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Do we always prioritize balance when walking? Towards an integrated model of task prioritization

Authors

  • Galit Yogev-Seligmann PT, MSc,

    1. Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. The Dr. Miriam and Sheldon G. Adelson Graduate School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Jeffrey M. Hausdorff PhD,

    Corresponding author
    1. Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
    3. Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
    • Laboratory for Gait Analysis and Neurodynamics, Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
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  • Nir Giladi MD

    1. Movement Disorders Unit, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
    2. Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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  • Relevant conflicts of interest/financial disclosures: J.M.H. is funded by the Michael J. Fox Foundation for Parkinson's Research, the National Institutes of Health (NIH; AG14100 and AG034227), the Israel Ministry of Health, and the Israel Science Foundation. N.G.'s research is funded by the Michael J. Fox Foundation for Parkinson's Research, the National Parkinson Foundation, the Israel Ministry of Health, European Union, and the Israel Science Foundation, with internal funds from Sourasky Medical Center, The European Union, and the NIH.

  • Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Previous studies suggest that strategies such as “posture first” are implicitly employed to regulate safety when healthy adults walk while simultaneously performing another task, whereas “posture second” may be inappropriately applied in the presence of neurological disease. However, recent understandings raise questions about the traditional resource allocation concept during walking while dual tasking. We propose a task prioritization model of walking while dual tasking that integrates motor and cognitive capabilities, focusing on postural reserve, hazard estimation, and other individual intrinsic factors. The proposed prioritization model provides a theoretical foundation for future studies and a framework for the development of interventions designed to reduce the profound negative impacts of dual tasking on gait and fall risk in patients with neurological diseases. © 2012 Movement Disorder Society

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