Quantitative assessment of the stops walking while talking test in the elderly

Objective: To examine whether trunk sway and walking speed differ between elderly "stoppers" and "nonstoppers" during a shorter version of the stops walking while talking (SWWT) test-an observational assessment of impaired dual-task performance-and during a normal walking trial. Design: The original SWWT test was administered on the way to the test room (over a distance of 150m). Then, subjects were asked to walk 2 trials of 8m while wearing a trunk sway measuring device strapped firmly to their lower back. For the first 8-m trial, no questions were asked (control trial). During the second 8-m trial, subjects were asked an easy question (What is your age?) after walking 2m. Setting: Long-stay geriatric care unit in Switzerland. Participants: Seventeen institutionalized elderly (16 women, 1 man; mean age, 86.3y; range, 79-93y). Subjects had to be able to walk at least 150m and to understand simple questions. Interventions: Not applicable. Main Outcome Measures: The amplitude of trunk sway angle and angular velocity in the forward-backward (pitch) and side-to-side (roll) directions and the duration of each trial were compared between the two 8-m walking trials with and without a question among subjects who did and did not come to a complete stop. Results: In the original SWWT test 4 persons stopped walking while talking, compared with 8 persons who stopped in the short (8-m) walking trial when a question was asked. Persons who stopped during the 8-m trial when a question was asked had significantly longer walking durations (by 19s) and larger trunk roll angular displacements (by 5.5degrees) during trials, both with and without a question. For both stoppers and non-stoppers, duration was longer during the trial when a question was asked. Conclusion: A fixed and brief walking distance, coupled with a single sudden question, provided an effective method of identifying subjects who stop walking while talking. These subjects are those who have slower walking speeds and more unstable trunk control in the roll plane even under normal walking conditions. Our findings support the predictive capabilities of a brief SWWT test for the unstable and fall-prone elderly, as well as the usefulness of objective trunk sway measures to identify gait instabilities. (C) 2003 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.