Examining conscious motor processing and the effect of single-task, dual-task and analogy training on walking during rehabilitation by older adults at risk of falling in Hong Kong: Design and methodology of a randomized controlled trial

Walking is a common activity among older adults. Fallers were discovered to have a higher propensity to conscious motor processing (reinvestment) than age-matched non-fallers, leading to movement disruption, possibly by constraining or interfering with automatic motor control mechanisms. However, gait rehabilitation programs by implicit motor learning methodologies may ameliorate reinvestment propensity while improving gait ability in older adults. One hundred and five older adults, with moderate to high risk of falling, will be recruited from different community centres in Hong Kong to investigate the effect of single-task, dual-task and analogy training (implicit motor learning methodologies) on walking during rehabilitation in the context of reinvestment propensity, balance, walking ability and fear of falling. Participants will be randomly allocated and received 12 training sessions in either a Single-task Walking Group (STWG), a Dual-task Walking Group (DTWG) or an Analogy Walking Group (AGWG). Reinvestment propensity, walking ability, balance and fear of falling will be assessed by the Chinese version Movement Specific Reinvestment Scale (MSRS-C), 10-meter Walk Test, Tinetti Balance Assessment Tool, Timed ‘Up & Go’ Test (TU&G), Berg Balance Scale (BBS) and 13-item Falls Efficacy Scale (FES-13), respectively at baseline before training (T0), just after completion of all training sessions (T1), and 6 months after completion of all training sessions (T2). Participants' number of falls between T1 and T2 will also be recorded. The results could establish a solid foundation for further development and implementation of a novel and effective gait rehabilitation program in fall prevention for older adults at risk of falling.