The Role of Executive Function and Attention in Gait

Mov Disord. Author manuscript; available in PMC 2009 February 15.Published in final edited form as: Mov Disord. 2008 February 15; 23(3): 329–472. ____________________________________________________________________________

Executive function (EF) refers to an assimilation of numerous higher central nervous system cognitive processes from various regions of the brain in order to process, manipulate and generate behavior. Dr Ivo talked about this in some of the recent Neuromechanics lectures as the “Central Integrated State”.

This study suggests that people with gait abnormalities are much more susceptible to developing dementia.  As they say here , “subtle gait changes predicted the subsequent development of dementia."  This kinda makes what The Gait Guys are trying to bring to light, well … , pretty darn important for us all ! The study also suggested that those that walk daily, as a form of exercise we are assuming, significantly reduced this risk compared to those who were more sedentary. 

This study postulates that gait, daily walking, uses Executive Function (EF) in the brain and thus if someone refrains from daily activities such as gait that EF will diminish.  And since EF loss and dementia see parallel, the less active we are, the more the risk for dementia. So the old adage "if you don’t use it, you lose it” applies here.

The study does point out that the relationship between walking and cognitive function is multifactorial. The study seems to suggest that there could be a relationship between dual tasking gait abilities and the development of dementia although studies are not yet available. Remember that the brain works best when running parallel tasks, rather than unitasking. Studies seem to suggest that the cerebellum is involved (with learning), and thus a gravitational activity like gait certainly would apply.

Now, we are sure they are not talking about walking and juggling chainsaws but they could be eluding to conscious awareness of corrective gait exercises such as those we use in our office with our patients to cue certain corrective patterns however they very well mean engaging in stimulating conversation with someone while walking might fit the bill. 

They make this suggestion when they discuss the fact that attention demanding tasks change the walking pattern in subjects and thus an alteration in Executive function (EF) but they also mention that a change in executive function will also change walking patterns. So, it appears it is clearly a two way street. We see these things in our office, and  you will see them in your patients and athletes. With a change in information or a change of focus, you see a change in patterning because EF has had a demand change.  When we  have patients doing a gait patterning exercise and we suddenly ask them what they had for lunch, basically engaging either a memory or a spacial-temporal memory, their gait pattern reverts to the older established pattern we are trying to amend. 

 As the study summarizes, “a causal relationship between EF changes and gait changes remains to be more firmly proven, however, there is ample evidence demonstrating a relationship between these two seemingly disparate domains including numerous investigations which have documented changes in the gait pattern in response to dual tasking. This dependence is most notable in patient populations where the ability to compensate for an impaired gait is restricted to due a lack of “cognitive reserve.”

This study has pertinence on many levels. From athletes, to elderly with the risk of falls and dementia and possibly on the subconscious levels of learning.

we highly suggest you obtain this article for your archives.

Shawn and Ivo, The Gait Guys……. looking at how we move from every aspect……from the brain to the toes.