Every-day life means being part of a complex environment and performing complex tasks that usually involve a combination of motor and cognitive skills. However, the process of aging or the sequelae of neurological diseases such as Multiple Sclerosis (MS) compromises motor-cognitive interaction necessary for an independent lifestyle. While motor-cognitive performance has been identified as an important goal for sustained health across different clinical populations, little is known about underlying brain function leading to these difficulties and how to best target these motor-cognitive difficulties in the context of rehabilitation and exercise interventions. The challenge of improving treatments of motor-cognitive difficulties (such as dual-tasking and navigation) is daunting, and an important step is arriving at a method that accurately portrays these impairments in an ecological valid state. The investigators aim therefore to explore brain function during complex walking in MS (in comparison with people with Parkinson's disease and healthy controls) by investigating the effects of neurological disease on motor-cognitive performance and its neural correlates during three conditions of complex walking (dual-task walking, navigation and a combination of both) using non-invasive measures of brain activity (functional near infrared spectrometry, fNIRS) and advanced gait analysis in real time in people with MS (in comparison with people with Parkinson's disease and healthy adults).
Study Type
OBSERVATIONAL
Enrollment
41
Assessment of brain activity with fNIRS and behavioural assessments (motor, motor-cognitive and cognitive) during three complex walking conditions. 1. Dual-task walking with the auditory stroop task. 2. Navigational walking - a course consisting of a distribution of 45 and 90 degrees turns to the left and right 3. Navigational and dual-task walking (condition 1 and 2 together)
Karolinska Institutet
Stockholm, Solna, Sweden
Functional near infrared spectrometry (fNIRS)
The measurement of changes in concentration of HbO and HHb in the prefrontal cortex will be assessed using a NIRSPORT 2 (NIRx Medizintechnik, Berlin, Germany) device.
Time frame: During the test session during all three conditions
Gait performance during all conditions
Gait variables such as stride time and/or velocity will be analyzed with the APDM mobility system.
Time frame: During the test session during all three conditions
Dual-task performance-reaction time
Cognitive performance of the dual task will be assessed as errors in the response to the Auditory stroop task.
Time frame: During the test session during complex walking condition 1 and 3
Cognitive function- composite score
The cognitive test battery comprised the following tests: The Color-Word Interference Test (CWIT), Verbal Fluency, Trail Making Test (TMT) and Ray Auditory Verbal Learning Test (RAVLT) and Symbol Digit Modalities Test (SDMT). Cognitive function will be assessed as a composite measure of these test together.
Time frame: During the test session, takes about 50 minutes
Cognitive function - verbal fluency
Verbal function, initiation \& task-set switching with the Verbal Fluency test from D-KEFS (Delis-Kaplan Executive Function System).
Time frame: During the test session, takes about 12 minutes
Cognitive function - Attention and psychomotor processing speed
Attention and psychomotor processing speed will be assessed with the Trail Making Test (TMT) from D-KEFS (Delis-Kaplan Executive Function System).
Time frame: During the test session, takes about 3 minutes
Cognitive function - Episodic memory
Episodic memory will be assessed with the Ray Auditory Verbal Learning Test (RAVLT).
Time frame: During the test session, takes about 30 minutes
Cognitive function - Cognitive processing speed
Cognitive processing speed will be assessed with the Symbol Digit Modalities Test (SDMT)
Time frame: During the test session, takes about 3 minutes
Cognitive function - Inhibition & task-set switching
Inhibition \& task-set switching with the The Color-Word Interference Test (CWIT) from D-KEFS (Delis-Kaplan Executive Function System).
Time frame: During the test session, takes about 5 minutes
Self-reported level of physical activity
Assessed with the Frändin-Grimby Scale (score 1-6, higher score=better)
Time frame: Will be answered before the test session in the patients home or during the test session
Physical activity level and intensity
Assessed with accelerometers (Actigraph GT3X+)
Time frame: For one week after the test session
Overall MS-disability
Assessed with the Expanded Disability Status Scale (EDSS). Higher scores=worse/more severe disability
Time frame: During the test session
Balance performance
Assessed with the Mini-BESTest (Balance Evaluation Systems test), 0-28p.
Time frame: During the test session
Anxiety and depression
Assessed with Hospital Anxiety and Depression Scale (HADS), 0-24 on the depression and anxiety part respectively. Lower score=better
Time frame: Will be answered before the test session in the patients home or during the test session
Walking ability
Self-assessed walking ability with the WALK-12G.
Time frame: Will be answered before the test session in the patients home or at the test session
Dual-task performance -errors
Cognitive performance of the dual task will be assessed as the reaction time to respond during Auditory stroop
Time frame: During the test session during dual task conditions
Disability
WHO Disability Assessment Schedule (WHODAS) version 2.0, 12 self-assessed questions (12 to 60) more points=worse
Time frame: Will be answered before the test session in the patients home or during the test session
Impact of Fatigue
Self-assessed impact of fatigue on physical, cognitive, and psychosocial functioning, with the Modified Fatigue Impact Scale (MFIS). 21 items, scored from 0 to 4. Higher scores indicate a larger impact of fatigue.
Time frame: Will be answered before the test session in the patients home or during the test session
Impact of MS on health
Self-assessed physical and psychological impact of MS on health. 29 items, rated from 1 to 5. Higher score indicates perceived worse physical or psychological impacts of MS, respectively, on health.
Time frame: Will be answered before the test session in the patients home or during the test session
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