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Winesett SP, Chatterjee SA, Borgia B, Cox BA, Hawkins KA, Miles JW, Swanson CW, Choi JT, Seidler RD, Fox EJ, Clark DJ. Visuospatial cognition predicts performance on an obstructed vision obstacle walking task in older adults. Exp Gerontol 2024; 189:112403. [PMID: 38490285 DOI: 10.1016/j.exger.2024.112403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
Walking performance and cognitive function demonstrate strong associations in older adults, with both declining with advancing age. Walking requires the use of cognitive resources, particularly in complex environments like stepping over obstacles. A commonly implemented approach for measuring the cognitive control of walking is a dual-task walking assessment, in which walking is combined with a second task. However, dual-task assessments have shortcomings, including issues with scaling the task difficulty and controlling for task prioritization. Here we present a new assessment designed to be less susceptible to these shortcomings while still challenging cognitive control of walking: the Obstructed Vision Obstacle (OBVIO) task. During the task, participants hold a lightweight tray at waist level obstructing their view of upcoming foam blocks, which are intermittently spaced along a 10 m walkway. This forces the participants to use cognitive resources (e.g., attention and working memory) to remember the exact placement of upcoming obstacles to facilitate successful crossing. The results demonstrate that adding the obstructed vision board significantly slowed walking speed by an average of 0.26 m/s and increased the number of obstacle strikes by 8-fold in healthy older adults (n = 74). Additionally, OBVIO walking performance (a score based on both speed and number of obstacle strikes) significantly correlated with computer-based assessments of visuospatial working memory, attention, and verbal working memory. These results provide initial support that the OBVIO task is a feasible walking test that demands cognitive resources. This study lays the groundwork for using the OBVIO task in future assessment and intervention studies.
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Affiliation(s)
- Steven P Winesett
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA.
| | - Sudeshna A Chatterjee
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, USA
| | - Brianne Borgia
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Neurology, University of Florida, Gainesville, FL, USA; Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Brigette A Cox
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Kelly A Hawkins
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jon W Miles
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Clayton W Swanson
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Julia T Choi
- Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Rachael D Seidler
- Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brooks Rehabilitation, Jacksonville, FL, USA
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Neurology, University of Florida, Gainesville, FL, USA
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Sood P, Chatterjee SA, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ, Clark DJ. Somatosensory impairment of the feet is associated with higher activation of prefrontal cortex during walking in older adults. Exp Gerontol 2022; 165:111845. [PMID: 35644417 PMCID: PMC9892701 DOI: 10.1016/j.exger.2022.111845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/18/2021] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over-activation of prefrontal cortex during walking has been reported in older adults versus young adults. Heighted activity in prefrontal cortex suggests a shift toward an executive control strategy to control walking. A potential contributing factor is degraded functioning of pattern-generating locomotor circuits in the central nervous system that are important to walking coordination. Somatosensory information is a crucial input to these circuits, so age-related impairment of somatosensation would be expected to compromise the neural control of walking. The present study tested the hypothesis that poorer somatosensation in the feet of older adults will be associated with greater recruitment of the prefrontal cortex during walking. This study also examines the extent to which somatosensory function and prefrontal activity are associated with performance on walking and balance assessments. METHODS Forty seven older adults (age 74.6 ± 6.8 years; 32 female) participated in walking assessments (typical walking and obstacle negotiation) and Berg Balance Test. During walking, prefrontal activity was measured with functional near infrared spectroscopy (fNIRS). Participants also underwent somatosensory testing with Semmes-Weinstein monofilaments. RESULTS The primary findings is that worse somatosensory monofilament level was associated with greater prefrontal cortical activity during typical walking (r = 0.38, p = 0.008) and obstacle negotiation (r = 0.40, p = 0.006). For the obstacle negotiation task, greater prefrontal activity was associated with faster walking speed (p = 0.004). Poorer somatosensation was associated with slower typical walking speed (p = 0.07) and obstacles walking speed (p < 0.001), as well as poorer balance scores (p = 0.03). CONCLUSIONS The study findings are consistent with a compensation strategy of recruiting prefrontal/executive control resources to overcome loss of somatosensory input to the central nervous system. Future research should further establish the mechanisms by which somatosensory impairments are linked to the neural control and performance of walking tasks, as well as develop intervention approaches.
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Affiliation(s)
- Pallavi Sood
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jared W. Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Paige E. Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Ronald A. Cohen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Dorian K. Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Adam J. Woods
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David J. Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
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Chatterjee SA, Seidler RD, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ, Clark DJ. Effects of Prefrontal Transcranial Direct Current Stimulation on Retention of Performance Gains on an Obstacle Negotiation Task in Older Adults. Neuromodulation 2022:S1094-7159(22)00561-X. [DOI: 10.1016/j.neurom.2022.02.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
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Clark DJ, Rose DK, Butera KA, Hoisington B, DeMark L, Chatterjee SA, Hawkins KA, Otzel DM, Skinner JW, Christou EA, Wu SS, Fox EJ. Rehabilitation with accurate adaptability walking tasks or steady state walking: A randomized clinical trial in adults post-stroke. Clin Rehabil 2021; 35:1196-1206. [PMID: 33722075 PMCID: PMC10416755 DOI: 10.1177/02692155211001682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess changes in walking function and walking-related prefrontal cortical activity following two post-stroke rehabilitation interventions: an accurate adaptability (ACC) walking intervention and a steady state (SS) walking intervention. DESIGN Randomized, single blind, parallel group clinical trial. SETTING Hospital research setting. SUBJECTS Adults with chronic post-stroke hemiparesis and walking deficits. INTERVENTIONS ACC emphasized stepping accuracy and walking adaptability, while SS emphasized steady state, symmetrical stepping. Both included 36 sessions led by a licensed physical therapist. ACC walking tasks recruit cortical regions that increase corticospinal tract activation, while SS walking activates the corticospinal tract less intensely. MAIN MEASURES The primary functional outcome measure was preferred steady state walking speed. Prefrontal brain activity during walking was measured with functional near infrared spectroscopy to assess executive control demands. Assessments were conducted at baseline, post-intervention (three months), and follow-up (six months). RESULTS Thirty-eight participants were randomized to the study interventions (mean age 59.6 ± 9.1 years; mean months post-stroke 18.0 ± 10.5). Preferred walking speed increased from baseline to post-intervention by 0.13 ± 0.11 m/s in the ACC group and by 0.14 ± 0.13 m/s in the SS group. The Time × Group interaction was not statistically significant (P = 0.86). Prefrontal fNIRS during walking decreased from baseline to post-intervention, with a marginally larger effect in the ACC group (P = 0.05). CONCLUSIONS The ACC and SS interventions produced similar changes in walking function. fNIRS suggested a potential benefit of ACC training for reducing demand on prefrontal (executive) resources during walking.
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Affiliation(s)
- David J. Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - Dorian K. Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Katie A. Butera
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Brooke Hoisington
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Louis DeMark
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Kelly A. Hawkins
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Dana M. Otzel
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
| | - Jared W. Skinner
- VA Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA
| | - Evangelos A. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd, Gainesville, FL 32603
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
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5
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Clark DJ, Chatterjee SA, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ. Combining Frontal Transcranial Direct Current Stimulation With Walking Rehabilitation to Enhance Mobility and Executive Function: A Pilot Clinical Trial. Neuromodulation 2020; 24:950-959. [PMID: 32808403 DOI: 10.1111/ner.13250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This pilot study assessed whether frontal lobe transcranial direct current stimulation (tDCS) combined with complex walking rehabilitation is feasible, safe, and shows preliminary efficacy for improving walking and executive function. MATERIALS AND METHODS Participants were randomized to one of the following 18-session interventions: active tDCS and rehabilitation with complex walking tasks (Active/Complex); sham tDCS and rehabilitation with complex walking tasks (Sham/Complex); or sham tDCS and rehabilitation with typical walking (Sham/Typical). Active tDCS was delivered over F3 (cathode) and F4 (anode) scalp locations for 20 min at 2 mA intensity. Outcome measures included tests of walking function, executive function, and prefrontal activity measured by functional near infrared spectroscopy. RESULTS Ninety percent of participants completed the intervention protocol successfully. tDCS side effects of tingling or burning sensations were low (average rating less than two out of 10). All groups demonstrated gains in walking performance based on within-group effect sizes (d ≥ 0.50) for one or more assessments. The Sham/Typical group showed the greatest gains for walking based on between-group effect sizes. For executive function, the Active/Complex group showed the greatest gains based on moderate to large between-group effect sizes (d = 0.52-1.11). Functional near-infrared spectroscopy (fNIRS) findings suggest improved prefrontal cortical activity during walking. CONCLUSIONS Eighteen sessions of walking rehabilitation combined with tDCS is a feasible and safe intervention for older adults. Preliminary effects size data indicate a potential improvement in executive function by adding frontal tDCS to walking rehabilitation. This study justifies future larger clinical trials to better understand the benefits of combining tDCS with walking rehabilitation.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Sudeshna A Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jared W Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Paige E Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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Chatterjee SA, Seidler RD, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ, Clark DJ. Obstacle Negotiation in Older Adults: Prefrontal Activation Interpreted Through Conceptual Models of Brain Aging. Innov Aging 2020; 4:igaa034. [PMID: 32995566 DOI: 10.1093/geroni/igaa034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The influence of interindividual differences on brain activation during obstacle negotiation and the implications for walking performance are poorly understood in older adults. This study investigated the extent to which prefrontal recruitment during obstacle negotiation is explained by differences in age, executive function, and sex. These data were interpreted according to the Compensation-Related Utilization of Neural Circuits Hypothesis (CRUNCH) framework of brain aging. We also tested the association between prefrontal recruitment and walking performance. Research Design and Methods Prefrontal oxygenated hemoglobin concentration (O2Hb) was measured during typical walking (Typical) and obstacle negotiation (Obstacles) tasks in 50 adults aged 65 years and older using functional near-infrared spectroscopy. The primary outcome was the change in prefrontal recruitment (∆PFR), measured as Obstacles ∆O2Hb minus Typical ∆O2Hb. Multiple regression was used to test the relationship between ∆PFR and age, executive function measured by the Trail Making Test, and sex. Pearson's correlation coefficient was used to investigate the association between ∆PFR and the cost of Obstacles walking speed relative to Typical walking. Results Age, executive function, and their interaction significantly predicted greater ∆PFR (R 2 = 0.34, p = .01). Participants were subgrouped according to age and executive function to examine the interaction effects. Adults of lower age and with lower executive function exhibited greater ∆PFR during Obstacles compared to their peers with higher executive function (p = .03). Adults of advanced age exhibited a ceiling of prefrontal recruitment during obstacle negotiation, regardless of executive function level (p = .87). Greater ∆PFR was significantly associated with a smaller cost of Obstacles (r = 0.3, p = .03). Discussion and Implications These findings are consistent with the CRUNCH framework: neural inefficiency where a greater amount of brain activation is needed for task performance at a similar level, compensatory overactivation to prevent a steeper decline in task performance, and capacity limitation with a recruitment ceiling effect.
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Affiliation(s)
- Sudeshna A Chatterjee
- Department of Physical Therapy, University of Florida, Gainesville.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville
| | - Jared W Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Paige E Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville
| | - Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida.,Department of Aging and Geriatric Research, University of Florida, Gainesville
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Chatterjee SA, Fox EJ, Daly JJ, Rose DK, Wu SS, Christou EA, Hawkins KA, Otzel DM, Butera KA, Skinner JW, Clark DJ. Interpreting Prefrontal Recruitment During Walking After Stroke: Influence of Individual Differences in Mobility and Cognitive Function. Front Hum Neurosci 2019; 13:194. [PMID: 31316360 PMCID: PMC6611435 DOI: 10.3389/fnhum.2019.00194] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Functional near-infrared spectroscopy (fNIRS) is a valuable neuroimaging approach for studying cortical contributions to walking function. Recruitment of prefrontal cortex during walking has been a particular area of focus in the literature. The present study investigated whether task-related change in prefrontal recruitment measured by fNIRS is affected by individual differences in people post-stroke. The primary hypotheses were that poor mobility function would contribute to prefrontal over-recruitment during typical walking, and that poor cognitive function would contribute to a ceiling in prefrontal recruitment during dual-task walking (i.e., walking with a cognitive task). Methods: Thirty-three adults with chronic post-stroke hemiparesis performed three tasks: typical walking at preferred speed (Walk), serial-7 subtraction (Serial7), and walking combined with serial-7 subtraction (Dual-Task). Prefrontal recruitment was measured with fNIRS and quantified as the change in oxygenated hemoglobin concentration (ΔO2Hb) between resting and active periods for each task. Spatiotemporal gait parameters were measured on an electronic walkway. Stepwise regression was used to assess how prefrontal recruitment was affected by individual differences including age, sex, stroke region, injured hemisphere, stroke chronicity, 10-meter walking speed, balance confidence measured by Activities-specific Balance Confidence (ABC) Scale, sensorimotor impairment measured by Fugl-Meyer Assessment, and cognitive function measured by Mini-Mental State Examination (MMSE). Results: For Walk, poor balance confidence (ABC Scale score) significantly predicted greater prefrontal recruitment (ΔO2Hb; R 2 = 0.25, p = 0.003). For Dual-Task, poor cognitive function (MMSE score) significantly predicted lower prefrontal recruitment (ΔO2Hb; R 2 = 0.25, p = 0.002). Conclusions: Poor mobility function predicted higher prefrontal recruitment during typical walking, consistent with compensatory over-recruitment. Poor cognitive function predicted lower prefrontal recruitment during dual-task walking, consistent with a recruitment ceiling effect. These findings indicate that interpretation of prefrontal recruitment should carefully consider the characteristics of the person and demands of the task.
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Affiliation(s)
- Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
- Brooks Rehabilitation, Jacksonville, FL, United States
| | - Janis J. Daly
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Dorian K. Rose
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Evangelos A. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Kelly A. Hawkins
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Dana M. Otzel
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Katie A. Butera
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Jared W. Skinner
- Geriatric Research, Education and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - David J. Clark
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, Gainesville, FL, United States
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
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Chatterjee SA, Rose DK, Porges EC, Otzel DM, Clark DJ. A Perspective on Objective Measurement of the Perceived Challenge of Walking. Front Hum Neurosci 2019; 13:161. [PMID: 31139069 PMCID: PMC6527756 DOI: 10.3389/fnhum.2019.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Perceived challenge of walking is a broad term that we use to encompass walking-related anxiety, balance self-efficacy/confidence, and fear of falling. Evidence shows that even after accounting for physical performance capabilities, a higher perceived challenge can cause individuals to self-impose restrictions in walking-related activities. Perceived challenge is typically measured by self-report, which is susceptible to subjective measurement bias and error. We assert that measurement of perceived challenge can be enhanced by augmenting self-report with objective, physiologically based measures. A promising approach that has emerged in the literature is measurement of sympathetic nervous system (SNS) activity by recording skin conductance. Heightened SNS activity is a physiological stress response to conditions that are cognitively, emotionally, or physically challenging. In the present article, we explain the rationale and physiological basis for measuring SNS activity to assess perceived challenge of walking. We also present existing and new evidence supporting the feasibility of this approach for assessing perceived challenge in lab-based and real-world walking environments. Future research directions are also discussed.
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Affiliation(s)
- Sudeshna A Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Eric C Porges
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Dana M Otzel
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
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9
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Hawkins KA, Fox EJ, Daly JJ, Rose DK, Christou EA, McGuirk TE, Otzel DM, Butera KA, Chatterjee SA, Clark DJ. Prefrontal over-activation during walking in people with mobility deficits: Interpretation and functional implications. Hum Mov Sci 2018; 59:46-55. [PMID: 29604488 DOI: 10.1016/j.humov.2018.03.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/02/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Control of walking by the central nervous system includes contributions from executive control mechanisms, such as attention and motor planning resources. Executive control of walking can be estimated objectively by recording prefrontal cortical activity using functional near infrared spectroscopy (fNIRS). OBJECTIVE The primary objective of this study was to investigate group differences in prefrontal/executive control of walking among young adults, older adults, and adults post-stroke. Also assessed was the extent to which walking-related prefrontal activity fits existing cognitive frameworks of prefrontal over-activation. METHODS Participants included 24 adults post-stroke with moderate to severe walking deficits, 15 older adults with mild gait deficits, and 9 young healthy adults. Executive control of walking was quantified as oxygenated hemoglobin concentration in the prefrontal cortex measured by fNIRS. Three walking tasks were assessed: typical walking, walking over obstacles, and walking while performing a verbal fluency task. Walking performance was assessed by walking speed. RESULTS There was a significant effect of group for prefrontal activity (p < 0.001) during typical and obstacles walking tasks, with young adults exhibiting the lowest level of prefrontal activity, followed by older adults, and then adults post-stroke. In young adults the prefrontal activity during typical walking was much lower than for the verbal fluency dual-task, suggesting substantial remaining prefrontal resources during typical walking. However, in older and post-stroke adults these remaining resources were significantly less (p < 0.01). Cumulatively, these results are consistent with prefrontal over-activation in the older and stroke groups, which was accompanied by a steeper drop in walking speed as task complexity increased to include obstacles (p < 0.05). CONCLUSIONS There is a heightened use of prefrontal/executive control resources in older adults and post-stroke adults during walking. The level of prefrontal resource utilization, particularly during complex walking tasks like obstacle crossing, may approach the ceiling of available resources for people who have walking deficits. Prior cognitive research has revealed that prefrontal over-activation combined with limited prefrontal resources can lead to poor cognitive performance. The present study suggests a similar situation influences walking performance. Future research should further investigate the extent to which prefrontal over-activation during walking is linked to adverse mobility outcomes.
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Affiliation(s)
- Kelly A Hawkins
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Emily J Fox
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA; Brooks Rehabilitation, 3901 University Blvd S, Jacksonville, FL 32216, USA.
| | - Janis J Daly
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Neurology, University of Florida, PO Box 100383, Gainesville, FL 32610, USA.
| | - Dorian K Rose
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, PO Box 118205, Gainesville, FL 32611, USA.
| | - Theresa E McGuirk
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA.
| | - Dana M Otzel
- VA Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA.
| | - Katie A Butera
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - Sudeshna A Chatterjee
- Department of Physical Therapy, University of Florida, PO Box 100154, Gainesville, FL 32610, USA.
| | - David J Clark
- Brain Rehabilitation Research Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA; Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32603, USA.
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Clark DJ, Chatterjee SA, McGuirk TE, Porges EC, Fox EJ, Balasubramanian CK. Sympathetic nervous system activity measured by skin conductance quantifies the challenge of walking adaptability tasks after stroke. Gait Posture 2018; 60:148-153. [PMID: 29216598 PMCID: PMC5911926 DOI: 10.1016/j.gaitpost.2017.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 08/25/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking adaptability tasks are challenging for people with motor impairments. The construct of perceived challenge is typically measured by self-report assessments, which are susceptible to subjective measurement error. The development of an objective physiologically-based measure of challenge may help to improve the ability to assess this important aspect of mobility function. The objective of this study to investigate the use of sympathetic nervous system (SNS) activity measured by skin conductance to gauge the physiological stress response to challenging walking adaptability tasks in people post-stroke. METHODS Thirty adults with chronic post-stroke hemiparesis performed a battery of seventeen walking adaptability tasks. SNS activity was measured by skin conductance from the palmar surface of each hand. The primary outcome variable was the percent change in skin conductance level (ΔSCL) between the baseline resting and walking phases of each task. Task difficulty was measured by performance speed and by physical therapist scoring of performance. Walking function and balance confidence were measured by preferred walking speed and the Activities-specific Balance Confidence Scale, respectively. RESULTS There was a statistically significant negative association between ΔSCL and task performance speed and between ΔSCL and clinical score, indicating that tasks with greater SNS activity had slower performance speed and poorer clinical scores. ΔSCL was significantly greater for low functioning participants versus high functioning participants, particularly during the most challenging walking adaptability tasks. CONCLUSION This study supports the use of SNS activity measured by skin conductance as a valuable approach for objectively quantifying the perceived challenge of walking adaptability tasks in people post-stroke.
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Affiliation(s)
- David J. Clark
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA,Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32611, USA
| | - Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA,Department of Physical Therapy, University of Florida, 1225 Center Drive, HPNP Building Room 1142, Gainesville FL, 32610, USA
| | - Theresa E. McGuirk
- Brain Rehabilitation Research Center of Excellence, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL, 32608 USA
| | - Eric C. Porges
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Drive, HPNP Building, Gainesville, FL, 32610, USA
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, 1225 Center Drive, HPNP Building Room 1142, Gainesville FL, 32610, USA,Clinical Research Center, Brooks Rehabilitation, 3599 University Blvd S, Jacksonville, FL, 32216, USA
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