Neural Fitness

Welcome to the sMAP CREATE Webinar Series for Academic Year 2021/22 featuring experts from different fields whose commitment and research relates to mobility in aging populations.  The September 2021 webinar features Dr. Tony Szturm speaking on game-based dual-task neural fitness assessment program for individuals with mobility limitations and cognitive impairments.

Please join us on Zoom (meeting link will be provided upon registration).  For more information email smap.create@gmail.com

Neural Fitness:   Game-Based Dual-task Training Program with embedded assessment:  Blending Balance Gait, Visuomotor and Cognitive Functions [For Individuals with mobility Limitations & cognitive impairments.

BIO

Tony Szturm PT, Ph.D. attended University of Western Ontario, graduating with Bachelor’s Degree in Biology and Physical Therapy, he worked four years as a staff Physiotherapist in Winnipeg.  He returned to university and completed his PhD in Neurophysiology at the University of Manitoba specializing in balance, gait and movement disorders.  Presently he is a Professor at the Department of Physical Therapy and an Adjunct Professor in the Department of Mechanical Engineering at the University of Manitoba.  His research area is the design, development, and validation of Technology, and game-assisted rehabilitation platform for mobility limitations, integration of balance, gait, visuomotor & executive cognitive functions (dual-task functions). Patient populations include: a) Parkinson’s disease, b) aging, mobility limitation & cognitive decline and c) acquired brain injuries.

Tony Szturm PT, Ph.D. attended University of Western Ontario, graduating with Bachelor’s Degree in Biology and Physical Therapy, he worked four years as a staff Physiotherapist in Winnipeg.  He returned to university and completed his PhD in Neurophysiology at the University of Manitoba specializing in balance, gait and movement disorders.  Presently he is a Professor at the Department of Physical Therapy and an Adjunct Professor in the Department of Mechanical Engineering at the University of Manitoba.  His research area is the design, development, and validation of Technology, and game-assisted rehabilitation platform for mobility limitations, integration of balance, gait, visuomotor & executive cognitive functions (dual-task functions). Patient populations include: a) Parkinson’s disease, b) aging, mobility limitation & cognitive decline and c) acquired brain injuries.

ABSTRACT

Balance and gait impairments and consequently mobility restrictions and falls are common in Parkinson’s disease (PD). Various forms of cognitive deficits are also common in PD and are associated with increased fall risk. Deficits in mobility and cognitive function are serious problems that many people with Parkinson’s disease face in their day-to-day lives, and are limiting factors in a person’s health, ability to perform activities of daily living, and overall quality of life.  Community ambulation involves many dual-task (DT) conditions that require processing of several cognitive tasks while navigating the environment and managing sudden or unexpected balance challenges. Consequently, dual- task (DT) screening and training programs are important to consider in rehabilitation and promotion of healthy active lives.

We will present   an engaging cognitive game-based treadmill platform (GTP) for DT training, which includes an automated assessment subsystem. The GTP provides an integrated approach to address the decline in balance, gait, visuomotor, and executive cognitive functions. The GTP consists of: a) a standard treadmill instrumented with a pressure mapping system to record center of foot pressure during walking, b) a hands-free, interactive computer game subsystem for DT; and c) an automated monitoring application and analysis methods to quantify both gait and cognitive outcome measures while DT-walking.

We will present   preliminary findings   of a RCT – novel behavioral PET brain imaging methods are used to evaluate the molecular basis and neural underpinnings of: (a) the decline of mobility function in Parkinson’s disease, specifically, Balance, gait visuomotor and cognitive function, and (b) the effects of an Engaging, game-based Dual-task treadmill walking program on mobility and cognitive functions. Both the interactive cognitive game tasks and treadmill walking require continuous visual attention, and share spatial processing functions, notably to minimize any balance disturbance or gait deviation/stumble. The ability to “walk and talk” normally includes activation of specific regions of the prefrontal cortex and the basal ganglia.

The behavioral PET imaging analysis and comparison with healthy age-match controls will allow us to identify areas of abnormal, reduced activity levels as well as areas of excessive activity (increased attentional resources) during dual-task walking. We will then be able to identify areas of brain plasticity associated with improvements in mobility functions (balance, gait, and cognition). We expect the gait – cognitive training effect to involve re-organization of prefrontal cortex activity and likely other brain regions yet to be identified. Preliminary data from PET imaging of DT walking of PD patients and feasibility/benefits of the DT training program in PD will be presented.

The dual-task mobility-training platform is directly applicable to other diseases that affect gait and cognition, e.g., cognitive vascular impairment, Alzheimer’s disease, as well as in aging.  Results of an exploratory RCT comparing DT treadmill walking to DT recumbent cycle program in a sample of older adults (age 76-85) with increased fall risk will also be presented.

SELECTED REFERENCES

Szturm T, Beheshti I, Mahana B, Hobson DE, Goertzen A, Ko JH. Imaging Cerebral Glucose Metabolism during Dual-Task Walking in Patients with Parkinson’s disease. J Neuroimaging. 2020 Dec 8. doi: 10.1111/jon.12812.

Szturm T, Kolesar T, Mahana B, Goertzen A, Hobson D, Strafella A, Ko JH Changes in Metabolic Activity and Gait Function by Dual-Task Cognitive Game-Based Treadmill System in Parkinson’s Disease: Protocol of a Randomized Controlled Trial.  Front. Aging Neurosci., 04 June 2021 | https://doi.org/10.3389/fnagi.2021.680270

Mahana B, Bhatt B, Gupta A, Hobson D, Ko JH, Szturm T. Does Use of a Dual-Task Cognitive Game-Based Treadmill Platform Improve Gait in Parkinson Disease? A Feasibility Study. Brain, Body, Cognition 2021, 9#: 5 May 2021

Mayank Bhatt, Bhuvan Mahana, Ji Hyun Ko, Tiffany Kolesar, Tony Szturm Computerized dual-task testing of gait visuomotor and cognitive functions in Parkinson’s disease: Test-retest reliability and validity. Accepted Frontiers in human Neurosciences, in press Aug 2021

Nnankar M., Szturm T., Shay B., Marotta J., Beauchet O., Allali G. The Interacting Effects of Treadmill Walking and Different Types of Visuospatial Cognitive Task: Discriminating Dual Task and Age effects. (2017) Archives of Gerontology and Geriatrics. 73, November 2017, Pages 50-59