Citation

Brach JS, Lowry K, Perera S, Hornyak V, Wert D, Studenski SA, Vanswearingen JM. Arch. Phys. Med. Rehabil. 2014; 96(3): 388-394.

Affiliation

Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.apmr.2014.10.018

PMID

25448244

Abstract

OBJECTIVE: The objective was to test the proposed mechanism of action of a task-specific motor learning intervention by examining its effect on measures of the motor control of gait.

DESIGN: Single blinded randomized clinical trial. SETTING: University research laboratory. PARTICIPANTS: Forty older adults 65 years of age and older, with gait speed >1.0 m/s and impaired motor skill (Figure of 8 walk time > 8 secs). INTERVENTIONS: The two interventions included a task-oriented motor learning and a standard exercise program, both interventions included strength training. Both interventions lasted 12 weeks, with twice weekly one hour physical therapist supervised sessions. MAIN OUTCOME MEASURES: Two measures of the motor control of gait, gait variability and smoothness of walking, were assessed pre and post intervention by assessors masked to treatment arm.

RESULTS: Of 40 randomized subjects; 38 completed the trial (mean age 77.1±6.0 years). Motor learning group improved more than standard group in double support time variability (0.13 vs. 0.05 m/s; adjusted difference, AD=0.006, p=0.03). Smoothness of walking in the anterior/posterior direction improved more in motor learning than standard for all conditions (usual: AD=0.53, p=0.05; narrow: AD=0.56, p=0.01; dual task: AD=0.57, p=0.04). Smoothness of walking in the vertical direction also improved more in the motor learning than standard for the narrow path (AD=0.71, p=0.01) and dual task (AD=0.89, p=0.01) conditions.

CONCLUSIONS: Among older adults with subclinical walking difficulty, there is initial evidence that task-oriented motor learning exercise results in gains in the motor control of walking, while standard exercise does not. Task-oriented motor learning exercise is a promising intervention for improving timing and coordination deficits related to mobility difficulties in older adults, and needs to be evaluated in a definitive larger trial.

Language: en