Effect of task difficulty on dual-task cost during dual-task walking in people with multiple sclerosis

Background: Cognitive-motor dual-task walking results a decrease in walking performance of patients with multiple sclerosis (PwMS) and it is known as dual-task cost (DTC). However, there is a lack of evidence about the effects of dual-tasks with hierarchical difficulty on DTC in PwMS.

Research question: This study aimed to investigate the effect of task difficulty on DTC during cognitive-motor dual-task walking in people with multiple sclerosis (PwMS).

Methods: 32 PwMS and 32 healthy controls were included. The 6-meter walking test (6-Meter WT) with comfortable speed was used as single-task walking condition. For dual-task conditions, walking tasks and cognitive tasks at two difficulty levels (simple and difficult) were combined and DTC for four cognitive-motor dual-task walking conditions as simple motor-simple cognitive (SM-SC), simple motor-difficult cognitive (SM-DC), difficult motor-simple cognitive (DM-SC) and difficult motor-difficult cognitive (DM-DC) were calculated. The 6-Meter WT was used also for simple dual-task walking task. The 6-Meter WT was applied by walking in a narrow base condition for creating a difficult dual-task walking task. For cognitive task difficulty, participants were asked to count backwards by 3 as simple cognitive task and by 7 as difficult cognitive task.

Results: DTC was higher in PwMS than control subjects. DTC in all conditions were different (SM-SC<SM-DC<DM-SC<DM-DC). DTC was higher in PwMS than control subjects in three conditions and was similar SM-SC condition. In addition, DTC in all conditions (SM-SC<SM-DC<DM-SC<DM-DC) were different in both PwMS and control subjects.

Conclusion: The results suggest that task difficulty affects the magnitude of DTC during cognitive-motor dual-task walking in PwMS. Moreover, difficult walking tasks combined with simple cognitive tasks result greater DCT on walking than simple walking tasks combined with difficult cognitive tasks.