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Table 2 The duality training program

From: Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson’s disease: the DUALITY trial

6 weeks 2x/week 40 min Therapy session with physiotherapist
  2x/week 30 min Therapy session without physiotherapist
Integrated training group Consecutive training group
- Gait training while doing cognitive exercises - Cognitive training while sitting
- Functional training of dual tasks in ADL - Gait training without extra cognitive load
   - Consecutive functional training avoiding dual tasks
Contents of components in both training arms
  Exercises Progression
Gait training Depending on clinical need walking while: Increase speed
Focussing on big steps Increase amplitude
Focussing on heel strike Increase or decrease frequency
Focussing on arm swing Introduce speed variations
Focussing on upright posture  
Walking while raising knees Decrease exercise execution time
Tandem gait Increase coordination demands
Turning Increase environmental demands: surfaces, narrow spaces, doorways, outdoors
Transitions: sit-to-stand, start-stop
  Stepping in multi-directions  
Cognitive training Verbal fluency tasks  
e.g. Name cities and countries starting with A,B,C More difficult categories
Discrimination and decision making tasks
e.g. Say yes when you hear “strawberry” but say nothing when you hear another sort of fruit Decrease response time, responding to two or three different words
Working memory tasks
e.g. Digit span backwards, Word memory task Increase the length of series, related vs. unrelated words
Mental tracking tasks
e.g. Count how many times you hear the word “cat” in this story about cats. Count two or three words in a story
Counting: summing and subtracting Increase the complexity of the counting task
Reaction time tasks
e.g. React as fast as you can on a certain word or sound Decrease time between two reactions, react to two or three words or sounds
Cognitive exercise is delivered by the therapist using a laptop.
  During self-administered practice, cognitive exercise is played via an MP3 player
Functional training Integrated training group  
Walking while having a conversation  
Describing route while walking  
Taking wallet, handkerchief, … out pocket while walking  
Closing buttons and zipper while walking  
Carrying tray, cup, plate  
Carrying groceries  
Moving kitchenware from sink to cupboard  
Integrated AND consecutive training group  
Laying the table  
Picking object from the ground  
Maneuvering in bathroom  
Getting mail out the mailbox  
  Self-reported functional difficulties