Chapter 18

Cognitive, Dual-task, and Multi-task Training

I say with humor – by now, you may have figured out that the BRAIN is our favorite muscle (if you will)! As discussed in chapter five, the development of new neural firing pathways during our workouts will help with activities of daily living.

The content in this chapter focuses on reducing falls and fall risk by developing improved dual-task and multi-tasking abilities.

The exercises in this chapter are likely to have the greatest impact in achieving these goals with your clients and patients.

As discussed in chapter five, cognitive training during movement is not only challenging, but it can be fun and offers a seemingly infinite number of ways to be creative. But let’s take things a bit further.

Lighting up the brain to the maximum: Humans are designed to move. Movement helps the body, but also helps to grow and develop the brain. Just the act of standing up and walking lights up the brain. Taking this a few steps further, we can add layers to our movement that will light up the brain even more. The ideal combination of layers to light up the brain to the maximum would be the combination of:

  • Get moving
  • Move barefoot whenever possible
  • Move outdoors. A natural environment has distinct advantages over a built environment
  • Move with another person. Interaction between people lights up the brain
  • GAMIFY your sessions! Gamification fires up brain cells while having fun
  • Move with music when possible. Music lights up the brain

Movement professionals: Choose appropriately challenging movements or exercises for your client. Once they have had a chance to give it a try and get the feel of it, add a cognitive challenge into the mix. Your client may slow down a bit at first. As they begin the cognitive challenge, do not be surprised if they stop moving in an effort to execute that challenge. This is common and to be expected. In addition, once they start moving again, you may have to cue them to continue performing the cognitive exercise. Almost every time we combine a new movement and cognitive challenge, we find it necessary to continue cueing our client to keep them moving and thinking (out loud, of course). You may wish to use cues such as “remember to keep moving” or “let’s try to keep doing both things at the same time.”

Each cognitive training concept is vitally important to use in your training sessions. Each technique creates new neural firing patterns in the brain, but in distinctly different ways. The more ways in which we create these connections, the more likely we can help to reduce fall risk and improve movement.

Dozens of dual-task and multi-tasking videos can be found by hoovering over the chapter 18 drop down menu.

Stacking: As we move forward, we will be doing what I refer to as stacking

  • Choose a movement or exercise
  • Add a challenge or technique to it
  • Keep adding as described below

Let’s say you choose side stepping. Start stepping sideways, and as you become reasonably comfortable with the movement, add a cognitive task (i.e.; counting backwards, doing math equations, naming capitals of states or countries and spelling them forward and backwards, etc.,) Next, add an additional task such as playing catch with  a ball. Next, the trainer can start moving around while playing catch with the client. This will cause the head to turn and eyes to track and activate the vestibular and visual systems. Take it one step further with the addition of rhythm or music and move to the beat.

Now, you have six things happening simultaneously:

  • A focused movement (in this example, side stepping)
  • A cognitive challenge
  • Hand-eye coordination (catching and throwing a ball)
  • Vestibular system activation (turning the head)
  • Visual system activation (tracking of the eyes)
  • The pulse of the music or beat

This is what we call stacking and it is a game changer.

First: Choose a movement

Movement and exercise ideas (videos of everything can be found on support website). These are just ideas. Get creative and come up with movements you think of, as well:

  • Walking (walking presents a challenge for some people)
  • Side stepping
  • Skipping sideways
  • Walking backwards
  • Walking a line (one foot directly in front of the other while walking a line)
  • Walking a line backwards
  • Walking/stepping sideways with cross-body movements (i.e., step left by moving the right foot in front of or behind the left foot, and repeat)
  • Boxing
  • Dancing
  • Rotations
  • Infinity walk (i.e., walk a figure 8 pattern around cones while the eyes are focused on an object. This forces the head to turn and eyes to track, activating the vestibular and visual systems)
  • Infinity walk modifications (try walking the figure 8 backwards)
  • Ladder drills
    • Walking – stepping over each rung into the next square
    • Walking – stepping over every other rung
    • Jump through the ladder
      • Two legs: forward, sideways, zig zag, backwards, etc.
      • Single leg: forward, sideways, zig zag, backwards, etc.

Next: Choose a cognitive challenge to pair with a focused movement. Choose from the concepts in the chapter 18 drop down menu.