of falling and activity restriction on normal and dual task walking in community dwelling older adults. Gait Posture.
  15. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: a frontal assessment battery at bedside. Neurology 55:1621–1626PubMedCrossRefGoogle Scholar
  16. Ebersbach G, Dimitrijevic MR, Poewe W (1995) Influence of concurrent tasks on gait: a dual-task approach. Percept Mot Skills 81:107–113PubMedCrossRefGoogle Scholar
  17. Fahn S (1987) Members of the UPDRS Developmental Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson’s disease, vol 2. Macmillan Health Care Information, Florham Park, pp 153–163 (Elton R)Google Scholar
  18. Frenkel-Toledo S, Giladi N, Peretz C, Herman T, Gruendlinger L, Hausdorff JM (2005) Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson’s disease. Mov Disord 20:1109–1114PubMedCrossRefGoogle Scholar
  19. Galletly R, Brauer SG (2005) Does the type of concurrent task affect preferred and cued gait in people with Parkinson’s disease? Aust J Physiother 51:175–180PubMedCrossRefGoogle Scholar
  20. Gelb DJ, Oliver E, Gilman S (1999) Diagnostic criteria for Parkinson disease. Arch Neurol 56:33–39PubMedCrossRefGoogle Scholar
  21. Goldberger AL, Amaral LA, Hausdorff JM, Ivanov PC, Peng CK, Stanley HE (2002) Fractal dynamics in physiology: alterations with disease and aging. Proc Natl Acad Sci USA 99(Suppl 1):2466–2472PubMedCrossRefGoogle Scholar
  22. Hausdorff JM, Mitchell SL, Firtion R, Peng CK, Cudkowicz ME, Wei JY, Goldberger AL (1997) Altered fractal dynamics of gait: reduced stride-interval correlations with aging and Huntington’s disease. J Appl Physiol 82:262–269PubMedGoogle Scholar
  23. Hausdorff JM, Lertratanakul A, Cudkowicz ME, Peterson AL, Kaliton D, Goldberger AL (2000) Dynamic markers of altered gait rhythm in amyotrophic lateral sclerosis. J Appl Physiol 88:2045–2053PubMedGoogle Scholar
  24. Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056PubMedCrossRefGoogle Scholar
  25. Hausdorff JM, Lowenthal J, Herman T, Gruendlinger L, Peretz C, Giladi N (2007) Rhythmic auditory stimulation modulates gait variability in Parkinson’s disease. Eur J Neurosci 26:2369–2375PubMedCrossRefGoogle Scholar
  26. Hausdorff JM, Schweiger A, Herman T, Yogev-Seligmann G, Giladi N (2008) Dual-task decrements in gait: contributing factors among healthy older adults. J Gerontol A Biol Sci Med Sci 63:1335–1343PubMedCrossRefGoogle Scholar
  27. Herman T, Mirelman A, Giladi N, Schweiger A, Hausdorff JM (2010) Executive control deficits as a prodrome to falls in healthy older adults: a prospective study linking thinking, walking, and falling. J Gerontol A Biol Sci Med Sci 65:1086–1092PubMedCrossRefGoogle Scholar
  28. Kave G (2005a) Phonemic fluency, semantic fluency, and difference scores: normative data for adult Hebrew speakers. J Clin Exp Neuropsychol 27:690–699PubMedCrossRefGoogle Scholar
  29. Kave G (2005b) Standardization and norms for a Hebrew naming test. Brain Lang 92:204–211PubMedCrossRefGoogle Scholar
  30. Kelly VE, Eusterbrock AJ, Shumway-Cook A (2012) A review of dual-task walking deficits in people with Parkinson’s disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons Dis 2012:918719PubMedGoogle Scholar
  31. Kerr B, Condon SM, McDonald LA (1985) Cognitive spatial processing and the regulation of posture. J Exp Psychol Hum Percept Perform 11:617–622PubMedCrossRefGoogle Scholar
  32. Lezak MD (1995) Neuropsychological assessment. Oxford University Press, Inc., New YorkGoogle Scholar
  33. Li KZ, Lindenberger U, Freund AM, Baltes PB (2001) Walking while memorizing: age-related differences in compensatory behavior. Psychol Sci 12:230–237PubMedCrossRefGoogle Scholar
  34. Li KZ, Abbud GA, Fraser SA, Demont RG (2012) Successful adaptation of gait in healthy older adults during dual-task treadmill walking. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 19:150–167PubMedCrossRefGoogle Scholar
  35. Lindenberger U, Marsiske M, Baltes PB (2000) Memorizing while walking: increase in dual-task costs from young adulthood to old age. Psychol Aging 15:417–436PubMedCrossRefGoogle Scholar
  36. Lundin-Olsson L, Nyberg L, Gustafson Y (1997) “Stops walking when talking” as a predictor of falls in elderly people. Lancet 349:617PubMedCrossRefGoogle Scholar
  37. Maylor EA, Wing AM (1996) Age differences in postural stability are increased by additional cognitive demands. J Gerontol B Psychol Sci Soc Sci 51:143–154CrossRefGoogle Scholar
  38. McNevin NH, Wulf G, Carlson C (2000) Effects of attentional focus, self-control, and dyad training on motor learning: implications for physical rehabilitation. Phys Ther 80:373–385PubMedGoogle Scholar
  39. Mirelman A, Maidan I, Herman T, Deutsch JE, Giladi N, Hausdorff JM (2011) Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson’s disease? J Gerontol A Biol Sci Med Sci 66:234–240PubMedCrossRefGoogle Scholar
  40. Miyai I, Tanabe HC, Sase I, Eda H, Oda I, Konishi I, Tsunazawa Y, Suzuki T, Yanagida T, Kubota K (2001) Cortical mapping of gait in humans: a near-infrared spectroscopic topography study. Neuroimage 14:1186–1192PubMedCrossRefGoogle Scholar
  41. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53:695–699PubMedCrossRefGoogle Scholar
  42. Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems AM, Chavret F, Hetherington V, Baker K, Lim I (2007) Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 78:134–140PubMedCrossRefGoogle Scholar
  43. O’Shea S, Morris ME, Iansek R (2002) Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys Ther 82:888–897PubMedGoogle Scholar
  44. Perry J (1992) Gait analysis: normal and pathological function. SLACK Incorporate, ThorofareGoogle Scholar
  45. Pichierri G, Wolf P, Murer K, de Bruin ED (2011) Cognitive and cognitive-motor interventions affecting physical functioning: a systematic review. BMC Geriatr 11:29PubMedCrossRefGoogle Scholar
  46. Pichierri G, Coppe A, Lorenzetti S, Murer K, de Bruin ED (2012) The effect of a cognitive-motor intervention on voluntary step execution under single and dual task conditions in older adults: a randomized controlled pilot study. Clin Interv Aging 7:175–184PubMedCrossRefGoogle Scholar
  47. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedGoogle Scholar
  48. Rochester L, Hetherington V, Jones D, Nieuwboer A, Willems AM, Kwakkel G, Van WE (2005) The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson’s disease. Arch Phys Med Rehabil 86:999–1006PubMedCrossRefGoogle Scholar
  49. Segev-Jacubovski O, Herman T, Yogev-Seligmann G, Mirelman A, Giladi N, Hausdorff JM (2011) The interplay between gait, falls and cognition: can cognitive therapy reduce fall risk? Expert Rev Neurother 11:1057–1075PubMedCrossRefGoogle Scholar
  50. Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH (2009) Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil 90:381–387PubMedCrossRefGoogle Scholar
  51. Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM (2005) Dual tasking effects on gait variability: the role of aging, falls and executive function. Mov Disord 21:950–957CrossRefGoogle Scholar
  52. Stuss DT, Levine B (2002) Adult clinical neuropsychology: lessons from studies of the frontal lobes. Annu Rev Psychol 53:401–433PubMedCrossRefGoogle Scholar
  53. Toledo-Frankel S, Giladi N, Gruendlinger L, Baltadjieva R, Herman T, Hausdorff JM (2004) Treadmill walking as an external cue to improve gait rhythm and stability in Parkinson’s disease. Mov Disord 19:S138–S139Google Scholar
  54. Verghese J, Kuslansky G, Holtzer R, Katz M, Xue X, Buschke H, Pahor M (2007) Walking while talking: effect of task prioritization in the elderly. Arch Phys Med Rehabil 88:50–53PubMedCrossRefGoogle Scholar
  55. Verghese J, Mahoney J, Ambrose AF, Wang C, Holtzer R (2010) Effect of cognitive remediation on gait in sedentary seniors. J Gerontol A Biol Sci Med Sci 65:1338–1343PubMedCrossRefGoogle Scholar
  56. Wang C, Wai Y, Kuo B, Yeh YY, Wang J (2008) Cortical control of gait in healthy humans: an fMRI study. J Neural Transm 115:1149–1158PubMedCrossRefGoogle Scholar
  57. Woollacott M, Shumway-Cook A (2002) Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 16:1–14PubMedCrossRefGoogle Scholar
  58. Wulf G, McNevin NH, Fuchs T, Ritter F, Toole T (2000) Attentional focus in complex skill learning. Res Q Exerc Sport 71:229–239PubMedCrossRefGoogle Scholar
  59. Yang YR, Chen YC, Lee CS, Cheng SJ, Wang RY (2007) Dual-task-related gait changes in individuals with stroke. Gait Posture 25:185–190PubMedCrossRefGoogle Scholar
  60. Yogev G, Giladi N, Peretz C, Springer S, Simon ES, Hausdorff JM (2005) Dual tasking, gait rhythmicity, and Parkinson’s disease: which aspects of gait are attention demanding? Eur J Neurosci 22:1248–1256PubMedCrossRefGoogle Scholar
  61. Yogev G, Plotnik M, Peretz C, Giladi N, Hausdorff JM (2006) Gait asymmetry in patients with Parkinson’s disease and elderly fallers: when does the bilateral coordination of gait require attention? Exp Brain Res 177:336–346CrossRefGoogle Scholar
  62. Yogev-Seligmann G, Hausdorff JM, Giladi N (2008) The role of executive function and attention in gait. Mov Disord 23:329–342PubMedCrossRefGoogle Scholar
  63. Yogev-Seligmann G, Rotem-Galili Y, Mirelman A, Dickstein R, Giladi N, Hausdorff JM (2010) How does explicit prioritization alter walking during dual-task performance? Effects of age and sex on gait speed and variability. Phys Ther 90:177–186PubMedCrossRefGoogle Scholar
  64. Yogev-Seligmann G, Giladi N, Brozgol M, Hausdorff JM (2012) A training program to improve gait while dual tasking in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil 93:176–181PubMedCrossRefGoogle Scholar
  65. Zanone PG, Monno A, Temprado JJ, Laurent M (2001) Shared dynamics of attentional cost and pattern stability. Hum Mov Sci 20:765–789PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Galit Yogev-Seligmann
    • 1
    • 2
  • Nir Giladi
    • 1
    • 5
  • Leor Gruendlinger
    • 1
  • Jeffrey M. Hausdorff
    • 1
    • 3
    • 4
  1. 1.Laboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Department of NeurologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Faculty of Medicine, The Dr. Miriam and Sheldon G. Adelson Graduate School of Medicine SacklerTel-Aviv UniversityTel AvivIsrael
  3. 3.Department of Physical Therapy, Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  4. 4.Department of MedicineHarvard Medical SchoolBostonUSA
  5. 5.Department of Neurology, Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael

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