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Dual Tasking Treatments for Occupational Therapy

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General:

Dual Tasking combines movement with cognition. Your body is an integrated system, it heals through movement, and movement requires executive functioning. Combining these two things is very difficult and we don’t realize how difficult it is – until it has been impacted by a trauma or injury! As an occupational therapy practitioner, your role with the client is so much more expansive than providing them with advice on how to be happy with their current level of function. It is so much more than providing advice on adaptive technology and external memory aids. As an occupational therapy practitioner, you have a duty to help heal the brain and body connection! Your job is also restorative rehabilitation and, therefore, you must know how to improve cognitive and executive function during activity participation! Dual tasking is a specific approach to rehabilitation and it is crucial to include in the occupational therapy plan of care. Cognitive and executive function deficits may be more apparent when movement is also required because the brain cannot dedicate resources to mobility and mental/cognitive/executive functioning at one time! This area of practice will typically require 9-12+ weeks of consistent and constant therapeutic interventions by an occupational therapy practitioner while following the plan of care continuum. 

How does Dual Tasking affect your client?

  • Forgetting where they put something down.
  • Forgetting why they walked into a room or went to the store.
  • Leaving the store without the item they went to the store to buy.
  • Doing two things at once (following a recipe or cooking while having a conversation about something else).
  • Listening for their children while cleaning the house.
  • Focusing on the road while listening to music or focusing on the road and what they are seeing while following directions to a new place.
  • Walking to do something while also being aware of obstacles in front of them like ice or a change in elevation.

Assessments to use in Evaluation and Progress Notes:

  • Dual Tasking digit span and 20 ft fast walking 
  • SLUMS
  • STROOP
  • Executive Function Performance Test
  • Site specific objective-base measures

How should you approach Dual Tasking in Occupational Therapy? 

Explanation: Understanding that you are a remediating and restorative therapist is the first step to helping your patient maintain their cognitive reserve and maximize their cognitive potential. Remember that there is plenty of evidence-based interventions that are considered non-pharmacologic approaches to cognition repair and maintenance even with a progressive neurological disorder! The occupational therapy practitioner role and scope expands far beyond adaptation and compensation

What kind of Dual Tasking elements can you include in your Occupational Therapy POC? 

  • Movement and numbers

  • Movement and words

  • Movement and problem solving

  • Movement and remembering stories

  • Movement and Executive Functioning

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Some Research on Dual Tasking

Smith-Ray, R., Hughes, S., Prohaska, T., Little, D., Jurivich, D., & Hedeker, D. (2015). Impact of Cognitive Training on Balance and Gait in Older Adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(3), 357–366. https://doi.org/10.1093/geronb/gbt097

Zavaglia, M., Astolfi, L., Babiloni, F., & Ursino, M. (2006). A neural mass model for the simulation of cortical activity estimated from high resolution EEG during cognitive or motor tasks.(Report). Journal of Neuroscience Methods, 157(2), 317–329. https://doi.org/10.1016/j.jneumeth.2006.04.022
Solianik, R., Satas, A., Mickeviciene, D., Cekanauskaite, A., Valanciene, D., Majauskiene, D., & Skurvydas, A. (2018). Task-relevant cognitive and motor functions are prioritized during prolonged speed–accuracy motor task performance. Experimental Brain Research, 236(6), 1665–1678. https://doi.org/10.1007/s00221-018-5251-1
Reports on Stroke Findings from Soonchunhyang University Provide New Insights (Effects of cognitive-motor dual-task training combined with auditory motor synchronization training on cognitive functioning in individuals with chronic stroke: A …). (2018). Obesity, Fitness & Wellness Week
Yoon, J., Lee, S., Lim, H., Kim, T., Jeon, J., & Mun, M. (2013). The effects of cognitive activity combined with active extremity exercise on balance, walking activity, memory level and quality of life of an older adult sample with dementia. Journal of Physical Therapy Science, 25(12), 1601–1604. https://doi.org/10.1589/jpts.25.1601
Smith-Ray, R., Hughes, S., Prohaska, T., Little, D., Jurivich, D., & Hedeker, D. (2015). Impact of Cognitive Training on Balance and Gait in Older Adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70(3), 357–366. https://doi.org/10.1093/geronb/gbt097
Leisman, G., Moustafa, A., & Shafir, T. (2016). Thinking, Walking, Talking: Integratory Motor and Cognitive Brain Function. Frontiers In Public Health, 4, 94. https://doi.org/10.3389/fpubh.2016.00094