The effect of dual cognitive task on motor sequencing in patients with Parkinson's disease

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The effect of dual cognitive task on motor sequencing in patients with Parkinson's disease

 

Author: Hui, Pik-si
Title: The effect of dual cognitive task on motor sequencing in patients with Parkinson's disease
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Parkinson's disease -- Patients -- Rehabilitation.
Parkinson's disease -- Treatment.
Motor ability -- Testing.
Department: Dept. of Rehabilitation Sciences
Pages: xii, 65 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2301014
URI: http://theses.lib.polyu.edu.hk/handle/200/5103
Abstract: Background: Patients with Parkinson's disease are known to have movement sequencing effect which is the progressive slowing of a motor sequence. Walking is a continuous repetitive movement sequence of steps. The impact of dual cognitive task on the continuous stepping movement in patients with PD was investigated. Objectives: (1) To examine the effect of concurrent cognitive task on step amplitude and change of step amplitude in PD subjects, (2) to explore the impact of complexity of concurrent cognitive task on step amplitude and change of step amplitude in PD subjects and (3) to assess the accuracy of concurrent cognitive task in PD group. Methods: Fifteen patients with idiopathic PD and nine controls were instructed to perform 5 tasks arranged in randomized order. Under single-task condition, there were 1 single motor and 2 single cognitive tasks: (1) single stepping task (Stepping), (2) single easy number recalling task in standing position (Easy number) and (3) single difficult number recalling task in standing position (Difficult number). Dual tasks conditions included 2 dual motor and cognitive tasks, there were: (4) stepping while performing an easy number recalling task (Stepping dual easy) and (5) stepping while performing a difficult number recalling task (Stepping dual difficult)- The knee flexion angle and knee height during stepping were captured with the Vicon motion analysis system. The accuracy of easy and difficult number recalling in single and dual task conditions were examined. Linear regression technique was employed to determine the slope of knee flexion angle and knee height change over time. The value of slope reflected the sequence effect. Results: When comparing with the controls , PD group demonstrated significant smaller right and left knee flexion angle respectively for Stepping (by 37.6o and 34.7o, Stepping dual easy (by 43.9o and 35.9o, and Stepping dual difficult tasks (by 45.5o and 41.3o) (p<0.001). For the knee height, PD group showed significant lower knee height than control subjects for Stepping (by 94.3 mm), Stepping dual easy (by 88.4 mm) and Stepping dual difficult tasks (by 91.2 mm) (p=0.001). When compared with single stepping task, significant decrease of mean knee height during Stepping dual easy (by 18.1 mm) and Stepping dual difficult tasks (by 24.3 mm) were observed in PD group (p<0.001). When comparing with the control, the knee height showed significant sequence effect in PD group for all 3 stepping tasks (p=0.009). In PD patients, both right knee angle and knee height showed a decreasing trend during Stepping dual easy and Stepping dual difficult tasks, hence a sequence effect was observed. But these changes did not reach a significant level, in right knee angle and knee height among tasks in PD group. For the accuracy of number recalling tasks, PD subjects demonstrated significant lower accuracy among 4 conditions than controls (p<0.05). Discussions and conclusion: Dual cognitive task significantly decrease the step amplitude in terms of knee flexion angle and knee height in PD subjects. Besides, PD subjects demonstrated significant step sequence effect on mean knee height when performing dual cognitive task. The limited attention resources and lack of automaticity of movement in patients with PD may account for the difference. Improve automaticity of movement by repeated practice/ training and directing attention to the posture/ gait was proved to be effective by the past studies. Ensuring the safety and helping them to reduce the interference of dual task is important. The result of the present study may provide new insights for the future rehabilitation plan.

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