ABSTRACT
Introduction: Spatial navigation is a complex cognitive function that declines in older age. Finding one's way around in familiar and new environments is crucial to live and function independently. However, the current literature illustrates the efficacy of spatial navigation interventions in rehabilitative contexts such as pathological aging and traumatic injury, but an overview of existing training studies for healthy older adults is missing. This scoping review aims to identify current evidence on existing spatial navigation interventions in healthy older adults and analyze their efficacy. Methods: To identify spatial navigation interventions and assessments and investigate their effectiveness, four electronic databases were searched (Pubmed, Web of Science, CINAHL and EMBASE). Two independent reviewers conducted a screening of title, abstract and full-texts and performed a quality assessment. Studies were eligible if (1) published in English, (2) the full text was accessible, (3) at least one group of healthy older adults was included with (4) mean age of 65 years or older, (5) three or more spatial navigation-related training sessions were conducted and (6) at least one spatial ability outcome was reported. Results: Ten studies were included (N = 1,003, age-range 20-95 years, 51.5% female), only healthy older adults (n = 368, mean age ≥ 65) were assessed further. Studies differed in sample size (n = 22-401), type of training, total intervention duration (100 min-50 h), and intervention period (1-16 weeks). Conclusion: The spatial navigation abilities addressed and the measures applied to elicit intervention effects varied in quantity and methodology. Significant improvements were found for at least one spatial ability-related outcome in six of 10 interventions. Two interventions achieved a non-significant positive trend, another revealed no measurable post-training improvement, and one study did not report pre-post-differences. The results indicate that different types of spatial navigation interventions improve components of spatial abilities in healthy older adults. The existing body of research does not allow conclusions on transferability of the trained components on everyday life spatial navigation performance. Future research should focus on reproducing and extending the promising approaches of available evidence. From this, valuable insights on healthy aging could emerge. Trial Registration: This scoping review was preregistered at Open Science Framework (https://osf.io/m9ab6).
ABSTRACT
Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments. Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50-70 years) and 48 younger adults (20-30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes. Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.
ABSTRACT
Previous studies argued that body turns are executed in an ordered sequence: the eyes turn first, followed by the head and then by the trunk. The purpose of this study was to find out whether this sequence holds even if body turns are not explicitly instructed, but nevertheless are necessary to reach an instructed distal goal. We asked participants to shop for grocery products in a simulated supermarket. To retrieve each product, they had to walk down and aisle, and then turn left or right into a corridor that led towards the target shelf. The need to make a turn was never mentioned by the experimenter, but it nevertheless was required in order to approach the target shelf. Main variables of interest were the delay between eye and head turns towards the target shelf, as well as the delay between head and trunk turns towards the target shelf. We found that both delays were consistently positive, and that their magnitude was near the top of the range reported in literature. We conclude that the ordered sequence of eye - then head - then trunk turns can be observed not only with a proximal, but also with a distal goal.
Subject(s)
Head Movements , Walking , Biomechanical Phenomena , Head , Humans , Orientation , TorsoABSTRACT
BACKGROUND: In nursing home residents, the combination of decreasing mobility and declining cognitive abilities, including spatial orientation, often leads to reduced physical activity (PA) and life-space (LS) mobility. As a consequence of sedentary behavior, there is a lack of social interaction and cognitive stimulation, resulting in low quality of life. It has not yet been examined whether cognitive-motor training including spatial cognitive tasks is suitable to improve spatial orientation and, as a consequence, to enlarge LS mobility, and increase well-being and general cognitive-motor functioning. Therefore, the overall goal of this multicentric randomized controlled trial (RCT) is to compare the effect of three different intervention approaches including functional exercise and orientation tasks on PA, LS and spatial orientation in nursing home residents. METHODS: A three-arm single-blinded multicenter RCT with a wait-list control group will be conducted in a sample of 513 individuals (needed according to power analysis) in three different regions in Germany. In each nursing home, one of three different intervention approaches will be delivered to participating residents for 12 weeks, twice a week for 45 min each: The PROfit basic group will perform functional strength, balance, flexibility, and walking exercises always at the same location, whereas the PROfit plus group changes the location three times while performing similar/the same exercises as the PROfit basic group. The PROfit orientation group receives navigation tasks in addition to the relocation during the intervention. Physical and cognitive functioning as well as psychological measures will be assessed in all study groups at baseline. Participants will then be randomized into either the intervention group or the wait-list control group. After 12 weeks, and after 24 weeks the measures will be repeated. DISCUSSION: This study evaluates whether the three different interventions are feasible to reduce the decline of or even improve PA, LS, and spatial orientation in nursing home residents. By adding different training locations in PROfit plus, the program is expected to be superior to PROfit basic in increasing physical and cognitive parameters. Moreover, we expect the PROfit orientation intervention to be most effective in terms of PA, LS, and spatial orientation due to two mechanisms: (1) increased physical and cognitive activity will enhance cognitive-motor capacity and (2) the spatial training will help to build up cognitive strategies to compensate for age-related loss of spatial orientation abilities and related limitations. TRIAL REGISTRATION: The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020 and was granted permission by the Technical University Berlin local ethics committee (No. GR_14_20191217).
