Schott Nadja
Institut für Sport und Bewegungswissenschaft, Universität Stuttgart, Allmandring 28, 70569, Stuttgart, Deutschland.
Z Gerontol Geriatr. 2015 Dec;48(8):722-33. doi: 10.1007/s00391-015-0866-3. Epub 2015 Mar 24.
Activities of daily living (ADL), such as walking, often involve the added complexity of walking while doing other activities (i.e. dual task walking). A complex walking task may require a greater motor and mental capacity, resulting in decrements in gait performance not seen for simple walking tasks.
The purpose of this study was to determine if the trail walking test (TWT), the mobile adaptation of the trail making test (TMT), could be a reliable and valid early detection tool to discriminate between non-fallers and fallers.
This study examined dual task costs of a cognitive and a sensorimotor task (walking) in 94 older adults aged 50-81 years (average age M = 67.4 years, SD ± 7.34). Based on the idea of the paper and pencil TMT, participants walked along a fixed pathway (TWT-1), stepped on targets with increasing sequential numbers (i.e. 1, 2, 3, TWT-2), and increasing sequential numbers and letters (i.e. 1, A, 2, B, 3, C, TWT-3). The dual task costs were calculated for each task. Additionally, the following tests were conducted: TMT, block tapping test (BTT), timed up and go (TUG) test, 30s chair rising test, 10 m walking time test with and without head turns, German physical activity questionnaire (German PAQ-50 +) and the activities-specific balance confidence (ABC-D) scale.
The TWT performance times as well as errors increased with increasing age. Reliability coefficients were high (interclass correlation ICC > 0.90). Correlations between the different TWT conditions and potential falls-related predictors were moderate to high (r = -0.430 to 0.699). Of the participants 34 % reported falling in the past year. The stepwise logistic regression analysis revealed that the dual task costs for the numbers and letters (odds ratio OR 1.162, 95 % confidence interval CI 1.058-1.277, p = 0.002), the ABC-D (OR 0.767, 95 % CI 0.651-0.904, p = 0.002) and exercise (OR 1.027, 95 % CI 1.008-1.046, p = 0.006) were significantly related to falls and 91.6 % of cases were correctly classified.
The results indicate that high-level cognitive processes interfere with automatic processes such as walking. The TWT which converts a relevant fall risk-associated standard neuropsychological test (TMT) with increasing cognitive load into a mobility task, was shown to be a feasible, reliable and valid tool for older adults to discriminate between non-fallers and fallers.
日常生活活动（ADL），如行走，通常涉及在进行其他活动时行走的额外复杂性（即双重任务行走）。复杂的行走任务可能需要更大的运动和心理能力，导致步态表现下降，而简单行走任务则不会出现这种情况。
本研究的目的是确定步道行走测试（TWT），即连线测验（TMT）的移动适应性测试，是否可以作为一种可靠且有效的早期检测工具，用于区分非跌倒者和跌倒者。
本研究考察了94名年龄在50 - 81岁之间的老年人（平均年龄M = 67.4岁，标准差±7.34）在一项认知任务和一项感觉运动任务（行走）中的双重任务成本。基于纸笔版TMT的理念，参与者沿着固定路径行走（TWT - 1），按顺序踩上数字逐渐增加的目标（即1、2、3，TWT - 2），以及数字和字母按顺序增加的目标（即1、A、2、B、3、C，TWT - 3）。计算每个任务的双重任务成本。此外，还进行了以下测试：TMT、方块敲击测试（BTT）、定时起立行走（TUG）测试、30秒椅子起立测试、有和没有转头的10米行走时间测试、德国身体活动问卷（German PAQ - 50 +）以及特定活动平衡信心（ABC - D）量表。
TWT的表现时间以及错误随着年龄的增长而增加。可靠性系数很高（组内相关系数ICC > 0.90）。不同TWT条件与潜在跌倒相关预测因素之间的相关性为中度到高度（r = - 0.430至0.699）。34%的参与者报告在过去一年中跌倒过。逐步逻辑回归分析显示，数字和字母的双重任务成本（优势比OR 1.162，95%置信区间CI 1.058 - 1.277，p = 0.002）、ABC - D（OR 0.767，95% CI 0.651 - 0.904，p = 0.002）和运动（OR 1.027，95% CI 1.008 - 1.046，p = 0.006）与跌倒显著相关，91.6%的病例被正确分类。
结果表明，高级认知过程会干扰诸如行走等自动过程。TWT将一项与跌倒风险相关的标准神经心理学测试（TMT）随着认知负荷增加转化为一项移动任务，被证明是一种可行、可靠且有效的工具，可用于老年人区分非跌倒者和跌倒者。
