The effects of integrated single- and dual-task training on automaticity and attention allocation in Parkinson's disease: A secondary analysis from a randomized trial.

Objective: People with Parkinson's disease (PwPD) demonstrate impaired automaticity of motor and cognitive tasks, with unclear prioritization strategies when exposed to dual-task situations. However, no randomized trials have investigated the effects of training on automaticity and prioritization strategies in this population. The purpose of this study was to investigate the effects of training on the automaticity of gait and cognitive processing in PwPD and the allocation of attention between gait and a cognitive task. Method: One-hundred PwPD were randomized to 10 weeks of challenging gait and balance training (including single and dual-task conditions) or to a control group (care as usual). Outcome measure was the absolute dual-task interference (difference between single- and dual-tasks) for gait and cognitive parameters. Differences between baseline and follow-up were compared between the groups. The Mann-Whitney U test was used to assess potential differences. Significance level was set to p = .05. The direction and magnitude of nonparametric effect sizes were used to investigate attention allocation. Results: No significant between-groups differences were found regarding any gait parameter. The training group significantly improved the dual-task interference of the cognitive task. The direction of between-groups effect sizes indicated that the training group primarily allocated attention to the cognitive task, whereas the control group appeared to prioritize gait. Conclusions: The results indicate that challenging training can improve automaticity of cognitive processing during walking. This may have a beneficiary effect on the ability to ambulate safely in the community, thereby improving independence and the quality of life in this population. This study provides the first findings regarding how challenging training entailing the simultaneous performance of walking and cognitive tasks affect people with Parkinson's disease and suggests that the training improved the performance on a cognitive task rather than gait. This implies that the training enabled people with Parkinson's disease to pay attention to the surrounding environment while walking, thereby reducing the risk of fall accidents when walking in the community.