Most humans have the cognitive capacity to do more than one thing at a time (walking while talking, talking on the phone while driving (although not a good idea), listening to the TV or music while cooking a meal). When a person experiences a decrease in cognitive ability either due to an injury/insult or organic changes (i.e. Dementia), their ability to simultaneously do two things at once can be severely affected. This can lead to trouble learning new information, forgetting correct/safe techniques when stressed and ultimately being at a higher risk for injuries/falls.
For many of us, walking is an activity we give no thought to. For someone who has had a stroke, closed head injury or has mild cognitive impairment, the activity may no longer be rote. A person with decreased cognitive capacity may have to focus their undivided attention on completing the activity (ex. walking, correct foot placement, use of an assistive device, etc.) and have minimal to no leftover cognitive capacity for other demands placed on them. This could include not thinking about safety hazards such as uneven surfaces, steps, environmental safety, etc. while walking. Divided attention or dual tasking requires us to focus on two different tasks at the same time (although one of the tasks may be rote). “Stops walking when talking” is a common example. Someone with mild cognitive issues/impairment maybe able to carry on a conversation, recall current/past events and present the image of someone who has no cognitive issues. But while engaged in walking, they may literally come to a stop if they are being engaged in a conversation which requires them to concentrate on what you are saying or having to think about how they are to respond. In this case, the person may not have the ability to simultaneously complete the two activities (walking and talking) at the same time.
A simple exercise to assess someone’s dual tasking ability is to have them perform a cognitive task while ambulating. This could include reciting the alphabet backwards; count backwards by 5 starting at 100, etc. If you notice a change in the person’s ability to engage in the activity while performing the cognitive activity (ex. quality of gait pattern decreases, unable to continue walking, unable to do the cognitive task simultaneously), the person has dual tasking or divided attention deficits. This is also apparent with someone while doing an ADL task. If an environmental distractor is added, does the quality of the performance of the ADL task decrease or even come to a stop?
It is critical to have an understanding of a person’s dual tasking ability in order to maximize therapy and/or activity input. How often do we pay attention to the environmental stimuli around us while working with patients/residents? Is the TV or music playing in the background while we are attempting to instruct the person in a therapy technique? Is the person with cognitive impairment receiving their therapy in a highly stimulating environment (ex. therapy gym/activity room)? Understanding what a person’s dual tasking ability is allows you to make sure the person is in an environment that is always conducive to maximizing their cognitive/memory ability. In addition, environmental distractions cannot always be eliminated (i.e. the real world environment). Subsequently, someone may not perform at the same level of independence in the real world (i.e. home environment) as they do in a controlled environment. This information can also be used to educate the patient, family and caregivers on how to minimize distractions at home.