Computerized Dual-Task Testing of Gait Visuomotor and Cognitive Functions in Parkinson's Disease: Test-Retest Reliability and Validity

Mayank Bhatt, Bhuvan Mahana, Ji Hyun Ko, Tiffany A Kolesar, Anuprita Kanitkar, Tony Szturm, Mayank Bhatt, Bhuvan Mahana, Ji Hyun Ko, Tiffany A Kolesar, Anuprita Kanitkar, Tony Szturm

Abstract

Background: Mobility 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.

Objective: The 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.

Methods: Thirty 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.

Results: With 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.

Conclusion: The 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 registration: www.ClinicalTrials.gov, identifier NCT03232996.

Keywords: Parkinson’s disease; cognitive performance; dual-task performance; intra-class correlation coefficient; spatiotemporal gait variables; treadmill walking.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Bhatt, Mahana, Ko, Kolesar, Kanitkar and Szturm.

Figures

FIGURE 1
FIGURE 1
Illustration of the treadmill platform and experimental set-up; (A) the motion mouse is shown attached to the head via a baseball cap. (D) Participant is walking on the instrumented treadmill while viewing a computer monitor. Head rotation (via motion mouse) is used to interact with the visuospatial cognitive task. (B,C) present snap shots of the VMT and VCG. (E) Presents synchronous plots of the target cursor motion and user movement trajectories (head rotation) for a typical VMT task. Maxima are the left most position and minima the right most position. (F) Presents the trajectory for one game movement response from target appearance to target disappearance. (G) Presents overlay trajectories of all game movement responses for one game session. Parts of Figure 1 have previously been published in Szturm et al. (2017, 2021).
FIGURE 2
FIGURE 2
Plots and values of group means and in brackets standard error of mean (SEM) for the gait variables by task condition and disease stage.
FIGURE 3
FIGURE 3
Plots and values of group means and in brackets standard error of mean (SEM) for the VMT and VCG outcome measures by task condition and disease stage.

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