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Long-term dual-task training may improve dynamic balance and functional independence in individuals with Down syndromeDual Task Training May Improve Balance in Down Syndrome

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Key Takeaway
Note that acute dual-task demands impair gait in individuals with Down syndrome, but 8-week training may improve outcomes.

This systematic review synthesizes data from 10 studies involving 363 participants to evaluate the effects of dual-task (DT) paradigms on postural control and gait in individuals with Down syndrome. The review distinguishes between acute DT conditions, such as counting or word generation, and long-term training programs lasting 8 weeks.

Findings indicate that acute DT conditions consistently result in significantly impaired gait parameters, including reduced velocity and increased step time, across 8 studies. Additionally, 8 studies reported increased postural sway during acute dual-task tasks compared to single-task conditions. In contrast, 2 studies reported significant improvements in dynamic balance and functional independence following an 8-week long-term training program.

A correlation was noted in 6 studies between IQ scores (mean range: 26.97-66.60) and gait speed/step length. The authors note limitations including heterogeneity in outcome measures and varying risk of bias across the included studies. Clinical application is limited by the preliminary nature of the evidence for long-term training outcomes and the need for high-quality RCTs with standardized protocols.

How this fits prior evidence

This systematic review addresses a gap in understanding how cognitive demands impact physical mobility in individuals with Down syndrome. While previous coverage noted the lack of clear treatment guidelines for Down syndrome T-ALL, this evidence focuses on physical rehabilitation and gait stability. The findings regarding impaired gait during acute dual-task conditions are consistent across 8 studies, while long-term training benefits remain preliminary.

Researchers reviewed several studies involving 363 people with Down syndrome to see how performing two tasks at once affects movement. They looked at both immediate effects and the results of long-term training programs lasting about 8 weeks.

In short, doing two things at once—like walking while counting or naming objects—was found to make balance harder and slow down walking speeds in the moment. However, the data suggests a different story for consistent practice. Two studies showed that people who participated in a structured dual-task training program for 8 weeks saw improvements in their dynamic balance and functional independence.

Because these findings come from a review of various studies with different methods, the results for long-term training are still considered preliminary. The evidence is not yet strong enough to change standard care. It shows that while multitasking can be challenging in the moment, consistent training might help improve daily mobility over time.

What this means for you:
Short-term multitasking may hinder balance, but 8 weeks of dual-task training may improve walking and stability.

Common questions

Does multitasking make it harder to walk safely?

Yes, the study found that performing two tasks at once (like counting or naming objects) led to worse gait parameters. This included slower walking speeds and a longer time spent with both feet on the ground. These results were consistent across 8 different studies looking at immediate effects.

Can training help improve balance over time?

Evidence from two studies suggests that an 8-week program of dual-task training can lead to significant improvements in dynamic balance and functional independence. However, because these results are preliminary, more high-quality research is needed to confirm how effective this specific training is.

How does intelligence relate to walking speed?

In 6 of the studies reviewed, researchers found a positive link between IQ scores and certain walking measurements. Specifically, higher IQ scores were associated with faster gait speeds and longer step lengths in individuals with Down syndrome.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
Background and aimsIndividuals with Down syndrome (DS) exhibit deficits in postural control (PC) and gait. Dual-task (DT) paradigms, which involve performing concurrent cognitive or motor tasks, may exacerbate these deficits or, conversely, serve as effective interventions.ObjectiveThis systematic review synthesizes evidence on how DT conditions affect PC and gait in individuals with DS, examining both acute effects and long-term training outcomes.MethodsPubMed, Web of Science, and Scopus were searched from inception to February 2025. Included studies examined DT effects on PC or gait in DS populations. Risk of bias was assessed using ROBINS-I (non-randomized studies; non-RCTs) and RoB-2 (randomized controlled trials; RCTs). Due to heterogeneity in the outcome measures, a narrative synthesis following SWiM guidelines was conducted.ResultsTen studies [363 participants; mean age 13.66 ± 2.53 years; eight non-RCTs (including six with control groups) and two RCTs] met inclusion criteria. Eight studies examining acute DT effects demonstrated that concurrent cognitive or motor tasks significantly impaired gait parameters (reduced velocity, increased step time, prolonged double support phase) and increased postural sway in individuals with DS compared to single-task conditions. These deficits were observed across various DT paradigms, including counting, word generation, and object manipulation. Conversely, two long-term DT intervention studies (8 weeks) reported significant improvements in dynamic balance, functional independence, and DT performance. IQ scores, reported in six studies (mean range: 26.97–66.60), correlated positively with gait speed and step length. Risk of bias was moderate in seven studies, low in two, and raised some concerns in one.ConclusionAcute DT conditions compromise PC and gait in individuals with DS, reflecting attention resource limitations. However, preliminary evidence suggests that DT training may improve long-term functional outcomes. Longitudinal, high-quality RCTs with standardized protocols and comprehensive cognitive assessment are urgently needed to establish evidence-based DT interventions for this population and determine whether initial improvements are sustained over time.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42023483849, CRD42023483849.
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