JMIR Publications

ABSTRACT

Background:

The interest towards dual-task training (DTT) is increased due to the ascertainment that the traditional interventions may not prepare patients to adequately face the challenges of most activities of daily living. These do usually involve cognitive and motor tasks at the same time with often a decline in performance. Cognitive-motor interference (CMI) has been investigated in different neurological populations, but few evidences are present for people with Multiple Sclerosis (PwMS). To date, the use of computerized tools is mandatory to allow the application of more standardized assessment and rehabilitation intervention protocols, and easier implementation of multi-center and multi-language studies.

Objective:

Here, we describe the design and development of CMI-APP, an adaptive and interactive technology tablet-based application. Moreover, we present the preliminary results of a multi-center pilot study on PwMS performed in several European centers to evaluate feasibility and adherence to a rehabilitation program based on CMI-APP.

Methods:

CMI-APP includes user-friendly interfaces for personal data input and management, for assessment of CMI and for DTT. A dedicated team developed CMI-APP for any Android tablet above API level 14 (version 4.0), using C# as programming language and Unity and Visual Studio as development tools. Three cognitive assessment tests for working memory, information processing speed, sustained attention and four motor assessment tests for walking at different difficulty level were implemented in CMI-APP. Dual cognitive-motor tasks were given by the combination of single cognitive and motor tasks. CMI-APP implements exercises for DTT for twelve different cognitive functions, namely: sustained attention, text comprehension, verbal fluency, auditory discrimination, visual discrimination, working memory, information processing speed, auditory memory, visual memory, verbal analog reasoning, visual analog reasoning, visual spatial planning, which can be performed during walking or stepping on the spot. Fifteen PwMS were recruited (mean age: 52.6±8.6 years; mean disease duration 9.4±8.4 years; Expanded Disability Status Scale: 3.6±1.1) and requested to perform a DTT of 20 sessions. Adherence to the rehabilitation program was evaluated with the percentage of performed sessions, perceived exertion during the training with the Borg 15-point Ratings of Perceived Exertion Scale (RPE) and subjective experience towards the training with the Intrinsic Motivation Inventory (IMI).

Results:

Adherence was 91%. DTT was perceived as ‘’a little bit heavy’’ (mean RPE: 12.6±1.9). IMI revealed participants enjoyed the training, felt it valuable and to some extent important to them, without feelings of pressure. They felt competent although they did not always feel they could choose the exercises probably because the therapist chose them and many exercises had few difficulty levels.

Conclusions:

CMI-APP is a tool safe, highly usable, motivating and well-accepted by PwMS for DTT. This is fundamental in preparation of future large-sample studies examining CMI and the effectiveness of a DTT intervention with CMI-APP on PwMS.