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Gülşen Ç, Söke F, Aydin F, Özcan Gülşen E, Yilmaz Ö, Koçer B, Çürük E, Demirkaya Ş, Yücesan C. Effect of task difficulty on dual-task cost during dual-task walking in people with multiple sclerosis. Gait Posture 2024; 114:95-100. [PMID: 39303409 DOI: 10.1016/j.gaitpost.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Cognitive-motor dual-task walking results a decrease in walking performance of patients with multiple sclerosis (PwMS) and it is known as dual-task cost (DTC). However, there is a lack of evidence about the effects of dual-tasks with hierarchical difficulty on DTC in PwMS. RESEARCH QUESTION This study aimed to investigate the effect of task difficulty on DTC during cognitive-motor dual-task walking in people with multiple sclerosis (PwMS). METHODS 32 PwMS and 32 healthy controls were included. The 6-meter walking test (6-Meter WT) with comfortable speed was used as single-task walking condition. For dual-task conditions, walking tasks and cognitive tasks at two difficulty levels (simple and difficult) were combined and DTC for four cognitive-motor dual-task walking conditions as simple motor-simple cognitive (SM-SC), simple motor-difficult cognitive (SM-DC), difficult motor-simple cognitive (DM-SC) and difficult motor-difficult cognitive (DM-DC) were calculated. The 6-Meter WT was used also for simple dual-task walking task. The 6-Meter WT was applied by walking in a narrow base condition for creating a difficult dual-task walking task. For cognitive task difficulty, participants were asked to count backwards by 3 as simple cognitive task and by 7 as difficult cognitive task. RESULTS DTC was higher in PwMS than control subjects. DTC in all conditions were different (SM-SC CONCLUSION The results suggest that task difficulty affects the magnitude of DTC during cognitive-motor dual-task walking in PwMS. Moreover, difficult walking tasks combined with simple cognitive tasks result greater DCT on walking than simple walking tasks combined with difficult cognitive tasks.
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Affiliation(s)
- Çağrı Gülşen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Fatih Söke
- Gulhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Fatma Aydin
- Diskapi Yildirim Beyazit Teaching and Research Hospital, Department of Neurology, University of Health Sciences, Ankara, Turkey
| | - Elvan Özcan Gülşen
- Yunus Emre Vocational School, Department of Health Care Services, Program in Geriatric Care, Anadolu University, Eskişehir, Turkey
| | - Öznur Yilmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Bilge Koçer
- Diskapi Yildirim Beyazit Teaching and Research Hospital, Department of Neurology, University of Health Sciences, Ankara, Turkey
| | - Etem Çürük
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Korkut Ata University, Osmaniye, Turkey
| | - Şeref Demirkaya
- Gulhane Faculty of Medicine, Department of Neurology, University of Health Sciences, Ankara, Turkey
| | - Canan Yücesan
- Faculty of Medicine, Department of Neurology, Ankara University, Ankara, Turkey
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Hernandez ME, Motl RW, Foley FW, Picone MA, Izzetoglu M, Lipton ML, Wagshul M, Holtzer R. Disability Moderates Dual Task Walking Performance and Neural Efficiency in Older Adults With Multiple Sclerosis. Neurorehabil Neural Repair 2024:15459683241273411. [PMID: 39177188 DOI: 10.1177/15459683241273411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Mobility and cognitive impairment are prevalent and co-occurring in older adults with multiple sclerosis (OAMS), yet there is limited research concerning the role of disability status in the cognitive control of gait among OAMS. OBJECTIVE We investigated the levels of prefrontal cortex (PFC) activation, using oxygenated hemoglobin (HbO2), during cognitively-demanding tasks in OAMS with lower and higher disability using functional near-infrared spectroscopy (fNIRS) to: (1) identify PFC activation differences in single task walk and cognitively-demanding tasks in OAMS with different levels of disability; and (2) evaluate if disability may moderate practice-related changes in neural efficiency in OAMS. METHODS We gathered data from OAMS with lower (n = 51, age = 65 ± 4 years) or higher disability (n = 48, age = 65 ± 5 years), using a cutoff of 3 or more, in the Patient Determined Disease Steps, for higher disability, under 3 different conditions (single-task walk, Single-Task-Alpha, and Dual-Task-Walk [DTW]) administered over 3 counterbalanced, repeated trials. RESULTS OAMS who had a lower disability level exhibited decreased PFC activation levels during Single-Task-Walk (STW) and larger increases in PFC activation levels, when going from STW to a cognitively-demanding task, such as a DTW, than those with higher disability. OAMS with a lower disability level exhibited greater declines in PFC activation levels with additional within session practice than those with a higher disability level. CONCLUSIONS These findings suggest that disability moderates brain adaptability to cognitively-demanding tasks and demonstrate the potential for fNIRS-derived outcome measures to complement neurorehabilitation outcomes.
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Affiliation(s)
- Manuel E Hernandez
- Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Neuroscience Program, College of Liberal Arts & Sciences, University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Frederick W Foley
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Multiple Sclerosis Center, Holy Name Medical Center, Teaneck, NJ, USA
| | - Mary Ann Picone
- Multiple Sclerosis Center, Holy Name Medical Center, Teaneck, NJ, USA
| | - Meltem Izzetoglu
- Electrical and Computer Engineering, Villanova University, Villanova, PA, USA
| | - Michael L Lipton
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Department of Radiology, Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark Wagshul
- Department of Radiology, Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Kahraman T, Temiz H, Abasiyanik Z, Baba C, Ozakbas S. Dual-task difficulties as a risk factor for unemployment in people with multiple sclerosis. Brain Behav 2023; 13:e3299. [PMID: 37881143 PMCID: PMC10726913 DOI: 10.1002/brb3.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND No study has investigated the impact of dual-tasking difficulties as a risk factor for unemployment in people with multiple sclerosis (pwMS). The aim was to examine the influence of dual-task performance on employment status and work difficulties and to identify the predictors of employment status in pwMS. METHODS Eighty-four pwMS, including 42 employed and 42 unemployed, participated in the study. Dual-task difficulties were assessed using the Dual-task Impact on Daily-living Activities-Questionnaire (DIDA-Q), while dual-task performance was evaluated through the 30-second Walk Test and Nine-Hole Peg Test, incorporating a cognitive task. Walking and cognitive function were also measured. RESULTS Employed pwMS had better scores in walking, cognitive function, single and dual-task performance than unemployed pwMS (p < .05). Lower scores in walking (odds ratio [OR] = 1.81, p < .001) and upper extremity-related (OR = 1.44, p = .019) dual-task performance and higher scores in the cognitive subscale of the DIDA-Q questionnaire (OR = 1.20, p = .037) were significantly associated with higher odds of being unemployed. Among employed pwMS, DIDA-Q subscales showed moderate-to-strong correlations with MSWSDQ-23 scores. The other variables showed weak-to-moderate correlations with subscale and total scores of MSWSDQ-23. CONCLUSION Cognitive function, as opposed to motor function, has been found to be a significant predictor of unemployment in pwMS.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health SciencesIzmir Katip Celebi UniversityIzmirTurkey
- Department of Health Professions, Faculty of Health and EducationManchester Metropolitan UniversityManchesterUK
| | - Hasretgul Temiz
- Graduate School of Health SciencesIzmir Katip Celebi UniversityIzmirTurkey
| | - Zuhal Abasiyanik
- Department of Physiotherapy and Rehabilitation, Faculty of Health SciencesIzmir Katip Celebi UniversityIzmirTurkey
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation SciencesHasselt UniversityHasseltBelgium
| | - Cavid Baba
- Graduate School of Health SciencesDokuz Eylül UniversityIzmirTurkey
| | - Serkan Ozakbas
- Department of Neurology, Faculty of MedicineIzmir University of EconomicsIzmirTurkey
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Koçer B, Gülşen Ç, Söke F, Özcan Gülşen E, Ersoy N, Tunca Yılmaz Ö, Çomoğlu SS. Comparison of dual-task costs during different types of walking in people with Parkinson's disease: a controlled study. Acta Neurol Belg 2023; 123:2221-2227. [PMID: 37036604 DOI: 10.1007/s13760-023-02271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/05/2023] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Many of the activities in daily living require different walking skills such as straight walking (SW), walking with turning (WwT), curved walking (CW) or backward walking (BW) in a dual-task condition. However, there is a lack of evidence regarding the dual task cost (DTC) during different types of walking. Therefore, this study was planned to compare the DTC during different types of walking in people with Parkinson's disease (PwPD) and healthy controls. METHODS Thirty-one PwPD and 31 healthy controls were included. Different types of walking were assessed using the 10-Meter Walk Test for SW, the Timed Up and Go Test for WwT, the Figure-of-Eight Walk Test for CW, and the Three-Meter Backward Walk Test for BW. Walking assessments were performed in a single-task and a dual-task condition. RESULTS The DTC on SW was the lowest in both groups. The DTC on WwT, BW, and CW were similar in healthy controls, whereas the order of the DTC on remaining walking types from lowest to highest was; WwT, BW, and CW in PwPD. Also, the DTC on WwT, BW, and CW were higher in PwPD than healthy controls. However, the DTC on SW was similar in PwPD and healthy controls. CONCLUSION The DTC is different during SW, WwT, BW, and CW in PwPD. Therefore, walking type should be considered in studies investigating dual task walking in PwPD. Also, dual task exercises consisting of different types of walking should be included in rehabilitation programs of PwPD.
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Affiliation(s)
- Bilge Koçer
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Çağrı Gülşen
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Eskişehir Osmangazi University, Eskişehir, Turkey.
| | - Fatih Söke
- Gülhane Faculty of Physiotherapy and Rehabilitation, University of Health Sciences, Ankara, Turkey
| | - Elvan Özcan Gülşen
- Yunus Emre Vocational School, Department of Health Care Services, Program in Geriatric Care, Anadolu University, Eskişehir, Turkey
| | - Nursena Ersoy
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara University, Ankara, Turkey
| | - Öznur Tunca Yılmaz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Selim Selçuk Çomoğlu
- Neurology Clinic, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Elosúa MR, Villadangos N. Executive functions in relapsing-remitting multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-9. [PMID: 37930795 DOI: 10.1080/23279095.2023.2252125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Some studies suggest that patients with relapsing-remitting multiple sclerosis have problems in the functioning of working memory, and more specifically in executive functions, but the available results are still inconsistent. The aim of the present study was to examine executive functioning in multiple sclerosis using classical and representative tasks for divided attention, updating, attentional shifting, and inhibition. The sample was composed of 48 participants aged between 18 and 59 years (24 persons living with multiple sclerosis and 24 healthy participants matched in age and education level). The executive functions of divided attention, updating, attentional shifting, and inhibition were analyzed through the Dual-Task Paradigm, the N-Back task, the Trail Making Test (TMT), and the Stroop test, respectively. The analyses of the data showed that the functioning of working memory was impaired in multiple sclerosis in the executive functions of divided attention and updating when the group of persons living with MS and the control group were compared. In addition, the performance in the four executive functions analyzed did not show the same profile across the persons living with MS in the sample, as no deficit in attentional shifting or inhibition was observed. It can be concluded that the presence of deficits was observed only in the executive functions of divided attention and updating under the condition of greater cognitive demand. The clinical implications of these results are underlined due to their impact on daily life.
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Affiliation(s)
- M Rosa Elosúa
- Departamento de Psicología Básica I, UNED, Madrid, Spain
| | - Noelia Villadangos
- Departamento de Psicología Básica I, UNED, Madrid, Spain
- Fundación de Esclerosis Múltiple de Madrid, Madrid, Spain
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Veldkamp R, D'hooge M, Sandroff BM, DeLuca J, Kos D, Salter A, Feinstein A, Amato MP, Brichetto G, Chataway J, Farrell R, Chiaravalloti ND, Dalgas U, Filippi M, Freeman J, Motl RW, Meza C, Inglese M, Rocca MA, Cutter G, Feys P. Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study. J Neurol 2023; 270:3120-3128. [PMID: 36881147 DOI: 10.1007/s00415-023-11636-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.
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Affiliation(s)
- R Veldkamp
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
- UMSC, Hasselt-Pelt, Belgium.
| | - M D'hooge
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
- National MS Center Melsbroek, Steenokkerzeel, Belgium
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - D Kos
- National MS Center Melsbroek, Steenokkerzeel, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - A Salter
- Department of Neurology, Section on Statistical Planning and Analysis, UT Southwestern Medical Center, Dallas, TX, USA
| | - A Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society (AISM), Via Operai 30, 16149, Genoa, Italy
| | - J Chataway
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - R Farrell
- Queen Square MS Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, UCL, London, UK
| | - N D Chiaravalloti
- Kessler Foundation, East Hanover, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - U Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, Denmark
| | - M Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - J Freeman
- School of Health Professions, Faculty of Health, University of Plymouth, Devon, UK
| | - R W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, USA
| | - C Meza
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON, M5R 3B6, Canada
| | - M Inglese
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - G Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - P Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
- UMSC, Hasselt-Pelt, Belgium
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Hu W, Combden O, Jiang X, Buragadda S, Newell CJ, Williams MC, Critch AL, Ploughman M. Machine learning corroborates subjective ratings of walking and balance difficulty in multiple sclerosis. Front Artif Intell 2022; 5:952312. [PMID: 36248625 PMCID: PMC9556653 DOI: 10.3389/frai.2022.952312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Machine learning can discern meaningful information from large datasets. Applying machine learning techniques to raw sensor data from instrumented walkways could automatically detect subtle changes in walking and balance. Multiple sclerosis (MS) is a neurological disorder in which patients report varying degrees of walking and balance disruption. This study aimed to determine whether machine learning applied to walkway sensor data could classify severity of self-reported symptoms in MS patients. Ambulatory people with MS (n = 107) were asked to rate the severity of their walking and balance difficulties, from 1-No problems to 5-Extreme problems, using the MS-Impact Scale-29. Those who scored less than 3 (moderately) were assigned to the “mild” group (n = 35), and those scoring higher were in the “moderate” group (n = 72). Three machine learning algorithms were applied to classify the “mild” group from the “moderate” group. The classification achieved 78% accuracy, a precision of 85%, a recall of 90%, and an F1 score of 87% for distinguishing those people reporting mild from moderate walking and balance difficulty. This study demonstrates that machine learning models can reliably be applied to instrumented walkway data and distinguish severity of self-reported impairment in people with MS.
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Affiliation(s)
- Wenting Hu
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Owen Combden
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Xianta Jiang
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
- *Correspondence: Xianta Jiang
| | - Syamala Buragadda
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Caitlin J. Newell
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Maria C. Williams
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Amber L. Critch
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Hynes A, Czarnuch S, Kirkland MC, Ploughman M. Spatiotemporal Gait Measurement With a Side-View Depth Sensor Using Human Joint Proposals. IEEE J Biomed Health Inform 2021; 25:1758-1769. [PMID: 32946402 DOI: 10.1109/jbhi.2020.3024925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We propose a method for calculating standard spatiotemporal gait parameters from individual human joints with a side-view depth sensor. Clinical walking trials were measured concurrently by a side-view Kinect and a pressure-sensitive walkway, the Zeno Walkway. Multiple joint proposals were generated from depth images by a stochastic predictor based on the Kinect algorithm. The proposals are represented as vertices in a weighted graph, where the weights depend on the expected and measured lengths between body parts. A shortest path through the graph is a set of joints from head to foot. Accurate foot positions are selected by comparing pairs of shortest paths. Stance phases of the feet are detected by examining the motion of the feet over time. The stance phases are used to calculate four gait parameters: stride length, step length, stride width, and stance percentage. A constant frame rate was assumed for the calculation of stance percentage because time stamps were not captured during the experiment. Gait parameters from 52 trials were compared to the ground truth walkway using Bland-Altman analysis and intraclass correlation coefficients. The large spatial parameters had the strongest agreements with the walkway (ICC(2, 1) = 1.00 and 0.98 for stride and step length with normal pace, respectively). The presented system directly calculates gait parameters from individual foot positions while previous side-view systems relied on indirect measures. Using a side-view system allows for tracking walking in both directions with one camera, extending the range in which the subject is in the field of view.
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Chaves AR, Snow NJ, Alcock LR, Ploughman M. Probing the Brain-Body Connection Using Transcranial Magnetic Stimulation (TMS): Validating a Promising Tool to Provide Biomarkers of Neuroplasticity and Central Nervous System Function. Brain Sci 2021; 11:384. [PMID: 33803028 PMCID: PMC8002717 DOI: 10.3390/brainsci11030384] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/18/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method used to investigate neurophysiological integrity of the human neuromotor system. We describe in detail, the methodology of a single pulse TMS protocol that was performed in a large cohort of people (n = 110) with multiple sclerosis (MS). The aim was to establish and validate a core-set of TMS variables that predicted typical MS clinical outcomes: walking speed, hand dexterity, fatigue, and cognitive processing speed. We provide a brief and simple methodological pipeline to examine excitatory and inhibitory corticospinal mechanisms in MS that map to clinical status. Delayed and longer ipsilateral silent period (a measure of transcallosal inhibition; the influence of one brain hemisphere's activity over the other), longer cortical silent period (suggestive of greater corticospinal inhibition via GABA) and higher resting motor threshold (lower corticospinal excitability) most strongly related to clinical outcomes, especially when measured in the hemisphere corresponding to the weaker hand. Greater interhemispheric asymmetry (imbalance between hemispheres) correlated with poorer performance in the greatest number of clinical outcomes. We also show, not surprisingly, that TMS variables related more strongly to motor outcomes than non-motor outcomes. As it was validated in a large sample of patients with varying severities of central nervous system dysfunction, the protocol described herein can be used by investigators and clinicians alike to investigate the role of TMS as a biomarker in MS and other central nervous system disorders.
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Affiliation(s)
| | | | | | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1A 1E5, Canada; (A.R.C.); (N.J.S.); (L.R.A.)
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Dual-Task Cost and Related Clinical Features in Patients With Multiple Sclerosis. Motor Control 2021; 25:211-233. [PMID: 33440347 DOI: 10.1123/mc.2020-0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/11/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the dual-task cost of both motor and cognitive performances in patients with multiple sclerosis (PwMS) and in healthy controls and to determine their relationships with clinical features in PwMS. The participants performed motor tasks (postural stability, walking, and manual dexterity) and cognitive tasks (mental tracking and verbal fluency) under single- and dual-task conditions. The results showed that postural stability under dual-task conditions did not change, whereas walking and manual dexterity deteriorated, regardless of the concurrent cognitive task, in PwMS (median Expanded Disability Status Scale score: 1) and the healthy controls. Verbal fluency decreased during postural stability, whereas it increased during walking, and it was maintained during manual dexterity in both groups. Mental tracking did not change during walking; it declined during manual dexterity in both groups. Mental tracking during postural stability deteriorated in PwMS, while it did not change in the healthy controls. In general, dual-task costs were associated with baseline performances of tasks rather than clinical features. Therefore, baseline performances of both tasks should be increased for improving dual-task performance in PwMS.
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Leone C, Moumdjian L, Patti F, Vanzeir E, Baert I, Veldkamp R, Van Wijmeersch B, Feys P. Comparing 16 Different Dual-Tasking Paradigms in Individuals With Multiple Sclerosis and Healthy Controls: Working Memory Tasks Indicate Cognitive-Motor Interference. Front Neurol 2020; 11:918. [PMID: 32982934 PMCID: PMC7485559 DOI: 10.3389/fneur.2020.00918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Cognitive–motor interference (CMI) is measured by dual-tasking (DT), which involves motor and cognitive tasks. There is no consensus as to whether CMI is present in multiple sclerosis (MS). Objectives: We investigated the effects of 16 DT conditions by measuring motor complexity, cognitive domain, and task difficulty. Method: In total, 40 persons with MS (pwMSs) with Expanded Disease Status Scale (EDSS) 3.2 ± 1.7 and 31 age- and sex-matched healthy controls (HCs) completed 2 single walking, 8 single cognitive, and 2 complex walking tasks and 16 cognitive–motor DT. The main outcomes were mean values of gait velocity and the percentage change from single to DT (motor DT costs, mDTCs) and mean values of cognitive task accuracy and the percentage changes (cognitive DTC, cDTC). Results: Two-way analyses of variance showed the main effect of cognitive task yielded an F ratio of F(4, 268) = 72.35, p < 0.01, for mean gait velocity, and an F ratio of F(4, 304) = 17.12, p < 0.001, for mDTC, indicating that the mean velocity was significantly lower and the mDTC significantly higher for DS_B (mean = 1.27, SD = 0.03, and mean = 13.52, SD = 1.28, respectively). The main effect of cognitive task yielded an F ratio of F(4, 116) = 84.32, p < 0.001, with the lowest average accuracy for DS_B (mean = 43.95, SD = 3.33); no effect was found for cDTC. In pwMSs, the EDSS accounted for 28% (F = 13.65, p = 0.001) of variance in a model predicting the highest mDTC. Conclusions: Overall, among different cognitive tasks added, the Digit Span backward was the most interfering cognitive task over gait velocity and accuracy. The effect was similar independently from the motor complexity and the group. PwMSs and HCs behaved in a similar manner at all motor complexity levels and during all cognitive task.
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Affiliation(s)
- Carmela Leone
- Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Lousin Moumdjian
- Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium.,Faculty of Arts and Philosophy, IPEM Institute of Psychoacoustics and Electronic Music, Ghent University, Ghent, Belgium
| | - Francesco Patti
- Section of Neurosciences, Department of Medical Sciences, Surgical and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Ellen Vanzeir
- Rehabilitation and MS Centre Overpelt, Overpelt, Belgium
| | - Ilse Baert
- Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Renee Veldkamp
- Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
| | - Bart Van Wijmeersch
- Rehabilitation and MS Centre Overpelt, Overpelt, Belgium.,FBI, BIOMED, Faculty of Life Sciences and Physiotherapy, Hasselt University, Hasselt, Belgium
| | - Peter Feys
- Faculty of Rehabilitation Sciences, REVAL Rehabilitation Research Center, Hasselt University, Hasselt, Belgium
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Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS. Mult Scler Int 2020; 2020:6707414. [PMID: 32963832 PMCID: PMC7495208 DOI: 10.1155/2020/6707414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
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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13
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Kirkland MC, Wadden KP, Ploughman M. Bipedal hopping as a new measure to detect subtle sensorimotor impairment in people with multiple sclerosis. Disabil Rehabil 2020; 44:1544-1555. [PMID: 32955951 DOI: 10.1080/09638288.2020.1820585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Bipedal hopping has the potential to detect subtle multiple sclerosis (MS)-related impairments, especially among patients who "pass" typical movement tests. In this narrative review, we outline the biomechanics of bipedal hopping and propose its usefulness as a novel outcome measure for people with MS having mild disability. METHODS We summarize articles that (1) examined the biomechanics of jumping or hopping and (2) tested the validity and/or reliability of hopping tests. We consolidated consistencies and gaps in research and opportunities for future development of the bipedal hop test. RESULTS Bipedal hopping requires immense power, coordination, balance, and ability to reduce co-contraction; movement components typically affected by MS. These impairments can be measured and differentiated by examining specific variables, such as hop length (power), symmetry (coordination), center of pressure (balance), and coefficient of variability (co-contraction/spasticity). Bipedal hopping challenges these aspects of movement and exposes sensorimotor impairments that may not have been apparent during walking. CONCLUSIONS Testing of bipedal hopping on an instrumented walkway may detect and monitor sensorimotor control in people with MS who do not currently present with clinical deficits. Early measurement is imperative for precise rehabilitation prescription to slow disability progression prior to onset of measurable gait impairment.Implications for rehabilitationJumping and hopping tests detect lower limb and balance impairments in children, athletes, and older adults.Bipedal hop test measures multiple domains: power, coordination, balance, and muscle timing.Bipedal hop test may expose subtle sensorimotor impairments in people with multiple sclerosis.Multiple variables measured can discern type of sensorimotor impairment to direct personalized rehabilitation programs.
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Affiliation(s)
- Megan C Kirkland
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Katie P Wadden
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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14
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Effect of a Combined Program of Strength and Dual Cognitive-Motor Tasks in Multiple Sclerosis Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176397. [PMID: 32887411 PMCID: PMC7503584 DOI: 10.3390/ijerph17176397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
This study investigated the effects of a 24-week combined training program (CTP) based on strength exercises and cognitive–motor tasks performed concurrently in participants with multiple sclerosis. A randomized, controlled intervention study was carried out. In total, 31 subjects with a confirmed diagnosis of multiple sclerosis (14 men and 17 women) were stratified and randomized into an intervention group (17 subjects) and a control group (14 subjects). The intervention group completed three weekly training sessions for 24 weeks, while the control group pursued their normal daily activities. In this program, cognitive–motor tasks were completed at once (dual tasking). A 3D photogrammetry connected to a selective attention system designed for dual tasking while walking was used. Ground reaction forces were measured using two force plates, one for sit-to-stand testing, while the other was used for static force measurement. Postural equilibrium was examined using a stabilometric plate based for Romberg test assessment. The 24-week training program for multiple sclerosis patients improved their static peak force by 11% (p < 0 .05), their rate of force development by 36% (p < 0.05), and their balance (p < 0.05). Performance in daily activities such as walking or sitting-to-standing improved significantly in multiple sclerosis participants. CTP training was effective in reducing the dual-task costs of step length (48%) and walking velocity (54%), as compared to a matched control group.
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15
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Devasahayam AJ, Chaves AR, Lasisi WO, Curtis ME, Wadden KP, Kelly LP, Pretty R, Chen A, Wallack EM, Newell CJ, Williams JB, Kenny H, Downer MB, McCarthy J, Moore CS, Ploughman M. Vigorous cool room treadmill training to improve walking ability in people with multiple sclerosis who use ambulatory assistive devices: a feasibility study. BMC Neurol 2020; 20:33. [PMID: 31969132 PMCID: PMC6975092 DOI: 10.1186/s12883-020-1611-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16 °C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids. METHODS Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT. RESULTS Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6. CONCLUSION Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability. TRIAL REGISTRATION The study was approved by the Newfoundland and Labrador Health Research Ethics Board (reference number: 2018.088) on 11/07/2018 prior to the enrollment of first participant (retrospectively registered at ClinicalTrials.gov: NCT04066972. Registered on 26 August 2019.
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Affiliation(s)
- Augustine J Devasahayam
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Arthur R Chaves
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Wendy O Lasisi
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Marie E Curtis
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Katie P Wadden
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Liam P Kelly
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Ryan Pretty
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Alice Chen
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Elizabeth M Wallack
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Caitlin J Newell
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - John B Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Rm H4360, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Hannah Kenny
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Matthew B Downer
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Jason McCarthy
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada
| | - Craig S Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Rm H4360, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, Rm 400, L.A. Miller Centre, 100 Forest Road, St. John's, NL, A1A 1E5, Canada.
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17
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Saleh S, Sandroff BM, Vitiello T, Owoeye O, Hoxha A, Hake P, Goverover Y, Wylie G, Yue G, DeLuca J. The Role of Premotor Areas in Dual Tasking in Healthy Controls and Persons With Multiple Sclerosis: An fNIRS Imaging Study. Front Behav Neurosci 2018; 12:296. [PMID: 30618658 PMCID: PMC6297844 DOI: 10.3389/fnbeh.2018.00296] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/16/2018] [Indexed: 11/16/2022] Open
Abstract
Persons with multiple sclerosis (pwMS) experience declines in physical and cognitive abilities and are challenged by dual-tasks. Dual-tasking causes a drop in performance, or what is known as dual-task cost (DTC). This study examined DTC of walking speed (WS) and cognitive performance (CP) in pwMS and healthy controls (HCs) and the effect of dual-tasking on cortical activation of bilateral premotor cortices (PMC) and bilateral supplementary motor area (SMA). Fourteen pwMS and 14 HCs performed three experimental tasks: (1) single cognitive task while standing (SingCog); (2) single walking task (SingWalk); and (3) dual-task (DualT) that included concurrent performance of the SingCog and SingWalk. Six trials were collected for each condition and included measures of cortical activation, WS and CP. WS of pwMS was significantly lower than HC, but neuropsychological (NP) measures were not significantly different. pwMS and HC groups had similar DTC of WS, while DTC of CP was only significant in the MS group; processing speed and visual memory predicted 55% of this DTC. DualT vs. SingWalk recruited more right-PMC activation only in HCs and was associated with better processing speed. DualT vs. SingCog recruited more right-PMC activation and bilateral-SMA activation in both HC and pwMS. Lower baseline WS and worse processing speed measures in pwMS predicted higher recruitment of right-SMA (rSMA) activation suggesting maladaptive recruitment. Lack of significant difference in NP measures between groups does not rule out the influence of cognitive factors on dual-tasking performance and cortical activations in pwMS, which might have a negative impact on quality of life.
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Affiliation(s)
- Soha Saleh
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tyler Vitiello
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Oyindamola Owoeye
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Armand Hoxha
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Patrick Hake
- Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
| | - Yael Goverover
- Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States.,Department of Occupational Therapy, New York University, New York, NY, United States
| | - Glenn Wylie
- Rocco Ortenzio Neuroimaging Center, Kessler Foundation, West Orange, NJ, United States
| | - Guang Yue
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Rutgers New Jersey Medical School, Newark, NJ, United States
| | - John DeLuca
- Rutgers New Jersey Medical School, Newark, NJ, United States.,Neuropsychology and Neuroscience Research, Kessler Foundation, East Hanover, NJ, United States
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18
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Exploring cognitive motor interference in multiple sclerosis by the visual Stroop test. Mult Scler Relat Disord 2018; 22:8-11. [PMID: 29501850 DOI: 10.1016/j.msard.2018.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/16/2018] [Accepted: 02/23/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The dual task paradigm (the simultaneous performance of motor and cognitive task) is used in a laboratory setting to evaluate walking impairments that affect patients' daily lives. Although promising, it is poorly standardized and neither the cognitive task nor the motor task have been validated in a matched healthy control group (HC) for multiple sclerosis (MS). OBJECTIVE Our aim was to set up a standardized instrument to evaluate cognitive motor interference in MS using the interference test par excellence: the stroop colour word test (SCWT). METHODS Patients with MS and HC underwent 3D gait analysis with a dual task protocol, using the SCWT as a cognitive task. Gait performance impairment during the dual task was evaluated by dual task cost (DTC). A MANOVA was used to verify the effect of status (MS, HC) on DTC, calculated for the spatiotemporal parameter of the gait. RESULTS In MS, the DTC was higher for the following gait parameters: speed (p = .013), cadence (p = .004), stride time (p = .005) stance phase (p < .001), and swing phase duration (p = .032). CONCLUSION DTC is present in MS and HC, but the motor cost in MS is higher. The present work provides a useful and validated basis for future studies about cognitive motor interference in MS.
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19
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Mofateh R, Salehi R, Negahban H, Mehravar M, Tajali S. Effects of cognitive versus motor dual-task on spatiotemporal gait parameters in healthy controls and multiple sclerosis patients with and without fall history. Mult Scler Relat Disord 2017; 18:8-14. [PMID: 29141826 DOI: 10.1016/j.msard.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/25/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the current study was to compare the effects of cognitive or motor tasks on gait performance between healthy controls and multiple sclerosis (MS) patients with and without fall history. METHODS The investigation included MS patients with fall history (n = 25) and without fall history (n = 25) and matched healthy controls (n = 25). Participants walked at their preferred speed on a motorized treadmill under three walking conditions in a randomized order: walking only, walking while performing a concurrent cognitive task (counting backward aloud by 3s), and walking while performing a concurrent motor task (carrying a tray with glasses). RESULTS The findings showed that in patients with MS, regardless of fall history, spatiotemporal gait parameters were different compared to healthy controls. In contrast to average gait parameters, variability in stride length and stride time could discriminate between MS fallers and non-fallers. Simultaneous performance of cognitive task and walking resulted in higher dual-task costs (DTC) in gait performance compared to the motor dual-task. However, the pattern of change was not different among the three groups. All participants responded to the cognitive task challenges by increasing stride length and decreasing cadence and stride length variability while maintaining cognitive task performance. CONCLUSIONS The findings may reflect successful adaptation of locomotor system to preserve cognitive task performance under cognitive dual-task condition. Future studies should examine more complex concurrent cognitive and motor tasks to better understand the dual-task-related gait changes and their contribution to falls in patients with MS.
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Affiliation(s)
- Razieh Mofateh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Reza Salehi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Shirin Tajali
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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20
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Goverover Y, Sandroff BM, DeLuca J. Dual Task of Fine Motor Skill and Problem Solving in Individuals With Multiple Sclerosis: A Pilot Study. Arch Phys Med Rehabil 2017; 99:635-640. [PMID: 29108966 DOI: 10.1016/j.apmr.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/06/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To (1) examine and compare dual-task performance in patients with multiple sclerosis (MS) and healthy controls (HCs) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task; and (2) examine whether difficulties in dual-task performance are associated with problems in performing an everyday internet task. DESIGN Pilot study, mixed-design with both a within and between subjects' factor. SETTING A nonprofit rehabilitation research institution and the community. PARTICIPANTS Participants (N=38) included persons with MS (n=19) and HCs (n=19) who were recruited from a nonprofit rehabilitation research institution and from the community. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participant were presented with 2 testing conditions: (1) solving mathematical everyday problems or placing bolts into divots (single-task condition); and (2) solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday internet competence. RESULTS As expected, dual-task performance was significantly worse than either of the single-task tasks (ie, number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet tasks. CONCLUSIONS Cognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed.
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Affiliation(s)
- Y Goverover
- Department of Occupational Therapy, New York University, New York, NY; Kessler Foundation, East Hanover, NJ.
| | - B M Sandroff
- Kessler Foundation, East Hanover, NJ; Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - J DeLuca
- Kessler Foundation, East Hanover, NJ; Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, NJ
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Kirkland MC, Downer MB, Holloway BJ, Wallack EM, Lockyer EJ, Buckle NCM, Abbott CL, Ploughman M. Bipedal Hopping Reveals Evidence of Advanced Neuromuscular Aging Among People With Mild Multiple Sclerosis. J Mot Behav 2016; 49:505-513. [PMID: 28033483 DOI: 10.1080/00222895.2016.1241750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Measures of walking such as the timed 25-ft walk test (T25FWT) may not be able to detect subtle impairment in lower limb function among people with multiple sclerosis (MS). We examined bipedal hopping to determine to what extent people with mild (Expanded Disease Severity Scale ≤ 3.5) MS (n = 13) would differ compared to age-, gender-, and education-matched controls (n = 9) and elderly participants (n = 13; ≥ 70 years old). We estimated lower limb power (e.g., hop length, velocity), consistency (e.g., variability of hop length, time), and symmetry (ratio of left to right foot). Participants completed the T25FWT and, after a rest, they then hopped using both feet 4 times along the walkway. We found that although all groups scored below the 6 -s cutoff for T25FWT, the elderly group had significantly shorter hop lengths, more variability, and more asymmetry than the controls. The results of the MS group were not significantly different from the elderly or controls in most measures and most of their values fell between the control and elderly groups. Hop length, but not measures of walking predicted Expanded Disease Severity Scale score (R2 = .38, p = .02). Bipedal hopping is a potentially useful measure of lower limb neuromuscular performance.
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Affiliation(s)
- Megan C Kirkland
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Matthew B Downer
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Brett J Holloway
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Elizabeth M Wallack
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Evan J Lockyer
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Natasha C M Buckle
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Courtney L Abbott
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
| | - Michelle Ploughman
- a Recovery & Performance Laboratory, Faculty of Medicine , Memorial University , St. John's, Newfoundland , Canada
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Downer MB, Kirkland MC, Wallack EM, Ploughman M. Walking impairs cognitive performance among people with multiple sclerosis but not controls. Hum Mov Sci 2016; 49:124-31. [PMID: 27371919 DOI: 10.1016/j.humov.2016.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/07/2016] [Accepted: 06/22/2016] [Indexed: 11/30/2022]
Abstract
People with multiple sclerosis (MS) complain of problems completing two tasks simultaneously; sometimes called 'dual-tasking' (DT). Previous research in DT among people with MS has focused on how adding a cognitive task interferes with gait and few have measured how adding a motor task could interfere with cognition. We aimed to determine the extent to which walking affects a concurrent working memory task in people with MS compared to healthy controls. We recruited MS participants (n=13) and controls (n=10) matched by age (±3years), education (±3years) and gender. Participants first completed the cognitive task (subtracting 7's from the previous number) and then again while walking on an instrumented walkway. Although there were no baseline differences in cognition or walking between MS participants and controls, MS participants demonstrated a 52% decrease in number of correct answers during DT (p<0.001). Mental Tracking Rate (% correct answers/min) correlated strongly with MS-related disability measured using the Expanded Disability Status Scale (EDSS; r(11)=-0.68, p<0.01). We propose that compromised mental tracking during walking could be related to limited neural resource capacity and could be a potentially useful outcome measure to detect ecologically valid dual tasking impairments.
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Affiliation(s)
- Matthew B Downer
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, Rm 400, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Megan C Kirkland
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, Rm 400, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Elizabeth M Wallack
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, Rm 400, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, Rm 400, 100 Forest Rd., St. John's, NL A1A 1E5, Canada.
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