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KN 571 Biomechanics of Normal and Abnormal Movement

Dr. Andrew Sawers
04/23/2017
Attention Demands of Walking
Introduction
During concurrent performance of a motor and cognitive task, it has been observed that the
performance of one or both tasks deteriorates. These results are interpreted through theoretical
models of attention developed in the field of cognitive psychology. One of these theories is the
capacity theory. This theory models attention as either a single pool or multiple pools of attention
which dictate performance. According to this theory, if a task requires attention, its performance
should deteriorate when another attention demanding task is performed. This paradigm has been
used to assess the attention demands of walking, a task which has typically been considered an
overlearned, automatic task. Additionally, neurological experiments have been performed which
corroborate these findings. However, there is evidence which runs contrary to these findings and
advocate a bottleneck theory. Task and individual differences have been proposed to reconcile
this contradictory evidence.
Capacity model of attention
The capacity theory of attention was developed to complement the findings of the structural
bottleneck theory which is also used to interpret deteriorated performance when multiple tasks
are performed simultaneously. The bottleneck theory states that performance of either or both
tasks deteriorate in multi-tasking situations due to the inability for an individual to process and
respond to multiple input stimuli in parallel. However, this theory is unable to explain results in
which the reaction time and response error rate to simultaneous stimuli are unimpaired in relative
easy dual tasks (Kahneman 1973). To reconcile this evidence, the capacity model of attention
was introduced to the field of cognitive psychology by Daniel Kahneman. As opposed to the
bottleneck theory, the capacity theory states that attention is a limited resource which can be
voluntarily directed to and used to respond to a particular stimulus (Kahneman 1973; Pashler
1994). As such, dual task decrements can be explained as insufficient capacity to handle multiple
stimuli simultaneously; with inter- and intra-individual differences explained as differences in
overall attention capacity or insufficient arousal in response to the stimulus. The capacity theory
has been supported by results in dual task experiments which have assessed the recall, reaction
time and identification of particular letter (or digit) while simultaneous performing simple
arithmetic tasks or reading. A prominent example of this paradigm is an experiment in which
participants were required to perform an arithmetic task in which they added one to a series of
numbers after all numbers were given while simultaneously identifying a letter on a screen.
These participants were required to maintain a constant level of performance of the arithmetic
task which consequently reduced the performance of the identification task by 80% (Kahneman
1973).
 Figure 1. Capacity model of attention allocation presented by Kahneman. (Kahneman 1973)

Attentional requirements of walking

Cognitive-motor dual task experiments are the primary behavioral method used to probe the
attention demand of walking (with walking being the motor task). In this paradigm, walking is
deemed to be attention-demanding if the quality of walking deteriorates during the simultaneous
performance of walking and a known attention demanding task which serves as the primary task
For interpretation purposes, it is important that the participant in dual task experiments is
explicitly instructed to focus primarily on the attention task in order to satisfactorily claim that
walking is attention demanding (Yogev 2005). Walking performance is typically quantified as
the average change or change in variability of one or more temporal-spatial variable such as
walking speed, cadence, step length, double support time, step width and step time.
During dual tasking, it has been consistently reported that decrements will occur to gait speed
and variables related to gait speed such as stride length, cadence and double support time (Yogev
2005). Additionally, dual tasking has been associated with increase in stride time variability, and
the ability to navigate complex environments and avoid obstacles (Yogev 2005). These
decrements in gait speed and stride time are increased with aging which is known to result in
slight neurological decline. Neurological deficits such as Parkinson’s disease, Alzheimer’s
disease and stroke exacerbate decrements to walking during dual tasking (Yogev 2005). In these
populations, the significant gait decrements occur in gait speed, gait asymmetry and step time
variability.
The principal tool for assessing the attention demands of locomotion is functional near infrared
spectroscopy (FNIRS) imaging of the prefrontal cortex during normal walking or dual task
walking (Clark 2015). FNIRS is used primarily during walking dual task studies because, unlike
electroencalography, the quality of the signal can be maintained while walking. The prefrontal
cortex is the primary brain region examined because it has been shown to be active during
movement planning and the execution of cognitive and motor tasks (Clark 2015). Briefly, FNIRS
is a method of recording blood flow via a laser diode at the surface of the skin which emits near-
infrared light that passes through the skin, soft tissue and bone to reach the cortex. At the cortex,
the light is absorbed by hemoglobin while a portion of the non-absorbed light scatters back to the
surface. The non-absorbed light is then measured by a diode.
Figure 2. From Foy et al 2017. Representation of FNIRS probe placement and recording of prefrontal cortex activity. “(a)
Positioning of the 4 light sources (red) and 10 detectors (blue) with references to the nasion. (b) Sensitivity profile of the
fNIRS probe used in this experiment projected onto a digital brain atlas based on the “Colin27” atlas commonly used in
MRI studies. The colour scale depicts the sensitivity logarithmically. Both images were created using AtlasViewerGUI.”
(Foy et al 2016)

Studies using FNIRS to examine changes to the prefrontal cortex activation during walking has
shown that there is an increase in this area while walking during dual-task conditions, walking in
complex (and novel) environments, and when there is damage to the neuromuscular and skeletal
systems (Clark 2015). These findings have been supported with the additional use of single
neuron measures to determine the effects of dual-tasking on neural activity in monkeys
(Watanabe 2014). This study showed that dual-tasking (i.e. increased attention demands) results
in decreased response time and ability to recruit single neurons in the pre-frontal cortex
(Watanabe 2014). However, FNIRS imaging of the prefrontal cortex during regular walking
show no substantial increase in activation. These results suggest that walking is attention
demanding unless it is challenged by complex tasks or neurological and musculoskeletal deficits,
a conclusion which is contrary to those obtained from behavioral studies alone. However,
attention and executive function are not primarily localized to the prefrontal cortex so it is
prudent to expand the scope of neural imaging to include other regions of the brain.
Conclusions
Overall, these behavioral and neurological studies indicate that walking, under certain
conditions, is attention demanding and not entirely automatic. This results align well with
mechanical models of walking such as Dynamic walking which show that locomotion is possible
given just the passive dynamics of the locomotor system (i.e. no spinal or supraspinal control is
necessary) (Kuo 2011). Additionally, these findings have been useful in developing novel
rehabilitation strategies such as cognitive-motor training (Silsupadol 2009) and developing
methods capable of detecting fall risk in older adults and patients with neurological deficits
(Beauchet 2009; Nordin 2010; Ayers 2013). Lastly, the results that walking is only negatively
affected during complex dual-task conditions indicate that attention is best explained by a
capacity theory.
References
1. Ayers E.I., Tow A.C., Holtzer R, Verghese J. Walking while talking and falls in aging.
Gerontology. 2011, 60: 108-113: doi 10.1159/000355119
2. Beauchet O., Annweiler C., Dubost V., et. al. Stops walking when talking: a predictor of
falls in older adults? Euro. J. Neurol. 2005, 16: 786 – 795.
3. Clark D.J. Automacity of walking: functional significance, mechanisms, measurement
and rehabilitation strategies. Front. Hum. Neurosci. 9:246:doi:
10.3389/fnhum.2015.00246
4. Foy H.J., Runham P., Chapman P. Prefrontal cortex activation and young driver
behavior: a fNIRS study. PLoS ONE. 2016, 11(5): e0156512.
doi:10.1371/journal.pone.0156512
5. Kahneman D. Attention and Effort. Prentice-Hall Inc., Englewood Cliffs, New Jersey.
1973
6. Kuo A.D., Donelan J.M. Dynamic principles of gait and their clinical implications. Phys.
Ther. 2011, 90.2: 157- 174
7. Nordin E., Moe-Nilssen R., Ramnemark A., Lundin-Olsson L. Changes in step-width
during dual-task walking predicts falls. Gait Posture, 2010, 32: 92-97
8. Pashler H. Dual-task interference in simple tasks: data and theory. Psych Bulletin, 1994,
116(2): 220-244
9. Silsupadol P., Lugade V., Shuway-Cook A., et. al. Training-related changes in dual-task
walking performance of elderly persons with balance impairment: A double-blind,
randomized controlled trial. Gait Posture. 2009, 29(4): 634 – 639.
doi:10.1016/j.gaitpost.2009.01.006.
10. Watanabe K., Funahashi S. Neural mechanisms of dual-task interference and cognitive
capacity limitation in the prefrontal cortex. Nat. Neurosci. 2014, 17(4): 601-611
11. Yogev G., Hausdorff J.M., Giladi N. The role of executive function and attention in gait.
Mov. Disord. 2008. 23 (3): 392 – 472. Doi:10.1002/mds.21720.