Falling Head Over Heels:
Investigating the higher-level cognitive and electrophysiological processes underlying gait control and falls
in older adults and stroke survivors
Falls are a common problem for Ireland’s older adults and stroke survivors, which have severe consequences for the individual and high care costs for the state. Current clinical interventions that focus solely on musculoskeletal function are not evidenced to be consistently effective in the long term, or in those older adults without muscle and bone impairments (Cadore, Rodríguez-Mañas, Sinclair, & Izquierdo, 2013; Teasell, McRae, Foley, & Bhardwaj, 2002). The role of cognition in gait control and falls has become increasingly apparent, with higher-level executive functions exhibiting a clear relationship with falls and cognitive decline with ageing (Morris, Lord, Bunce, Burn, & Rochester, 2016). This research aims to address a gap in the literature by identifying the specific higher-level executive processes that play a role in gait control, and examining if these processes are impaired in older adults and stroke survivors with a high risk of falling. Behavioural and electrophysiological measures were used to examine walking gait in both single- and dual-task conditions, as well as cognitive performances and the associated event-related potentials in healthy young and older adult “fallers” and “non-fallers”, and also in a sample of stroke survivors. The results suggest that executive top-down processes (working memory in particular), play a role in gait control during dual-task walking generally, and that executive processes are relied upon more in older age. This work suggests that there may also be neural markers of “successful” ageing that differentiate fallers from non-fallers, and that there can be substantial recovery of both cognition and gait post-stroke. These findings support the resource capacity and compensatory theories of neurocognitive ageing, and suggest that executive neuropsychological tasks could be developed to offer alternative cognitive/neural fall screening assessments and rehabilitation programmes for stroke patients and the wider older adult population
