Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy
Abstract
:1. Background and Purpose
2. Method
2.1. Participants
2.2. Procedures
2.3. Statistical Analysis
3. Results
3.1. Feasibility and Safety
3.2. Motor Measures
3.2.1. MDS-UPDRS III Score
3.2.2. M-PPT Score
3.3. Cognitive Measures
3.3.1. PD-CRS Score
3.3.2. TMT B/A Ratio
3.4. Perceived Disability Measure
MDS-UPDRS II Score
4. Discussion
4.1. Potential Predictive Characteristics for Differential Response to Gamified DTT versus STT
4.2. Limitations
4.3. Potential Advantages and Implications in Traditional Clinical Setting and Telerehabilitation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclosures
Appendix A
Task A | Task B | |
---|---|---|
Pair 1 | Sit-to-stand | Multi-plane locomotion (obstacle course) |
Pair 2 | Gait | Reach and grasp |
Pair 3 | Floor-to-stand; stand-to-floor | Single limb standing |
Name of Game | Targeted Cognitive Processes | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Selective Attention | Sustained Attention | Inhibitory Control | Cognitive Flexibility | Decision-Making | Visual Search | Visual-Perceptual Processing | Visuospatial Working Memory | Language Processing | Information Processing Speed | |
Category: Chase | ||||||||||
Chase the Color | 1 | 2 | 1 | 1 | ||||||
Chase the Target | 1 | 1 | 2 | 2 | 1 | 1 | ||||
Category: Equations | ||||||||||
Addition, Subtraction | 2 | 1 | 2 | 2 | ||||||
Squares, Division, Multiplication | 2 | 2 | 2 | 1 | 1 | 2 | ||||
Category: Memory | ||||||||||
Color, Numbers, Shapes | 2 | 2 | 1 | 2 | ||||||
Dice, Symbols | 2 | 2 | 1 | |||||||
Category: Seek | ||||||||||
Seek the Color | 1 | 2 | 2 | 2 | ||||||
Seek the Letter | 1 | 2 | 2 | 2 | ||||||
Seek the Smiley | 1 | 2 | 2 | |||||||
Category: Track | ||||||||||
Track Left, Right, Both | 2 | 1 | 2 | 2 | 1 | 2 | 2 | |||
Track the Letter | 1 | 2 | 1 | 2 | ||||||
Track the Color | 1 | 2 | 2 | |||||||
Non-Categorized Games | ||||||||||
Lights Out | 1 | 2 | 1 | |||||||
Pattern Recognition | 2 | 1 | 1 | |||||||
Rally | 2 | 2 | 1 | |||||||
Spelling | 1 |
Pair 1 Task A: Sit-to-Stand | ||||||
---|---|---|---|---|---|---|
Level | Amplitude/Speed | Endurance | Balance | Vision | Accuracy | |
1 | Perform task well enough so that the task is able to be completed in one attempt—18-inch height chair | Complete 10 repetitions | Both feet on the ground and allowed to use upper extremity support | No manipulation | Not using back of legs on the chair and standing up to full upright posture; no “toes up” | |
2 | Perform task well enough so that the task is able to be completed in one attempt—16-inch height chair | Complete 20 repetitions | Both feet on the ground with goal of no upper extremity support | Look left/right | ||
3 | Perform task well enough so that the task is able to be completed in one attempt—14-inch height chair | Complete 40+ repetitions | No upper extremity support with pelvis or feet on an unstable surface (i.e., DynaDisk cushion; Airex pad) | Eyes closed | Maintain end upright posture—no wobbling, no “toes up” end position | |
Pair 1 Task B: Multi-plane locomotion (turns, stepping over, around, and between obstacles, steps, or stairs) | ||||||
Level | Amplitude/speed | Endurance | Balance | Vision | Accuracy | |
1 | Largest step at comfortable speed | 15 min with any number of rest breaks | PT UE support | Stable surface but obstructed path with obstacles to walk around and over (short objects) | No manipulation | Not knocking over any obstacle |
2 | Maintain largest step length and increase speed | 15 min with 1–2 rest breaks | Cane | Stable with obstacles to walk around and over (tall objects), and unstable surfaces (thick floor mat) | Look left/right | Predictable start and stops and 90° turns |
3 | Maintain largest step length and as fast as possible safely | 15 min with no rest break | No Support | Stable with obstacles to walk around and over (tall objects), and unstable surfaces (step on Airex pads or river stones) | Scanning environment with head turns | Unpredictable start and stops and turns of 90° (2-steps), 180° (max of 4 steps), or 360° (max of 8 steps) |
Pair 2 Task A: Gait | ||||||
Level | Amplitude/speed | Endurance | Balance | Vision | Accuracy | |
1 | Largest step at comfortable speed | 15 min with any number of rest breaks | Forward, side-ways, and backward walking with PT in front giving UE support | No manipulation | No accuracy manipulation | |
2 | Maintain largest step length and increase speed | 15 min with 1–2 rest breaks | Forward, side-ways, and backward walking with a cane | Look left/right | PT directed stop and start | |
3 | Maintain largest step length and as fast as possible safely | 15 min with no rest break | Forward, side-ways, and backward walking with no UE support | Scanning environment with head turns | Stop and start and regular turns (left, right, 180° or reversal from forward to back or side-stepping direction | |
Pair 2 Task B: Reach and grasp | ||||||
Level | Amplitude/speed | Endurance | Balance | Vision | Accuracy | |
1 | Sitting—maximum excursion (DISTANCE) of the reach with variations in both HEIGHT: Shoulder height, up and down AND DIRECTION: forward, lateral, and across | 10 reaches each arm | Blocked direction and blocked height | No manipulation | Grasp large object (e.g., water bottle) with palmer grasp | |
2 | Standing—maximum excursion (DISTANCE) of the reach with variations in both HEIGHT: Shoulder height, up and down AND DIRECTION: forward, lateral, and across | 20 reaches each arm | Blocked height variable direction | Look left/right | Grasp medium-sized object (e.g., highlighter) with tripod grasp | |
3 | Standing: Step and reach Maximum excursion (DISTANCE) of the reach with variations in both HEIGHT: Shoulder height, up and down AND DIRECTION: forward, lateral, and across | 40 reaches each arm | Variable height and direction | Look at object and then close eyes for reach and grasp | Grasp small object (e.g., paper clip) with pincer grasp | |
Pair 3 Task A: Floor-to-stand; stand-to-floor | ||||||
Level | Amplitude/speed | Endurance | Balance | Vision | Accuracy | |
1 | With chair in front—down to knees and back up | 5 repetitions | Using chair for upper extremity support | No manipulation | Best posture possible but OK if trunk is flexed; minimal sway or instability through the transition and in end positions | |
2 | Down onto hands and knees and back up | 10 repetitions | Not using chair | Look left/right | Maintenance of extension in trunk; minimal sway or instability through the transition and in end positions | |
3 | All the way down into prone and back up | 20 repetitions | Using least number of limbs possible (arms and legs) | Eyes closed | Maintenance of extension in trunk; minimal sway or instability through the transition and in end positions | |
Pair 3 Task B: Single limb standing | ||||||
Level | Amplitude/speed | Endurance | Balance | Vision | Accuracy | |
1 | Lift one foot up slightly to hip/knee flexion 15°, and to hip abduction 10° | 5 repetitions | Hand contact on an object as support | No manipulation | Maintain for 5 s per repetition | |
2 | Lift one foot up to hip/knee flexion 30°, and to hip abduction 20° | 10 repetitions | Hands on hip | Look left/right | Maintain for 10 s per repetition | |
3 | Lift one foot up to hip/knee flexion 45°, and to hip abduction 30° | 20 repetitions | With bilateral shoulder abduction/flexion 90° | Eyes closed | Maintain for 20 s per repetition |
Appendix B
Category of Treatment Response | Participant | Order of Training Conditions | Dx (y) a | HoF b | ABC c | LAPAQ d | |
---|---|---|---|---|---|---|---|
Responders | DS | P1 | STT-DTT | 5.7 | 0 (NF) | 97.2 (H) | 286 (A) |
P7 | STT-DTT | 1.9 | 0 (NF) | 76.3 (L) | 300 (A) | ||
D | P2 | DTT-STT | 0.3 | 3 (F) | 94.1 (H) | 220 (A) | |
P3 | DTT-STT | 1.6 | 2 (F) | 85.8 (H) | 107 (I) | ||
P6 | DTT-STT | 1.8 | 1 (F) | 98.4 (H) | 264 (A) | ||
S | P5 | STT-DTT | 0.6 | 0 (NF) | 95.0 (H) | 86 (I) | |
Non- Responders | P4 | DTT-STT | 6.9 | 0 (NF) | 95.6 (H) | 103 (I) | |
P8 | DTT-STT | 6.5 | 0 (NF) | 87.3 (H) | 220 (A) |
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Participant | Age (y) | Sex | Dx (y) | H&Y Stage | MoCA | HoF | ABC | GDS | LAPAQ | Perceived Disability | Motor Function | Cognitive Function | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MDS-UPDRS II d | MDS- UPDRS III d | M-PPT e | PD-CRS e | TMT B/A d | ||||||||||
P1 b | 80 | F | 5.7 | 3 | 30 | 0 | 97.2 | 1 | 286 | 3 | 38 | 29 | 106 | 2.33 |
P2 c | 53 | F | 0.3 | 2 | 30 | 3 | 94.1 | 2 | 220 | 7 | 24 | 34 | 113 | 1.31 |
P3 c | 72 | F | 1.6 | 3 | 28 | 2 | 85.8 | 0 | 107 | 12 | 26 | 33 | 114 | 1.39 |
P4 c | 60 | F | 6.9 | 2 | 26 | 0 | 95.6 | 5 | 103 | 4 | 17 | 33 | 113 | 1.15 |
P5 b | 68 | F | 0.6 | 2 | 26 | 0 | 95.0 | 4 | 86 | 1 | 25 | 32 | 95 | 1.72 |
P6 c | 75 | F | 1.8 | 2 | 28 | 1 | 98.4 | 1 | 264 | 0 | 33 | 33 | 100 | 1.32 |
P7 b | 58 | F | 1.9 | 2 | 19 b | 0 | 76.3 | 19 c | 300 | 7 | 47 | 22 | 53 | 2.05 |
P8 c | 69 | M | 6.5 | 2 | 27 | 0 | 87.3 | 5 | 220 | 13 | 45 | 28 | 102 | 1.95 |
P9 d | 73 | M | 0.1 | 2 | 28 | 0 | 98.8 | 2 | 294 | 1 | 13 | 33 | 106 | 1.37 |
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Chua, L.-K.; Chung, Y.-C.; Bellard, D.; Swan, L.; Gobreial, N.; Romano, A.; Glatt, R.; Bonaguidi, M.A.; Lee, D.J.; Jin, Y.; et al. Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy. Int. J. Environ. Res. Public Health 2021, 18, 12384. https://doi.org/10.3390/ijerph182312384
Chua L-K, Chung Y-C, Bellard D, Swan L, Gobreial N, Romano A, Glatt R, Bonaguidi MA, Lee DJ, Jin Y, et al. Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy. International Journal of Environmental Research and Public Health. 2021; 18(23):12384. https://doi.org/10.3390/ijerph182312384
Chicago/Turabian StyleChua, Lee-Kuen, Yu-Chen Chung, David Bellard, Laura Swan, Nicole Gobreial, Amanda Romano, Ryan Glatt, Michael A. Bonaguidi, Darrin J. Lee, Yi Jin, and et al. 2021. "Gamified Dual-Task Training for Individuals with Parkinson Disease: An Exploratory Study on Feasibility, Safety, and Efficacy" International Journal of Environmental Research and Public Health 18, no. 23: 12384. https://doi.org/10.3390/ijerph182312384