Body and brain – An inseparable team

Effectiveness of cognitive-motor training in neurology and geriatrics.

Getting up, going shopping or going for a walk with friends: all activities of our everyday life require the precise interaction of the motor system, the sensors and the central nervous system. The brain, which is responsible for coordinating these subsystems, plays a central role in this. This interaction usually works flawlessly in healthy, young people. In old age, after illnesses or accidents, people often find it difficult to interact optimally with their environment due to disturbances in the above-mentioned subsystems or their coordination. This can lead to limitations in everyday functions, mobility, falls and loss of independence.

Falls - causes, consequences and prevention

In industrialized countries, on average, every third person over the age of 65 falls once a year. In the age group over 85 years, the annual risk of falling even increases to 50%. Falls in older people result in serious injuries in approximately 15% of those affected. These injuries mean pain, a reduction in mobility and independence and often also an increasing fear of falling. In addition to personal suffering, falls also lead to high costs for society and represent a socio-economic problem.

In medicine, a fall is an accident that results from losing balance while standing or moving. The following degenerative changes, which can be triggered by aging processes, injuries or diseases, are given in the literature as reasons for an increased risk of falling:

Changes in the motor system:

e.g. reduced muscle mass/muscle strength

Changes in the sensory system:

e.g. impaired sensory perception

Changes in the central nervous system:

e.g. reduced signal line

Loss of muscle mass (sarcopenia) and muscle strength (dynapenia) are given as the main causes of an increased risk of falls. Interestingly, dynapenia progresses faster than sacropenia, so it is not linearly related. This makes it clear that one of the most important fall risk factors, muscular weakness, is due to deficits not only in the motor system but also in the nervous system [1].

In addition to an intact signal line and functional motor areas of the brain, the complex process of walking also requires higher-level brain functions (cognitive processes). Above all, attentional and executive functions are necessary for a secure gait pattern. Executive functions refer to cognitive abilities that enable goal-oriented action (e.g. attention control).

The executive functions are located in the front part of the brain (frontal lobe), which is subject to particularly strong degenerative changes during the aging process. If age, illness or injury lead to impairment of cognitive functions, this results in an increased risk of falls [2].

Especially in so-called dual-task paradigms, it becomes apparent that walking requires cognitive resources. If a person is given a cognitive task such as arithmetic (dual-task condition) in addition to walking, the gait pattern changes. The additional task requires resources that are no longer available for controlling walking. The so-called dual-task interference, which can also be observed in healthy people, is intensified not only by aging processes but also by neurological diseases [3].

For a successful fall prevention, the training of the cognitive functions must be considered in addition to the improvement of muscle strength and balance. Central to this is the training of the interaction between the body (motor and sensory system) and the brain. Therefore, physical activity should be combined with cognitive challenges. This type of training is increasingly known as cognitive-motor training [4].

Cognitive-motor training - benefits and implementation

A new and particularly promising type of training starts with this combined concept. Interactive cognitive-motor training (also called dual-task training) links movements to cognitive tasks. It simulates the demands of our daily life and specifically trains brain-body communication [4]. There is ample evidence in the research literature that cognitive-motor training is effective [5,6,7,8]. There are improvements in physical functions (e.g. balance, coordination, gait) but also in cognitive functions (e.g. attention or executive functions). It is also described that cognitive-motor training can minimize the risk of falls in older people [9].

Cognitive-motor training is suitable for all those who want to strengthen brain-body communication.

Researchers suspect that combined cognitive-motor training can lead to superior effects compared to sequential training approaches. Findings from animal research confirm this assumption, which is caused by a synergy effect [10]: Physical activity seems to trigger positive changes in the brain (neuroplastic effects) (e.g. the formation of new nerve cells), whereby the cognitive challenge could be decisive for these effects (e.g. integration of the new cells into the existing network).

The senso was developed in cooperation with the ETH Zurich, which enables such an interactive cognitive-motor training in combination with exergames (exercise games). Training games are presented to the user on a screen, each of which addresses specific brain functions. The games are controlled by body movements such as steps or balance shifts. The movements are recorded by a pressure-sensitive plate.

Fields of application and scientific evidence

Cognitive-motor training is suitable for all those who want to strengthen brain-body communication. It is used in prevention as well as in therapy and rehabilitation. The senso is often used in the field of "active aging", fall prevention and geriatrics as well as in neurorehabilitation.

Studies with healthy seniors in the context of fall prevention have shown that training on the senso can improve the most important gait parameters (e.g. walking speed or step length) [11,12]. These parameters are in turn directly related to a reduced risk of falling.

The cognitive-motor training on the THERA-Trainer senso is also suitable for use in neurological diseases such as dementia, Parkinson's, stroke or multiple sclerosis. A study with stroke patients showed that both improvements in physiological parameters (e.g. gait pattern) and optimization of brain functions (e.g. psychomotor speed) can be achieved through training with the THERA-Trainer senso [13]. A study with patients with severe cognitive impairments in the context of dementia showed positive effects of THERA-Trainer senso training on walking speed and the speed of step execution, on the general cognitive status and on psychological well-being [14].

In industrialized countries, on average, every third person over the age of 65 falls once a year. In the age group over 85 years, the annual risk of falling even increases to 50%.