MS | Dual-Task Training for Cognitive-Motor Interference

This brief summarizes the evidence for using dual-task training (DTT) to improve cognitive-motor interference in people with MS. We'll cover practical ways to implement DTT in the clinic to improve patient outcomes.

Research: October 2024

Key Findings

1Dual-task training is effective at improving dynamic stability during walking in people with MS.
2Cognitive-motor interference is associated with lower cognitive function in MS.
3DTT can reduce the 'cost' of dual-tasking, meaning performance drops less when doing two things at once.
4Commonly used cognitive tasks in DTT include serial subtractions, verbal fluency, and alphabet recitation.
5There is a need for more standardized DTT protocols in both research and clinical practice.

Cognitive-motor interference (CMI) is a big deal for our patients with MS. It's that frustrating drop-off in either walking or thinking when they try to do both at the same time. This isn't just an inconvenience; it's linked to a higher risk of falls. The good news is, we can do something about it. A growing body of evidence, including a 2023 randomized controlled trial, shows that dual-task training (DTT) can significantly improve dynamic stability and reduce the cognitive-motor cost. A recent scoping review of 128 studies highlighted that while DTT is effective, there's a lot of variability in how it's being applied in research. The most common cognitive tasks used alongside walking are things like serial subtractions (counting backward by 7s), verbal fluency (naming animals), and reciting the alphabet. The key is to challenge both the motor and cognitive systems simultaneously. The 2023 RCT by Tramontano et al. used a protocol of 45-minute sessions, twice a week for 8 weeks. The training involved walking on a treadmill while performing cognitive tasks of increasing difficulty. The results were promising, with significant improvements in dual-task gait speed and stability.

Clinician's Note

I've found that DTT can be a game-changer for my patients with MS. It's not just about improving their walking; it's about giving them the confidence to navigate the real world, where they're constantly multitasking. I had one patient who was terrified of walking in a crowded grocery store. After 8 weeks of DTT, she was able to go shopping with her grandkids without fear of falling. It's a powerful tool to have in our toolbox.

Clinic Action Plan

1. Screen for CMI: Use a simple 'walk and talk' test. Have the patient walk at a self-selected speed for 10 meters, then repeat while counting backward from 100 by 3s. Note any changes in gait speed, stability, or counting accuracy. 2. Start with single tasks: Before jumping into dual-tasks, ensure the patient can perform the motor and cognitive tasks independently with good form and accuracy. 3. Introduce simple dual-tasks: Begin with a stable motor task (e.g., stationary bike) and a simple cognitive task (e.g., naming months of the year). 4. Progress difficulty: Gradually increase the complexity of both tasks. For example, move from stationary bike to treadmill walking, and from simple naming to more complex serial subtractions. 5. Vary the tasks: Don't just stick to one cognitive task. Mix it up with different types of challenges (e.g., verbal fluency, working memory, attention). This will help with generalization. 6. Focus on safety: Always use a gait belt and be prepared to provide support, especially in the early stages of training. 7. Educate your patient: Explain what CMI is and why you're using DTT. This will help with buy-in and adherence.

Common Mistakes to Avoid

•Starting with tasks that are too difficult: This can lead to frustration and increase the risk of falls.
•Not progressing the difficulty: The brain needs to be challenged to adapt. If the tasks are too easy, you won't see much improvement.
•Only focusing on the motor task: It's crucial to monitor both motor and cognitive performance. If the patient is sacrificing all their cognitive resources to maintain their gait, the training isn't as effective.
•Not providing enough feedback: Let the patient know how they're doing and what they need to work on. This will help them stay motivated and engaged.

Frequently Asked Questions

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