Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina 27599, USA. karen
J Head Trauma Rehabil. 2010 May-Jun;25(3):155-63. doi: 10.1097/HTR.0b013e3181dc82e7.
To examine the relationship between balance, attention, and dual-task performance in individuals with acquired brain injury.
Cross-sectional study.
Rehabilitation center and supported living program.
Twenty-four individuals aged 18 to 58 years (mean = 39 years) with acquired brain injury who were able to ambulate 40 ft with (29%) or without an assistive device. Fifty-eight percent were independent community ambulators. Fifty-four percent had fallen in the past 6 months; and 42% reported feeling unsteady with standing or walking.
Participants completed a battery of balance, attention, and dual-task assessments.
Balance: Berg Balance Scale (BBS), Four Square Step Test (FSST), High Level Mobility Assessment Test (HiMAT); Attention: Symbol Digit Modalities Test (SDMT), Moss Attention Rating Scale (MARS), modified for a single test session; and a walking dual-task assessment, the Walking and Remembering Test.
Mean scores: BBS, 48 of 56; FSST, 19.6 seconds; HiMAT, 20 of 54; SDMT, 30 correct; and MARS, 80. Dual-task costs were observed with variable patterns across subjects: 48% demonstrated primarily motor slowing, 9% had reduced cognitive accuracy without motor slowing, and 35% demonstrated decrements in both tasks. Subjects with a falls history had more impaired balance (HiMAT, BBS, and FSST, all P <.026) but were not significantly different in dual-task performance or attention measures.
The test battery matched the range of motor and cognitive abilities of the sample. Balance was more strongly related to falls history than measures of attention or dual-task performance. Injury chronicity may have allowed some subjects to develop strategies to optimize dual-task performance. Alternatively, motor slowing in dual-task conditions may be an adaptive strategy, allowing performance of multiple tasks with reduced safety risk. Further investigation in this area is warranted to clarify the utility of dual-task methods in identifying falls risk after brain injury.
研究后天性脑损伤患者平衡、注意力和双重任务表现之间的关系。
横断面研究。
康复中心和支持性居住计划。
24 名年龄在 18 至 58 岁（平均 39 岁）之间、能够使用（29%）或不使用辅助设备行走 40 英尺的后天性脑损伤患者。58%的人是独立的社区漫步者。54%的人在过去 6 个月里跌倒过；42%的人报告说站立或行走时感到不稳定。
参与者完成了一系列平衡、注意力和双重任务评估。
平衡：伯格平衡量表（BBS）、四四方方步测试（FSST）、高级移动能力评估测试（HiMAT）；注意力：符号数字模态测试（SDMT）、莫斯注意力评定量表（MARS），经修改后可用于单次测试；以及步行双重任务评估，行走和记忆测试。
平均得分：BBS，48/56；FSST，19.6 秒；HiMAT，20/54；SDMT，30 个正确；MARS，80。在不同的受试者中观察到双重任务成本的变化模式：48%的受试者主要表现为运动速度减慢，9%的受试者认知准确性下降而运动速度没有减慢，35%的受试者在两个任务中都表现出下降。有跌倒史的受试者平衡能力更差（HiMAT、BBS 和 FSST，均 P<.026），但在双重任务表现或注意力测量方面无显著差异。
测试组合与样本的运动和认知能力范围相匹配。平衡与跌倒史的关系比注意力或双重任务表现的关系更密切。损伤的慢性可能使一些受试者能够制定策略来优化双重任务表现。或者，在双重任务条件下的运动速度减慢可能是一种适应性策略，允许在降低安全风险的情况下执行多项任务。需要进一步在该领域进行调查，以澄清双重任务方法在确定脑损伤后跌倒风险方面的效用。
