Changes in Metabolic Activity and Gait Function by Dual-Task Cognitive Game-Based Treadmill System in Parkinson’s Disease: Protocol of a Randomized Controlled Trial

Abstract

Balance and gait impairments, and consequently, mobility restrictions and falls are common in Parkinson’s disease (PD). Various cognitive deficits are also common in PD and are associated with increased fall risk. These mobility and cognitive deficits are limiting factors in a person’s health, ability to perform activities of daily living, and overall quality of life. Community ambulation involves many dual-task (DT) conditions that require processing of several cognitive tasks while managing or reacting to sudden or unexpected balance challenges. DT training programs that can simultaneously target balance, gait, visuomotor, and cognitive functions are important to consider in rehabilitation and promotion of healthy active lives. In the proposed multi-center, randomized controlled trial (RCT), novel behavioral positron emission tomography (PET) brain imaging methods are used to evaluate the molecular basis and neural underpinnings of: (a) the decline of mobility function in PD, specifically, balance, gait, visuomotor, and cognitive function, and (b) the effects of an engaging, game-based DT treadmill walking program on mobility and cognitive functions. Both the interactive cognitive game tasks and treadmill walking require continuous visual attention, and share spatial processing functions, notably to minimize any balance disturbance or gait deviation/stumble. The ability to “walk and talk” normally includes activation of specific regions of the prefrontal cortex (PFC) and the basal ganglia (site of degeneration in PD). The PET imaging analysis and comparison with healthy age-matched controls will allow us to identify areas of abnormal, reduced activity levels, as well as areas of excessive activity (increased attentional resources) during DT-walking. We will then be able to identify areas of brain plasticity associated with improvements in mobility functions (balance, gait, and cognition) after intervention. We expect the gait-cognitive training effect to involve re-organization of PFC activity among other, yet to be identified brain regions. The DT mobility-training platform and behavioral PET brain imaging methods are directly applicable to other diseases that affect gait and cognition, e.g., cognitive vascular impairment, Alzheimer’s disease, as well as in aging.

Effects of dual-task training on gait and balance in stroke patients: A meta-analysis

“…Brain activity differs during single-task and dual-task walking, with increased activation of the sensorimotor and cerebellar regions and decreased activation of the prefrontal cortex during dual-task walking. 41 These changes in the brain activation patterns are associated with reduced gait and cognitive performance measurements as well as the size of the dual-task effect. Most studies used a fixed dual-task mode during the duration of the intervention, and the lack of task difficulty at the late stage of intervention may be the reason for the non-significant difference in the parameters.…”

ACID: A Comprehensive Toolbox for Image Processing and Modeling of Brain, Spinal Cord, and Post-mortem Diffusion MRI Data

“…Table 6 provides the computation times for selected ACID functions on a typical brain and spinal cord dMRI dataset. (Deppe et al, 2016a(Deppe et al, , 2016bDossi et al, 2018;Kugler & Deppe, 2018) and Parkinson's disease (Szturm et al, 2021), and to assess gliomas (Paschoal et al, 2022;Raja et al, 2016). ACID has also been used to investigate spinal cord white matter following spinal cord injury (David et al, 2019(David et al, , 2021(David et al, , 2022Grabher et al, 2016;Huber et al, 2018;Seif et al, 2020;Vallotton et al, 2021).…”

Computerized Dual-Task Testing of Gait Visuomotor and Cognitive Functions in Parkinson’s Disease: Test-Retest Reliability and Validity

“…Two cursors of different shapes appear on the monitor. The target was a circle, its motion was computer Szturm et al (2017Szturm et al ( , 2021.…”

“…(G) Presents overlay trajectories of all game movement responses for one game session. Parts of Figure 1 have previously been published inSzturm et al (2017Szturm et al ( , 2021.…”