scholarly journals Simple Smartphone-Based Assessment of Gait Characteristics in Parkinson Disease: Validation Study

10.2196/25451 ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. e25451
Author(s):  
Dongning Su ◽  
Zhu Liu ◽  
Xin Jiang ◽  
Fangzhao Zhang ◽  
Wanting Yu ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Movement Disorder ◽  
Dual Task ◽  
Gold Standard ◽  
Rating Scale ◽  
Time Variability ◽  
Stride Time ◽  
Task Condition ◽  
Single Task ◽  
Gait Assessment

Background Parkinson disease (PD) is a common movement disorder. Patients with PD have multiple gait impairments that result in an increased risk of falls and diminished quality of life. Therefore, gait measurement is important for the management of PD. Objective We previously developed a smartphone-based dual-task gait assessment that was validated in healthy adults. The aim of this study was to test the validity of this gait assessment in people with PD, and to examine the association between app-derived gait metrics and the clinical and functional characteristics of PD. Methods Fifty-two participants with clinically diagnosed PD completed assessments of walking, Movement Disorder Society Unified Parkinson Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scale tests. Participants followed multimedia instructions provided by the app to complete two 20-meter trials each of walking normally (single task) and walking while performing a serial subtraction dual task (dual task). Gait data were simultaneously collected with the app and gold-standard wearable motion sensors. Stride times and stride time variability were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone and from the wearable sensor system. Results High correlations were observed between the stride time and stride time variability derived from the app and from the gold-standard system (r=0.98-0.99, P<.001), revealing excellent validity of the app-based gait assessment in PD. Compared with those from the single-task condition, the stride time (F1,103=14.1, P<.001) and stride time variability (F1,103=6.8, P=.008) in the dual-task condition were significantly greater. Participants who walked with greater stride time variability exhibited a greater UPDRS III total score (single task: β=.39, P<.001; dual task: β=.37, P=.01), HAM-A (single-task: β=.49, P=.007; dual-task: β=.48, P=.009), and HAM-D (single task: β=.44, P=.01; dual task: β=.49, P=.009). Moreover, those with greater dual-task stride time variability (β=.48, P=.001) or dual-task cost of stride time variability (β=.44, P=.004) exhibited lower MoCA scores. Conclusions A smartphone-based gait assessment can be used to provide meaningful metrics of single- and dual-task gait that are associated with disease severity and functional outcomes in individuals with PD.

scholarly journals A Novel Easy-of-Use Smartphone-Based Assessment of Gait Characteristics in Parkinson’s Disease (Preprint)

2020 ◽  
Author(s):  
Dongning Su ◽  
Zhu Liu ◽  
Xin Jiang ◽  
Fangzhao Zhang ◽  
Wanting Yu ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Dual Task ◽  
Gold Standard ◽  
Rating Scale ◽  
Standard System ◽  
Functional Characteristics ◽  
Velocity Signal ◽  
Single Task ◽  
Gait Assessment

BACKGROUND Parkinson’s disease (PD) is common movement disorder and patients with PD had multiple gait impairments, leading to increased risk of falls, and diminished quality of life. The gait measurement in patients with Parkinson’s disease (PD) is thus important for the management of PD. OBJECTIVE We have developed and validated a smartphone-based assessment of gait, allowing the remote gait assessment in healthy cohorts. We here aimed to test the validity of this App-based gait measurement in people with PD and explore the association between the gait metrics measured by App and the clinical and functional characteristics in PD. METHODS Fifty-two participants with clinically-diagnosed PD completed assessments of walking, MDS-Unified Parkinson's Disease Rating Scale III (UPDRS III), Montreal Cognitive Assessment (MoCA), Hamilton Anxiety (HAM-A) and Depression (HAM-D) rating scale tests. Participants followed multi-media instructions provided by the App to complete two 20-meter trials each of walking normally (single-task) and walking while performing a serial subtraction dual task (dual-task). The locomotion data were simultaneously collected with the App and a gold-standard system. The gait stride times (ST) and stride time variability (STV) were derived from the acceleration and angular velocity signal acquired from the internal motion sensor of the phone, and from the wearable sensor system. RESULTS High correlations between the ST and STV derived from the App and those from gold-standard system were observed (r=0.98~0.99, p<.0001), revealing excellent validity of the App-based gait assessment in PD. Compared to single-task, the ST (F=13.1, p=.0005) and STV (F=6.3, p=.01) in dual-task condition were significantly greater. Participants with greater STV in both conditions had greater total score of UPDRS III (r=0.37~0.39, p=.0007~.01), HAM-A (single-task: r=0.49, p=.007; dual-task: r=0.48, p=.009) and HAM-D (single-task: r=0.44, p=.01; dual-task: r=0.49, p=.009); and those with greater dual-task STV (r=0.48, p=.001) and/or dual-task cost to STV (r=0.44, p=.004) had lower MoCA score. CONCLUSIONS These results demonstrated that this ease-of-its-use smartphone-based gait measurement is validated and provides meaningful metrics that are associated with clinical and functional characteristics in PD.

scholarly journals Critical spatiotemporal gait parameters for individuals with dementia: A systematic review and meta-analysis

2020 ◽  
pp. 1-14
Author(s):  
Rita Chiaramonte ◽  
Matteo Cioni
Keyword(s):  
Systematic Review ◽  
Gait Analysis ◽  
Dual Task ◽  
Stride Length ◽  
Meta Analysis ◽  
Time Variability ◽  
Stride Time ◽  
Single Task ◽  
Gait Parameters ◽  
Risk Of Falls

Instrumented gait analysis allows for the identification of walking parameters to predict cognitive decline and the worsening of dementia. The aim of this study was to perform a meta-analysis to better clarify which gait parameters are affected or modified with the progression of the dementia in a larger sample, as well as which gait assessment conditions (single-task or dual-task conditions) would be more sensitive to reflect the influence of dementia. Literature searches were conducted with the keywords “quantitative gait” OR “gait analysis” AND “dementia” AND “single-task” AND “dual-task,” and for “quantitative gait” OR “gait analysis” AND “dementia” AND “fall risk” on PubMed, EMBASE, the Cochrane Library, Scopus, and Web of Science. The results were used to perform a systematic review focussing on instrumental quantitative assessment of the walking of patients with dementia, during both single and dual tasks. The search was performed independently by two authors (C. R. and C. M.) from January 2018 to April 2020 using the PICOS criteria. Nine publications met the inclusion criteria and were included in the systematic review. Our meta-analysis showed that during a single task, most of the spatiotemporal parameters of gait discriminated best between patients with dementia and healthy controls, including speed, cadence, stride length, stride time, stride time variability, and stance time. In dual tasks, only speed, stride length, and stride time variability discriminated between the two groups. In addition, compared with spatial parameters (e.g. stride length), some temporal gait parameters were more correlated to the risk of falls during the comfortable walking in a single task, such as cadence, stride time, stride time variability, and stance time. During a dual task, only the variability of stride time was associated with the risk of falls.

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

2BALANCE: Test-retest reliability of a cognitive-motor dual-task protocol

2021 ◽  
pp. 1-13
Author(s):  
Maya Danneels ◽  
Ruth Van Hecke ◽  
Laura Leyssens ◽  
Dirk Cambier ◽  
Raymond van de Berg ◽  
...  
Keyword(s):  
Mental Rotation ◽  
Dual Task ◽  
Motor Task ◽  
Mental Rotation Task ◽  
Cognitive Tasks ◽  
Task Condition ◽  
Dual Task Condition ◽  
Single Task ◽  
Retest Reliability ◽  
Test Retest Reliability

PURPOSE: Aside from typical symptoms such as dizziness and vertigo, persons with vestibular disorders often have cognitive and motor problems. These symptoms have been assessed in single-task condition. However, dual-tasks assessing cognitive-motor interference might be an added value as they reflect daily life situations better. Therefore, the 2BALANCE protocol was developed. In the current study, the test-retest reliability of this protocol was assessed. METHODS: The 2BALANCE protocol was performed twice in 20 healthy young adults with an in-between test interval of two weeks. Two motor tasks and five different cognitive tasks were performed in single and dual-task condition. Intraclass correlation coefficients (ICC), the standard error of measurement, and the minimal detectable difference were calculated. RESULTS: All cognitive tasks, with the exception of the mental rotation task, had favorable reliability results (0.26≤ICC≤0.91). The dynamic motor task indicated overall substantial reliability values in all conditions (0.67≤ICC≤0.98). Similar results were found for the static motor task during dual-tasking (0.50≤ICC≤0.92), but were slightly lower in single-task condition (–0.26≤ICC≤0.75). CONCLUSIONS: The 2BALANCE protocol was overall consistent across trials. However, the mental rotation task showed lowest reliability values.

scholarly journals Impaired attentional modulation of sensorimotor control and cortical excitability in schizophrenia

Brain ◽  
2019 ◽  
Vol 142 (7) ◽  
pp. 2149-2164 ◽  
Author(s):  
Loïc Carment ◽  
Lucile Dupin ◽  
Laura Guedj ◽  
Maxime Térémetz ◽  
Marie-Odile Krebs ◽  
...  
Keyword(s):  
Dual Task ◽  
Cortical Excitability ◽  
Task Force ◽  
Tracking Error ◽  
Sensorimotor Control ◽  
Group Differences ◽  
Task Condition ◽  
Dual Task Condition ◽  
Single Task ◽  
Force Tracking

Abstract Impairments in attentional, working memory and sensorimotor processing have been consistently reported in schizophrenia. However, the interaction between cognitive and sensorimotor impairments and the underlying neural mechanisms remains largely uncharted. We hypothesized that altered attentional processing in patients with schizophrenia, probed through saccadic inhibition, would partly explain impaired sensorimotor control and would be reflected as altered task-dependent modulation of cortical excitability and inhibition. Twenty-five stabilized patients with schizophrenia, 17 unaffected siblings and 25 healthy control subjects were recruited. Subjects performed visuomotor grip force-tracking alone (single-task condition) and with increased cognitive load (dual-task condition). In the dual-task condition, two types of trials were randomly presented: trials with visual distractors (requiring inhibition of saccades) or trials with addition of numbers (requiring saccades and addition). Both dual-task trial types required divided visual attention to the force-tracking target and to the distractor or number. Gaze was measured during force-tracking tasks, and task-dependent modulation of cortical excitability and inhibition were assessed using transcranial magnetic stimulation. In the single-task, patients with schizophrenia showed increased force-tracking error. In dual-task distraction trials, force-tracking error increased further in patients, but not in the other two groups. Patients inhibited fewer saccades to distractors, and the capacity to inhibit saccades explained group differences in force-tracking performance. Cortical excitability at rest was not different between groups and increased for all groups during single-task force-tracking, although, to a greater extent in patients (80%) compared to controls (40%). Compared to single-task force-tracking, the dual-task increased cortical excitability in control subjects, whereas patients showed decreased excitability. Again, the group differences in cortical excitability were no longer significant when failure to inhibit saccades was included as a covariate. Cortical inhibition was reduced in patients in all conditions, and only healthy controls increased inhibition in the dual-task. Siblings had similar force-tracking and gaze performance as controls but showed altered task-related modulation of cortical excitability and inhibition in dual-task conditions. In patients, neuropsychological scores of attention correlated with visuomotor performance and with task-dependant modulation of cortical excitability. Disorganization symptoms were greatest in patients with weakest task-dependent modulation of cortical excitability. This study provides insights into neurobiological mechanisms of impaired sensorimotor control in schizophrenia showing that deficient divided visual attention contributes to impaired visuomotor performance and is reflected in impaired modulation of cortical excitability and inhibition. In siblings, altered modulation of cortical excitability and inhibition is consistent with a genetic risk for cortical abnormality.

scholarly journals Effects of a Dual-Task Paradigm and Gait Velocity on Dynamic Gait Stability during Stair Descent

2020 ◽  
Vol 10 (6) ◽  
pp. 1979 ◽  
Author(s):  
Qipeng Song ◽  
Wei Sun ◽  
Cui Zhang ◽  
Min Mao ◽  
Li Li
Keyword(s):  
Dual Task ◽  
Center Of Pressure ◽  
Force Plate ◽  
Gait Velocity ◽  
Task Condition ◽  
Dual Task Condition ◽  
Gait Stability ◽  
Single Task ◽  
Dual Task Paradigm ◽  
Dynamic Gait

Falls during stair negotiation have become one of the leading causes of accidental death. The effects of a concurrent cognitive or manual dual-task paradigm on dynamic gait stability remain uncertain. How much dynamic gait stability is influenced by gait velocity is also not clear. A total of 16 healthy young females descended a staircase under three different walking conditions: descend stairs only (single task), descend stairs while performing subtraction (cognitive dual-task), and descend stairs while carrying a glass of water (manual dual-task). An eight-camera Vicon motion analysis system and a Kistler force plate embedded into the third step of the staircase were used synchronously to collect kinematic and kinetic data. Gait velocity decreased and dynamic gait stability increased with both cognitive and manual dual-task conditions. The center of mass–center of pressure inclination angle increased with gait velocity but decreased with the manual dual-task condition compared to the single-task condition. Changes in gait velocity caused by the dual-task paradigm can partially explain the effects of dual-task dynamic gait stability. The influence of gait velocity should be considered in the assessment of dual-task effects.

Effects of Hearing Loss on Dual-Task Performance in an Audiovisual Virtual Reality Simulation of Listening While Walking

2016 ◽  
Vol 27 (07) ◽  
pp. 567-587 ◽  
Author(s):  
Sin Tung Lau ◽  
M. Kathleen Pichora-Fuller ◽  
Karen Z. H. Li ◽  
Gurjit Singh ◽  
Jennifer L. Campos
Keyword(s):  
Virtual Reality ◽  
Hearing Loss ◽  
Word Recognition ◽  
Dual Task ◽  
Recognition Accuracy ◽  
Lower Probability ◽  
Stride Time ◽  
Task Condition ◽  
Kinematic Parameters ◽  
Task Conditions

Background: Most activities of daily living require the dynamic integration of sights, sounds, and movements as people navigate complex environments. Nevertheless, little is known about the effects of hearing loss (HL) or hearing aid (HA) use on listening during multitasking challenges. Purpose: The objective of the current study was to investigate the effect of age-related hearing loss (ARHL) on word recognition accuracy in a dual-task experiment. Virtual reality (VR) technologies in a specialized laboratory (Challenging Environment Assessment Laboratory) were used to produce a controlled and safe simulated environment for listening while walking. Research Design: In a simulation of a downtown street intersection, participants completed two single-task conditions, listening-only (standing stationary) and walking-only (walking on a treadmill to cross the simulated intersection with no speech presented), and a dual-task condition (listening while walking). For the listening task, they were required to recognize words spoken by a target talker when there was a competing talker. For some blocks of trials, the target talker was always located at 0° azimuth (100% probability condition); for other blocks, the target talker was more likely (60% of trials) to be located at the center (0° azimuth) and less likely (40% of trials) to be located at the left (270° azimuth). Study Sample: The participants were eight older adults with bilateral HL (mean age = 73.3 yr, standard deviation [SD] = 8.4; three males) who wore their own HAs during testing and eight controls with normal hearing (NH) thresholds (mean age = 69.9 yr, SD = 5.4; two males). No participant had clinically significant visual, cognitive, or mobility impairments. Data Collection and Analysis: Word recognition accuracy and kinematic parameters (head and trunk angles, step width and length, stride time, cadence) were analyzed using mixed factorial analysis of variances with group as a between-subjects factor. Task condition (single versus dual) and probability (100% versus 60%) were within-subject factors. In analyses of the 60% listening condition, spatial expectation (likely versus unlikely) was a within-subject factor. Differences between groups in age and baseline measures of hearing, mobility, and cognition were tested using t tests. Results: The NH group had significantly better word recognition accuracy than the HL group. Both groups performed better when the probability was higher and the target location more likely. For word recognition, dual-task costs for the HL group did not depend on condition, whereas the NH group demonstrated a surprising dual-task benefit in conditions with lower probability or spatial expectation. For the kinematic parameters, both groups demonstrated a more upright and less variable head position and more variable trunk position during dual-task conditions compared to the walking-only condition, suggesting that safe walking was prioritized. The HL group demonstrated more overall stride time variability than the NH group. Conclusions: This study provides new knowledge about the effects of ARHL, HA use, and aging on word recognition when individuals also perform a mobility-related task that is typically experienced in everyday life. This research may help inform the development of more effective function-based approaches to assessment and intervention for people who are hard-of-hearing.

scholarly journals Effects of Age on Dual Task Walking Performance as Measured Using a Smartphone Application in Middle-Aged Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Junhong Zhou ◽  
Gabriele Cattaneo ◽  
Wanting Yu ◽  
Jose Tormos ◽  
Lewis Lipsitz ◽  
...  
Keyword(s):  
Dual Task ◽  
Age Group ◽  
Stride Time ◽  
Brain Health ◽  
Middle Aged ◽  
Single Task ◽  
Age Related ◽  
Walking Performance ◽  
The Mean ◽  
Middle Aged Adults

Abstract After the age of 65, one’s ability to walk while performing an additional cognitive task (i.e., dual-tasking) is predictive of both future falls and cognitive decline. However, while it is well-known that older adults exhibit diminished dual-task performance, the time course of age-related dual-task decline has not been established. We thus conducted an analysis of data collected within the ongoing Barcelona Brain Health Initiative, a prospective population-based study characterizing the determinants of brain health maintenance in middle-aged adults. Cognitively-unimpaired participants (n=655) aged 40-65 years without neuro-psychiatric disease completed laboratory-based trials of walking normally (single-task) and walking while performing a verbalized serial subtraction task (dual-task). A smartphone-based gait assessment application was used to capture data and derive both the mean stride time (ST) and stride time variability (STV, defined as the coefficient of variation about the mean stride time) of each trial. The dual-task costs (DTC) to each gait metric were obtained by calculating the percent change from single- to dual-task conditions. We categorized participants into five groups according to age (e.g. Group 1: 40-45 years; Group 5: 60-65 years). Age group did not have an effect on single-task gait outcomes (p&gt;0.51). However, the oldest age group, as compared to each of the other groups, exhibited greater DTC to both ST and STV (p&lt;0.03). These results indicate that dual-task walking performance in particular may begin to diminish in late middle age even in the absence of detectable cognitive issues, DTC may offer a sensitive metric to age-related change in cognitive function.

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