The individuals in control group were given exercises in group. All the 18 sessions were conducted in six weeks every alternate day. Total time for these sessions was 45 minutes each. Total 5 dropouts were observed till the last session. Exercises include the following-

All the exercises were progressed in the sequence on weekly basis reducing the repetition of previous ones. The last session consisted of all exercises. First session started with 10 exercises with 10 repetitions each.

Tandem standing Side to side reach outs

The study was completed in 6 weeks out of 30 individuals of them complete the entire 18 sessions. Post reading of both the intervention on berg balance scale, dynamic gait index and modified falls efficacy scale showed positive results.

Table no.1: Demographic data

Table no.2: Pre and Post Mean for BBS

Table no.3: Pre and Post Mean for DGI

Table no.4: Pre and Post for MFES

The above mentioned table shows mean, standard deviation, p value, t value and significance for the readings mentioned in previous tables. When the paired t test was applied to check results of pre and post readings they showed significant values for both the groups in all the three scales. For berg balance scale in experimental group the p value was 0.0205 which is considered significant with t value 8.817 and 14 degrees of freedom where as for control group the p value was 0.0001 with t value 6.53 and 14 degrees of freedom which is considered extremely significant.

Similarly for the scale dynamic gait index the experimental group and control group both had significant p values 0.0176 and 0.0135 respectively. The modified falls efficacy scale for the experimental group showed p value 0.0305 with t value 2.47 and 14 degrees of freedom where as for control group the p value is 0.0001 with t value 8.031 and 14 degrees of freedom which is considered extremely significant.

For the comparative result for both the groups was calculated on the basis of their post intervention readings which also showed significant result. The static balance measure with berg balance scale showed positive results in both the groups and P value calculated was 0.0293 which is considered significant having t = 1.971 with 28 degrees of freedom.

Dynamic balance was measured with dynamic gait index showed significant P value 0.0001 having t=7.465 with 28 degrees of freedom.

The dual task training helped subjects to gain more confidence improving their scores in modified falls efficacy scale with P value 0.0285 which is significant having t=1.984 with 28 degrees of freedom.

This study was done on the geriatric population above the age group of 65 for improving balance and reducing risk of fall by performing dual task training on treadmill on 20 individuals. This was then compared to group of 20 individuals performed conventional balance exercise. After six weeks of intervention the improvement in balance measures was consistent with previous reports in elderly fallers. As a group, the change in the BBS and DGI scores resulted in meaningful clinical and statistical difference, suggesting relevant improvement in balance.

The correlation found post-intervention further highlighted the possibility that the combined motor-cognitive training enhanced improvements in both the domains which influenced each other and created a functional change. The results of the study shows that subjects of dual task training and balance exercises both have benefited from the intervention with significant improvement in post-intervention balance scores on berg balance scale, dynamic gait index as well as modified falls efficacy scale. The post intervention scores were more significant in experimental group than the control group. So the dual task training was found to be more effective in improving balance in older adults. One of the factors that may have contributed to improved scores could be the task coordination and management theory proposed by Kramer et al [2]. According to this theory practicing two tasks together allows participants to develop task coordination skills. There is automatization of tasks which decreases the demand required to perform the task, hence rapidly developing the skills.

A study performed by Nora E. Fritz, PT, DPT, in his study after DTT for 10 to 12weeks, the healthy elderly demonstrated improvements in reaction time on a lower extremity motor task, Community Balance and Mobility Scale and reduced fear of falling[5]. Also DTT for 6 weeks resulted in greater improvement in memory performance compared with controls who received only walking training in elderly individuals with risk of fall. Elderly adults with balance impairment had 4 weeks of DTT which showed improvements in cognition on the Stroop and both single and DT walking. Variable training (i.e., instructions to prioritize either the motor or cognitive task) was more effective for improvement of mobility and cognitive outcomes under DT conditions than fixed-priority or single-task conditions, and hence maintained the gains. This variable-priority effect has been noted in cognitive-cognitive DT training programs of healthy adults, where individuals trained with variable-priority instructions learned tasks faster and performed better than those who received fixed-priority instructions. Segev-Jacubovski et al in a systematic review exploring the use of DTs to identify elderly fallers suggested that DTs may have added benefit in the assessment of fall prediction and should be studied further. Moreover, in an exploration of gait, falls, and cognition, concluded that combining motor and cognitive therapies should be included in clinical practice to improve mobility and reduce safety in older adults.

The present findings suggest dual task training on treadmill training is feasible for older adults who are at a risk of fall and enhances balance, cognitive function, and functional mediators related to fall risk. Improved scores of BBS, DGI and MFES were seen more in dual task training than conventional exercises.

I extend my gratitude to Dr. Snehal Ghodey, PRINCIPAL – MAEER’S PHYSIOTHERAPY COLLEGE, for giving me this chance to work on my project and also for her constant support for it. Also, I like to thank my guide Dr. Anuradha Sutar, Professor –MAEER’S PHYSIOTHERAPY COLLEGE, who was my constant source of encouragement during the entire project work. It was a wonderful experience working under her in this project.

I would also like to thank my parents Mr. Ninad Pathak and Mrs. Anita Pathak for providing me all the sources required for my project and their moral support and encouragement to complete my work in time.