CMI in Persons with MS


Lead: University of Hasselt, REVAL, Belgium (P. Feys & I. Baert)

Participants: Masku Neurological Rehabilitation Centre, Finland); FISM Scientific Research, AISM, Italy; Sheba medical Center, Tel-hashomer, Israel; National Multiple Sclerosis Center Melsbroek, Belgium; Rehabilitation and Multiple Sclerosis centre Overpelt, Belgium; AZ Klina, campus De Mick, rehabilitation, Brasschaat, Belgium; Centre Hospitalier Universitaire de Liège; Belgium MS society Flanders, Belgium (Flemish partners in collaboration with MS Society Flanders)

This is a development & research project on cognitive-motor dual task assessment and training with multiple partners. An interactive, adaptive technology tool with therapist interface for supported assessment and dual task training methodology has been developed in 2016 within a multi-disciplinary team consisting of physical and occupational therapists, neuropsychologists and medical doctors in interaction with engineers of UHasselt (EDM/IMO) & PXL in Flanders. In total, 81 patients participated in the study, of which 40 in the interventional part. Results will be analyzed and will be shared within the RIMS network including special interest groups in the second half of 2019.

Dual tasking (DT), doing two things at once, such as walking while talking on the phone or while reading off a shopping list is very frequently required in everyday life. Cognitive-motor interference (CMI) occurs when the performance on a motor or cognitive task decreases when both are performed simultaneously (dual task) compared to single task execution, being the so-called dual task cost (DTC). This CMI is greater in elderly and patients with neurological conditions compared to healthy persons, impeding daily life functioning. Problematic cognitive-motor DT has been related to unemployment and fall risk. Walking dysfunction and cognitive impairment are very prevalent in persons with MS (pwMS), already starting in an early disease phase. Moreover, even in patients without clinically evident motor or cognitive impairment, “invisible disability” may arise during multi-tasking performances. Therefore, this study focuses on the assessment of CMI and effectiveness of integrated dual task versus singular motor task training. The goal of the study is to enhance current rehabilitation treatment content, in order to improve daily life mobility and related quality of life of pwMS.

In total, 34 pwMS and 31 age-gender matched healthy controls participated in the CMI assessment study and 47 pwMS participated in the dual task training study of which 40 completed the intervention. Data will be used to investigate the magnitude of the DTC according to different types of cognitive distractors (information processing, memory, attention, etc.) and its association with factors as severity of cognitive or motor dysfunction, fatigue and quality of life. Test-retest reliability has already been examined for the various cognitive-motor dual tasks used in this study and is currently under revision by a top rehabilitation journal. In general, reliability of the motor DTC was good (ranging from moderate to excellent), while that of the cognitive DTC was poor. Further, 40 pwMS completed the training program in either the dual task or single motor task training group. The dual task training program performed with the developed technology tool using a tablet and headset (see figures below) has shown to be feasible in pwMS. A paper describing the design and development of the CMI-APP is currently being written. Next to that, reactions of pwMS and therapists on the dual task training were in general positive. Participants perceived it as useful, challenging, interesting and fun. It is hypothesized that effects on DT will be greatest after integrated training. Analyses will allow identifying which patient profiles responds best. The training program will be ameliorated and the goal is to deliver a protocol that provides stimuli to perform cognitive tasks during walking or during other forms of physical activity, in a therapist setting or at home.

Examples of assessment and training tools.

cmi training

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