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Kannan L, Pitts J, Szturm T, Purohit R, Bhatt T. Perturbation-based dual task assessment in older adults with mild cognitive impairment. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1384582. [PMID: 38813371 PMCID: PMC11133526 DOI: 10.3389/fresc.2024.1384582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
Background Dual tasking (i.e., concurrent performance of motor and cognitive task) is significantly impaired in older adults with mild cognitive impairment (OAwMCI) compared to cognitively intact older adults (CIOA) and has been associated with increased fall risk. Dual task studies have primarily examined volitionally driven events, and the effects of mild cognitive impairment on reactive balance control (i.e., the ability to recover from unexpected balance threats) are unexplored. We examined the effect of cognitive tasks on reactive balance control in OAwMCI compared to CIOA. Methods Adults >55 years were included and completed the Montreal Cognitive Assessment (MoCA) to categorize them as OAwMCI (MoCA: 18-24, n = 15) or CIOA (MoCA: ≥25, n = 15). Both OAwMCI [MoCA: 22.4 (2.2), 65.4 (6.1) years, 3 females] and CIOA [MoCA: 28.4 (1.3), 68.2 (5.5) years, 10 females] responded to large magnitude stance slip-like perturbations alone (single task) and while performing perceptual cognitive tasks targeting the visuomotor domain (target and tracking game). In these tasks, participants rotated their head horizontally to control a motion mouse and catch a falling target (target game) or track a moving object (track). Margin of stability (MOS) and fall outcome (harness load cell >30% body weight) were used to quantify reactive balance control. Cognitive performance was determined using performance error (target) and sum of errors (tracking). A 3 × 2 repeated measures ANOVA examined the effect of group and task on MOS, and generalized estimating equations (GEE) model was used to determine changes in fall outcome between groups and tasks. 2 × 2 repeated measures ANOVAs examined the effect of group and task on cognitive performance. Results Compared to CIOA, OAwMCI exhibited significantly deteriorated MOS and greater number of falls during both single task and dual task (p < 0.05), and lower dual task tracking performance (p < 0.01). Compared to single task, both OAwMCI and CIOA exhibited significantly deteriorated perceptual cognitive performance during dual task (p < 0.05); however, no change in MOS or fall outcome between single task and dual task was observed. Conclusion Cognitive impairment may diminish the ability to compensate and provide attentional resources demanded by sensory systems to integrate perturbation specific information, resulting in deteriorated ability to recover balance control among OAwMCI.
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Affiliation(s)
- Lakshmi Kannan
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Jessica Pitts
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Tony Szturm
- Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada
| | - Rudri Purohit
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, United States
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Honvo G, Sabico S, Veronese N, Bruyère O, Rizzoli R, Amuthavalli Thiyagarajan J, Mikton C, Diaz T, Cooper C, Reginster JY. Measures of attributes of locomotor capacity in older people: a systematic literature review following the COSMIN methodology. Age Ageing 2023; 52:iv44-iv66. [PMID: 37902521 PMCID: PMC10615073 DOI: 10.1093/ageing/afad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Locomotor capacity (LC) is an important domain of intrinsic capacity and key determinant of functional ability and well-being in older age. The United Nations Decade of Healthy Ageing (2021-2030) calls for strengthening data and research on healthy ageing, including the measurement of older persons' LC. To advance the measurement and monitoring of LC, there is pressing need to identify valid and reliable measures. OBJECTIVE To identify all the available tools that were validated for measurement of LC or of its specific attributes in older people and to assess the methodological quality of the studies and measurement properties of the tools. DESIGN Systematic review. SETTING Anywhere (Community-dwelling; long-term care facility; etc.). SUBJECTS Older people. METHODS We used highly sensitive search strategies to search the following databases: Medline, Embase, Scopus, CINAHL and PsycINFO. The study was conducted following the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of outcome measurement instruments. RESULTS A total of 125 studies were included, which assessed tools for balance (n = 84), muscle power (n = 12), muscle strength (n = 32, including four studies about tools for balance and muscle power) and endurance (n = 1). No studies on tools for muscle function, joint function, or locomotor capacity overall, were retrieved. We identified 69 clinician-report or objective assessment tools for balance, 30 for muscle strength, 12 for muscle power and 1 endurance assessment tool. The GRADE assessment of quality of evidence showed that only a few tools have high quality evidence for both sufficient validity and reliability: The Balance Evaluation Systems Test (BESTest), the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Berg Balance Scale (BBS) and the Timed Up and Go (TUG) test. CONCLUSIONS A few tools with high quality evidence for sufficient validity and reliability are currently available for balance assessment in older people that may be recommended for use in clinical and research settings. Further validation studies are required for muscle strength, muscle power and endurance assessment tools.
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Affiliation(s)
- Germain Honvo
- World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Shaun Sabico
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nicola Veronese
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Olivier Bruyère
- World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - René Rizzoli
- World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Christopher Mikton
- Demographic Change and Healthy Aging Unit, Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Epidemiology, Monitoring and Evaluation Unit, Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Cyrus Cooper
- World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Jean-Yves Reginster
- World Health Organization (WHO) Collaborating Center for Epidemiology of Musculoskeletal Health and Ageing, University of Liège, Liège, Belgium
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Thompson AC, Miller ME, Handing EP, Chen H, Hugenschmidt CE, Laurienti PJ, Kritchevsky SB. Examining the intersection of cognitive and physical function measures: Results from the brain networks and mobility (B-NET) study. Front Aging Neurosci 2023; 15:1090641. [PMID: 36819728 PMCID: PMC9932333 DOI: 10.3389/fnagi.2023.1090641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Background and objectives Although evidence exists that measures of mobility and cognition are correlated, it is not known to what extent they overlap, especially across various domains. This study aimed to investigate the intersection of 18 different objective cognitive and physical function measures from a sample of unimpaired adults aged 70 years and older. Research design and methods Canonical correlation analysis was utilized to explore the joint cross-sectional relationship between 13 cognitive and 6 physical function measures in the baseline visit of the Brain Networks and Mobility Function (B-NET) Study (n = 192). Results Mean age of participants was 76.4 years. Two synthetic functions were identified. Function 1 explained 26.3% of the shared variability between the cognition and physical function variables, whereas Function 2 explained 19.5%. Function 1 termed "cognitive and physical speed" related the expanded Short Physical Performance Battery (eSPPB), 400-m walk speed, and Dual Task gait speed measures of physical function to semantic fluency animals scores, Digit Symbol Coding (DSC), and Trail Making Test B. Function 2 termed "complex motor tasks and cognitive tasks" related the Force Plate Postural Sway Foam Task and Dual Task to the following cognitive variables: MoCA Adjusted Score, Verbal Fluency L words, Craft story immediate and delayed recall, and Trail Making Test B. Discussion and implications We identified groups of cognitive and physical functional abilities that were linked in cross-sectional analyses, which may suggest shared underlying neural network pathway(s) related to speed (Function 1) or complexity (Function 2). Translational significance Whether such neural processes decline before measurable functional losses or may be important targets for future interventions that aim to prevent disability also remains to be determined.
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Affiliation(s)
- Atalie C Thompson
- Department of Surgical Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Michael E Miller
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Elizabeth P Handing
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Haiying Chen
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Christina E Hugenschmidt
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Paul J Laurienti
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Stephen B Kritchevsky
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Szturm T, Parmar ST, Mehta K, Shetty DR, Kanitkar A, Eskicioglu R, Gaonkar N. Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:761. [PMID: 35161508 PMCID: PMC8838424 DOI: 10.3390/s22030761] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 05/16/2023]
Abstract
The objective of this exploratory randomized controlled trial (RCT) was to provide evidence for the feasibility and therapeutic value of a novel game-based dual-task balance exercise program in children with cerebral palsy (CP). Twenty children with CP were recruited and randomized into two groups: (a) the conventional balance training group (CG) and (b) the experimental group (XG), which received a game-based dual-task (DT) balance exercise program. Both groups received their respective therapy programs for 12 weeks at a frequency of three sessions per week. Semi-structured interviews with the parents and children and qualitative analysis were conducted to evaluate the children's experiences with the game-based exercise program. The quantitative analysis included (a) the Pediatric Balance Scale (PBS), (b) Gross Motor Function Measure-88 (GMFM-88), and (c) computerized measures of standing balance performance during various dual-task conditions. Compliance was 100% for all 20 participants. Four themes captured the range of each participant's experiences and opinions: (a) reasons for participation, (b) likes and dislikes with the technologies, (c) positive effects of the program, and (d) future expectations. Children in the XG demonstrated greater improvements in PBS, GMFM, and DT balance measures as compared to children in the CG. The findings demonstrate feasible trial procedures and acceptable DT-oriented training with a high compliance rate and positive outcomes. These findings support further research and development and progression to the next phase of a full-scale RCT to evaluate the clinical effectiveness of the game-based DT balance exercise program for children with CP.
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Affiliation(s)
- Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
| | | | - Kavisha Mehta
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
| | | | - Anuprita Kanitkar
- Department of Applied Health Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
| | - Rasit Eskicioglu
- Computer Sciences, University of Manitoba, Winnipeg, MB R3E0T6, Canada;
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Lubetzky AV, Coker E, Arie L, Aharoni MMH, Krasovsky T. Postural Control under Cognitive Load: Evidence of Increased Automaticity Revealed by Center-of-Pressure and Head Kinematics. J Mot Behav 2021; 54:466-479. [PMID: 34902292 DOI: 10.1080/00222895.2021.2013768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
How postural responses change with sensory perturbations while also performing a cognitive task is still debatable. This study investigated this question via comprehensive assessment of postural sway, head kinematics and their coupling. Twenty-three healthy young adults stood in tandem with eyes open or wearing the HTC Vive Head-Mounted Display (HMD) with a static or dynamic (i.e., movement in the anterior-posterior direction at 5 mm or 32 mm at 0.2 Hz) 3-wall stars display. On half of the trials, participants performed a cognitive serial subtraction task. Medio-lateral center-of-pressure (COP) path significantly increased with the cognitive task, particularly with dynamic visuals whereas medio-lateral variance decreased with the cognitive task. Head path and velocity significantly increased with the cognitive task in both directions while variance decreased. Head-COP cross-correlations ranged between 0.78 and 0.66. These findings, accompanied by frequency analysis, suggest that postural control switched to primarily relying on somatosensory input under challenging cognitive load conditions. Several differences between head and COP suggest that head kinematics contribute an important additional facet of postural control and the relationship between head and COP may depend on task and stance position. The potential of HMDs for clinical assessments of balance needs to be further explored.
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Affiliation(s)
- Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, New York, USA
| | - Elizabeth Coker
- Department of Dance, Tisch School of the Arts, New York University, New York, New York, USA
| | - Liraz Arie
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, New York, USA
| | - Moshe M H Aharoni
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tal Krasovsky
- Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
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6
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Parmar ST, Kanitkar A, Sepehri N, Bhairannawar S, Szturm T. Computer Game-Based Telerehabilitation Platform Targeting Manual Dexterity: Exercise Is Fun. "You Are Kidding-Right?". SENSORS (BASEL, SWITZERLAND) 2021; 21:5766. [PMID: 34502656 PMCID: PMC8434447 DOI: 10.3390/s21175766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
There is a need for innovation to improve the engagement and accessibility of rehabilitation programs for children and adults with upper extremity motor impairments due to neurodevelopmental disorders, acquired brain injuries, or spinal cord injuries. For this purpose, a computer game-based telerehabilitation platform (GTP) was developed to address this need. Through the application of a miniature inertial-based computer mouse and the wide variety of commercial computer games, the developed GTP can provide engaging task-specific exercises for the rehabilitation of manual dexterity (object handling and manipulation). A purpose-built repetitive task practice software (RTP) was also developed to gather event data and synchronize it with patient movements during gameplays. This provides automated monitoring and quantification of patients' motor skills, while they practice a range of game-based exercises with their hand and/or arm. The GTP would initially be used in a supervised clinical setting followed by a transition to function at home and be monitored by clinician specialists. Clinical support for home and rural communities, with protocols that can be easily updated, will help increase accessibility to targeted and personalized solutions for patients and achieve the desired training effect.
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Affiliation(s)
| | - Anuprita Kanitkar
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Nariman Sepehri
- Department of Mechanical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Satish Bhairannawar
- Department of Electronics and Communication Engineering, SDM College of Engineering and Technology, Dharwad 580009, Karnataka, India;
| | - Tony Szturm
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
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Psychometric Properties of Cognitive-Motor Dual-Task Studies With the Aim of Developing a Test Protocol for Persons With Vestibular Disorders: A Systematic Review. Ear Hear 2021; 41:3-16. [PMID: 31283530 DOI: 10.1097/aud.0000000000000748] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Patients suffering from vestibular disorders (VD) often present with impairments in cognitive domains such as visuospatial ability, memory, executive function, attention, and processing speed. These symptoms can be attributed to extensive vestibular projections throughout the cerebral cortex and subcortex on the one hand, and to increased cognitive-motor interference (CMI) on the other hand. CMI can be assessed by performing cognitive-motor dual-tasks (DTs). The existing literature on this topic is scarce and varies greatly when it comes to test protocol, type and degree of vestibular impairment, and outcome. To develop a reliable and sensitive test protocol for VD patients, an overview of the existing reliability and validity studies on DT paradigms will be given in a variety of populations, such as dementia, multiple sclerosis, Parkinson's disease, stroke, and elderly. DESIGN The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An extensive literature search on psychometric properties of cognitive-motor DTs was run on MEDLINE, Embase, and Cochrane Databases. The studies were assessed for eligibility by two independent researchers, and their methodological quality was subsequently evaluated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). RESULTS AND CONCLUSIONS Thirty-three studies were included in the current review. Based on the reliability and validity calculations, including a static as well as dynamic motor task seems valuable in a DT protocol for VD patients. To evoke CMI maximally in this population, both motor tasks should be performed while challenging the vestibular cognitive domains. Out of the large amount of cognitive tasks employed in DT studies, a clear selection for each of these domains, except for visuospatial abilities, could be made based on this review. The use of the suggested DTs will give a more accurate and daily life representation of cognitive and motor deficiencies and their interaction in the VD population.
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Nayak A, Alhasani R, Kanitkar A, Szturm T. Dual-Task Training Program for Older Adults: Blending Gait, Visuomotor and Cognitive Training. FRONTIERS IN NETWORK PHYSIOLOGY 2021; 1:736232. [PMID: 36925571 PMCID: PMC10013153 DOI: 10.3389/fnetp.2021.736232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022]
Abstract
Objective: Physical and cognitive impairments are common with aging and often coexist. Changes in the level of physical and mental activity are prognostic for adverse health events and falls. Dual-task (DT) training programs that can improve mobility and cognition simultaneously can bring significant improvements in rehabilitation. The objective of this mixed methods exploratory RCT was to provide evidence for the feasibility and therapeutic value of a novel game-assisted DT exercise program in older adults. Methods: Twenty-two community dwelling participants, between the ages of 70-85 were randomized to either dual-task treadmill walking (DT-TR) or dual-task recumbent bicycle (DT-RC). Both groups viewed a standard LED computer monitor and performed a range of cognitive game tasks while walking or cycling; made possible with the use of a "hands-free", miniature, inertial-based computer mouse. Participants performed their respective 1-h DT exercise program twice a week, for 12 weeks at a community fitness centre. Semi-structured interviews and qualitative analysis was conducted to evaluate the participant's experiences with the exercise program. Quantitative analysis included measures of standing balance, gait function (spatiotemporal gait variable), visuomotor and executive cognitive function, tested under single and DT walking conditions. Results: Compliance was 100% for all 22 participants. Four themes captured the range of participant's experiences and opinions: 1) reasons for participation, 2) difficulties with using the technologies, 3) engagement with the computer games, and 4) positive effects of the program. Both groups showed significant improvements in standing balance performance, visuomotor and visuospatial executive function. However, significant improvement in dual task gait function was observed only in the DT-TR group. Medium to large effect sizes were observed for most balance, spatiotemporal gait variables, and cognitive performance measure. Conclusion: With only minor difficulties with the technology being reported, the findings demonstrate feasible trial procedures and acceptable DT oriented training with a high compliance rate and positive outcomes. These findings support further research and development, and will direct the next phase of a full-scale RCT.
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Affiliation(s)
- Akshata Nayak
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rehab Alhasani
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Anuprita Kanitkar
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tony Szturm
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, MB, Canada
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Litz E, Ball C, Jansen CP, Werner C, de Bruin E, Hauer K. Validation of a Motor-Cognitive Assessment for a Stepping Exergame in Older Adults: Use of Game-Specific, Internal Data Stream. Games Health J 2019; 9:95-107. [PMID: 31651191 DOI: 10.1089/g4h.2019.0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To comprehensively validate an assessment tailored to an exergaming training program with motor-cognitive challenges. Materials and Methods: Fifty-eight cognitively intact, multimorbid, independently living older adults (mean age [standard deviation]: 78.3 [6.5] years) with moderate functional limitations participated in the study. For construct validity, Spearman's rank correlations (rs) between game parameters and established cognitive (Number-Connection-Test [Zahlen-Verbindungs-Test], Simple Response Time Task, Simon Task) and motor (Short Physical Performance Battery, Physiomat® balance tests) measures were calculated. Test-retest reliability was documented by intraclass correlation coefficients (ICCs), sensitivity to change by effect sizes using partial eta squared (ηp2), and feasibility by mean completion time and completion rates. Results: Good construct validity of the assessment was observed, with on average moderate-to-high correlations between game parameters and cognitive tests, measures of lower extremity function and dynamic balance (range of rs including extreme outliers = 0.00-0.70, P < 0.001-0.998). Test-retest reliability was good, with ICCs mostly ranging from moderate to high (ICCs = 0.37-0.93, P < 0.001-0.130), and sensitivity to change was excellent (ηp2 = 0.16-0.81, P < 0.001-0.044). Completion rates for the initial challenge levels were 100%, mean completion time 36.3 minutes, and no clinical events or safety problems were observed. Conclusion: Study results documented on average good validity, test-retest reliability and feasibility, with an extraordinary high responsiveness of the presented game-based assessment in older adults with moderate functional limitations. The innovative, data-based assessment validated in this study may serve as a blueprint for future, tailored assessments for exergaming.
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Affiliation(s)
- Elena Litz
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
| | - Caroline Ball
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
| | | | - Christian Werner
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany.,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Eling de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Geriatric Centre of Heidelberg University, Heidelberg, Germany
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Ahmadi S, Wu C, Sepehri N, Kantikar A, Nankar M, Szturm T. The Effects of Aging and Dual Tasking on Human Gait Complexity During Treadmill Walking: A Comparative Study Using Quantized Dynamical Entropy and Sample Entropy. J Biomech Eng 2018; 140:2654974. [PMID: 28975279 DOI: 10.1115/1.4037945] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 11/08/2022]
Abstract
Quantized dynamical entropy (QDE) has recently been proposed as a new measure to quantify the complexity of dynamical systems with the purpose of offering a better computational efficiency. This paper further investigates the viability of this method using five different human gait signals. These signals are recorded while normal walking and while performing secondary tasks among two age groups (young and older age groups). The results are compared with the outcomes of previously established sample entropy (SampEn) measure for the same signals. We also study how analyzing segmented and spatially and temporally normalized signal differs from analyzing whole data. Our findings show that human gait signals become more complex as people age and while they are cognitively loaded. Center of pressure (COP) displacement in mediolateral direction is the best signal for showing the gait changes. Moreover, the results suggest that by segmenting data, more information about intrastride dynamical features are obtained. Most importantly, QDE is shown to be a reliable measure for human gait complexity analysis.
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Affiliation(s)
- Samira Ahmadi
- Department of Mechanical Engineering, University of Manitoba, Room E1-451 EITC, 15 Gillson Street, Winnipeg, MB R3T 5V6, Canada e-mail:
| | - Christine Wu
- Fellow ASME Department of Mechanical Engineering, University of Manitoba, Room E2-327 Engineering Information and Technology Complex, 75A Chancellors Circle, Winnipeg, MB R3T 5V6, Canada e-mail:
| | - Nariman Sepehri
- Fellow ASME Department of Mechanical Engineering, University of Manitoba, Room E2-327 Engineering Information and Technology Complex, 75A Chancellors Circle, Winnipeg, MB R3T 5V6, Canada e-mail:
| | - Anuprita Kantikar
- College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada e-mail:
| | - Mayur Nankar
- College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada e-mail:
| | - Tony Szturm
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, R106-771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada e-mail:
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11
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Nankar M, Szturm T, Marotta J, Shay B, Beauchet O, Allali G. The interacting effects of treadmill walking and different types of visuospatial cognitive task: Discriminating dual task and age effects. Arch Gerontol Geriatr 2017; 73:50-59. [PMID: 28778023 DOI: 10.1016/j.archger.2017.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/08/2017] [Accepted: 07/20/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study is to examine the influence that visuospatial cognitive tasks have on gait function during DT treadmill walking, and as a function of age. Conversely, to examine the influence that walking has on executive functions involving visuospatial processing. METHODS Twenty-five young (26±6.1years) and 25 older adults (76±3.9) performed different types of computerized visuomotor (VM) tracking and visuospatial cognitive tasks (VCG) while standing and treadmill walking. Spatiotemporal gait variables, average values and co-efficient of variation (COV) were obtained from 40 consecutive steps during single- and dual-task walk trials. Performance-based measures of the VM and VCG task were obtained during standing and walking. RESULTS VM dual-task walking had a significant effect on gait measures in the young age group (YG), but no DT effect was observed in the old age group (OG). Visuomotor tracking performance, however, was significantly reduced in the OG as compared to the YG when tested in both standing and walking. The opposite was true for VCG; a significant DT effect on gait performance was observed in the OG, but no DT effect was observed in the YG. Success rate of the VCG task decreased during walking, but only for OG. CONCLUSION Controlling gait speed and objective evaluation of the visuospatial cognitive tasks helps to determine the level of engagement in the DT tasks. This is important in order to determine the strategies used during the DT test protocols, i.e. cross-domain interference.
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Affiliation(s)
- Mayur Nankar
- College of Rehabilitation Sciences, University of Manitoba, Canada.
| | - Tony Szturm
- College of Rehabilitation Sciences, University of Manitoba, Canada.
| | - Jonathan Marotta
- Department of Psychology, Faculty of Arts, University of Manitoba, Canada.
| | - Barbara Shay
- College of Rehabilitation Sciences, University of Manitoba, Canada.
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
| | - Gilles Allali
- Department of Neurology, Geneva University Hospital and University of Geneva, Switzerland.
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Lemke NC, Wiloth S, Werner C, Hauer K. Validity, test-retest reliability, sensitivity to change and feasibility of motor-cognitive dual task assessments in patients with dementia. Arch Gerontol Geriatr 2017; 70:169-179. [DOI: 10.1016/j.archger.2017.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
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Paquet N, Jehu DA, Lajoie Y. Age-related differences in Fukuda stepping and Babinski-Weil tests, within-day variability and test-retest reliability. Aging Clin Exp Res 2017; 29:223-230. [PMID: 26914486 DOI: 10.1007/s40520-016-0544-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Fukuda stepping and Babinski-Weil tests are associated with unperceived body rotation and linear displacements in young adults, but performance in older adults on these two tests has yet to be determined. AIM The main purpose was to compare the performance and reliability of the Fukuda stepping and Babinski-Weil tests in young and older adults. METHODS Fifty older and 50 young adults executed three trials of each test on day 1 (test) and day 2 (retest). Lateral and longitudinal displacements and body rotation relative to the starting position were measured. Means and standard deviations (SD) were compared between the two groups with Mann-Whitney tests. Test-retest reliability was assessed with intra-class correlation coefficients (ICC). Foot preference was determined from the score on the Waterloo Footedness Questionnaire and correlated with test scores. RESULTS Lateral and longitudinal displacements were significantly larger in older than young participants on the Fukuda stepping test (p < .01) and significantly smaller on the Babinski-Weil test (p < .001). Older participants displayed a significantly smaller SD on the three Babinski-Weil test trials (p < .001). Displacement and rotation measures ICC ranged between 0.25 and 0.77 in older and between 0.58 and 0.80 in young participants. Foot preference correlated with rotation on the Fukuda stepping test in young (p < .05), but not in older participants (p > .05). DISCUSSION AND CONCLUSION Linear displacements, but not body rotation, were different between older and young adults. There was no clear age-related differences in test-retest reliability, but the moderate reliability indicates that performance can vary from day to day in both age groups.
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Affiliation(s)
- Nicole Paquet
- School of Human Kinetics, University of Ottawa, 125, University Avenue, Ottawa, ON, K1N 6N5, Canada.
- School of Rehabilitation Sciences, University of Ottawa, 451 Smyth road, Ottawa, ON, K1H 8M5, Canada.
| | - Deborah A Jehu
- School of Human Kinetics, University of Ottawa, 125, University Avenue, Ottawa, ON, K1N 6N5, Canada
| | - Yves Lajoie
- School of Human Kinetics, University of Ottawa, 125, University Avenue, Ottawa, ON, K1N 6N5, Canada
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Szturm TJ, Sakhalkar VS, Kanitkar A, Nankar M. Computerized Dual-Task Testing of Gait and Visuospatial Cognitive Functions; Test-Retest Reliability and Validity. Front Hum Neurosci 2017; 11:105. [PMID: 28367119 PMCID: PMC5355418 DOI: 10.3389/fnhum.2017.00105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
The common occurrence of age decline in mobility and cognition does cause a decrease in the level of physical activity and an increased falls risk. Consequently, dual -task (DT) assessment that simultaneously addresses both mobility skills and cognitive functions are important because, continued difficulties and fall injuries will have a sizable impact in this population. The first objective of the present study was to assess test-retest reliability of a computerized DT treadmill walking protocol and concurrent outcome measures of gait and visuospatial executive function in a group of healthy older adults. Secondly, discriminative validity was evaluated by examining the effect of DT conditions (single task vs. dual-task) on; (a) spatiotemporal gait measures (average and coefficient of variation) and (b) visuomotor and visuospatial executive performance measures. Twenty-five community-dwelling individuals median age 65 (range 61-67) were recruited from a Fitness Facility. Participants performed a computerized visuomotor tracking task and a visuospatial executive game task in standing and while treadmill walking. Testing was conducted on two occasions, 1 week apart. Moderate to high test-retest reliability (ICC values of 0.65-0.88) were observed for spatiotemporal gait variables. No significant differences between the group means were observed between test periods in any gait variable. Moderate test-retest reliability (ICC values of 0.6-0.65) was observed for measures of visuomotor and visuospatial executive performance during treadmill walking. Significant DT effects were observed for both spatiotemporal gait variables and visuospatial executive performance measures. This study demonstrates the reliability and reproducibility of the computer-based assessment tool for dual task treadmill walking. The high to moderate ICC values and the lack of systematic errors in the measures indicate that this tool has the ability to repeatedly record reliable data from community-dwelling older adults. The present computerized dual-task protocols broaden the types of standardized visuomotor and visuospatial executive activities for use with DT treadmill walking that has previously been reported.
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Affiliation(s)
- Tony J Szturm
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Department of Physical Therapy, University of ManitobaWinnipeg, MB, Canada
| | - Vedant S Sakhalkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; School of Medical Rehabilitation, University of ManitobaWinnipeg, MB, Canada
| | - Anuprita Kanitkar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of ManitobaWinnipeg, MB, Canada; Applied Health Sciences, University of ManitobaWinnipeg, MB, Canada
| | - Mayur Nankar
- Mobility and Cognition Lab, College of Rehabilitation Sciences, University of Manitoba Winnipeg, MB, Canada
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15
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Kurapati NT, Krzak JJ, Graf A, Hassani S, Tarima S, Sturm PF, Hammerberg K, Gupta P, Harris GF. Effect of Surgical Fusion on Volitional Weight-Shifting in Individuals With Adolescent Idiopathic Scoliosis. Spine Deform 2016; 4:432-438. [PMID: 27927573 DOI: 10.1016/j.jspd.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 06/22/2016] [Accepted: 08/03/2016] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Prospective. OBJECTIVES The goals of this study were to (1) evaluate the differences in weightbearing symmetry between individuals with adolescent idiopathic scoliosis (AIS) and typically developing controls; (2) observe the effect of posterior spinal fusion and instrumentation (PSFI) on volitional weight-shifting at 1 and 2 years postoperatively; and (3) evaluate whether lowest instrumented fusion level (ie, lowest instrumented vertebra [LIV]) in PSFI has an effect on volitional weight-shifting. SUMMARY OF BACKGROUND DATA Previous studies have conflicting findings with regard to the effect of scoliosis on postural control tasks as well as the effect of surgery. They have also noted an inconsistent effect of PSFI at different LIVs, with more distal LIVs exhibiting greater reductions in postoperative range of motion. METHODS The study was designed with an AIS group of 41 patients (8 males and 33 females) with AIS who underwent PSFI, along with a Control Group of 24 age-matched typically developing participants (12 male and 12 female). Both groups performed postural control tasks (static balance and volitional weight-shifting), with the AIS group repeating the tasks at 1 and 2 years postoperatively. RESULTS At baseline, the AIS group showed increased weightbearing asymmetry than the Control Group (p = .01). The AIS group showed improvements in volitional weight-shifting at 2 years over baseline (p < .01). There was no effect of LIV on volitional weight-shifting by the second postoperative year. CONCLUSIONS Individuals with AIS have greater weightbearing asymmetry but improved volitional weight-shifting over typically developing controls. PSFI improves volitional weight-shifting beyond preoperative baseline but does not differ significantly by LIV.
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Affiliation(s)
- Nikhil T Kurapati
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA; College of Engineering, Marquette University, Milwaukee, WI, USA; Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA.
| | - Joseph J Krzak
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA; Physical Therapy Program, College of Health Sciences, Midwestern University, Downers Grove, IL, USA
| | - Adam Graf
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Sahar Hassani
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Sergey Tarima
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Peter F Sturm
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA; Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kim Hammerberg
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Purnendu Gupta
- Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
| | - Gerald F Harris
- College of Engineering, Marquette University, Milwaukee, WI, USA; Motion Analysis Laboratory, Shriners Hospital for Children, Chicago, IL, USA
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Test-Retest Reliability of Dual-Task Outcome Measures in People With Parkinson Disease. Phys Ther 2016; 96:1276-86. [PMID: 26847010 DOI: 10.2522/ptj.20150244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Dual-task (DT) training is gaining ground as a physical therapy intervention in people with Parkinson disease (PD). Future studies evaluating the effect of such interventions need reliable outcome measures. To date, the test-retest reliability of DT measures in patients with PD remains largely unknown. OBJECTIVE The purpose of this study was to assess the reliability of DT outcome measures in patients with PD. DESIGN A repeated-measures design was used. METHODS Patients with PD ("on" medication, Mini-Mental State Examination score ≥24) performed 2 cognitive tasks (ie, backward digit span task and auditory Stroop task) and 1 functional task (ie, mobile phone task) in combination with walking. Tasks were assessed at 2 time points (same hour) with an interval of 6 weeks. Test-retest reliability was assessed for gait while performing each secondary task (DT gait) for both cognitive tasks while walking (DT cognitive) and for the functional task while walking (DT functional). RESULTS Sixty-two patients with PD (age=39-89 years, Hoehn and Yahr stages II-III) were included in the study. Intraclass correlation coefficients (ICCs) showed excellent reliability for DT gait measures, ranging between .86 and .95 when combined with the digit span task, between .86 and .95 when combined with the auditory Stroop task, and between .72 and .90 when combined with the mobile phone task. The standard error of measurements for DT gait speed varied between 0.06 and 0.08 m/s, leading to minimal detectable changes between 0.16 and 0.22 m/s. With regard to DT cognitive measures, reaction times showed good-to-excellent reliability (digit span task: ICC=.75; auditory Stroop task: ICC=.82). LIMITATIONS The results cannot be generalized to patients with advanced disease or to other DT measures. CONCLUSIONS In people with PD, DT measures proved to be reliable for use in clinical studies and look promising for use in clinical practice to assess improvements after DT training. Large effects, however, are needed to obtain meaningful effect sizes.
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Wiloth S, Lemke N, Werner C, Hauer K. Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia. JMIR Serious Games 2016; 4:e12. [PMID: 27432746 PMCID: PMC4969551 DOI: 10.2196/games.5696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. OBJECTIVE Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test-retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7±5.9). METHODS Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman's rank correlations (rs). For test-retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. RESULTS Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=-.22 to .68, P ≤.001-.03), moderate (rs=-.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=-.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test-retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. CONCLUSIONS Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game.
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Affiliation(s)
- Stefanie Wiloth
- AGAPLESION Bethanien Hospital, Geriatric Centre of the University of Heidelberg, Heidelberg, Germany.
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Szturm T, Hochman J, Wu C, Lisa L, Reimer K, Wonneck B, Giacobbo A. Games and Telerehabilitation for Balance Impairments and Gaze Dysfunction: Protocol of a Randomized Controlled Trial. JMIR Res Protoc 2015; 4:e118. [PMID: 26490109 PMCID: PMC4704916 DOI: 10.2196/resprot.4743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital media and gaming have received considerable interest from researchers and clinicians as a model for learning a broad range of complex tasks and facilitating the transfer of skills to daily life. These emerging rehabilitation technologies have the potential to improve clinical outcomes and patient participation because they are engaging, motivating, and accessible. Our research goal is to develop preventative and therapeutic point-of-care eHealth applications that will lead to equivalent or better long-term health outcomes and health care costs than existing programs. We have produced a novel computer-aided tele-rehabilitation platform that combines computer game-based exercises with tele-monitoring. OBJECTIVE Compare the therapeutic effectiveness of an in-home, game-based rehabilitation program (GRP) to standard care delivered in an outpatient physical therapy clinic on measures of balance, gaze control, dizziness, and health-related quality of life. METHODS A randomized, controlled, single-blind pilot trial will be conducted. Fifty-six participants with a diagnosis of peripheral vestibular disorder will be randomly assigned to either usual physical therapy (comparator group) or to a game-based intervention (experimental group). Measures to be assessed will include gaze control, dynamic balance, and self-reported measures of dizziness. RESULTS The project was funded and enrollment was started in August 2014. To date, 36 participants have been enrolled. There have been 6 drop-outs. It is expected that the study will be completed January 2016 and the first results are expected to be submitted for publication in Spring of 2016. CONCLUSIONS A successful application of this rehabilitation program would help streamline rehabilitation services, leverage therapist time spent with clients, and permit regular practice times at the client's convenience. TRIAL REGISTRATION Clinicaltrials.gov: NCT02134444; https://clinicaltrials.gov/ct2/show/NCT02134444 (Archived by WebCite at http://www.webcitation.org/6cE18bqqY).
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Affiliation(s)
- Tony Szturm
- College of Rehabilitation Sciences, Department of Physical Therapy, University of Manitoba, Winnipeg, MB, Canada.
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