Computer Games Based Dual-Task Testing and Training of Gait Visuomotor and Executive Cognitive Functions in Parkinson's Disease: A feasibility study

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Abstract Introduction Parkinson's Disease (PD) often leads to worsened gait and cognitive performance under dual-task conditions, making it essential to explore interventions that target both motor and cognitive functions. A treadmill-based motor-cognitive system, enhanced with computer games, may provide a cost-effective solution to improve spatiotemporal gait parameters and executive cognitive functions in individuals with PD. Objective The feasibility of a design for evaluation of a computer games-based dual-task treadmill (CDT) intervention for individuals with PD was assessed. Adherence to and acceptance of the intervention was analysed. Method Five community-dwelling participants with PD (age 52-76 years) were recruited. The intervention involved dual-task (DT) training, where participants engaged in commercial computer games while walking on a treadmill with sessions of 45 minutes held twice a week over a period of 8 weeks. Inclusion criteria included successful completion of a 6-minute walking test and a 20-meter walking speed assessment. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Spatiotemporal gait parameters were recorded from pre- to post-intervention. Executive cognitive outcomes were assessed through computer-based tasks. Semi-structured qualitative interviews were conducted after the intervention Results All participants adhered to the intervention with minimal absences. From pre- to post-intervention, improvements were observed in both physical and cognitive performance. Specifically, gait improvements included reductions in 20-meter walk time (median score from 12.3s to 10.6s), increased distance in the 6-minute walk test (median score from 418m to 497m), and enhanced spatiotemporal gait parameters, including stride length and step duration. Cognitive function, as assessed by MoCA, also improved (median score increased from 25 to 27). Notably, the qualitative interviews identified six key themes: motivation, perceived physical and cognitive improvements, challenges faced during the intervention, engagement with the method, cognitive aspects of the dual-tasking, and future intentions. These themes show participants' perceived value of the intervention, the challenges they encountered, and their interest in continuing similar therapy. Conclusion The CDT intervention was feasible and well-accepted. It resulted in significant improvements in mobility and executive cognitive functions. Participants found the intervention valuable for enhancing both gait and cognitive abilities in PD.

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