Abstract

BackgroundMobility and cognitive impairments in Parkinson’s disease (PD) often coexist and are prognostic of adverse health events. Consequently, assessment and training that simultaneously address both gait function and cognition are important to consider in rehabilitation and promotion of healthy aging. For this purpose, a computer game-based rehabilitation treadmill platform (GRP) was developed for dual-task (DT) assessment and training.ObjectiveThe first objective was to establish the test-retest reliability of the GRP assessment protocol for DT gait, visuomotor and executive cognitive function in PD patients. The second objective was to examine the effect of task condition [single task (ST) vs. DT] and disease severity (stage 2 vs. stage 3) on gait, visuomotor and cognitive function.MethodsThirty individuals aged 55 to 70 years, diagnosed with PD; 15 each at Hoehn and Yahr scale stage 2 (PD-2) and 3 (PD-3) performed a series of computerized visuomotor and cognitive game tasks while sitting (ST) and during treadmill walking (DT). A treadmill instrumented with a pressure mat was used to record center of foot pressure and compute the average and coefficient of variation (COV) of step time, step length, and drift during 1-min, speed-controlled intervals. Visuomotor and cognitive game performance measures were quantified using custom software. Testing was conducted on two occasions, 1 week apart.ResultsWith few exceptions, the assessment protocol showed moderate to high intraclass correlation coefficient (ICC) values under both ST and DT conditions for the spatio-temporal gait measures (average and COV), as well as the visuomotor tracking and cognitive game performance measures. A significant decline in gait, visuomotor, and cognitive game performance measures was observed during DT compared to ST conditions, and in the PD-3 compared to PD-2 groups.ConclusionThe high to moderate ICC values along with the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable DT interference (DTI) effects over time. The use of interactive digital media provides a flexible method to produce and evaluate DTI for a wide range of executive cognitive activities. This also proves to be a sensitive tool for tracking disease progression.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03232996.

Highlights

  • Safe, independent community walking requires both mobility skills and cognitive flexibility to manage complex terrains, for navigation in busy environments, to identify and track relevant visual targets, reading, and for processing of what is being seen

  • The present study aims to establish the reliability of the game-based rehabilitation treadmill platform (GRP) assessment protocol in individuals with Parkinson’s disease (PD), and to examine the influence that visuospatial cognitive tasks have on gait performance in Hoehn and Yahr stage 2 (PD-2) vs. stage 3 (PD-3) patients

  • Paired student t-tests revealed no significant difference between test 1 and test 2 for any of the gait variables

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Summary

Introduction

Independent community walking requires both mobility skills and cognitive flexibility to manage complex terrains, for navigation in busy environments, to identify and track relevant visual targets, reading, and for processing of what is being seen. Mobility limitations (balance and gait impairments; Rochester et al, 2004; Kang et al, 2005) and decline in executive cognitive function (Olchik et al, 2017; Roheger et al, 2018) common to Parkinson’s disease (PD) often coexist (Plotnik et al, 2011; Schneider et al, 2015) and are prognostic of adverse health events, including falls (Mak et al, 2014; Paul et al, 2014). Assessment and training that simultaneously address both gait function and cognition are important to consider in rehabilitation and promotion of healthy aging. A computer game-based rehabilitation treadmill platform (GRP) was developed for dual-task (DT) assessment and training

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