Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT

Veldkamp, Renee; Baert, Ilse; Kalron, Alon; Tacchino, Andrea; D'hooge, Mieke; Vanzeir, Ellen; Geel, Fanny Van; Raats, Joke; Goetschalckx, Mieke; Brichetto, Giampaolo; Shalmoni, Nov; Hellinckx, Peter; Weerdt, Natasja De; Wilde, Dorien De; Feys, Peter

doi:10.3390/jcm8122177

Cited by 39 publications

(27 citation statements)

References 43 publications

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“…Moreover, the cognitive demand of the task could be further burdened by the need to verbally indicate when the shoulders mentally crossed the finish line in order to stop the temporal acquisition. Although it is a simple request, for PwMS it could represent a sort of dual-task condition 64 with consequent slower mental performances 65 . It seems that imagining themselves walking while considering path constraints (additional cognitive task), that require dividing attentional capacities is more difficult than a single task 66 .…”

Section: Discussionmentioning

confidence: 99%

Spatial constraints and cognitive fatigue affect motor imagery of walking in people with multiple sclerosis

Podda

Pedullà

Bragadin

et al. 2020

Sci Rep

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Motor imagery (MI) is the mental simulation of an action without any overt motor execution. Interestingly, a temporal coupling between durations of real and imagined movements, i.e., the so-called isochrony principle, has been demonstrated in healthy adults. On the contrary, anisochrony has frequently been reported in elderly subjects or those with neurological disease such as Parkinson disease or multiple sclerosis (MS). Here, we tested whether people with MS (PwMS) may have impaired MI when they imagined themselves walking on paths with different widths. When required to mentally simulate a walking movement along a constrained pathway, PwMS tended to overestimate mental movement duration with respect to actual movement duration. Interestingly, in line with previous evidence, cognitive fatigue was found to play a role in the MI of PwMS. These results suggest that investigating the relationship between cognitive fatigue and MI performances could be key to shedding new light on the motor representation of PwMS and providing critical insights into effective and tailored rehabilitative treatments.

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Section: Discussionmentioning

confidence: 99%

Spatial constraints and cognitive fatigue affect motor imagery of walking in people with multiple sclerosis

Podda

Pedullà

Bragadin

et al. 2020

Sci Rep

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“…Dual-task walking assessments that require individuals to perform multiple tasks simultaneously often result in a decrement in performance of one or both tasks in persons with MS [ 7 ]. Given that walking in daily life is rarely practiced without concurrent cognitive demands or secondary motor tasks, dual-task walking assessments are more generalizable to everyday life [ 8 ] and thus may improve upon the current measures of single-task forward walking. Additionally, dual-task walking requires increased cognitive and motor demands [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Edwards

Kegelmeyer

Kloos

et al. 2020

Multiple Sclerosis International

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Background. Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods. All measures were collected in a single session. A 2×2×2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results. Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p=0.015) and dual-task (p=0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p=0.023; p=0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p=0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p<0.001) and forward (p=0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r=−0.490; p=0.046) and slower velocity (r=−0.483; p=0.050). Conclusion. Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.

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“…The information presented here is a small part of a larger study on the assessment and DTT of CMI in people with MS. The whole study consisted of an assessment study with a test-retest design and an intervention study as described previously [18,37]. The intervention study was a multicenter, randomized, two-arm, controlled trial consisting of the integrated DTT as provided by the CMI-APP and a single mobility training group.…”

Section: Overviewmentioning

confidence: 99%

“…The intervention study was a multicenter, randomized, two-arm, controlled trial consisting of the integrated DTT as provided by the CMI-APP and a single mobility training group. The results of this study on DT and cognitive and motor performances are published in another manuscript [37]. Here, the development and technical details of the CMI-APP are described.…”

Section: Overviewmentioning

confidence: 99%

“…Portable and low-cost technology-based products, such as mobile phones and tablets, are the main candidates for these aims [45,46]. In fact, the benefits of adopting electronic devices instead of traditional pen and paper tools depend on several factors, such as dynamic presentation of the stimuli (eg, speed and difficulty levels according to an individual's specific needs and progression in training), more reliable recording of cognitive and perceptual performance (eg, reaction time), standardization of the test and training environment (eg, reduced or null errors in administration), availability of faster feedback and behavioral information (eg, the time spent on each item), and reduced time in delivering and scoring exercises [37,47]. Moreover, owing to the unavoidable requirement of the execution of motor and cognitive tasks at the same time, the use of traditional computerized tools could limit or make both CMI assessment and DTT impossible.…”

Section: Principal Findingsmentioning

confidence: 99%

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Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study

Tacchino¹,

Veldkamp²,

Coninx³

et al. 2020

JMIR Mhealth Uhealth

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Background Interest toward dual-task training (DTT) is increasing as traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These usually involve simultaneous cognitive and motor tasks, and they often show a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but limited evidence is present for people with multiple sclerosis (MS). The use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols and easier implementation of multicenter and multilanguage studies. Objective To describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based app, and to present the preliminary results of a multicenter pilot study involving people with MS performed in several European centers for evaluating the feasibility of and adherence to a rehabilitation program based on CMI-APP. Methods CMI-APP includes user-friendly interfaces for personal data input and management, assessment of CMI, and DTT. A dedicated team developed CMI-APP for Android tablets above API level 14 (version 4.0), using C# as the programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, and sustained attention and four motor assessment tests for walking at different difficulty levels were implemented. Dual cognitive-motor tasks were performed by combining single cognitive and motor tasks. CMI-APP implements exercises for DTT involving the following 12 cognitive functions: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, and visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen people with MS (mean age 52.6, SD 8.6 years; mean disease duration 9.4, SD 8.4 years; mean Expanded Disability Status Scale score 3.6, SD 1.1) underwent DTT (20 sessions). Adherence to the rehabilitation program was evaluated according to the percentage of performed sessions, perceived exertion during the training (Borg 15-point Ratings of Perceived Exertion [RPE] Scale), and subjective experience of the training (Intrinsic Motivation Inventory [IMI]). Results The adherence rate was 91%. DTT was perceived as “somewhat difficult” (mean RPE Scale score 12.6, SD 1.9). IMI revealed that participants enjoyed the training and felt that it was valuable and, to some extent, important, without feelings of pressure. They felt competent, although they did not always feel they could choose the exercises, probably because the therapist chose the exercises and many exercises had few difficulty levels. Conclusions CMI-APP is safe, highly usable, motivating, and well accepted for DTT by people with MS. The findings are fundamental for the preparation of future large-sample studies examining CMI and the effectiveness of DTT interventions with CMI-APP in people with MS.

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Structured Cognitive-Motor Dual Task Training Compared to Single Mobility Training in Persons with Multiple Sclerosis, a Multicenter RCT

Cited by 39 publications

References 43 publications

Spatial constraints and cognitive fatigue affect motor imagery of walking in people with multiple sclerosis

Spatial constraints and cognitive fatigue affect motor imagery of walking in people with multiple sclerosis

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

Design, Development, and Testing of an App for Dual-Task Assessment and Training Regarding Cognitive-Motor Interference (CMI-APP) in People With Multiple Sclerosis: Multicenter Pilot Study

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