Beauchet Olivier, Berrut Gilles
Service de gérontologie clinique, CHU de Saint-Etienne.
Psychol Neuropsychiatr Vieil. 2006 Sep;4(3):215-25.
Walking is an automated rythmic motor behavior that is mostly controlled by subcortical brain regions. Automaticity implies that gait can be performed without attention. However, recent works highlight the involvement of attentional resources in gait, using a "dual-task" methodology in which performance on attention-demanding tasks such as spoken verbal response and walking is compared when they are performed separately and concurrently. Changes in gait patterns due to simultaneous performance of an attention-demanding task are interpreted as interference caused by competing demands for attentional resources involving the cortical level in gait control. Dual-task related gait changes are a new way to assess age-associated change in gait control. Furthermore, new screening tools of falling risk based on the dual-task paradigm have been developed, comparing walking performance alone to walking while performing a simultaneous attention-demanding task. However, the consistent prediction of falls by dual-task testing remains difficult. The recent availability and growing number of validated, user-friendly portable gait analysis systems allow simple objective gait measurement such as gait variability. The study of gait variability under dual-task represents a new challenge for the clinicians because high stride-to-stride variability is a powerful fall predictor in older adults. Because there is increasing evidence that age-related gait changes are associated with incidence of dementia, dual-task related gait changes could provide useful information about relationship between gait disorders and cognitive decline. Furthermore, dual-task could be a new approach of the gait disorders rehabilitation.
行走是一种自动的节律性运动行为,主要由大脑皮层下区域控制。自动性意味着步态可以在无需注意力的情况下执行。然而,最近的研究通过“双任务”方法突出了注意力资源在步态中的作用,该方法比较了诸如口语应答和行走等需要注意力的任务在单独执行和同时执行时的表现。由于同时执行一项需要注意力的任务而导致的步态模式变化被解释为对涉及步态控制皮层水平的注意力资源的竞争需求所造成的干扰。与双任务相关的步态变化是评估与年龄相关的步态控制变化的一种新方法。此外,基于双任务范式的跌倒风险新筛查工具已经开发出来,将单独行走的表现与同时执行一项需要注意力的任务时的行走表现进行比较。然而,通过双任务测试一致预测跌倒仍然很困难。最近,经过验证的、用户友好的便携式步态分析系统的可用性不断提高且数量不断增加,这使得简单的客观步态测量成为可能,例如步态变异性测量。在双任务情况下对步态变异性的研究对临床医生来说是一项新挑战,因为步幅间的高变异性是老年人跌倒的有力预测指标。由于越来越多的证据表明与年龄相关的步态变化与痴呆症的发病率有关,与双任务相关的步态变化可能会提供有关步态障碍与认知衰退之间关系的有用信息。此外,双任务可能是步态障碍康复的一种新方法。