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Dual-task performance as a clinical marker of upper limb decline in Duchenne muscular dystrophy
Dilan Savas-Kalender1, Merve Kurt-Aydin2, Tulay Tarsuslu3
1Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkiye.
Insights
Children with Duchenne muscular dystrophy show slower upper extremity performance during dual-task activities compared to peers. This dual-task testing reveals functional challenges not seen in single-task tests, aiding rehabilitation planning.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Movement Science
Background:
- Duchenne muscular dystrophy (DMD) affects mobility and balance in ambulant children.
- Upper extremity (UE) performance is crucial for daily activities but less studied under dual-task conditions in DMD.
Purpose of the Study:
- To compare UE performance in ambulant boys with DMD versus typically developing (TD) peers under single- and dual-task conditions.
- To investigate the association between UE dual-task performance and mobility/balance in children with DMD.
- To assess the diagnostic accuracy of dual-task testing for identifying DMD.
Main Methods:
- Cross-sectional observational study involving 20 ambulant boys with DMD and 19 TD peers (aged 6-12 years).
- UE performance assessed using the Nine-Hole Peg Test (NHPT) under single-task, motor dual-task, and cognitive dual-task conditions.
- Functional mobility, balance, and clinical scales were evaluated.
Main Results:
- Children with DMD exhibited significantly slower performance than TD peers under cognitive dual-task (p < 0.001) and left-hand motor dual-task (p = 0.032) conditions.
- Slower dual-task performance correlated with poorer balance and trunk control.
- Cognitive dual-task performance demonstrated high diagnostic accuracy for DMD (AUC = 0.91-0.96).
Conclusions:
- Dual-task paradigms highlight functional UE limitations in ambulant children with DMD, which single-task tests may miss.
- Cognitive-motor demands exacerbate functional difficulties in DMD, extending beyond primary muscle weakness.
- Dual-task assessment can supplement conventional evaluations and inform rehabilitation strategies for DMD.
Abstract:
ObjectiveTo compare upper extremity performance of ambulant children with Duchenne muscular dystrophy and typically developing peers under single- and dual-task conditions, and to examine its associations with mobility and balance.DesignCross-sectional observational study.SettingData were collected at the Pediatric Neurology Department and the Pediatric Rehabilitation Unit of the Faculty of Physical Therapy and Rehabilitation.ParticipantsTwenty ambulant boys with Duchenne muscular dystrophy (6-12 years) and 19 age-matched typically developing peers.InterventionNot applicable.Main measuresUpper extremity performance was assessed using the Nine-Hole Peg Test under single-task, motor dual-task, and cognitive dual-task conditions. Functional mobility and balance, as well as clinical scales, were also evaluated.ResultsChildren with Duchenne muscular dystrophy performed significantly slower than typically developing peers under cognitive dual-task conditions (p < 0.001) and under motor dual-task conditions for the left hand (p = 0.032). Slower dual-task performance was moderately associated with poorer balance and trunk control. Cognitive dual-task performance showed high diagnostic accuracy for identifying Duchenne muscular dystrophy (area under curve = 0.91-0.96).ConclusionsDual-task paradigms may reveal functional vulnerability in upper-limb performance in ambulant children with Duchenne muscular dystrophy that is not evident during single-task testing. Increased cognitive-motor demands appear to exacerbate functional difficulties beyond muscle weakness. These findings suggest that dual-task assessment may complement conventional clinical evaluations and provide additional insight for rehabilitation planning.
