Robotic Motor–Cognitive Dual–Task Assessment and Training for Balance and Cognition

Motor and cognitive impairments frequently coexist in older adults and individuals with neurological disorders, compromising postural control and gait, functional independence, and quality of life. Because many everyday activities require the simultaneous execution of motor and cognitive processes, Motor–Cognitive Dual-Task (MCDT) paradigms have become increasingly relevant for both clinical assessment and rehabilitation. Despite their growing application in clinical settings, current MCDT approaches remain limited in several respects. Most studies have focused on gait rather than standing balance, although these activities involve partly different motor control mechanisms. When standing balance is investigated, postural demands are often restricted to relatively simple or not fully controlled conditions. In addition, the concurrent cognitive task is commonly treated merely as a distractor to interfere with balance performance, while cognitive performance is typically quantified only through conventional neuropsychological scores. Consequently, current MCDT paradigms provide limited insight into the reciprocal interaction between motor and cognitive performance and may lack the sensitivity required to detect subtle impairments. This thesis addresses these limitations through the development of a robotic framework using hunova for quantitative MCDT assessment, complemented by the implementation of training-oriented exercises designed to extend its potential application to rehabilitation contexts. The proposed MCDTs combine cognitive tasks targeting multiple cognitive domains with balance tasks performed under static and dynamic conditions, allowing motor and cognitive performance to be evaluated simultaneously within a standardized and reproducible environment. The research was structured in two sequential phases. The proposed protocol was first investigated in unimpaired adults across the adult lifespan to characterize the effects of cognitive task complexity, postural demand, and aging on balance and cognitive performance. These studies also identified the combinations of cognitive tasks and balance conditions that were most sensitive to age-related changes, providing an initial normative framework for subsequent clinical investigations. A shortened version of the same assessment protocol was then applied to individuals with Parkinson’s disease and mild traumatic brain injury to evaluate its feasibility in neurological populations and to determine which combinations of cognitive tasks and balance conditions most effectively differentiated impaired individuals from unimpaired controls. The results demonstrated that motor–cognitive performance was influenced by both the characteristics of the cognitive task and the level of postural challenge. Furthermore, different neurological populations exhibited distinct patterns of motor–cognitive impairment, indicating that the diagnostic sensitivity of MCDTs arises from the interaction between cognitive and motor demands, rather than from either component alone. Beyond conventional neuropsychological outcome measures, the digital implementation of the proposed cognitive tasks enabled the extraction of detailed quantitative metrics describing task execution strategies. These measures provided additional information on motor–cognitive performance and revealed subtle alterations that were not captured by traditional performance scores. Overall, this thesis presents a comprehensive robotic framework for standardized MCDT assessment, complemented by training-oriented extensions aimed at supporting future rehabilitation applications. By integrating controlled balance perturbations with quantitative digital cognitive evaluation, the proposed methodology advances the objective assessment of motor–cognitive interactions, establishes an initial normative reference data in unimpaired individuals, and demonstrates the clinical applicability of robotic MCDTs in neurological populations. These findings provide a foundation for the development of more sensitive assessment protocols and personalized rehabilitation strategies targeting the interaction between balance and cognition.