Dual task training in persons with Multiple Sclerosis: a feasability randomized controlled trial.

OBJECTIVE: To determine the feasibility of dual task training in persons with Multiple Sclerosis. DESIGN: Randomized, single-blinded controlled trial. SETTING: University research laboratory. PARTICIPANTS: A total of 234 individuals inquired about the investigation. After screening, 20 individuals with multiple sclerosis who self-reported problems with multitasking and were ambulatory volunteered for the investigation. 14 participants completed the post-assessment following the 12-week intervention. INTERVENTION: Participants were randomly assigned to either single task training program which focused on balance and walking function ( n=6) or dual task training program that incorporated cognitive tasks in balance and walking training ( n=8). MEASURES: Before and after the 12-week interventions participants underwent assessments of walking; dual task walking; balance (Berg Balance Scale and balance confidence) and cognition as indexed by the Brief International Cognitive Assessment for MS. RESULTS: There was an 8.5% recruitment rate, a 70% retention rate, and a 100% adherence rate. There was a trend for dual task gait speed to improve in the dual task training group following the intervention (Pre: task 1: 109.8±39, task 2: 104.2±34.1; Post: task 1:127.6±40.1, task 2: 122.8±37.4; P=0.14; η2 = 0.24). There was also a trend for the dual task training group (28.1) to have greater performance than the control group (24.7) on visuospatial memory ( P=0.10; η2= 0.23). There were no changes in cognitive performance during walking trials. CONCLUSIONS: The study procedures were found to be feasible and improvements should be made in recruitment efforts going forward. Further examination of dual task training programs in individuals with multiple sclerosis is warranted.

A systematic review of balance and fall risk assessments with mobile phone technology.

Falls are a major health concern for older adults. Preventative measures can help reduce the incidence and severity of falls. Methods for assessing balance and fall risk factors are necessary to effectively implement preventative measures. Research groups are currently developing mobile applications to enable seniors, caregivers, and clinicians to monitor balance and fall risk. The following systematic review assesses the current state of mobile health apps for testing balance as a fall risk factor. Thirteen studies were identified and included in the review and analyzed based on study design, population, sample size, measures of balance, main outcome measures, and evaluation of validity and reliability. All studies successfully tested their applications, but only 38% evaluated the validity, and 23% evaluated the reliability of their applications. Of those, all applications were found to accurately and reliably measure balance on select variables. Four of the 13 studies included special populations groups. Out of the 13 studies, 12 reported clinicians as their intended user and seven reported seniors as their intended user. Further research should examine the validity of mobile health applications as well as report on the application's usability.

Unplanned gait termination in individuals with multiple sclerosis.

Despite the pervasive nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine unplanned gait termination with and without cognitive distractors in individuals with MS compared to healthy controls. Thirty-one individuals with MS and 14 healthy controls completed a series of unplanned gait termination tasks over a pressure sensitive walkway under distracting and non-distracting conditions. Individuals with MS were further broken down into groups based on assistive device use: (no assistive device (MSnoAD) n=18; and assistive device (MSAD) n=13). Individuals with MS who walked with an assistive device (MSAD: 67.8±15.1cm/s) walked slower than individuals without an assistive device (MSnoAD: 110.4±32.3cm/s, p<0.01) and controls (120.0±30.0cm/s; p<0.01). There was a significant reduction in velocity in the cognitively distracting condition (93.4±32.1cm/s) compared to the normal condition [108.8±36.2cm/s; F(1,43)=3.4, p=0.04]. All participants took longer to stop during the distracting condition (1.7±0.6s) than the non-distracting condition (1.4±0.4s; U=673.0 p<0.01). After controlling for gait velocity, post-hoc analysis revealed the MSAD group took significantly longer to stop compared to the control group (p=0.05). Further research investigating the control of unplanned gait termination in MS is warranted.

The Relationship Between Balance Confidence and Cognitive Motor Interference in Individuals With Multiple Sclerosis.

Gait and cognitive impairments are compounded when performed simultaneously in individuals with multiple sclerosis (MS), and this is termed cognitive-motor interference (CMI). The authors examined whether CMI is related to balance confidence in individuals with MS. They hypothesized that individuals with low balance confidence would exhibit greater CMI possibly indicating a behavioral modification during dual task conditions. Thirty-four individuals with MS completed Activity-specific Balance Confidence (ABC) scale and a cognitive assessment as well as single and dual task walking trials at a comfortable pace. CMI was calculated as the percent change in walking velocity and cognitive task performance from single- to dual-task conditions and termed dual-task cost (DTC). A correlation analysis was performed to determine the relationships between DTCs of gait and cognitive performance and ABC scores. The correlation analysis revealed no significant association between ABC and DTC of walking velocity (p > .05). A significant relationship between balance confidence and DTCs of cognition was observed. The observed relationships suggest individuals with MS tend to alter their cognitive performance rather than manipulating their gait when confronted with a dual task. Overall, the findings partially support a behavioral explanation of CMI in individuals with MS.

Gait termination in individuals with multiple sclerosis.

Despite the ubiquitous nature of gait impairment in multiple sclerosis (MS), there is limited information concerning the control of gait termination in individuals with MS. The purpose of this investigation was to examine planned gait termination in individuals with MS and healthy controls with and without cognitive distractors. Individuals with MS and age matched controls completed a series of gait termination tasks over a pressure sensitive walkway under non-distracting and cognitively distracting conditions. As expected the MS group had a lower velocity (89.9±33.3 cm/s) than controls (142.8±22.4 cm/s) and there was a significant reduction in velocity in both groups under the cognitive distracting conditions (MS: 73.9±30.7 cm/s; control: 120.0±25.9 cm/s). Although individuals with MS walked slower, there was no difference between groups in the rate a participant failed to stop at the target (i.e. failure rate). Overall failure rate had a 10-fold increase in the cognitively distracting condition across groups. Individuals with MS were more unstable during termination. Future research examining the neuromuscular mechanisms contributing to gait termination is warranted.