Cognitive-motor Interference in Persons With MS
Condition: Multiple Sclerosis
MeSH terms: Multiple Sclerosis
Study type: Interventional

Summary: 
      Dual tasking such as walking while talking on the phone or while remembering a shopping list
      is very frequently required in everyday life. Cognitive-motor interference occurs when the
      performance capacity of 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). Over the past five years, in MS, (pilot) studies have been conducted in order to
      investigate the presence and magnitude of the CMI during walking. It was shown that, even in
      the early stages of the disease, when walking speed is not affected as a single motor task,
      pwMS slow down more than healthy controls when performing DT walking. Studies have not yet
      investigated the impact of the complexity of the motor task, on the DTC. Across studies, many
      different types of cognitive distractors were applied without any documentation of
      psychometric properties, such as test-retest reliability, making it not yet suited as
      experimental outcome measure. Results have also focused on the effects of DT on walking
      performance, while the performance of the cognitive task was rarely assessed. Also, the
      majority of studies did not document the cognitive function level of pwMS or even excluded
      patients with cognitive deficits. As such, the relation between cognitive deficits and dual
      task (cognitive-motor) performance is unclear.

      Motor and cognitive impairment are currently also treated separately whereas real life
      performance very often requiring an integrated motor and cognitive function. So far, no
      studies in MS have investigated the effects of physical or cognitive exercises on DT
      performances, or investigated effects of integrated cognitive-motor dual task training (DTT).
      In elderly and other neurological conditions, superior effects of dual task training (DTT) on
      gait training have been suggested, but the evidence is not robust yet. All these studies
      suggest the feasibility of DTT on gait improvement and fall risk reduction, but further
      insights on factors identifying responders, and differential effect of cognitive distractors
      needs further elucidation.

      This research consist of two parts that aim to investigate:

      Part 1: Assessment

        1. the magnitude of the dual task cost according to different types of cognitive
           distractors (information processing, memory, attention, etc.),

        2. its reliability as experimental outcome measure and

        3. its association with factors as severity of cognitive or motor dysfunction, quality of
           life and fatigue.

      Part 2: Intervention

        1. the effectiveness of cognitive-motor DT-based training programs compared to single
           modality training, on DT and ST performances (cognition and mobility)

        2. whether dual task learning effects transfer to improvements in daily life and are
           sustained for 4 weeks without training

        3. which patient profiles benefit most from the integrated cognitive-motor training

        4. feasibility and usefulness of an adaptive, interactive ICT-guided DTT system.
    


Intervention name(s): Dual Task Training; Single Mobility Training
Intervention type(s): Behavioral; Other
Intervention description(s): In total 12 Dual Task conditions will be performed in which 3 cognitive tasks are combined with 4 motor tasks:
Cognitive tasks:
Titrated digit span backwards
Auditory vigilance with alphabets
Subtracting by 7
Motor tasks:
Walking at self-selected speed
Walking while carrying a cup of water
Walking while stepping over obstacles
Walking crisscross; standard routine training
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment