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.

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 Asymmetric interference between cognitive task components and concurrent sensorimotor coordination

2018 ◽  
Vol 120 (1) ◽  
pp. 330-342
Author(s):  
Joshua Baker ◽  
Antonio Castro ◽  
Andrew K. Dunn ◽  
Suvobrata Mitra
Keyword(s):  
Information Processing ◽  
Dual Task ◽  
Time Course ◽  
Cognitive Task ◽  
Tracking Task ◽  
Cognitive Tasks ◽  
State Monitoring ◽  
Sensorimotor Coordination ◽  
Dual Tasking ◽  
Task Conditions

Everyday cognitive tasks are frequently performed under dual-task conditions alongside continuous sensorimotor coordinations (CSCs) such as driving, walking, or balancing. Observed interference in these dual-task settings is commonly attributed to demands on executive function or attentional resources, but the time course and reciprocity of interference are not well understood at the level of information-processing components. Here we used electrophysiology to study the detailed chronometry of dual-task interference between a visual oddball task and a continuous visuomanual tracking task. The oddball task’s electrophysiological components were linked to underlying cognitive processes, and the tracking task served as a proxy for the continuous cycle of state monitoring and adjustment inherent to CSCs. Dual-tasking interfered with the oddball task’s accuracy and attentional processes (attenuated P2 and P3b magnitude and parietal alpha-band event-related desynchronization), but errors in tracking due to dual-tasking accrued at a later timescale and only in trials in which the target stimulus appeared and its tally had to be incremented. Interference between cognitive tasks and CSCs can be asymmetric in terms of timing as well as affected information-processing components. NEW & NOTEWORTHY Interference between cognitive tasks and continuous sensorimotor coordination (CSC) has been widely reported, but this is the first demonstration that the cognitive operation that is impaired by concurrent CSC may not be the one that impairs the CSC. Also demonstrated is that interference between such tasks can be temporally asymmetric. The asynchronicity of this interference has significant implications for understanding and mitigating loss of mobility in old age, and for rehabilitation for neurological impairments.

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

2017 ◽  
Vol 24 (3) ◽  
pp. 247-258 ◽  
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)

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

scholarly journals Reduction of Dual-task Costs by Noninvasive Modulation of Prefrontal Activity in Healthy Elders

2016 ◽  
Vol 28 (2) ◽  
pp. 275-281 ◽  
Author(s):  
Brad Manor ◽  
Junhong Zhou ◽  
Azizah Jor'dan ◽  
Jue Zhang ◽  
Jing Fang ◽  
...  
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Cognitive Task ◽  
Brain Regions ◽  
Dual Tasking ◽  
Single Task ◽  
Novel Approach ◽  
Before And After ◽  
Improved Performance ◽  
Task Conditions

Dual tasking (e.g., walking or standing while performing a cognitive task) disrupts performance in one or both tasks, and such dual-task costs increase with aging into senescence. Dual tasking activates a network of brain regions including pFC. We therefore hypothesized that facilitation of prefrontal cortical activity via transcranial direct current stimulation (tDCS) would reduce dual-task costs in older adults. Thirty-seven healthy older adults completed two visits during which dual tasking was assessed before and after 20 min of real or sham tDCS targeting the left pFC. Trials of single-task standing, walking, and verbalized serial subtractions were completed, along with dual-task trials of standing or walking while performing serial subtractions. Dual-task costs were calculated as the percent change in markers of gait and postural control and serial subtraction performance, from single to dual tasking. Significant dual-task costs to standing, walking, and serial subtraction performance were observed before tDCS (p < .01). These dual-task costs were less after real tDCS as compared with sham tDCS as well as compared with either pre-tDCS condition (p < .03). Further analyses indicated that tDCS did not alter single task performance but instead improved performance solely within dual-task conditions (p < .02). These results demonstrate that dual tasking can be improved by modulating prefrontal activity, thus indicating that dual-task decrements are modifiable and may not necessarily reflect an obligatory consequence of aging. Moreover, tDCS may ultimately serve as a novel approach to preserving dual-task capacity into senescence.

Dual-Task Performance in Multiple Sclerosis’ Patients: Cerebellum Matters?

2020 ◽  
Author(s):  
Ornella Argento ◽  
Barbara Spanò ◽  
Valerio Pisani ◽  
Chiara C Incerti ◽  
Marco Bozzali ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Dual Task ◽  
Mutual Influence ◽  
Cognitive Task ◽  
Word List ◽  
Generation Task ◽  
Dual Tasking ◽  
Concurrent Execution ◽  
Magnetic Resonance Imaging Mri ◽  
Multiple Sclerosis Patients

Abstract Objective Gait, cognitive impairments, and their mutual influence in dual tasking (cognitive–motor dual tasking, CM-DT) are important to address therapeutic approaches in patients with multiple sclerosis (PMS). CM-DT correlates have been widely investigated with variable and dissimilar results, due to differences in methods. However, although the cerebellum has recently shown to be involved in both motor and cognitive functions, few studies have explored its role in the integration of the concurrent execution of gait and cognition. This case–control study aims to explore the effects of adding a cognitive task to walking in PMS and to investigate the role of the cerebellum in the interfering process. Methods In total, 20 patients and 18 healthy controls (HC) underwent clinical assessments, dual task (DT), and 3 T magnetic resonance imaging (MRI). DT was composed by three 2-min trials requiring fast walking. In 2 of them 2 different cognitive tasks were added. Results Both groups evidenced the presence of cognitive–motor interference (CMI) for both cognitive conditions with a greater effect of word list generation task in PMS. Analysis of variance between HC and patients with high or low performances showed a significantly increased volume in Vermis lobules VIIIa and IX of high performers compared with HC. Conclusion Our results show that CMI is also present in healthy individuals but is significantly more disabling in PMS. Furthermore, MRI data point to the existence of an initial mechanism of cerebellar reorganization in PMS with lower interference. Subsequently, the failure of this mechanism due to the progression of disability leads to a more evident expression of symptoms.

scholarly journals Impairment of dual-task gait dynamics in older adults with mild cognitive impairment: Relationships to neuropsychological status, fitness and brain morphology

2019 ◽  
Author(s):  
Tess C Hawkins ◽  
Rebecca Samuel ◽  
Maria A Fiatarone Singh ◽  
Nicola Gates ◽  
Guy C Wilson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Dual Task ◽  
Well Being ◽  
Gait Variability ◽  
Time Variability ◽  
Stride Time ◽  
Gait Dynamics ◽  
Dual Tasking ◽  
Task Conditions

ABSTRACTBackgroundIndividuals with Mild Cognitive Impairment (MCI) have more gait variability under dual-task conditions than cognitively healthy adults. However, characteristics associated with this susceptibility of gait to dual-task stress are unknown.MethodsTesting was performed at baseline in the Study of Mental And Resistance Training (SMART). Ninety-three adults with MCI (age 70±6.8 years; 66.6% female) performed a single- and dual-task walk (cognitive distractor=letter fluency), in random order. Linear and non-linear gait variability were measured using force-sensitive insoles. Cognitive performance during dual-tasking was assessed by the number of correct words vocalized. Cognitive function, brain Magnetic Resonance Imaging (MRI), muscle strength, aerobic capacity, body composition, physical and psychosocial function were also assessed as potential correlates of gait dynamics.ResultsGait dynamics worsened during dual-tasking, with decrements in both stride time variability (p<0.001) and detrended fluctuation analysis (DFA) (p=0.001). Lower aerobic capacity and thinner posterior cingulate cortex were associated with greater decrements in DFA (p<0.05). Smaller hippocampal volume, worse psychological well-being and poorer static balance were associated with greater decrements in stride time variability (p<0.05). By contrast, cognitive performance did not change under dual-task conditions compared to seated testing (p=0.13).ConclusionsUnder dual-task conditions, participants with MCI preserved their cognitive performance at the expense of gait stability. Decrements in dual-tasking gait were associated with lower aerobic fitness, balance, psychological well-being, and brain volume in cognitively-relevant areas of the posterior cingulate and hippocampus, all potentially modifiable characteristics. Trials of targeted interventions are needed to determine the potential plasticity of gait variability in high-risk cohorts.

Turn Characteristics During Gait Differ With and Without a Cognitive Demand Among College Athletes

2020 ◽  
Vol 29 (4) ◽  
pp. 448-453
Author(s):  
Lauren A. Brown ◽  
Eric E. Hall ◽  
Caroline J. Ketcham ◽  
Kirtida Patel ◽  
Thomas A. Buckley ◽  
...  
Keyword(s):  
Cognitive Load ◽  
Dual Task ◽  
Sports Medicine ◽  
College Athletes ◽  
Cognitive Task ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Dual Task Condition ◽  
Dual Tasking ◽  
Task Conditions

Context: Sports often involve complex movement patterns, such as turning. Although cognitive load effects on gait patterns are well known, little is known on how it affects biomechanics of turning gait among athletes. Such information could help evaluate how concussion affects turning gait required for daily living and sports. Objective: To determine the effect of a dual task on biomechanics of turning while walking among college athletes. Design: Cross-sectional study. Setting: University laboratory. Participants: Fifty-three participants performed 5 trials of a 20-m walk under single- and dual-task conditions at self-selected speed with a 180° turn at 10-m mark. The cognitive load included subtraction, spelling words backward, or reciting the months backward. Interventions: Not applicable. Main Outcome Measures: Turn duration, turning velocity, number of steps, SD of turn duration and velocity, and coefficient of variation of turn duration and velocity. Results: Participants turned significantly slower (155.99 [3.71] cm/s vs 183.52 [4.17] cm/s; P < .001) and took longer time to complete the turn (2.63 [0.05] s vs 2.33 [0.04] s; P < .001) while dual tasking, albeit taking similar number of steps to complete the turn. Participants also showed more variability in turning time under the dual-task condition (SD of turn duration = 0.39 vs 0.31 s; P = .004). Conclusions: Overall, college athletes turned slower and showed more variability during turning gait while performing a concurrent cognitive dual-task turning compared with single-task turning. The slower velocity increased variability may be representative of specific strategy of turning gait while dual tasking, which may be a result of the split attention to perform the cognitive task. The current study provides descriptive values of absolute and variability turning gait parameters for sports medicine personnel to use while they perform their concussion assessments on their college athletes.

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

2019 ◽  
Vol 33 (8) ◽  
pp. 623-634 ◽  
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.

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

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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