Search Results (168)

Objective: To determine which physical clinical test best differentiates minimally impaired people with MS (pwMS) from healthy controls and to compare the discriminatory value of upper limb clinical assessments with sensor-based gait and postural control measures. Methods: Forty-one participants (21 pwMS, 20 matched healthy controls) completed a single testing session including upper limb clinical assessments (Nine-Hole Peg Test [9HPT], grip strength), gait (Timed 25-Foot Walk, Six-Minute Walk Test, and cognitive–walking dual task), and static balance assessments using wearable inertial sensors (APDM Mobility Lab system). Dual-task costs (DTCs) were calculated for gait parameters. Between-group comparisons were performed using independent t-tests. Pearson correlation analyses were conducted to examine interrelationships among gait variables, and a parsimonious binary logistic regression model was constructed, including non-dominant 9HPT and dual-task walking speed. Receiver operating characteristic (ROC) analyses were performed to evaluate discriminative performance and determine the optimal 9HPT cutoff. Results: PwMS performed significantly slower on the 9HPT for both hands (p ≤ 0.006) and demonstrated reduced walking performance and higher gait DTCs (p ≤ 0.041) compared with controls. No significant group differences were observed in grip strength or sensor-based postural control. In multivariable analysis, the overall model was significant (p < 0.001; Nagelkerke R² = 0.49), and the non-dominant 9HPT remained the only independent predictor of group status (OR = 1.75, 95% CI [1.17–2.61]), whereas dual-task walking speed was not significant after adjustment. ROC analysis demonstrated good discriminative ability for the non-dominant 9HPT (AUC = 0.84, 95% CI [0.71–0.97]) and acceptable discrimination for dual-task walking speed (AUC = 0.75, 95% CI [0.60–0.90]). The optimal 9HPT cutoff was ≥21.4 s, yielding 71% sensitivity and 100% specificity in this cohort. Conclusions: Manual dexterity of the non-dominant hand may serve as a sensitive screening marker of early functional impairment in MS, demonstrating greater discriminatory value than sensor-based gait and balance measures. These findings support the inclusion of upper limb dexterity testing in the routine assessment of minimally impaired pwMS. Validation in larger, longitudinal cohorts is warranted. Full article

Age-related declines in balance and cognitive function increase fall risk and reduce quality of life in older adults and people with neurological disorders. Studying these changes in unimpaired adults provides a normative reference for identifying pathological deviations. However, most dual-task studies focus on single cognitive tasks and static conditions, specifically during gait, limiting understanding of how cognitive demand interacts with postural control while standing and during dynamic challenges. This study identified cognitive and motor outcomes most sensitive to age-related differences during motor–cognitive dual tasks of varying complexity across static and dynamic balance conditions, accounting for minimal detectable change. Sixty healthy adults performed dual-tasks ranging from simple motor activities to complex cognitive challenges (Stroop Test) while standing on a robotic platform. Cognitive performance (reaction time) and balance outcomes, including trunk and center of pressure (CoP) sway area, were assessed. Reaction time was sensitive to aging, with standardized estimates ranging from 0.014 to 0.036. The highest values occurred in the most demanding dual-task condition, enabling detection of meaningful change over short timeframes. Age effects on balance were modest under static conditions but amplified during dynamic perturbations across all dual tasks. In the SCWT 3 condition, standardized estimates for CoP sway area increased from 0.006 in the static condition to 0.047 in the passive condition, reflecting an approximately eightfold increase in age sensitivity. Trunk sway primarily reflected cognitive load, whereas CoP sway was most sensitive to balance perturbations and exceeded minimal detectable thresholds over only a couple of years. These findings support sensitive task–condition combinations for early detection and monitoring of age-related cognitive and balance decline. Full article

Background: With advancing age, cognitive control and postural-gait regulation decline, while dual-task interference intensifies, leading to restricted mobility and increased fall risk. Variable-priority cognitive-motor dual-task training (VPDT) enhances attentional flexibility and task integration by systematically shifting attentional allocation during training. However, its effects on cognitive and physical function remain unclear. Objective: To review the effects of VPDT on cognitive and physical function in older adults. Method: A comprehensive database search was conducted in the PubMed, Embase, Cochrane, Web of Science, PsycInfo, and CINAHL databases from inception to April 2025, relevant articles were selected, data were extracted using a PICO framework and synthesized narratively. Result: Eight controlled trials (n = 284) were included. Across studies, VPDT was generally associated with improvements in functional balance and mobility outcomes, while between-group differences versus fixed-priority dual-task training (FPDT) were inconsistent. Cognitive outcomes were sparsely reported (only one trial), and psychosocial outcomes were assessed in only a small subset of studies, precluding firm inferences regarding cognitive or psychosocial benefits. Overall risk of bias was predominantly “some concerns,” with two studies rated “high risk,” and overall certainty of evidence ranged from low to moderate due to risk of bias, small samples, and heterogeneity in protocols and outcomes. Conclusions: VPDT may improve physical function in older adults, particularly balance and mobility, but current evidence does not demonstrate a consistent incremental advantage over FPDT. Confidence in comparative effects remains limited due to small sample sizes, risk-of-bias concerns, and heterogeneity in intervention design and outcome measurement. Full article

Background and Clinical Significance: Deep thalamic and periventricular lesions are uncommon in adults but can result in significant loss of function because of their convergence on three interdependent processes: thalamocortical state regulation, throughput of periventricular long association systems, and ventricular compartmental compliance. The resulting combination of executive control collapse, retrieval-weighted language fragility, and load-sensitive gait instability may occur early after a lesion forms an atrial/posterior horn interface, and pressure-linked autonomic symptoms may be late to develop. Screening deficits will likely be minimal and therefore underreported. Objective/Aim: To present a thalamic–atrial/posterior horn tumor case with quantified load-sensitive cognitive–language–gait dysfunction and to detail a physiology-guided, sequence-driven decompression approach emphasizing ventricular relaxation and perforator-preserving, interface-limited thalamic resection. Case Presentation: A 56-year-old female patient experienced a 3-month, rapidly progressive decline in her cognitive and language abilities. The clinical progression was not stepwise or punctuated by a single “sentinel” event. She had a moderate level of cognitive impairment consistent with both Broca’s and Wernicke’s aphasias (MoCA: 22/30) and suffered from significant interference effects and increased cost of task-switching. Her ability to generate novel responses and name objects was significantly impaired; however, she was able to repeat words and phrases appropriately. In addition, she exhibited a severe sustained attention signature and a high error rate during dual-task performance, indicating severe gait instability, although her overall global anchors were nearly neutral (GCS 15; FOUR 15/16; NIHSS 2). Nausea and vomiting occurred simultaneously with the cognitive and language decline, suggesting decreased intracranial compliance. MRI revealed a heterogeneous left-sided thalamic tumor extending into the posterior horn of the lateral ventricle. The tumor caused deformation of the lateral ventricle and midline displacement. The patient underwent microsurgical intervention using a physiology-conscious sequence of graded cerebrospinal fluid (CSF) equilibration and primary mechanical removal of the tumor from the ventricular system. Additionally, decompression of the thalamus was performed in a manner that was cognizant of the boundaries formed by the perforating arteries of the thalamus. Early resolution of pressure symptoms was noted postoperatively. Objective measures demonstrated significant improvement in the patient’s executive functioning, language skills, attentional errors, and dual-task performance stability. The patient remained functionally independent at discharge and at subsequent follow-up visits. Surveillance imaging did not demonstrate any evidence of tumor recurrence. Conclusions: The clinical presentation described above is supportive of a model in which the synergy between deep network damage and distortion of the posterior ventricular compartment amplifies network dysfunction. Additionally, the use of quantitative stress-phenotyping makes it possible to identify deep network pathology early in its course. Finally, the physiology-guided decompression approach that was used in this case has the potential to increase functional reserve in patients with pathology that requires millimeter transitions. Full article

Background: Age-related cognitive decline is linked to reduced gait complexity and higher fall risk. Traditional linear gait measures may miss subtle motor-cognitive deficits in older adults with dementia. This study examined whether an 8-week motor-cognitive exercise program could improve gait adaptability in institutionalized older adults with cognitive impairment. Gait complexity, measured using Sample Entropy, was the primary outcome. Methods: Forty-two institutionalized older adults completed follow-up assessments, including 26 with cognitive impairment and 16 controls. Gait was assessed during normal walking (single-task) and while performing cognitive tasks (dual-task), such as naming animals or counting backward. Inertial sensors recorded stride intervals, and Sample Entropy was calculated to evaluate gait regularity and adaptability, (gait complexity). The intervention included 24 structured sessions combining physical and cognitive exercises targeting balance, coordination, and executive function. Non-parametric tests (Wilcoxon) were used, with Bonferroni correction for multiple comparisons. Results: Participants with cognitive impairment showed increased gait complexity, especially during dual-task walking. Significant improvements were found in both limbs under dual-task conditions (left: p = 0.015, effect size = 0.34; right: p = 0.030, effect size = 0.31). During single-task walking, a significant improvement was observed in the left limb (p = 0.006, effect size = 0.39). Conclusions: Motor-cognitive exercise may enhance non-linear gait complexity in institutionalized older adults with cognitive impairment. The use of dual-task training in rehabilitation and highlight the value of entropy-based gait assessment for detecting subtle functional changes. However, the lack of a randomized non-exercising cognitive impairment control group limits definitive conclusions about causality. Full article

Axial postural abnormalities in Parkinson’s Disease (PD) are traditionally assessed using clinical rating scales, although picture-based assessment is considered the gold standard. This study evaluates the reliability and clinical relevance of two markerless body-tracking frameworks, the RGB-D-based Microsoft Azure Kinect (providing the reference KIN_3D model) and the RGB-only Google MediaPipe Pose (MP), using a synchronous dual-camera setup. Forty PD patients performed a 60 s static standing task. We compared KIN_3D with three MP models (at different complexity levels) across horizontal, vertical, sagittal, and 3D joint angles. Results show that lower-complexity MP models achieved high congruence with KIN_3D for trunk and shoulder alignment (ρ > 0.75), while the lateral view significantly improved tracking of sagittal angles (ρ ≥ 0.72). Conversely, the high-complexity model introduced significant skeletal distortions. Clinically, several angular parameters emerged as robust metrics for postural assessment and global motor impairments, while sagittal angles correlated with motor complications. Unexpectedly, a more upright frontal alignment was associated with greater freezing of gait severity, suggesting that static postural metrics may serve as proxies for dynamic gait performance. In addition, both RGB-only and RGB-D frameworks effectively discriminated between postural severity clusters. While the higher-complexity MP model should be avoided due to inaccurate 3D reconstructions, our findings demonstrate that low- and medium-complexity MP models represent a reliable alternative to RGB-D sensors for objective postural assessment in PD, facilitating the widespread application of objective posture measurements in clinical contexts. Full article

Fibromyalgia is a complex chronic disorder involving persistent widespread pain accompanied by functional limitations, cognitive impairments, and alterations in neural processing. Previous research indicates that exercise-based interventions can play a key role in alleviating symptom burden and enhancing physical performance; however, there is limited evidence regarding their impact on neurophysiological mechanisms. Creative dance, in combination with strength training, may stimulate both motor and cognitive systems, promoting brain plasticity and functional improvements. This study will analyze the effects of a six-week strength and creative dance program on physical fitness under single- and dual-task conditions in women with fibromyalgia and will explore the associated changes in brain electrical activity and autonomic modulation. Methods: This randomized controlled trial will be divided into an exercise group (n = 22) and a control group (n = 22). The 6-week supervised intervention consists of two 60-min sessions per week, combining strength exercises and creative dance. Primary outcomes include physical fitness tests (strength, mobility, balance, and agility gait test in single-task and dual-task), fibromyalgia symptoms, and quality of life. Secondary outcomes include changes in electroencephalography, heart rate variability, physical activity level, and fear of falling. Statistical analyses will compare within- and between-group differences using non-parametric tests and effect sizes. It is hypothesized that the intervention will improve physical fitness and dual-task performance, alongside increases in brain activity power. This study may provide insights into the neurophysiological mechanisms underlying the benefits of exercise benefits in fibromyalgia. Full article

Adaptive locomotion requires the integration of cognitive and motor processes and is challenged in neurological disorders. Dual-task (DT) training may improve cognitive–motor coordination, but its feasibility across heterogeneous clinical populations is uncertain. This pilot study aimed to understand if the effects of a secondary motor or cognitive task added to a walking task depend on the functional walking abilities of the subjects. We enrolled 30 participants with neurological disorders not related to traumatic events, 5 for each one of the following groups: healthy young subjects (HeY), healthy control subjects (HeC), subjects with stroke (ictus, IC), Parkinson’s disease (PD), multiple sclerosis (MS), and Long-COVID sequelae (LC). Spatiotemporal gait parameters were recorded using a wearable inertial magnetic unit, and subjective workload was assessed with the visual analog scale (VAS) and NASA-Task Load Index. Regression models revealed strong baseline–DT coupling for stride duration (slopes 1.11–1.37; R² 0.85–0.97), stride length (slopes 0.93–0.94; R² 0.86–0.93), walking speed (slopes 0.87–0.98; R² 0.78–0.93), and gait ratio (stance/swing, slopes 0.38–0.60; R² 0.21–0.52). Mixed-effects analyses identified significant group effects for walking speed (F(5) = 7.218, p < 0.001), stride length (F(5) = 4.834, p = 0.001), gait cycle duration (F(5) = 5.630–5.664, p < 0.001), Walking Quality (F(5) = 4.340–4.373, p = 0.001), and propulsion index (F(5) = 5.668–6.843, p < 0.001). The incongruent DT condition was the most sensitive in differentiating clinical groups. NASA-TLX indicated higher perceived workload in IC and MS compared with non-clinical groups. The protocol was completed by all participants without adverse events, supporting the feasibility of the procedure in this pilot sample. Its predictable scaling across baseline gait metrics supports its use as a personalized rehabilitation tool for diverse neurological populations. (ClinicalTrials.gov NCT07254377). Full article

Objective: This study aimed to investigate the effects of dual-task stroboscopic visual training (DTSVT) on balance, functional mobility, and gait in children who are hard-of-hearing. Methods: This randomized controlled study included 31 children (17 girls, 14 boys) with congenital sensorineural hearing loss. Participants were assigned to one of three groups: control group, conventional balance training (CBT) group, and DTSVT group. The CBT and DTSVT groups participated in an exercise program for 16 weeks, twice weekly, for 40 min (a total of 24 sessions). Static balance was assessed using the Tandem Romberg test and Single-Leg Stance (SLS) test, while dynamic balance was evaluated using the Functional Reach Test (FRT), balance disc test, and the Four Square Step Test (FSST). The Pediatric Balance Scale (PBS) was used as a subjective balance assessment. Functional mobility was assessed using the Timed Up and Go (TUG) Test, Step Test, 10 m Walk Test (10 MWT), and Functional Gait Assessment (FGA). Postural sway parameters were recorded using the GyKo device, including Sway Area (EA, cm²), Distance Length (DL, cm), Length (anterior–posterior (AP)) (cm), Length (medial–lateral (ML)) (cm), Mean Distance (D) (cm), Mean Distance (AP) (cm), and Mean Distance (ML) (cm). Results: Significant between-group differences were primarily observed in favor of the DTSVT group post-treatment, particularly in PBS scores, GyKoDL values during the eyes-open SLS test, and TUG test completion times (p < 0.05). Some baseline differences were noted among groups in functional reach distance, FSST completion time, and eyes-closed duration on the Balance Disc test (p < 0.05). Within-group comparisons revealed significant improvements in FSST times in both intervention groups, reduced postural sway parameters during the FRT in the DTSVT and control groups, and increased eyes-closed Tandem Romberg duration in the CBT group (p < 0.05). Most other outcome measures did not demonstrate statistically significant changes either within or between groups (p > 0.05). Conclusions: Dual-task stroboscopic visual training was more effective than conventional balance training in improving specific aspects of balance and functional mobility in children who are hard-of-hearing. These findings highlight the potential of adding cognitively demanding and visually engaging balance tasks to rehabilitation programs for this population. Larger and more diverse samples in future studies are needed to enhance the generalizability of these results. Studies that assess balance and gait using standardized clinical or laboratory tests may be particularly valuable. Given the small sample size and multiple comparisons, the results should be considered preliminary and exploratory. Full article

Background: Quantitative gait analysis is essential in both clinical and research contexts; however, traditional marker-based motion capture systems are costly and burdensome. Advances in three-dimensional markerless motion capture (3D-MMC) offer more accessible alternatives; however, they lack standardized protocols. Objectives: The present study aimed to establish a standardized protocol and procedures for 3D MMC-based gait analysis using OpenCap and to quantify the reliability and within-session precision of key spatiotemporal gait parameters. Methods: Fifty healthy university students (mean age = 22.15 ± 2.12 years) completed walking trials along a 10 m walkway under single-task (ST) and five dual-task (DT) conditions of varying cognitive complexity. Gait data were collected using a two-camera OpenCap 3D-MMC system, with standardized calibration, lighting, clothing, and trial segmentation. Spatiotemporal parameters were extracted, and within-session relative reliability was quantified using two-way mixed-effects intraclass correlation coefficients, and absolute reliability was quantified using general linear model–derived within-subject error (standard error of measurement, SEM) and minimal detectable change (MDC). Repeated-measures ANOVA with Bonferroni corrections were used to examine condition-related differences. Results: Of 500 trials, 491 (98.2%) were successfully processed. Within-subject test–retest reliability ranged from moderate to excellent for all variables, with gait speed, stride length, and cadence showing the highest ICCs and smallest SEM and MDC values, and step width and double support exhibiting larger measurement error. Conclusions: This study establishes a standardized 3D-MMC protocol for gait analysis using OpenCap and demonstrates good to excellent within-session relative and absolute reliability for most spatiotemporal gait parameters in healthy young adults. Dual-task walking is used here to illustrate how trial-averaged OpenCap measurements and their SEM/MDC can be used to determine which condition-related changes in gait exceed measurement error. Full article

In cervical dystonia (CD), balance and gait impairments can compromise daily activities and negatively affect quality of life. However, interventions addressing these deficits remain poorly investigated. A 54-year-old woman with CD, presenting balance and gait difficulties that interfered with work-related motor tasks, underwent a four-month training program. Sessions (40 min, three times per week) combined lower-limb strengthening, proprioceptive and balance exercises, and integrated motor–cognitive tasks. Pre- and post-intervention assessments included gait speed (GS), stride length (SL), and stance time (ST) under usual (UW), fast (FW), and dual-task (DT) walking conditions, measured with an inertial sensor (BTS G-Walk). DT cost was calculated for GS and SL. Balance was evaluated with the Mini-BEST and Four-Square Step Test (FSST), while fear of falling was measured with the Falls Efficacy Scale-International (FES-I). Of note, both assessment sessions were conducted in the absence of botulinum toxin effects, whereas the training was performed, at least in part, under its influence. After training, increase were observed in GS and SL, with reductions in ST across all gait conditions. DT cost decreased for both GS and SL. Balance performance increased, and fear of falling was reduced. Importantly, the patient reported a marked improvement in work-related performance. This case suggests that a specific training program may effectively ameliorate balance and gait in CD, with positive effects on functional mobility. Further studies on larger samples are warranted to confirm efficacy. Full article

Background/Objectives: Gait performance in aging relies heavily on cognitive resources, yet the extent to which short-term interventions can mitigate dual-task costs in institutionalized populations remains understudied. This study aimed to compare single and dual-task gait performance between older adults with and without suspected cognitive impairment and to evaluate the effects of an 8-week multicomponent exercise program on functional mobility. Methods: Institutionalized older adults (n = 42) were stratified into two groups: suspected cognitive impairment (n = 26) and no suspected impairment (n = 16), based on MMSE and Clock Drawing Test screening. Participants performed the Timed Up and Go (TUG) and Dual-Task TUG (TUG-DT) at baseline and post-intervention. Results: At baseline, the suspected impairment group exhibited significantly poorer performance on both tests (p < 0.001) compared to the non-impaired group. Following the 8-week intervention, the suspected impairment group demonstrated large, significant improvements in both TUG (r = −0.73) and TUG-DT (r = −0.59), whereas the non-impaired group remained stable. Notably, while the single-task TUG showed the greatest responsiveness to the exercise program, the TUG-DT continued to reveal a significant cognitive-motor load. Conclusions: Multicomponent exercise effectively enhances functional mobility in cognitively vulnerable older adults, reversing declines in both single and dual-task conditions. Significance: These findings support the implementation of dual-task screening to unmask latent functional deficits and validate the use of accessible, short-term multicomponent exercise programs as a vital strategy to preserve autonomy in institutionalized older adults. Full article

Background: The visual attention tracking task plays a pivotal role in studying posture control and gait regulation. This study aims to explore the effects of visual attention tracking tasks on gait performance in young adults, providing a theoretical basis for gait optimization strategies through dual-task training. Method: Twenty healthy young males were recruited. Participants in the experimental group performed a multi-objective tracking task while walking (dual-task, DT), while the control group performed only walking (single-task, ST). The Vicon motion capture system and gait analysis system were used to collect full-body kinematic and ground reaction force data. The symmetry index of key spatiotemporal parameters and continuous relative phase (CRP) metrics were calculated to assess gait symmetry and inter-joint coordination. Result: The dual-task condition led to significant alterations in gait patterns, characterized by increased stride time and frequency, as evidenced by a longer gait line and greater foot inclination angle. Furthermore, inter-joint coordination was disrupted, demonstrated by elevated magnitude of absolute relative phase values at the hip–knee and knee–ankle joints, alongside more variable continuous relative phase trajectories. Conclusions: Visual attention tracking during walking significantly compromises gait symmetry and inter-joint coordination in young adults, suggesting that divided attention during athletic activities may elevate injury risk and should be considered in training program design. Full article

Background: The ability to perform simultaneous tasks, such as walking while engaging in cognitive or secondary motor activities, is crucial for autonomy post-stroke but is often impaired. Exercise-based interventions may improve dual-task gait performance. Methods: A systematic review following PRISMA 2020 guidelines (PROSPERO CRD420251082293) searched six databases for RCTs published between January 2017 and June 2025, including adults post-stroke receiving exercise-based interventions, with dual-task gait speed as the primary outcome. Data extraction and methodological quality assessment (PEDro scale) were conducted independently. A narrative synthesis was used due to heterogeneity in interventions and outcomes. Results: Seven RCTs (248 participants, 4–15 weeks) were included. Six studies reported statistically significant within-group improvements in dual-task gait speed (0.05–0.31 m/s), whereas one study showed no change. Between-group comparisons were largely inconsistent, with only one study indicating superiority of dual-task over single-task training. Methodological quality ranged from fair to good (PEDro 5–8/10). No serious adverse events were reported. Conclusions: Exercise-based interventions appear safe and can improve dual-task gait speed post-stroke. Evidence supporting the superiority of dual-task over single-task training remains inconclusive. Clinical application should consider individual goals, baseline performance, and cognitive-motor capacity. Future research should focus on larger, high-quality RCTs, standardized protocols, and clinically meaningful thresholds for dual-task gait speed. Full article

Background: In recent years, extended reality has gained traction in people with multiple sclerosis (MS) for their ability to deliver engaging, task-specific, and multisensory therapeutic experiences. Aim: This systematic review investigates the application of Mixed Reality (MR) and Augmented Reality (AR) technologies in neurorehabilitation for individuals with MS. Method: A comprehensive systematic review was conducted across seven databases and seven eligible studies were identified involving MR/AR interventions targeting motor and cognitive functions, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Data extraction was performed independently by the two reviewers and discrepancies were resolved by consensus or consultation with a third reviewer. Participants were predominantly diagnosed with relapsing-remitting MS and presented mild to moderate disability. Technologies ranged from head-mounted displays to home-based AR platforms, with interventions addressing gait, upper-limb coordination, and dual-task performance. Outcome measures were mapped to the ICF framework, encompassing body function, activity, participation, and contextual factors. Results: Findings suggest short-term improvements in gait parameters, grip strength, and motor coordination, with enhanced engagement and usability reported. Methodological quality was moderate, with small sample sizes and heterogeneous protocols limiting generalizability. Risk of bias varied across study designs. Despite promising results, further research is needed to validate long-term efficacy, optimize cognitive load, and standardize intervention protocols. Conclusions: MR and AR may serve as effective complements to conventional and VR-based rehabilitation, particularly in personalized, task-oriented training for MS populations. Full article