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Copyright of PM & R: Journal of Injury, Function & Rehabilitation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Walking aids are often introduced to older adults to enable independent mobility. Single‐point canes are the most common device used. Benefits are tempered by research suggesting that walking aids increase fall risk. A better understanding of the effect of walking aid use on gait performance is required. Objective: To evaluate differences in the effect of initial single‐point cane use on gait between younger (YAs) and older adults (OAs). Design Cross‐sectional. Setting: Community‐dwelling. Participants: Twenty‐six YAs (mean age ± standard deviation [SD]: 23.7 ± 2.8 years) and 25 OAs (mean age ± SD: 70.8 ± 14.1 years) participated. Inclusion criteria were 18 to 35 years of age for YAs or ≥50 years for OAs, be able to ambulate unassisted, and without any condition affecting mobility. Interventions: Not applicable. Main Outcome Measure(s): Gait velocity and stride time variability under different walking path configurations (straight path, Groningen Meander Walking Test, Figure‐of‐8 Walk Test) and conditions (unassisted walking, walking with a single‐point cane, and walking with a single‐point cane while completing a cognitive task) were recorded in a laboratory. The arithmetic task of subtracting 1s from 100 was used as the secondary cognitive task. Data analysis included separate three‐way mixed analyses of variance (ANOVAs; path/condition/group). Results: There was a statistically significant two‐way interaction between walking path and condition for velocity (P <.001, ω2 = 0.03) and stride time variability (P =.032, ω2 = 0.02). In addition, a significant main effect of group was also observed (velocity: P =.004, ω2 = 0.07; stride time variability: P =.001, ω2 = 0.09). Conclusions: Using a single‐point cane decreased velocity and increased stride time variability in both YAs and OAs. However, the cognitive load and effect on gait of initial cane use was not different between age groups. Standardized guidelines aimed at facilitating a clientʼs transition toward the safe use of a walking aid are needed. Future research should evaluate if training can mitigate some of the adverse changes to gait stability observed with initial walking aid use. [ABSTRACT FROM AUTHOR]

Background: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI).Methods: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test.Results: Gait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%).Conclusions: Not all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk. [ABSTRACT FROM AUTHOR]

Background: Walking is a cognition intensive activity and impaired walking is associated with an increased fall risk in people with Alzheimer's dementia (AD). Walking in a curved path configuration increases complexity of the task, reflects real-life environments and situations when falls occur. The effect of walking path task complexity has not been evaluated in people with AD.Research Question: The purpose was 1) to assess the utility of a curved path walking task to detect differences in gait performance between people with AD and healthy controls and 2) to assess the relationship of cognitive function to gait performance on straight path and curved path walking.Methods: Participants with AD (n = 14, mean age ± SD = 73.08 ± 9.22) and age and sex matched controls (n = 14, mean age = 72.86 ± 9.53) were recruited. Time to complete a 6-meter straight path and a curved path (Figure of 8 Test) walking task was recorded. Steps taken, accuracy and qualitative measures of smoothness were rated for curved-path walking. Measures of global cognition (MMSE, MoCA) and executive function (Trail making A and B, Digit Span forwards and backwards) were assessed.Results: Gait was significantly slower in people with AD for both the straight-path (AD = 6.05 ± 1.26 s, Control = 5.09 ± 0.76 s, p = 0.02) and curved-path walking (AD = 11.25 ± 4.87 s, Control = 8.28 ± 2.44 s, p =  0.05). In addition, smoothness scores were significantly lower for people with AD (AD = 1.93±1.26; Control = 3.00±0.00, p = 0.004).Significance: Walking in a curved path resulted in a significant deterioration in gait quality in the people with AD. Executive function was related only to curved path walking, in which lower executive function scores were associated with longer time to walk. [ABSTRACT FROM AUTHOR]

• Walking with a 4-wheeled walker is a complex motor task. • People with Alzheimer's dementia experienced using a 4-wheeled walker were tested. • Complex walking paths and cognitive challenge resulted in increased instability. • People self-prioritized gait over the cognitive task in the most complex tests. Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations. What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker? Twenty-three adults with mild to moderate AD (87.4 ± 6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question. A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω2 = 0.36), cadence (p = 0.04, ω2 = 0.15) and STV (p < 0.001, ω2 = 0.53). Velocity and cadence decreased and STV increased with increasing walking configuration complexity and upon dual-tasking. Dual-task gait and cognitive task cost deteriorated in all walking configurations, but gait was prioritized in the GMWT and F8 configurations. Despite familiarity, experienced walker users with AD exhibit impaired gait when walking in complex situations which increases falls risk. Upon dual-task, individuals with AD self-prioritized a posture-first strategy in complex configurations. Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments. [ABSTRACT FROM AUTHOR]