Name: revised and neuroimaging-compatible versions of the dual task screen
Uploaded: 2020-10-05T13:00:00
Description: Watch this Scientific Journal Video about Revised and Neuroimaging-Compatible Versions of the Dual Task Screen at JoVE.com

We would like to thank Ms. Isabelle Booth, a Colorado State University honors student who assisted with accelerometry data analysis. We would also like to acknowledge funding from NIH K12 HD055931 and K01 HD096047-02 issued to author J.S.

All study procedures were approved by the Institutional Review Board (IRB) at Colorado State University, and all adult participants provided written informed consent prior to completing any study procedures. Written informed consent was provided by parents of participants under 18, and minor participants also provided written assent prior to completing any study procedures.
1. Revised Dual Task Screen (DTS)
<ol>
	<li>Lower Extremity (LE) Subtask
	<ol>
		<li>Start the single motor condition.
...

<ol>
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N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+criteria+used+to+define+recovery+from+sport-related+concussion+in+youth+athletes.">A systematic review of criteria used to define recovery from sport-related concussion in youth athletes.</a> British Journal of Sports Medicine. 52 (18), 1179-1190 (2018).</li><li>Conway, F. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concussion+Symptom+Underreporting+Among+Incoming+National+Collegiate+Athletic+Association+Division+I+College+Athletes.">Concussion Symptom Underreporting Among Incoming National Collegiate Athletic Association Division I College Athletes.</a> Clinical Journal of Sport Medicine. 30 (3), 203-209 (2020).</li><li>Broglio, S. P., Guskiewicz, K. 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R., Buckley, T. A., Lynall, R. C., Meehan, W. P. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Worsening+dual-task+gait+costs+after+concussion+and+their+association+with+subsequent+sport-related+injury.">Worsening dual-task gait costs after concussion and their association with subsequent sport-related injury.</a> Journal of Neurotrauma. 35 (14), 1630-1636 (2018).</li><li>Howell, D. R., Kirkwood, M. W., Provance, A., Iverson, G. L., Meehan, W. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+concurrent+gait+and+cognitive+assessments+to+identify+impairments+after+concussion:+a+narrative+review.">Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review.</a> Concussion. 3 (1), 54 (2018).</li><li>Lee, H., Sullivan, S. J., Schneiders, A. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+the+dual-task+paradigm+in+detecting+gait+performance+deficits+following+a+sports-related+concussion:+a+systematic+review+and+meta-analysis.">The use of the dual-task paradigm in detecting gait performance deficits following a sports-related concussion: a systematic review and meta-analysis.</a> Journal of Science and Medicine in Sport. 16 (1), 2-7 (2013).</li><li>Solomito, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Motion+analysis+evaluation+of+adolescent+athletes+during+dual-task+walking+following+a+concussion:+A+multicenter+study.">Motion analysis evaluation of adolescent athletes during dual-task walking following a concussion: A multicenter study.</a> Gait Posture. 64, 260-265 (2018).</li><li>Stephens, J. A., Nicholson, R., Slomine, B., Suskauer, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+pilot+testing+of+the+dual+task+screen+in+healthy+adolescents.">Development and pilot testing of the dual task screen in healthy adolescents.</a> American Journal of Occupational Therapy. 72 (3), (2018).</li><li>Ptak, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+frontoparietal+attention+network+of+the+human+brain:+action,+saliency,+and+a+priority+map+of+the+environment.">The frontoparietal attention network of the human brain: action, saliency, and a priority map of the environment.</a> Neuroscientist. 18 (5), 502-515 (2012).</li><li>Jasper, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Report+of+the+committee+on+methods+of+clinical+examination+in+electroencephalography:+1957.">Report of the committee on methods of clinical examination in electroencephalography: 1957.</a> Electroencephalography and Clinical Neurophysiology. 10 (2), 370-375 (1958).</li><li>Brigadoi, S., Cooper, R. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+short+is+short?+Optimum+source-detector+distance+for+short-separation+channels+in+functional+near-infrared+spectroscopy.">How short is short? Optimum source-detector distance for short-separation channels in functional near-infrared spectroscopy.</a> Neurophotonics. 2 (2), 025005 (2015).</li><li>Sato, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reduction+of+global+interference+of+scalp-hemodynamics+in+functional+near-infrared+spectroscopy+using+short+distance+probes.">Reduction of global interference of scalp-hemodynamics in functional near-infrared spectroscopy using short distance probes.</a> Neuroimage. 141, 120-132 (2016).</li><li>Scholkmann, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+review+on+continuous+wave+functional+near-infrared+spectroscopy+and+imaging+instrumentation+and+methodology.">A review on continuous wave functional near-infrared spectroscopy and imaging instrumentation and methodology.</a> Neuroimage. 85, 6-27 (2014).</li><li>Baker, W. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modified+Beer-Lambert+law+for+blood+flow.">Modified Beer-Lambert law for blood flow.</a> Biomedical Optics Express. 5 (11), 4053-4075 (2014).</li><li>Barker, J. W., Aarabi, A., Huppert, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Autoregressive+model+based+algorithm+for+correcting+motion+and+serially+correlated+errors+in+fNIRS.">Autoregressive model based algorithm for correcting motion and serially correlated errors in fNIRS.</a> Biomedical Optics Express. 4 (8), 1366-1379 (2013).</li><li>Aguirre, G. 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In this manuscript, we described the administration protocol for the newly revised Dual Task Screen (DTS). These revisions were completed to address limitations identified in the original DTS15 and included the addition of single cognitive conditions to test for dual task cognitive costs. It also included smart-device based accelerometry to more precisely measure gait characteristics. We included representative results which illustrate the type of clinical data that can be acquired with the DTS. W...

Each year, 42 million people worldwide sustain mild traumatic brain injuries (mTBIs)1. Although once considered benign, new research indicates that mTBIs, particularly repeat mTBIs, can elicit lasting negative consequences, such as physical, cognitive, and sleep disturbances2,3,4. Subsequently, researchers and clinicians are seeking enhanced evaluations and treatment methods to understand and address mTBI.
To date, best practice for mTBI evaluation includes self-reported symptoms and objective measurement of neurocognitive and motor function5. However, some individuals, like competitive collegiate-level athletes, are known to underreport mTBI-related symptoms6, limiting the utility of symptom reports. Objective neurocognitive and motor function measures also have limitations, including poor test-retest reliability, reliance on baseline testing, or insufficient difficulty for high-performing athletes7,8,9. However, dual task paradigms - which simultaneously assess motor and cognitive abilities - can detect subtle, residual impairments and may be particularly useful for evaluating high-performing athletes10,11,12,13,14.
Past research using dual task paradigms have often incorporated cumbersome, expensive laboratory equipment, such as motion capture systems14, to evaluate high-performing athletes. While these systems can accurately measure subtle motor impairments, they are impractical for use in everyday mTBI evaluation due to high equipment cost, limited portability, and long administration times (i.e., &#8805; 45 minutes per individual). Further, many past dual task paradigm studies focused solely on lower body or lower extremity skills, such as balance or gait11,12,13,14. Arguably, upper extremity function and hand-eye coordination is also important for high-performing athletes in many sports. Thus, we developed the Dual Task Screen (DTS), which is a brief measure designed to be administered and scored in &#60;10 minutes with portable, low-cost instruments. This original DTS included a lower extremity (LE) and upper extremity (UE) subtask, which evaluated gait speed (using a stopwatch) and hand-eye coordination under single motor and dual task conditions15.
In the first feasibility study, 32 healthy, female adolescent participants completed the original DTS. This study was designed to establish that the DTS could elicit dual task motor costs, as indicated by reduced motor performance during dual task vs. single motor conditions. We also sought to establish that the DTS could be administered and scored in fewer than 10 minutes. We found that all participants had poorer dual task motor performance on at least one subtask. Additionally, we were able to administer the DTS in an average of 5.63 minutes and score the test in 2-3 minutes15.
Although the first feasibility study was successful, a few limitations were revealed. Most notably, gait speed was measured with stopwatches, which are prone to natural human error. Therefore, in the revised DTS we used smart devices with built-in accelerometers (Table of Materials) on each ankle. This addition maintained the use of portable, low-cost instruments while still providing sophisticated measures of gait speed, total number of steps, average step length, average step duration, and step duration variability. Another limitation of the original DTS was the absence of single cognitive conditions, which prevented evaluation of dual task cognitive costs. Dual task cognitive costs are defined as poorer cognitive performance during the dual task vs. single cognitive condition. Subsequently, for both the LE and UE subtasks, we added a single cognitive condition (described in Protocol).
In addition to developing a measure for future clinical use, one of the team&#8217;s long-term goals is to evaluate the neural underpinnings of single and dual task performance in healthy athletes and contrast those findings to athletes with sports-induced mTBI. Thus, we have created a neuroimaging-compatible version of the DTS. We seek to determine if the DTS can be successfully modified for use with simultaneous functional near-infrared spectroscopy (fNIRS) measurement, and we are using a mobile fNIRS device specifically designed to accommodate gross-motor movement by reducing the influence of motion artifacts. Further, this device has the greatest amount of head coverage, to our knowledge, for mobile devices that are currently available for research purposes (Table of Materials).
In summary, the study protocol is designed to do the following:
<ol>
	<li>Describe the administration protocol for the revised Dual Task Screen (DTS), which is a measure we redesigned to address the limitations of the original DTS15 and a measure intended for future clinical use.</li>
	<li>Describe the research protocol for the neuroimaging-compatible Dual Task Screen (DTS), which we have designed to evaluate the neural underpinnings of single and dual task performance.</li>
</ol>

<table>
	<tbody>
		<tr>
			<td>Hardware (in alphabetical order)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>NIRx NIRSport2 Device: NSP2-CORE1616</td>
			<td>NIRx</td>
			<td>Reference #: GC359</td>
			<td>&#34;The NIRSport 2 is a user-friendly, modular, and robust wireless functional near-infrared spectroscopy (fNIRS) platform which measures hemodynamic responses to neuroactivation via oxy-, deoxy-, and total hemoglobin changes in the cerebral cortex.The NIRSport 2 comes with a host of ready-to-implement upgrades and modules to meet the needs of a broad range of cognitive neuroscience applications.&#34; (Direct quote from nirx.net/nirsport)</td>
		</tr>
		<tr>
			<td>NIRx NIRSCap (available in 5 difference sizes)</td>
			<td>NIRx</td>
			<td>N/A</td>
			<td>&#34;The NIRScap consists of a measuring cap and optode holders. The optode holders fit into the slits of the measuring cap.&#34; (Direct quote from NIRx&#39;s NIRScap Getting Started Guide)</td>
		</tr>
		<tr>
			<td>NIRx Optode Sources (x 2)</td>
			<td>NIRx</td>
			<td>Reference #: GC359</td>
			<td>&#34;8-source active source bundel for fiberless optical illumination with dual tip; 240 cm long.&#34; (Direct quote from NIRx Packing List Description)</td>
		</tr>
		<tr>
			<td>NIRx Optode Detectors (x 2)</td>
			<td>NIRx</td>
			<td>Reference #: GC359</td>
			<td>&#34;Bundle of 8x active sensores for fiberless optical detection; dual tip; 240 cm long.&#34; (Direct quote from NIRx Packing List Description)</td>
		</tr>
		<tr>
			<td>NIRx Short Distance Detector Probes</td>
			<td>NIRx</td>
			<td>N/A</td>
			<td>&#34;The probes come in a bundle of eight detector clips that allows coupling of short-distance data from eight independent sources sites to one common detector channel on the instrument.&#34; (Direct quote from NIRx&#39;s Short Distance Detector Probes Getting Started Guide)</td>
		</tr>
		<tr>
			<td>Software (in alphabetical order)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Aurora</td>
			<td>NIRx</td>
			<td>N/A</td>
			<td>&#34;NIRSport 2 Acquistion Software. Aurora fNIRS connects to your NIRSport 2 device via Wi-Fi or USB and can set-up a complete experimental configuration in only several clicks. Thanks to the automated signal optimization algorithm, Aurora fNIRS ensures optimal signal quality before a measurement is started. Raw data, HbO and Hb concentration changtes can be visualized in real-time in several display modes. In addition, high-end whole head visualizations are immediately available. Recorded data can be exported over the integrate Lab Streaming Layer (LSL) protocol, allowing for real-time processing in Brain-Computer Interface (BCI) and Neurofeedback paradigms.&#34; (Direct quote from nirx.net/software)</td>
		</tr>
		<tr>
			<td>Matlab</td>
			<td>Math Works</td>
			<td>N/A</td>
			<td>&#34;MATLAB&#174; combines a desktop environment tuned for iterative analysis and design processes with a programming language that expresses matrix and array mathematics directly. It includes the Live Editor for creating scripts that combine code, output, and formatted text in an executable notebook.&#34; (Direct quote from mathworks.com)</td>
		</tr>
		<tr>
			<td>NIRS Toolbox</td>
			<td>Developed by Huppert Brain Imaging Lab</td>
			<td>N/A</td>
			<td>&#34;NIRS toolbox is a Matlab based analysis program.&#34; (Direct quote from huppertlab.net/nirs-toolbox-2/)</td>
		</tr>
		<tr>
			<td>PsychoPy</td>
			<td>Python</td>
			<td>N/A</td>
			<td>&#34;PsychoPy is an open source software package written in the Python program,ming language primarily for us in neuroscience and experimntal psychology research.&#34; (Direct quote from psychopy.org)</td>
		</tr>
		<tr>
			<td>Lower Tech/Cost Research Supplies* (in alphabetical order)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>AmazonBasics 60-Inch Lightweight Tripod with Bag</td>
			<td>Amazon</td>
			<td>Item Model #: WT3540</td>
			<td>This lightweight tripod is perfect for most cameras up to 6.6 pounds. Setup is quick and easy. The included bag makes storage and transport a snap.The tripod&#8217;s legs can extend from 20&#8221; to 48&#8221;. Leg locks release smoothly and glide easily to your desired height. Crank up the center post for a tripod that is 60&#8221; tall. (Direct quote from Amazon.com)</td>
		</tr>
		<tr>
			<td>iPod Touch x 2</td>
			<td>Apple</td>
			<td>N/A</td>
			<td>Smart device with built-in accelerometer.</td>
		</tr>
		<tr>
			<td>Panasonic Full HD Video Camera Camcorder HC-V180K, 50X Optical Zoom, 1/5.8-Inch BSI Sensor, Touch Enabled 2.7-Inch LCD Display (Black)</td>
			<td>Amazon</td>
			<td>Item Model #: HC-V180K</td>
			<td>Compact, lightweight and easy to use, the Panasonic Full HD Camcorder HC-V180K brings a fun, worry-free experience to high-resolution video capture. Featuring a 5-axis image stabilizer for maximum handheld stability, this 1080p camera&#8217;s super-long 50X optical zoom and up to 90X intelligent zoom quickly bring distant objects in focus. A convenient 28mm wide-angle lens allows you to fit more people and scenery into settings like weddings, reunions and vacations. An advanced BSI sensor assures low-light video image quality while Panasonic&#8217;s Level Shot function automatically detects and compensates for distracting camera tilting. For added fun, the camera includes creative filter effects like 8mm Movie, Silent Movie, Miniature Effect and Time Lapse Recording, all easily accessible on the 2.7-inch LCD touch screen. A two-channel zoom microphone works in tandem with the zoom to ensure crisp, clear audio up close or at any distance.&#34; (Direct quote from Amazon.com)</td>
		</tr>
		<tr>
			<td>Post-it Notes, 3&#34; x 3&#34;, Canary Yellow, Pack Of 18 Pads</td>
			<td>Office Depot/Office Max</td>
			<td>Item # 1230652</td>
			<td>&#34;Post it&#174; Notes stick securely and remove cleanly, featuring a unique adhesive designed for use on paper.&#34;</td>
		</tr>
		<tr>
			<td>Scotch 232 Masking Tape, 1&#34; x 60 Yd</td>
			<td>Office Depot/Office Max</td>
			<td>Item # 910588</td>
			<td>&#34;High-performance paper masking tape produces sharp paint lines in medium-temperature paint bake operations. Scotch tape provides clean removal every time, even on traditionally difficult-to-remove surfaces.&#34; (Direct quote from officedepot.com)</td>
		</tr>
		<tr>
			<td>Stanley Tools Leverlock Tape Measure, Standard, 25&#39; x 1&#34; Blade</td>
			<td>Office Depot/Office Max</td>
			<td>Item #389512</td>
			<td>&#34;Tape rule features a power return with automatic bottom lock for easy operation. High-visibility case color makes it easy to find. Special Tru-Zero hook allows use of nail as pivot to draw circles and arcs. Tape rule offers a multiple riveted hook and polymer-coated blade for longer life, blade wear guard and comfortable rubber grip. Protected blade resists abrasion, oils, dirt and most solvents. Tape rule has Imperial ruling with consecutive feet on top and consecutive inches on bottom after the first foot. Its belt clip allows easy carrying.&#34; (Direct quote from officedepot.com)</td>
		</tr>
		<tr>
			<td>Stopwatch</td>
			<td>Office Depot/Office Max</td>
			<td>Item # 357698</td>
			<td>&#34;Offers split timing, precise to 1/100 of a second. Includes 6 functions &#8212; hour, minute, second, day, month and year.&#34; (Direct quote from officedepot.com)</td>
		</tr>
		<tr>
			<td>Tourna Ballport Deluxe Tennis Ball Hopper with Wheels - Holds 80 Balls</td>
			<td>Amazon</td>
			<td>Item Model #: BPD-80W</td>
			<td>&#34;Balloon port 80 deluxe holds 80 balls and comes with wheels for easy Maneuverability. The handles are an extra long 33 inch for more convenient feed and pickup. Very lightweight yet durable makes this one of the most premium hoppers on the market. Loaded with patented features: legs lock in up and down position. Bars at the top slide closed so your the balls don&#39;t fall out during transport. Bars roll at the bottom so the ball slips in the hopper easily.&#34; (Direct quote from Amazon.com)</td>
		</tr>
		<tr>
			<td>Tourna Pressureless Tennis Balls with Vinyl Tote (45 pack of balls)</td>
			<td>Amazon</td>
			<td>Item Model #: EPTB-45</td>
			<td>&#34;45 Pressure less tennis balls in a vinyl tote bag. Bag has a zipper for secure closure. Balls are regulation size and durable. Suitable for practice or tennis ball machines. Balls are pressure less so they never go dead. Pressure-less means they never go dead, which makes them great for tennis practice, ball machines, filling up ball baskets and hoppers, or just making sure your pet has hours of fun chasing these balls. They fit Chuck-it style dog ball launchers and automatic ball launchers. Durable rubber and a premium felt ensures their use can be universal, whether your a budding tennis player or a pet owner.&#34; (Direct quote from Amazon.com)</td>
		</tr>
		<tr>
			<td>Velcro</td>
			<td>Velcro</td>
			<td>N/A</td>
			<td>Self-adhesive strips and wraps; used to secure smart devices.</td>
		</tr>
		<tr>
			<td>Yoga Block 2 Pack &#8211; 2 High Density Light Weight Exercise Blocks 4 x 6 x 9 Inches Support All Poses - Lightweight Versatile Fitness and Balance Odor Free Bricks (Note: 6 blocks are needed for Dual Task Screen)</td>
			<td>Amazon</td>
			<td>N/A</td>
			<td>&#34;These blocks are made from recycled high density EVA foam and provide firm support in a wide range of different yoga poses. This will improve your posture and you can stay in challenging poses for longer.&#34; (Direct quote from Amazon.com)</td>
		</tr>
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			<td>*These items or comparable items can be obtained from a number of other sources</td>
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		</tr>
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</table>

revised and neuroimaging-compatible versions of the dual task screen

Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild traumatic brain injury (mTBI). However, past dual task paradigms have focused solely on lower extremity skills and have relied on cumbersome, expensive laboratory equipment - thus limiting their practicality for everyday mTBI evaluation. Subsequently, we developed the Dual Task Screen (DTS), which takes &#60;10 minutes to administer and score, uses low-cost portable equipment, and includes lower extremity (LE) and upper extremity (UE) subtasks. The purpose of this manuscript was twofold. First, we describe the administration protocol for the revised DTS, which we revised to address the limitations of the original DTS. Specifically, the revisions included additions of smart devices to acquire more detailed gait data and inclusion of single cognitive conditions to test for disrupted cognitive performance under dual task conditions. Importantly, the revised DTS is a measure intended for future clinical use, and we present representative results from three male athletes to illustrate the type of clinical data that can be acquired from the measure. Importantly, we have yet to evaluate the sensitivity and specificity of the revised DTS in athletes with mTBI, which is the next research initiative. The second purpose of this manuscript is to describe a neuroimaging-compatible version of the DTS. We developed this version so we could evaluate the neural underpinnings of single and dual task performance, for a better empirical understanding of the behavioral deficits associated with mTBI. Thus, this manuscript also describes the steps we took to enable simultaneous functional near-infrared spectroscopy (fNIRS) measurement during the DTS, along with how we acquired and completed first-level processing of the fNIRS data.

Participants 
Participants were recruited from local high school teams and university intercollegiate and club sports teams using word-of-mouth and advertising flyers. Participants were required to be between the ages of 15-22 and engage in regular participation in organized contact sports. Contact sports included all sports where physical contact with teammates or opponents is necessary during routine play. Participants also had to have normal or corrected vision and hearing, no history of neurolog...

Watch this Scientific Journal Video about Revised and Neuroimaging-Compatible Versions of the Dual Task Screen at JoVE.com

Revised and Neuroimaging-Compatible Versions of the Dual Task Screen

We developed the original Dual Task Screen (DTS) as a portable, low-cost measure that can evaluate athletes with sports-induced mild traumatic brain injury. We revised the original DTS for future clinical use and developed a neuroimaging-compatible version of the DTS to measure neural underpinnings of single and dual task performance.

Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild ...

Previous work has used dual test measures to evaluate athletes with recent concussion. Our protocol is significant because we've created a shorter, cost efficient measure that permits simultaneous neuroimaging. If effective at eliciting greater dual task cost in athletes with concussion, our dual task screen measure will be applicable for use in a variety of clinical settings.For a single condition lower extremity sub-task, place three yoga blocks in a horizontal position exactly 4.5 meters apart along an 18 meter walkway and firmly attach smart devices to both of the participant's ankles. Instruct the participant that they will have to walk as quickly as possible while stepping over the obstacles and quickly tap both accelerometers to start the test using a stopwatch to measure the time it takes the participant to complete the task. As the participant's heel strikes the ground, raw data will be generated that can be analyzed to assess the participant's gait characteristics.At the end of the task, inform the participant of the time it took them to complete the task from their single motor condition. Then ask the participant to say as many words as they can that begin with a particular letter. For a dual lower extremity sub-task, after instructing the participant how to perform the task, tap both accelerometers to start the task and time the participant while they step over obstacles as quickly as possible while simultaneously stating as many words as possible that begin with a particular letter.For a single upper extremity sub-task, use masking tape to mark a 1.5 meter distance from a wall and instruct the participant to stand behind the tape. Place a basket of tennis balls next to the participant and have the participant complete a wall toss with alternating hands for 30 seconds using a new ball from the basket for any balls they fail to catch. At the end of the task, ask the participant to sequentially subtract seven from a given number for 30 seconds.For a dual upper extremity sub-task, have the participant perform the wall toss with alternating hands while sequentially subtracting seven from a given number for 30 seconds, selecting a new ball from the basket after any misses as necessary. To set up a neuroimaging compatible task, place yoga blocks in a vertical position to mark the start and end of a 15-meter walkway and place two yoga blocks in a horizontal position exactly five meters apart along the 15 meter walkway. Then mark a 1.5 meter distance away from a smooth wall surface.Next, measure the participant's head circumference and place an appropriately sized fNIRS cap with pre-placed optodes and short channel detectors onto the participant's head. Turn on a dedicated acquisition laptop and connect the laptop to the fNIRS device WiFi network. In the fNIRS acquisition software, select the fNIRS device and perform a calibration to optimize the light intensity.At the end of the calibration, check the optodes'signal levels which should be acceptable or excellent. To fix any optodes with a less than acceptable signal level, remove the optode from the cap and part the participant's hair to ensure a direct connection to the participant's scalp. To acquire lower extremity sub-task neuroimaging data, open the stimulus presentation software and select the lower extremity sub-task file.Have the participant sit in a chair and click start to begin collecting baseline fNIRS data. Enter the subject ID, lower extremity, age, and sex into the popup window and click start experiment. Inform the participant that a quiet rest period is beginning and press the Space Bar to start a 60-second rest period.At the end of the rest period, explain the lower extremity task schedule to the participant and press the Space Bar to start the first trial. After 15 randomized trials of the lower extremity sub-tasks have been performed, have the participant rest for another 60 seconds in the chair. At the end of the rest period, exit out of the sub-task file in the stimulus presentation software and stop the data acquisition in the fNIRS data acquisition software.Then remove the accelerometers from the participant's ankles and use the software to perform the upper extremity analysis as demonstrated. At the end of the rest period, explain the upper extremity task schedule to the participant and press the Space Bar to start the first trial. In these representative analyses of three male participants, a slower gait speed, longer average step duration, and greater variability in step duration are observed during dual compared to single condition tasks.In contrast, two of three participants showed no changes in the number of total steps or the average step length under single motor versus dual task conditions. Two out of three participants also generated fewer words during the dual cognitive task condition compared to the single task condition. All three male participants had a dual task motor cost with fewer successful catches observed during the dual task condition compared to the single motor condition.Fewer correct subtractions during the dual task condition were also observed in two of the three participants compared to the single task condition. Here, a map of the placement of the 15 LED sources and 15 detectors on the participant's head can be observed. Use of the fNIRS cap during the lower and upper extremity sub-task trials allows measurement and comparison of the oxygenated hemoglobin levels produced by the participant during the dual and single motor sub-tasks.During the neuroimaging compatible dual test screen, the most important thing to remember is to provide the participant with the correct instructions for the tasks and to ensure their comprehension. Because fNIRS only allows us to evaluate superficial cortical structures, our data may suggest that we should complete complimentary neuroimaging using something like fMRI to evaluate deeper brain structures.

Research

JoVE Journal

Behavior

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fMRI Validation of fNIRS Measurements During a Naturalistic Task

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A Dual Task Procedure Combined with Rapid Serial Visual Presentation to Test Attentional Blink for Nontargets

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Quantifying Learning in Young Infants: Tracking Leg Actions During a Discovery-learning Task

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Task Interruption and Resumption Paradigm for Testing the Activation and Pursuit of an Abstract Thinking Goal

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The Knob Supination Task: A Semi-automated Method for Assessing Forelimb Function in Rats

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The "Motor" in Implicit Motor Sequence Learning: A Foot-stepping Serial Reaction Time Task

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The Modified Temptation Resistance Task: A Paradigm to Elicit Children's Strategic Lie-telling

The protocol for the temptation resistance paradigm was designed to elicit 2- to 8-year-old children's strategic lie-telling behaviors. The reward of ...

A Task for Assessing the Impact of a Partner on the Speed and Accuracy of Motor Performance in Rats

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