Cognitive-motor dual-task training improves dynamic stability during straight and curved gait in patients with multiple sclerosis: a randomized controlled trial

Abstract

Background: Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating, degenerative disease of the central nervous system and the second most frequent cause of permanent disability in young adults. One of the most common issues concerns the ability to perform postural and gait tasks while simultaneously completing a cognitive task (namely, dual-task DT).

Aim: Assessing cognitive-motor dual-task training effectiveness in patients with Multiple Sclerosis (PwMS) for dynamic gait quality when walking on straight, curved, and blindfolded paths.

Design: Two-arm single-blind randomized controlled trial. Follow-up at 8 weeks.

Setting: Neurorehabilitation Hospital.

Population: A sample of 42 PwMS aged 28-71, with a score of 4.00±1.52 on the Expanded Disability Status Scale were recruited.

Methods: Participants were randomized in conventional (CTg) neurorehabilitation and dual-task training (DTg) groups and received 12 sessions, 3 days/week/4 weeks. They were assessed at baseline (T0), after the treatment (T1), and 8 weeks after the end of the treatment (T2) through Mini-BESTest, Tinetti Performance Oriented Mobility Assessment, Modified Barthel Index, and a set of spatiotemporal parameters and gait quality indices related to stability, symmetry, and smoothness of gait extracted from initial measurement units (IMUs) data during the execution of the 10-meter Walk Test (10mWT), the Figure-of-8 Walk Test (Fo8WT) and the Fukuda Stepping Test (FST).

Results: Thirty-one PwMS completed the trial at T2. Significant improvement within subjects was found in Mini-BESTest scores for DTg from T0 to T1. The IMU-based assessment indicated significant differences in stability (P<0.01) and smoothness (P<0.05) measures between CTg and DTg during 10mWT and Fo8WT. Substantial improvements (P<0.017) were also found in the inter-session comparison, primarily for DTg, particularly for stability, symmetry, and smoothness measures.

Conclusions: This study supports the effectiveness of DT in promoting dynamic motor abilities in PwMS.

Clinical rehabilitation impact: Cognitive-motor DT implemented into the neurorehabilitation conventional program could be a useful strategy for gait and balance rehabilitation.

Figure 1

—Schematic representation of the experimental design.

Figure 2

—Schematic representation of the three motor tasks performed: A) 10mWT, patients were asked to walk at their preferred speed on a 14 m trail; B) Fo8WT, clockwise and counterclockwise directions are indicated with blue and green arrows, respectively; C) FST, patients were asked to walk on the spot with eyes closed and arms in front of them.

Figure 3

—CONSORT flow diagram of patient enrollment, randomization, and procedures.

Figure 4

—IMU-based assessment of 10mWT and Fo8WT, between groups analysis at T1 and T2. Normalized root mean square (nRMS), attenuation coefficients (AC) and Log Dimensionless Jerk on acceleration (LDLJa) values for DTg and CTg. Medians and interquartile ranges are reported. AP: antero-posterior; ML: medio-lateral; CC: cranio-caudal; P: pelvis; S: sternum; H: head. The asterisks indicate statistically significant between-group differences (* P<0.05; **P<0.01).