The Role Dual-Tasking Plays in People with Parkinson’s

Parkinson’s Disease (PD) is a devastating brain disorder caused by the impairment of nerve cells in the part of the brain that controls movement. The combination of two characteristic symptoms of PD can be very deleterious to a person’s overall health.

One symptom is a shuffling gait, and a struggle to continue to move forward (reported as a “freezing” sensation). The other symptom is decreased balance. Their balance is no longer controlled reflexively, like it is for the rest of us. Instead, they must pay more attention while they are walking in order to not lose their balance. The collective effect of both these symptoms is an increased fall risk for Parkinson’s patients.

To improve gait and balance, people with PD typically see a physical therapist to help them increase their stride length and reduce their chance of tripping. Counter to previous beliefs in which dual-tasking while walking could be detrimental to a person’s balance, research now shows dual-tasking can be an essential intervention in improving gait and balance in people with Parkinson’s, providing an alternative to the classic physical therapy techniques.

Sandra Brauer from the University of Queensland and Meg Morris from the University of Melbourne conducted a study on how added tasks and performing working memory tasks while walking can improve PD patients’ gait.

In their study, 20 participants with mild to moderate Parkinson’s had their baseline gait measured with and without added tasks, and then underwent a training period that included dual-task training to increase their gait. Subjects performed working memory tasks and counting tasks while they were walking and instructed to “take bigger steps”. As the training went on, the difficulty of the cognitive task increased.

After the training period, the subjects’ gait with the added tasks was measured again. The results of this study fully supported the hypothesis that dual-tasking training would improve gait in Parkinson’s patients. All 20 participants showed increased gait length after their dual-tasking training because they had learned how to focus more on the task, and less on the way they were walking (“reduced attention demand of gait”).

How does this relate to Nymbl Science? Nymbl uses a similar dual-tasking approach to train balance in older adults. Just like PD patients, balance in older adults is not as effectively controlled reflexively, but is instead something they have to consciously think about while performing their day-to-day tasks, ultimately creating a lot of anxiety.

As demonstrated in both the Parkinson’s study and in Nymbl users dual-tasking shifts balancefrom the frontal cortex (the “thinking” part of the brain) back to the cerebellum for reflexive balance control. For Nymbl users, performing simple exercises while interacting with fun cognitive tasks drives their balance control back to being reflexive.

The Brauer and Morris study is further proof that dual-tasking training has the power to transform balance in a wide range of people, which in turn leads to improved health and overall lifestyle.

Nymbl demonstrates significant improvement in stability in just 21 days

In a research study conducted by the MSk lab at Imperial College London and presented recently at the 8th World Congress of Biomechanics conference, Nymbl was shown to significantly improve stability in just 21 days. Sway improvements measured were:

Postural sway area reduced 37%
Sway velocity  reduced 15%
Medio-lateral sway improved 16%
Anterior-posterior sway improved 12%.

This impairment improvement correlated with 15% improvement in balance and an 82% engagement rate during the 21 days.

The study will continue to show improvement over time, but we are thrilled that we continue to accumulate scientific verification of our balance improvement system!

What’s the “dual tasking” approach to balance improvement, and why does it work so well?

dual tasking approach to balance

The foundation of Nymbl Science is years of clinical research into the science of balance by Dr JP Farcy.  He determined that balance can be improved through physical exercises (such as one legged stands) as well as cognitive exercises (such as solving math problems or learning  new language). But when you combine the two simultaneously, called “dual-tasking“, you get an accelerated effect.

This is because doing two things at once stimulates the brain to actually rebuild synapses in the brain. In order to maintain the posture, and concentrate on answering questions, requires opening as many synapses as possible to cope with the extra work. This is a well-known process called “neuro-plasticity”.

You can see examples of this in daily life. Often, if an older adult is walking and you ask them a question, they will stop. The brain has trouble walking and problem solving at the same time, because many of the balance and stride neurons have gotten “lazy” – the cognitive bandwidth has declined. After a few weeks of balance training, there is often a significant improvement.

In the Nymbl Training and Nymbl Class Apps, we accomplish dual tasking by providing isometric exercises with mental challenges on the iPhone’s screen.  In fact, because the app can simultaneously recommend isometric & cognitive exercises, time them, AND measure how well you’re doing (using the built in accelerometer), we are able to bring advance clinical tools and techniques to anyone with a smartphone – which pretty soon will literally be everyone!

We’ve put together additional answers to questions about balance on our Balance FAQ page.

Nymbl and The Academy Senior Living Community Partner to Dramatically Improve Balance Scores

Screen Shot 2017-03-15 at 16.48.29The Academy Senior Living Community in Boulder, Colorado, prides itself on its community and the active life style of its residents.  So when Nymbl approached them to pilot an innovative program to essentially turn the Academy into a living lab for balance improvement, they said “lets do it!”.

Continue reading “Nymbl and The Academy Senior Living Community Partner to Dramatically Improve Balance Scores”