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Impact of motor-cognitive interventions on selected gait and balance outcomes in older adults : ǂa ǂsystematic review and meta-analysis of randomized controlled trials
Kaja Teraž, Luka Šlosar, Armin Paravlić, Eling D. de Bruin, Uroš Marušič, 2022, review article

Abstract: Background: Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults. Methods: Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00. Results: From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585). Conclusions: This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.
Keywords: motor-cognitive interventions, dual-task, elderly, mobility, postural control
Published in DiRROS: 21.06.2022; Views: 61; Downloads: 63
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Dual-task performance in hearing-impaired older adults : study protocol for a cross-sectional mobile brain/body imaging study
Anna Wunderlich, Oliver Vogel, Maja Maša Šömen, Manca Peskar, Madeleine Fricke, Klaus Gramann, Janna Protzak, Uroš Marušič, Bettina Wollesen, 2021, original scientific article

Abstract: Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments. Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50%70 years) and 48 younger adults (20%30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes. Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.
Keywords: older adults, overground walking, dual-tasks, MoBi, hearing impairments
Published in DiRROS: 23.11.2021; Views: 313; Downloads: 270
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Inhaled therapies in patients with moderate COPD in clinical practice : current thinking
Ariel Amnon, Matjaž Fležar, 2018, review article

Abstract: COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups.
Keywords: dual bronchodilation, inhaled corticosteroid, LAMA, LABA, tiotropium, anticholinergic
Published in DiRROS: 17.12.2020; Views: 820; Downloads: 472
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In vitro interactions between Eutypella parasitica and some frequently isolated fungi from the wood of the dead branches of young Sycamore Maple (Acer pseudoplatanus)
Ana Brglez, Barbara Piškur, Nikica Ogris, 2020, original scientific article

Abstract: The ten most frequently isolated fungi from the wood of the dead branches of Acer pseudoplatanus L. were tested in dual cultures to evaluate their in vitro antagonistic activity against Eutypella parasitica R.W. Davidson and R.C. Lorenz, the causative agent of a destructive disease of maples in Europe and North America. The tested fungi, treated also as challenge isolates, were Diaporthe sp., Eutypa sp., Eu. maura, E. parasitica, Fusarium avenaceum, Neocucurbitaria acerina, Neonectria sp., Peniophora incarnata, Petrakia irregularis, and Phomopsis pustulata. The antagonistic ability of each challenge isolate was evaluated by calculating an index of antagonism (AI) based on the interaction type in the dual cultures. The results of competition between the fungal isolates were quantified after re-isolations from the interaction zone (s). The dual cultures revealed two main types of competitive interactions: Deadlock, consisting of mutual inhibition after mycelial contact or at a distance, and replacement, reflecting in the inhibition of E. parasitica, followed by partial overgrowth by the replacing fungus. Statistical analysis showed significant differences in average AI and s of challenge isolates between different dual culture assays. Based on the results of the antagonism index, Eutypa sp., Eu. maura, Neonectria sp., and P. incarnata had the highest inhibitory effect on E. parasitica growth and were recognized as the most promising candidates for further biocontrol studies of E. parasitica. The mycelium of E. parasitica at the interaction zones remained mostly viable, except in dual cultures with Eutypa sp., F. avenaceum, and Neonectria sp., where re-isolations did not yield any colony of the E. parasitica isolate. Based on the results, we assume that E. parasitica is a weak competitor, which invests less energy in direct mycelial competition. We discuss the potential of the observed antagonists as a possible biocontrol of Eutypella canker of maple. Nevertheless, additional experiments should be performed for a solid conclusion about competitive ability of E. parasitica and usefulness of antagonists as biocontrol.
Keywords: Eutypella parasitica, dual culture, hyphal interaction, deadlock, replacement, competition, antagonism, inhibition, re-isolation, biocontrol
Published in DiRROS: 19.10.2020; Views: 681; Downloads: 457
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