Identification and Evaluation of the Additional Effect of Cognitive Training in Balance Physiotherapy

This systematic review examines whether adding cognitive training to a multicomponent balance rehabilitation protocol provides additional benefits for older people with balance disorders who have no or mild cognitive impairment. A comprehensive search of electronic databases was conducted to identify eligible studies. The target population consists of community-dwelling older people at risk of falling and/or with a persistent history of imbalance, with an absence of or mild cognitive impairment. The GRADE system was used to assess the risk of bias. Sixteen RCTs were identified as eligible, integrating at least balance and cognitive training as modules of a multicomponent rehabilitation protocol. Strengthening exercises, endurance training, and advanced technology were also included. In almost all studies (except one), balance exercises were provided simultaneously with cognitive exercises. The recommended exercise dosage consisted of 40-60 minutes per session, performed 2-3 per week over a period of 12 weeks. Μotor-cognitive training improved standing posture, gait speed, functional mobility, domains of cognitive function, and motor-cognitive performance. Duration of interventions was correlated with the level of clinical improvement. Specific methodological issues may limit the overall reliability and generalizability of the findings. Cognitive training provided additional benefits for posture, gait speed, functional mobility, and dual-task performance in older people with balance disorders by optimizing the allocation of attentional demands.