What is Dual Tasking?
Dual tasking in vestibular rehabilitation refers to performing a vestibular or balance exercise while simultaneously engaging in a secondary task, typically cognitive or motor. It reflects the reality that daily activities rarely occur in isolation—patients must often maintain postural stability while talking, navigating complex environments, or making decisions [1].
Evidence
Patients with vestibular disorders frequently show cognitive–motor interference, where gait or balance deteriorates, or cognitive performance declines, when two tasks are combined [2]. For example, unilateral vestibular loss patients walking while counting backwards demonstrated worse cognitive performance despite prioritising gait [2].
Research supports the value of addressing this deficit. In stroke, integrating vestibular rehabilitation with dual-task gait training improved gait speed and balance more than single-task training [3]. Similar benefits are reported in Parkinson’s disease, where dual-task interventions enhance gait automaticity and reduce interference [4]. Current perspectives in vestibular physiotherapy highlight cognitive–motor dual tasks as a key development to improve ecological validity and prepare patients for complex environments [5].
Why It Works
Dual tasking may support rehabilitation through:
- Neuroplasticity and central compensation, by engaging broader neural networks and encouraging sensory reweighting [5].
- Automaticity of motor control, shifting balance and gaze tasks from conscious effort to reflexive patterns [4].
- Cognitive flexibility, strengthening divided attention and executive control, functions often impaired in vestibular disorders [1].
Clinical Application
Dual tasks can pair gait or balance activities with secondary cognitive tasks (e.g., walking while reciting sequences, or gaze stabilisation with mental arithmetic). Progression should be graded: start simple, then increase motor or cognitive load, and eventually simulate real-world scenarios. Monitoring is essential—mild transient dizziness is expected, but prolonged or severe symptoms indicate over-challenge [6].
Role of Head-Mounted Lasers
Head-mounted lasers add a valuable dimension to dual-task rehabilitation by making head motion visible and measurable. The device projects a crosshair or point onto a target, allowing patients to see in real time how their head moves in three dimensions.
In single-task mode, the laser provides feedback for exercises such as gaze stabilisation or joint position error testing.
In dual-task mode, patients maintain accurate laser control while performing a cognitive or motor secondary task (e.g., mental arithmetic, word recall, or responding to auditory cues). Clinicians can directly observe whether head movement accuracy declines under divided attention.
This setup trains automaticity: over time, patients learn to keep the laser steady or trace patterns even while distracted, mirroring the demands of daily life.
Difficulty can be increased by progressing from static holds to dynamic tracing (e.g., figure-of-eight patterns) with simultaneous cognitive challenges.
By quantifying the impact of cognitive load on vestibular and cervical control, head-mounted lasers support structured, progressive dual-task training and provide clear feedback for both clinician and patient.
Looking Ahead
Dual-task rehabilitation represents a pragmatic bridge between clinic and community. By challenging patients under divided attention, clinicians can help restore confidence and reduce fall risk. Tools that provide real-time visualisation of head movement, such as head-mounted lasers, align with this goal by making complex tasks more measurable and adaptive to patient progress.
References
- Pavlou M, et al. Cognition and dual-task gait in persons with vestibular disorder compared to healthy controls. Sci Rep. 2023;13:10130.
- Nascimbeni A, et al. Dual task interference during gait in patients with unilateral vestibular disorders. J Neuroeng Rehabil. 2010;7:47.
- Nairn B, et al. Vestibular rehabilitation therapy and dual-task gait training in stroke: a systematic review and meta-analysis. J Am Heart Assoc. 2025;14(11):e040663.
- Li KZH, et al. Cognitive dual-task training to improve gait and balance performance in older adults: a systematic review. Neurorehabil Neural Repair. 2018;32(9):765–776.
- Tramontano M, et al. Advances in vestibular physical therapy: updated perspectives. Healthcare (Basel). 2025;13(5):492.
- Hall CD, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline. J Neurol Phys Ther. 2016;40(2):124–155.