Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer’s Disease: Part I – Cane

Issue title: Gait Disorders in Alzheimer’s Disease and Other Dementias

Guest editors: Manuel Montero-Odasso and George Perry

Article type: Research Article

Authors: Hunter, Susan W.^{a; *} | Divine, Alison^b | Omana, Humberto^c | Wittich, Walter^d | Hill, Keith D.^e | Johnson, Andrew M.^f | Holmes, Jeffrey D.^g

Affiliations: [a] School of Physical Therapy, University of Western Ontario, London, Ontario, Canada | [b] Faculty of Sport and Exercise Psychology, University of Leeds, Leeds, England | [c] Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada | [d] École d’optométrie, Université de Montréal, Montreal, Quebec, Canada | [e] School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia | [f] School of Health Studies, University of Western Ontario, London, Ontario, Canada | [g] School of Occupational Therapy, University of Western Ontario, London, Ontario, Canada

Correspondence: [*] Correspondence to: Dr. Susan W. Hunter, University of Western Ontario, School of Physical Therapy, Room 1588, Elborn College, London, ON N6G 1H1, Canada. Tel.: +1 519 661 2111/Ext. 82754; E-mail: susan.hunter@uwo.ca.

Abstract: Background:People with Alzheimer’s disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD. Objectives:In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking. Methods:Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers. Results:Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task. Conclusion:Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance.

Keywords: Aged, assistive devices, cane, dementia, gait

DOI: 10.3233/JAD-181169

Journal: Journal of Alzheimer's Disease, vol. 71, no. s1, pp. S105-S114, 2019