Attentional requirements of postural control in people with spinal cord injury: The effect of dual task

Abstract

Study Design:Cross-sectional study.Objectives:To investigate the attentional requirements for maintaining standing balance in people with spinal cord injury (SCI) using a dual-task paradigm and to compare standing balance performance between SCI and able-bodied (AB) controls.Setting:LaboratoryMethods:Nine adults with incomplete SCI, who were able to stand unassisted were recruited, along with eight AB controls. Subjects performed a dual task involving counting backwards by 3 s out loud while standing with eyes open or closed. The primary outcome measures were the differences between SCI and control groups for movement reinvestment and the change in performance between single task and dual task for: (i) maximum standing time (STime); (ii) error ratio and total number of words uttered; and (iii) center of pressure measures. Perceptual measures included perceived mental workload, fear and confidence.Results:SCI subjects stood for shorter duration during dual task (stand and count) than single task (stand) compared with controls during eyes closed. Significant differences between groups were observed for movement reinvestment, center of pressure, perceived mental effort, fear and confidence. No significant effects were observed for math-task performance.Conclusions:Total STime during eyes closed is adversely affected by the addition of a math task for SCI subjects. Perceptual measures appear to correspond to increases in postural sway and conscious control of standing in subjects with SCI. Individuals who can stand for >60 s with eyes closed do not appear to be significantly affected by the addition of a concurrent secondary task of minimal mental workload.