Influence of serial subtraction tasks on transient characteristics of postural control.

We sought to better understand the influence of cognitive perturbations on transient aspects of postural control. Twenty healthy, younger adults had their postural control assessed during eyes open quiet stance. Participants completed three different conditions that either had no cognitive perturbation present, an easy cognitive perturbation (i.e., serial subtraction by ones), or a more difficult cognitive perturbation (i.e., serial subtraction by sevens). All trials finished with 60 s of undisturbed eyes open quiet stance, which was the focus of the balance assessment. 95% confidence ellipse area (EA) was calculated for 5-s epochs throughout the trial. The difference in EA from the first epoch after participants started (onset) or stopped (offset) the cognitive task to the last epoch of the trial (i.e., 55-60 s after perturbation) was used to characterize transient postural control behavior. Functional near-infrared spectroscopy was also used to quantify changes in prefrontal cortex activation during the counting tasks to support interpretation of the transient balance findings. There was a significant effect of condition for transient balance characteristics following a cognitive perturbation (P < 0.001), with greater transient increases in postural sway for both difficult (Cohen's d = 0.40, P < 0.001) and easier (Cohen's d = 0.29, P = 0.013) cognitive perturbations relative to no cognitive perturbation. The onset of cognitive tasks was also associated with greater transient increases in postural sway than the offset of the cognitive tasks (Cohen's d = 0.24, P = 0.019). The functional near-infrared spectroscopy data indicated that a significant decrease in deoxygenated hemoglobin was observed for left Brodmann area 46 for both the subtraction by ones (T = -3.97; Benjamini-Hochberg significance value (q) = 0.008) and subtraction by sevens (T = -3.11; q = 0.036) conditions relative to the baseline condition. The subtraction by sevens condition was also associated with a relative increase in deoxygenated hemoglobin for the right Brodmann area 9 (T = 3.36; q = 0.026) compared to the subtraction by ones condition. In conclusion, serial subtraction can elicit transient increases in postural sway, with more difficult tasks and the onset of the cognitive-motor challenge exhibiting magnified effects. Additionally, even the cessation of a cognitive task (i.e., serial subtraction) can be associated with lingering perturbing effects on balance control.