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

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Erin M. Edwards ◽  
Deborah A. Kegelmeyer ◽  
Anne D. Kloos ◽  
Manon Nitta ◽  
Danya Raza ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Dual Task ◽  
Mixed Model ◽  
Walking Ability ◽  
Healthy Controls ◽  
Backward Walking ◽  
Double Support ◽  
Task Conditions ◽  
Future Work ◽  
Age And Sex

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.

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

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

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

Motor Control ◽  
2020 ◽  
pp. 1-23
Author(s):  
Cagla Ozkul ◽  
Arzu Guclu-Gunduz ◽  
Kader Eldemir ◽  
Yasemin Apaydin ◽  
Cagri Gulsen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Features ◽  
Dual Task ◽  
Verbal Fluency ◽  
Postural Stability ◽  
Cognitive Task ◽  
Manual Dexterity ◽  
Healthy Controls ◽  
Dual Task Cost ◽  
Task Conditions

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.

scholarly journals The Complexity of Blood Pressure Fluctuation Mediated the Effects of Hypertension on Walking Speed in Older Adults

2021 ◽  
Vol 13 ◽  
Author(s):  
Xin Jiang ◽  
Yurun Cai ◽  
Yue Zhao ◽  
Xia Gao ◽  
Dan Peng ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Cognitive Function ◽  
Dual Task ◽  
Pressure Fluctuation ◽  
Walking Speed ◽  
Equation Modeling ◽  
Walking Performance ◽  
Blood Pressure Fluctuation ◽  
Task Conditions

Background: Older adults with hypertension often had diminished walking performance. The underlying mechanism through which hypertension affects walking performance, however, has not been fully understood. We here measured the complexity of the continuous systolic (SBP) and diastolic (DBP) blood pressure fluctuation, grade of white matter lesions (WMLs), and cognitive function and used structural equation modeling (SEM) to examine the interrelationships between hypertension, BP complexity, WMLs, cognitive function, and walking speed in single- and dual-task conditions.Methods: A total of 152 older adults with age &gt; 60 years (90 hypertensive and 62 normotensive participants) completed one MRI scan of brain structure, a finger BP assessment of at least 10 min, Mini-Mental State Examination (MMSE) to assess cognitive function, and 10-meter walking tests in single (i.e., normal walking) and dual tasks (i.e., walking while performing a serial subtraction of three from a random three-digit number). The grade of WMLs was assessed using the total score of Fazekas scale; the complexity of SBP and DBP was measured using multiscale entropy (MSE), and the walking performance was assessed by walking speed in single- and dual-task conditions.Results: As compared to normotensives, hypertensive older adults had significantly slower walking speed, lower complexity of SBP and DBP, greater grade of WMLs, and poorer cognitive function (p &lt; 0.03). Those with lower BP complexity (β &gt; 0.31, p &lt; 0.003), greater WML grade (β &lt; −0.39, p &lt; 0.0002), and/or poorer cognitive function (β &lt; −0.39, p &lt; 0.0001) had slower walking speed in single- and/or dual-task conditions. The SEM model demonstrated significant total effects of hypertension on walking speed, and such effects were mediated by BP complexity only, or BP complexity, WML grade, and cognitive function together.Conclusion: This study demonstrates the cross-sectional association between the complexity of continuous beat-to-beat BP fluctuation, WML grade, cognitive function, and walking speed in hypertensive and normotensive older adults, revealing a potential mechanism that hypertension may affect walking performance in older adults through diminished BP complexity, increased WML grade, and decreased cognitive function, and BP complexity is an important factor for such effects. Future longitudinal studies are warranted to confirm the findings in this study.

scholarly journals The effects of a secondary task on gait in axial spondyloarthritis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Julie Soulard ◽  
Jacques Vaillant ◽  
Athan Baillet ◽  
Philippe Gaudin ◽  
Nicolas Vuillerme
Keyword(s):  
Dual Task ◽  
Secondary Task ◽  
Stride Length ◽  
Axial Spondyloarthritis ◽  
Healthy Controls ◽  
Dual Tasking ◽  
Double Support ◽  
Manual Task ◽  
Gait Parameters ◽  
Stance Time

AbstractStudies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.

scholarly journals 85 Linking Diabetes and Dementia Risk: A Role for Aβ-42 Induced Activation of the NLRP3 Inflammasome? Results from the ENBIND Study

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Adam Dyer ◽  
Isabella Batten ◽  
Isabelle Killane ◽  
Conor Woods ◽  
James Gibney ◽  
...  
Keyword(s):  
Dual Task ◽  
Nlrp3 Inflammasome ◽  
Mononuclear Cells ◽  
Amyloid Β ◽  
Later Life ◽  
Innate Immune ◽  
Healthy Controls ◽  
Peripheral Blood Mononuclear ◽  
Dementia Risk ◽  
Task Conditions

Abstract Background Midlife Type 2 Diabetes Mellitus (T2DM) is associated with a greater risk of dementia in later life. The innate immune NLRP3 inflammasome, an innate immune receptor, has been implicated in both T2DM and Alzheimer’s Dementia (AD) and can become activated by Amyloid-β 42 (Aβ-42). We analysed inflammasome-dependent cytokine responses in midlife T2DM and correlated these with cognitive and gait performance Methods Peripheral Blood Mononuclear Cells (PBMCs) of otherwise healthy patients with T2DM (n=30; 52 ± 8 yrs) and matched controls (n=15; 52.5 ± 7.86 yrs) were incubated for 18h with the following NLRP3 ligands: (i) Lipopolysaccharide (LPS), (ii) Aβ42 or (ii) LPS & Aβ42. Cell supernatants were analysed for production of the inflammasome-dependent cytokine IL-1β. Cognitive function was assessed using the MoCA and gait speed assessed under self-selected, maximal and cognitive dual-task conditions. Mann-Whitney, Wilcoxon tests and linear regression of log-transformed data were used to analyse results Results Incubation of PBMCs from all participants with NLRP3 agonists was associated with significant production of IL-1β (all p<0.001). There were no statistically significant between-group differences in IL-1β production. MoCA score did not predict IL-1β production by PBMCs. However, poorer performance on the cognitive dual-task gait paradigm was associated with significantly greater IL-1β production in response to LPS & Aβ42 in those with T2DM (p=0.015), which persisted after robust control for demographic, cognitive and cardiovascular covariates (p=0.003). The same association was not seen for healthy controls (p=0.58). Conclusion Both LPS & Aβ42 induce significant IL-1β production in PBMCs which did not differ between those with midlife T2DM and healthy controls. Poorer performance on the cognitive dual task gait paradigm was associated with significantly greater IL-1β production in response to LPS & Aβ42. Given the value of dual task gait in predicting cognitive decline, longitudinal follow up of this cohort may provide insight into the underlying pathophysiological mechanisms and potential biomarkers of dementia risk in T2DM.

scholarly journals ASSOCIATION BETWEEN BALANCE SELF-EFFICACY AND WALKING ABILITY IN THOSE WITH NEW LOWER LIMB AMPUTATIONS

2022 ◽  
Vol 5 (1) ◽  
Author(s):  
Courtney Frengopoulos ◽  
Zaka Zia ◽  
Michael Payne ◽  
Ricardo Viana ◽  
Susan Hunter
Keyword(s):  
Dual Task ◽  
Lower Limb ◽  
Self Efficacy ◽  
Walking Ability ◽  
Walking Test ◽  
Single Task ◽  
Straight Path ◽  
Walking Velocity ◽  
Walking Tests ◽  
Task Conditions

BACKGROUND: A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). OBJECTIVE(S): To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. METHODOLOGY: Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). FINDINGS: Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. CONCLUSION: Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA. Layman's Abstract Self-efficacy is a person’s belief in their ability to do a certain task well. Improving self-efficacy can be done by watching others complete a task, by getting praise from experts, or by doing the task yourself. There is a link between how well some people walk and their confidence with walking, however this has not been studied in people learning to use a lower limb prosthesis. The goal of this paper was to study the link between balance self-efficacy, scores on walking tests and self-reported walking ability in those with lower limb amputations (LLA) when they leave rehabilitation. To do this, two walking tests were done (straight path and complex path) in two settings (walking only and walking with distraction). A survey about walking ability and a questionnaire on balance self-efficacy were also done. Results showed that self-efficacy of balance was related to the straight path walking test under both settings and the complex walking test during walking alone. A person’s satisfaction with walking ability was also linked. The only test not related was the complex walking test under distracting conditions. It might be that more time is needed for people with LLA to confidently do this task. This shows the link between physical and mental factors during rehabilitation. More research is needed to find other factors that might impact self-efficacy and walking ability in people with LLA when they leave rehabilitation. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36695/28904 How To Cite: Frengopoulos C, Zia Z, Payne M.W.C, Viana R, Hunter S.W. Association between balance self-efficacy and walking ability in those with new lower limb amputations. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.4. https://doi.org/10.33137/cpoj.v5i1.36695 Corresponding Author: Courtney Frengopoulos,University of Western Ontario, Room 1408, Elborn College, London, Ontario, Canada, N6G 1H1.E-Mail: [email protected] ID: https://orcid.org/0000-0002-4131-2727

Neural Variability in the Prefrontal Cortex as a Reflection of Neural Flexibility and Stability in Patients With Parkinson Disease

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013217
Author(s):  
Inbal Maidan ◽  
Roni Hacham ◽  
Ira Galperin ◽  
Nir Giladi ◽  
Roee Holtzer ◽  
...  
Keyword(s):  
Time Series ◽  
Prefrontal Cortex ◽  
Dual Task ◽  
Mixed Model ◽  
Near Infrared ◽  
Control Group ◽  
Healthy Controls ◽  
Class Iii ◽  
Functional Near Infrared Spectroscopy

Background and Objectives:Functional Near-Infrared Spectroscopy (fNIRS) studies provide direct evidence to the important role of the prefrontal cortex (PFC) during walking in aging and Parkinson's disease (PD). Most studies mainly explored mean HbO2 levels, while moment-to-moment variability measures have been rarely investigated. Variability measures can inform on flexibility that is imperative for adaptive function. We hypothesized that patients with PD will show less variability in HbO2 signals during walking compared to healthy controls.Methods:206 participants, 57 healthy controls (age: 68.9±1.0 years; 27 women) and 149 idiopathic PD patients (age: 69.8±0.6 years, 50 women, disease duration: 8.27±5.51 years) performed usual walking and dual-task walking (serial 3 subtractions) with an fNIRS system placed on the forehead. HbO2 variability was calculated using the standard deviation (SD), range, and mean detrended time series of fNIRS-derived HbO2 signal evaluated during each walking task. HbO2 variability was compared between groups and between walking tasks using mixed model analyses.Results:Higher variability (SD, range, mean detrended time series) was observed during dual-task walking, compared to usual walking (p<0.025), but this was derived from the differences within the healthy control group (group X task interaction: p<0.007). On the other hand, task repetition demonstrated reduced variability in healthy controls but increased variability in patients with PD (interaction group*walk-repetition: p<0.048). The MDS-UPDRS motor score correlated with HbO2 range (r=0.142, p=0.050) and HbO2 SD (r=0.173, p=0.018) during usual walking in all participants.Discussion:In this study, we suggest a new way to interpret changes in HbO2 variability. We relate increased HbO2 variability to flexible adaptation to environmental challenges and decreased HbO2 variability to the stability of performance. Our results show that both are limited in PD however, further investigation of these concepts is required. Moreover, HbO2 variability measures are an important aspect of brain function that adds new insights into the role of PFC during walking with aging and PD.Classification of Evidence:This study provides Class III evidence that patients with PD have more variability within Hb02 signals during usual-walking, compared to healthy controls, but not during dual-task walking.

scholarly journals Frontal vs. Posterior cognitive dysfunction: Does greater risk of dementia lead to a differential gait in Parkinson’s disease?

2019 ◽  
Vol 13 (1) ◽  
pp. 1-10
Author(s):  
Carolina R. A. Silveira ◽  
Eric A. Roy ◽  
Quincy J. Almeida
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Deficits ◽  
Dual Task ◽  
Brain Areas ◽  
Dual Task Condition ◽  
Double Support ◽  
Task Conditions ◽  
Base Of Support ◽  
Normal Cognition

Background: Gait impairment is suggested to predict the onset of dementia in Parkinson’s disease (PD). Interestingly, studies have shown that PD patients with cognitive deficits mediated by posterior brain areas are at greater risk of developing dementia than those with frontal deficits. Yet, it remains unknown whether PD patients with posterior cognitive deficits show differences in gait when compared to those with frontal deficits. Aim: This study aimed to compare gait of individuals with PD showing “posterior”, “frontal”, or no cognitive impairment (NCI). Methods: Based on a sample of 64 individuals with PD, median scores were calculated for three neuropsychological tests relying on “frontal” and three relying on “posterior” brain areas. Individuals assigned into the Frontal or Posterior groups showed at least 2 out of 3 scores lower than the median in frontal or posterior tests, respectively. Those with 0 or 1 score lower than the median were classified as NCI. Participants walked under single and dual task conditions. Results: All groups walked slower, with greater variability, wider base of support, and longer double support in the dual task condition.  Interpretation: PD patients with posterior cognitive deficits walk similarly to those with frontal deficits and those with normal cognition.

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

2009 ◽  
Vol 15 (10) ◽  
pp. 1215-1227 ◽  
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.

Effects of Concurrent Manual Task Performance on Connected Speech Acoustics in Individuals With Parkinson Disease

2019 ◽  
Vol 62 (7) ◽  
pp. 2099-2117 ◽  
Author(s):  
Jason A. Whitfield ◽  
Zoe Kriegel ◽  
Adam M. Fullenkamp ◽  
Daryush D. Mehta
Keyword(s):  
Task Performance ◽  
Speech Production ◽  
Dual Task ◽  
Motor Task ◽  
Task Condition ◽  
Connected Speech ◽  
Speech Acoustics ◽  
Single Task ◽  
Manual Task ◽  
Task Conditions

Purpose Prior investigations suggest that simultaneous performance of more than 1 motor-oriented task may exacerbate speech motor deficits in individuals with Parkinson disease (PD). The purpose of the current investigation was to examine the extent to which performing a low-demand manual task affected the connected speech in individuals with and without PD. Method Individuals with PD and neurologically healthy controls performed speech tasks (reading and extemporaneous speech tasks) and an oscillatory manual task (a counterclockwise circle-drawing task) in isolation (single-task condition) and concurrently (dual-task condition). Results Relative to speech task performance, no changes in speech acoustics were observed for either group when the low-demand motor task was performed with the concurrent reading tasks. Speakers with PD exhibited a significant decrease in pause duration between the single-task (speech only) and dual-task conditions for the extemporaneous speech task, whereas control participants did not exhibit changes in any speech production variable between the single- and dual-task conditions. Conclusions Overall, there were little to no changes in speech production when a low-demand oscillatory motor task was performed with concurrent reading. For the extemporaneous task, however, individuals with PD exhibited significant changes when the speech and manual tasks were performed concurrently, a pattern that was not observed for control speakers. Supplemental Material https://doi.org/10.23641/asha.8637008

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