Abstract
The aim was to compare the effectiveness of dual-task training (DTT) compared to single mobility training (SMT) on dual-task walking, mobility and cognition, in persons with Multiple Sclerosis (pwMS). Forty pwMS were randomly assigned to the DTT or SMT groups. The DTT-group performed dual-task exercises using an interactive tablet-based application, while the SMT-group received conventional walking and balance exercises. Both interventions were supervised and identical in weeks (8) and sessions (20). Nine cognitive-motor dual-task conditions were assessed at baseline, after intervention and at 4-weeks follow-up (FU). The dual-task cost (DTC), percentage change of dual-task performance compared to single-task performance, was the primary outcome. Mobility and cognition were secondarily assessed. Mixed model analyses were done with group, time and the interaction between group and time as fixed factors and participants as random factors. Significant time by group interactions were found for the digit-span walk and subtraction walk dual-task conditions, with a reduction in DTC (gait speed) for the DTT maintained at FU. Further, absolute dual-task gait speed during walking over obstacles only improved after the DTT. Significant improvements were found for both groups in various motor and cognitive measures. However, the DTT led to better dual-task walking compared to the SMT.
Highlights
Multiple sclerosis (MS) is characterized by both motor and cognitive impairments with a prevalence above 40% in both domains [1,2,3,4,5]
This cognitive-motor interference (CMI) is often quantified by the dual task cost (DTC), which is the percentage of change in dual task performance relative to single-task performance [6]
Participants generally enjoyed the training (IMI interest/enjoyment; dual task training (DTT): 27.3 ± 5.4, single mobility training (SMT): 27.5 ± 5.8), felt competent (IMI perceived competence; DTT: 26.1 ± 5.1, SMT: 28.2 ± 4.0) and felt it was valuable (IMI value/usefulness; DTT: 30.5 ± 9.2, SMT: 34.6 ± 6.6), without feelings of pressure (IMI pressure/tension; DTT: 9.4 ± 4.8, SMT: 11.3 ± 6.0). They felt to some extent that the training was important and that they had a choice in performing the exercises and training (IMI effort/importance; DTT: 23.8 ± 7.6, SMT: 25.5 ± 7.0; Intrinsic Motivation Inventory (IMI) perceived choice; DTT: 19.6 ± 6.4, SMT: 20.1 ± 5.3)
Summary
Multiple sclerosis (MS) is characterized by both motor and cognitive impairments with a prevalence above 40% in both domains [1,2,3,4,5]. These impairments negatively impact quality of life. In people with MS (pwMS), the combination of walking and a cognitive task often leads to reduced performance in one or both tasks, called cognitive-motor interference (CMI) [6,7,8]. Difficulties with cognitive-motor dual tasking have been related to higher risks of falls and lower quality of life in MS [9,10], this highlights the importance for rehabilitation strategies targeting CMI
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