AN ASSESSMENT OF THE ATTENTIONAL DEMANDS OF WALKING WITH AN ASSISTIVE DEVICE IN ELDERLY INDIVIDUALS
J. Angelo, MS, PT, K. Dyer, MS, PT, G. Eichhorn, MS, PT, W. Lockhart, MS, PT, R. Wellmon, MS, PT, NCS
PURPOSE: The purpose of this study was to examine the attentional demands of standing and walking with and without an assistive device (AD) among elderly individuals who were independent in community ambulation.
SUBJECTS: Fifty-one female subjects over the age of 69 (range = 69-98 yrs) were recruited from an independent living retirement community to participate in this study. Subjects were divided into three groups according to type of AD normally used for ambulation. The groups consisted of individuals who ambulated independently with either a rolling walker, a straight cane, or used no AD. A control group consisting of 15 female subjects ranging in age from 22-34 years was also included.
METHODS: A dual-task methodology was used to examine the attentional demands of standing and walking with and without an AD. The dual-task methodology assesses the attentional load associated with performing a specific task by introducing a secondary task that the subject must complete while performing the primary task. In this study, verbally responding to an auditory stimulus was used as the secondary task. Voice reaction time (VRT) was the amount of time elapsing between the presentation of the auditory stimulus and the recording of the subjects’ vocal response. VRT for all of the subjects was examined in sitting, standing and during ambulation on a level surface.
ANALYSIS: A 4 (Group) by 3 (Condition) ANOVA with repeated measures on the last factor was used to examine between and within subject differences in VRT for the sitting, standing and walking conditions.
RESULTS: No statistically significant differences were found between the groups for VRT during the sitting and standing conditions. A statistically significant difference was found for VRT during the walking condition between the AD and non-AD groups. AD users demonstrated slower voice reaction times during ambulation. Within group differences by condition were found for users of ADs. VRT for the walking condition was significantly slower than the sitting and standing conditions. No statistically significant differences were found between the control group and the group of elderly subjects who did not use an AD.
CONCLUSIONS: The results of this study indicate that greater attention is required to ambulate for users of ADs. The reason for the increase in attention may be due to the need to allocated attentional resources to appropriate device use. Cognitive processing issues or underlying balance problems are alternative explanations for differences in VRT between and within the groups.
RELEVANCE: ADs are prescribed to enhance a person’s ability to ambulate. However, there may be a tradeoff associated with AD prescription related to the increased attentional load required for incorporation of the device into the person’s pattern of gait. The decrease in the ability to allocate attentional resources to the surrounding environment during ambulation with an AD may place users at increase risk for falling. Therapists should take care in classifying individuals as being independent in AD use given the findings of this study
Research in completed in fulfillment of the MS in Physical Therapy Degree at the Institute for Physical Therapy Education, Widener University, Chester, PA. Submitted for presentation at American Physical Therapy Association Combined Section Meeting in New Orlean, LA, 2000.