Dual-Task Cost and Related Clinical Features in Patients With Multiple Sclerosis

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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Walking and talking: an investigation of cognitive—motor dual tasking in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458509106712 ◽

2009 ◽

Vol 15 (10) ◽

pp. 1215-1227 ◽

Cited By ~ 117

Author(s):

F. Hamilton ◽

L. Rochester ◽

L. Paul ◽

D. Rafferty ◽

CP O'Leary ◽

...

Keyword(s):

Multiple Sclerosis ◽

Dual Task ◽

Cognitive Task ◽

Time Variability ◽

Healthy Controls ◽

Motor Functioning ◽

Dual Tasking ◽

Risk Of Falls ◽

Clinical Tools ◽

Task Conditions

Background: Deficits in motor functioning, including walking, and in cognitive functions, including attention, are known to be prevalent in multiple sclerosis (MS), though little attention has been paid to how impairments in these areas of functioning interact. Objectives: This study investigated the effects of performing a concurrent cognitive task when walking in people with MS. Level of task demand was manipulated to investigate whether this affected level of dual-task decrement. Method: Eighteen participants with MS and 18 healthy controls took part. Participants completed walking and cognitive tasks under single- and dual-task conditions. Results: Compared to healthy controls, MS participants showed greater decrements in performance under dual-task conditions in cognitive task performance, walking speed and swing time variability. In the MS group, the degree of decrement under dual-task conditions was related to levels of fatigue, a measure of general cognitive functioning and self-reported everyday cognitive errors, but not to measures of disease severity or duration. Conclusions: Difficulty with walking and talking in MS may be a result of a divided attention deficit or of overloading of the working memory system, and further investigation is needed. We suggest that difficulty with walking and talking in MS may lead to practical problems in everyday life, including potentially increasing the risk of falls. Clinical tools to assess cognitive—motor dual-tasking ability are needed.

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Effects of dual task demanding manual dexterity and sit-to-stand in Parkinson disease individuals

Brazilian Journal of Motor Behavior ◽

10.20338/bjmb.v15i2.197 ◽

2021 ◽

Vol 15 (2) ◽

pp. 137-148

Author(s):

Tatiana B. Freitas ◽

José Eduardo Pompeu ◽

Briana R. B. Moraes ◽

Sandra M. A. A. Pompeu ◽

Keyte G. Silva ◽

...

Keyword(s):

Dual Task ◽

Verbal Fluency ◽

Manual Dexterity ◽

Dual Tasks ◽

Verbal Fluency Task ◽

Sit To Stand ◽

Yahr Scale ◽

Task Conditions ◽

The Cost ◽

Fluency Task

BACKGROUND: Parkinson's disease (PD) causes loss of automaticity and impairment in dual task (DT) performance. AIM: To investigate the performance and pattern of prioritization of individuals with PD in motor and cognitive DT. METHOD: An observational, transversal, comparative study assessed 20 individuals with PD between stages 1.5 to 3 of the modified Hoehn and Yahr scale. Performance was assessed during the execution of manual dexterity and sit-to-stand tasks, in a single task or in association with a verbal fluency task. RESULTS: There was a loss of performance in both dual task conditions. The cost of verbal fluency was higher than the cost of manual dexterity function. CONCLUSION: Individuals with PD showed worse DT performance and prioritized the manual dexterity task. There was no prioritization between sit-to-stand and verbal fluency. These findings suggest that the nature of tasks can influence the prioritization of dual tasks.

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A Mobile Device Dual-Task Paradigm for the Assessment of mTBI

Military Medicine ◽

10.1093/milmed/usy334 ◽

2019 ◽

Vol 184 (Supplement_1) ◽

pp. 174-180 ◽

Cited By ~ 2

Author(s):

Susan M Linder ◽

Mandy Miller Koop ◽

Sarah Ozinga ◽

Zachary Goldfarb ◽

Jay L Alberts

Keyword(s):

Mobile Device ◽

Dual Task ◽

Postural Stability ◽

Cognitive Task ◽

Eyes Closed ◽

Number Discrimination ◽

Significant Difference ◽

Dual Task Paradigm ◽

Using Data ◽

Task Conditions

Abstract Research Objective Dual-task performance, in which individuals complete two or more activities simultaneously, is impaired following mild traumatic brain injury. The aim of this project was to develop a dual-task paradigm that may be conducive to military utilization in evaluating cognitive-motor function in a standardized and scalable manner by leveraging mobile device technology. Methods Fifty healthy young adult civilians (18–24 years) completed four balance stances and a number discrimination task under single- and dual-task conditions. Postural stability was quantified using data gathered from iPad’s native accelerometer and gyroscope. Cognitive task difficulty was manipulated by presenting stimuli at 30, 60, or 90 per minute. Performance of cognitive and balance tasks was compared between single- and dual-task trials. Results Cognitive performance from single- to dual-task paradigms showed no significant main effect of balance condition or the interaction of condition by frequency. From single- to dual-task conditions, a significant difference in postural control was revealed in only one stance: tandem with eyes closed, in which a slight improvement in postural stability was observed under dual-task conditions. Conclusion The optimal dual-task paradigm to evaluate cognitive-motor performance with minimal floor and ceiling effects consists of tandem stance with eyes closed while stimuli are presented at a rate of one per second.

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Balancing the Demands of Two Tasks: An Investigation of Cognitive–Motor Dual-Tasking in Relapsing Remitting Multiple Sclerosis

Journal of the International Neuropsychological Society ◽

10.1017/s1355617717000947 ◽

2017 ◽

Vol 24 (3) ◽

pp. 247-258 ◽

Cited By ~ 6

Author(s):

Emma Butchard-MacDonald ◽

Lorna Paul ◽

Jonathan J. Evans

Keyword(s):

Multiple Sclerosis ◽

Dual Task ◽

Postural Stability ◽

Digit Span ◽

Dual Tasking ◽

Stable Surface ◽

Relapsing Remitting ◽

Task Conditions ◽

Relapsing Remitting Multiple Sclerosis ◽

The Impact

AbstractBackground:People with relapsing remitting multiple sclerosis (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance.Objectives:This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls, and (2) dual-task decrements are associated with everyday dual-tasking difficulties. The impact of mood, fatigue, and disease severity on dual-tasking was also examined.Methods:A total of 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of center of pressure on Biosway on stable and unstable surfaces) tasks under single- and dual-task conditions. Everyday dual-tasking was measured using the Dual-Tasking Questionnaire. Mood was measured by the Hospital Anxiety & Depression Scale. Fatigue was measuredviathe Modified Fatigue Index Scale.Results:No differences in age, gender, years of education, estimated pre-morbid IQ, or baseline digit span between groups. Compared with controls, PwRRMS showed significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=.007), but not a stable surface (p=.679). Balance decrement scores were not correlated with everyday dual-tasking difficulties or fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527;p=.001) and depression (rho=0.451;p=.007).Conclusions:RRMS causes dual-tasking difficulties, impacting balance under challenging conditions, which may contribute to increased risk of gait difficulties and falls. The relationship between anxiety/depression and dual-task decrement suggests that emotional factors may be contributing to dual-task difficulties. (JINS, 2018,24, 247–258)

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Effects of Dual-Task Conditions on Turning Characteristics of Stroke Survivors in Healthcare Environment

Environment-Behaviour Proceedings Journal ◽

10.21834/e-bpj.v1i1.206 ◽

2016 ◽

Vol 1 (1) ◽

pp. 134

Author(s):

Haidzir Manaf ◽

Nadia Mohd Mustafah ◽

Saiful Adli Bukry ◽

Maria Justine

Keyword(s):

Dual Task ◽

Social Impact ◽

Cognitive Task ◽

Publishing House ◽

Stroke Survivors ◽

Healthy Controls ◽

Healthcare Environment ◽

The Social ◽

International Publishing ◽

Task Conditions

Turning is an attentionally demanding task for stroke survivors especially when it involves challenging environments. The aim of this study was to investigate turning characteristics under dual-task conditions (dual motor and dual cognitive) in stroke survivors and healthy controls. We compared the turning characteristics based on the following: (1) staggering, (2) number of steps, (3) time was taken, and (4) strategy used to complete a 180º turn. We found that stroke survivors presented with turning difficulty, especially under dual cognitive task. Forthcoming research is needed to investigate further the social impact of stroke survival in their current environment.© 2016. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies, Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia.Keywords: Dual-task; stroke; turning; Timed Up & Go test

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Dual-task cost in people with multiple sclerosis: A case–control study

British Journal of Occupational Therapy ◽

10.1177/0308022618757936 ◽

2018 ◽

Vol 81 (7) ◽

pp. 384-392 ◽

Cited By ~ 2

Author(s):

Jolien Lemmens ◽

Sofie Ferdinand ◽

Annick Vandenbroucke ◽

Stephan Ilsbroukx ◽

Daphne Kos

Keyword(s):

Multiple Sclerosis ◽

Cognitive Performance ◽

Dual Task ◽

Motor Performance ◽

Hand Function ◽

Cognitive Capacity ◽

Fine Motor ◽

Dual Task Cost ◽

Task Conditions ◽

Fine Motor Performance

Introduction Limitations in fine motor functioning and cognitive performance are frequently reported in multiple sclerosis. Studies about dual-task costs in multiple sclerosis generally explore walking and postural performance. This study aims at exploring dual-task costs when simultaneously performing fine motor and cognitive tasks. Method Eighty people with multiple sclerosis and 80 matched controls performed the nine-hole peg test and the months backward test under single and dual-task conditions. Differences in performance over time were analysed with the paired t-test; differences in dual-task costs between groups were analysed with independent t-tests. Results People with multiple sclerosis and controls showed a significant decrease in fine motor and cognitive performance in dual-task conditions compared to single-task conditions ( P < 0.01). People with multiple sclerosis with limited hand capacity showed larger dual-task costs for cognitive performance compared to other hand capacity groups ( P < 0.05). Individuals with multiple sclerosis with lower cognitive capacity showed larger dual-task costs for fine motor performance ( P < 0.01). Conclusion Both people with multiple sclerosis and controls experience dual-task costs. People with multiple sclerosis with limited hand function showed an increased dual-task cost of cognitive performance and individuals with limited cognitive capacity showed a higher dual-task cost for fine motor performance. Therefore, occupational therapists should focus on cognitive or fine motor aspects during dual-task training dependent on individuals' capacities.

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Test-Retest Reliability of Cognitive-Motor Interference Assessments in Walking With Various Task Complexities in Persons With Multiple Sclerosis

Neurorehabilitation and Neural Repair ◽

10.1177/1545968319856897 ◽

2019 ◽

Vol 33 (8) ◽

pp. 623-634 ◽

Cited By ~ 6

Author(s):

Renee Veldkamp ◽

Anders Romberg ◽

Paivi Hämäläinen ◽

Xavier Giffroy ◽

Lousin Moumdjian ◽

...

Keyword(s):

Multiple Sclerosis ◽

Task Performance ◽

Dual Task ◽

Cognitive Task ◽

Digit Span ◽

Correlation Coefficients ◽

Cognitive Tasks ◽

Retest Reliability ◽

Task Conditions ◽

Test Retest Reliability

Background. Simultaneous execution of motor and cognitive tasks can result in worsened performance on one or both tasks, indicating cognitive-motor interference (CMI). A growing amount of research on CMI in persons with multiple sclerosis (pwMS) is observed. However, psychometric properties of dual-task outcomes have been scarcely reported. Objective. To investigate the between-day test-retest reliability of the motor and cognitive dual-task costs (DTCs) during multiple CMI test conditions with various task complexities in pwMS and matched healthy controls (HCs). Methods. A total of 34 pwMS (Expanded Disability Status Scale score 3.0 ± 0.8) and 31 HCs were tested and retested on 3 single cognitive, 4 single motor, and 12 cognitive-motor dual tasks. Cognitive tasks included serial subtraction by 7, titrated digit span backward, and auditory vigilance. Motor tasks were walking at self-selected speed, over obstacles, crisscross, and while carrying a water-filled cup. Outcome measures were cognitive and motor DTC, calculated as percentage change of dual-task performance compared with single-task performance. Intraclass correlations (ICCs) and Spearman correlation coefficients were calculated as appropriate. Results. For DTCmotor of gait speed, ICCs ranged from 0.45 to 0.81 and Spearman correlations from 0.74 to 0.82. For DTCcognitive, ICCs ranged from −0.18 to 0.49 and Spearman correlations from −0.28 to 0.26. Reliability depended on the type of motor and cognitive task. Conclusion. Reliability of the DTCmotor was, overall, good, whereas that of the DTCcognitive was poor. The “walking” and “cup” dual-task conditions were the most reliable regardless of the integrated cognitive task.

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EXPRESS: Attention in Post-Lexical Processes of Utterance Production: Dual-Task Cost in Younger and Older Adults

Quarterly Journal of Experimental Psychology ◽

10.1177/17470218211034130 ◽

2021 ◽

pp. 174702182110341

Author(s):

Maryll Fournet ◽

Michaela Pernon ◽

Sabina Catalano Chiuvé ◽

Ursula Lopez ◽

Marina Laganaro

Keyword(s):

Older Adults ◽

Dual Task ◽

Verbal Fluency ◽

Verbal Task ◽

Lexical Selection ◽

Speech Task ◽

Verbal Fluency Task ◽

Dual Task Cost ◽

Lexical Processes ◽

Fluency Task

There is a general agreement that speaking requires attention at least for conceptual and lexical processes of utterance production. However, conflicting results have been obtained with dual-task paradigms using either repetition tasks or more generally tasks involving limited loading of lexical selection. This study aimed to investigate whether post-lexical processes recruit attentional resources. We used a new dual-task paradigm in a set of experiments where a continuous verbal production task involved either high or low demand on lexical selection processes. Experiment 1 evaluates lexical and post-lexical processes with a semantic verbal fluency task, whereas experiments 2 and 3 focus on post-lexical processes with a non-propositional speech task. In each experiment, two types of non-verbal secondary tasks were used: processing speed (simple manual reaction times) or inhibition (Go/No-go). In Experiment 1, a dual-task cost was observed on the semantic verbal fluency task and each non-verbal task. In Experiment 2, a dual-task cost appeared on the non-verbal tasks but not on the speech task. The same paradigm was used with older adults (Experiment 3), as increased effort in post-lexical processes has been associated with ageing. For older adults, a dual-task cost was also observed on the non-propositional verbal task when speech was produced with the inhibition non-verbal task. The results suggest an attentional cost on post-lexical processes and strategic effects in the resolution of the dual-task.

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Independent and sensitive gait parameters for objective evaluation in knee and hip osteoarthritis using wearable sensors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04074-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ramon J. Boekesteijn ◽

José M. H. Smolders ◽

Vincent J. J. F. Busch ◽

Alexander C. H. Geurts ◽

Katrijn Smulders

Keyword(s):

Dual Task ◽

Wearable Sensors ◽

Body Motion ◽

Effect Sizes ◽

Upper Body ◽

Healthy Controls ◽

Gait Parameters ◽

Dual Task Cost ◽

Dual Task Performance ◽

Spatiotemporal Parameters

Abstract Background Although it is well-established that osteoarthritis (OA) impairs daily-life gait, objective gait assessments are not part of routine clinical evaluation. Wearable inertial sensors provide an easily accessible and fast way to routinely evaluate gait quality in clinical settings. However, during these assessments, more complex and meaningful aspects of daily-life gait, including turning, dual-task performance, and upper body motion, are often overlooked. The aim of this study was therefore to investigate turning, dual-task performance, and upper body motion in individuals with knee or hip OA in addition to more commonly assessed spatiotemporal gait parameters using wearable sensors. Methods Gait was compared between individuals with unilateral knee (n = 25) or hip OA (n = 26) scheduled for joint replacement, and healthy controls (n = 27). For 2 min, participants walked back and forth along a 6-m trajectory making 180° turns, with and without a secondary cognitive task. Gait parameters were collected using 4 inertial measurement units on the feet and trunk. To test if dual-task gait, turning, and upper body motion had added value above spatiotemporal parameters, a factor analysis was conducted. Effect sizes were computed as standardized mean difference between OA groups and healthy controls to identify parameters from these gait domains that were sensitive to knee or hip OA. Results Four independent domains of gait were obtained: speed-spatial, speed-temporal, dual-task cost, and upper body motion. Turning parameters constituted a gait domain together with cadence. From the domains that were obtained, stride length (speed-spatial) and cadence (speed-temporal) had the strongest effect sizes for both knee and hip OA. Upper body motion (lumbar sagittal range of motion), showed a strong effect size when comparing hip OA with healthy controls. Parameters reflecting dual-task cost were not sensitive to knee or hip OA. Conclusions Besides more commonly reported spatiotemporal parameters, only upper body motion provided non-redundant and sensitive parameters representing gait adaptations in individuals with hip OA. Turning parameters were sensitive to knee and hip OA, but were not independent from speed-related gait parameters. Dual-task parameters had limited additional value for evaluating gait in knee and hip OA, although dual-task cost constituted a separate gait domain. Future steps should include testing responsiveness of these gait domains to interventions aiming to improve mobility.

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Case Report: Combining Dalfampridine with Multicomponent Exercise and Gait Training in a Person with Multiple Sclerosis

International Journal of MS Care ◽

10.7224/1537-2073.2017-074 ◽

2018 ◽

Vol 20 (5) ◽

pp. 238-243

Author(s):

Prudence Plummer ◽

Corinne J. Bohling ◽

L. Ellese Nickles ◽

Alexis A. Williams ◽

Amy Thomas ◽

...

Keyword(s):

Multiple Sclerosis ◽

Case Report ◽

Dual Task ◽

Gait Speed ◽

Gait Training ◽

Important Change ◽

Relapsing Remitting ◽

History Of ◽

Task Conditions ◽

Clinically Important Change

Abstract Background: Dalfampridine extended release (D-ER) improves gait speed in some people with multiple sclerosis (MS), but many patients who take D-ER demonstrate only small improvements of questionable clinical significance. Physical therapy (PT) may augment the treatment effects of D-ER on the nervous system and improve clinical outcomes. This case report describes the successful use of D-ER combined with multicomponent PT in a patient who did not have a clinically important change in gait speed with D-ER alone. Methods: A 59-year-old woman with a 6-year history of relapsing-remitting MS was prescribed D-ER by her neurologist. After 3 weeks of D-ER therapy (10 mg twice daily), she demonstrated only a 7.1% improvement in the Timed 25-Foot Walk test. She then commenced PT consisting of two 40-minute sessions per week for 6 weeks while continuing D-ER therapy. Training focused on gait, balance, coordination, functional strengthening, and dual-task performance. Results: After 6 weeks of D-ER + PT, she had a further 14.6% improvement in Timed 25-Foot Walk gait speed, for a total improvement of 20.7%, which elevated her above the clinically meaningful threshold of 20%. Similar patterns of improvement were also observed for self-selected gait speed in single- and dual-task conditions. Improvements in fast and dual-task gait speed were retained 3 weeks later. Conclusions: For this patient, combining PT with D-ER therapy improved gait speed more than the use of D-ER alone. Further investigation of D-ER + PT or PT as an alternative to D-ER in patients with submeaningful medication response is warranted.

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