Adölesan İdiyopatik Skolyozda İkili Görev Etkisi ve Spinal Deformite ile Korelasyonu

Abstract

AMAÇ: Adölesan idiyopatik skolyozu (AIS) olan hastalar günlük aktivitelerinde bazı zorluklar yaşamaktadırlar. Bu aktivitelerin çoğu, eş zamanlı 
motor ve/veya bilişsel bileşenlerden oluşan çoklu görev yapmayı içerir. Bu çalışmanın amacı, AIS hastalarının yürüme performansını ve aynı 
anda iki görevi yerine getirme yeteneğini gerektiren çift görev etkisini (DTE) sağlıklı kontrol grubuyla karşılaştırmak ve bunların omurga 
deformitesiyle ilişkisini incelemektir.
GEREÇ ve YÖNTEM: Bu kesitsel vaka-kontrol çalışmasına 32 AIS hastası ve 34 sağlıklı kontrol dahil edildi. Fonksiyonel mobiliteyi değerlendirmek için Genişletilmiş Zamanlı Kalk ve Yürü (ETUG) Testi ve Tandem Yürüyüşü (TG) kullanıldı. Motor-motor ve bilişsel-motor çift görevli performansları kaydedilerek ilgili DTE’leri belirlendi. Skolyoz grubunun mevcut röntgen filmlerinden radyolojik parametreleri ölçüldü. Gövde rotasyon açısı skolyometre kullanılarak değerlendirildi. Spinal parametreler ile DTE’ler arasında korelasyon olup olmadığı analiz edildi. BULGULAR: AIS'li hastaların, sağlıklı kontrollere kıyasla, TG ile test edilen tek motor görevlerde daha yavaş oldukları, ancak ETUG ile böyle bir fark olmadığı bulundu (sırasıyla p=0,001, p=0,501). Hastaların hem bilişsel-motor hem de motor-motor DTE'lerinde artış görüldü (sırasıyla p<0,001, p=0,010). İncelenen spinal parametrelerden, lomber lordoz ölçümleri motor-motor DTE ile orta derecede korelasyon gösterirken 
(r=-0,48, p=0,005), gövde rotasyon açısı ve apikal vertebra translasyonu bilişsel-motor DTE ile zayıf korelasyon gösterdi (sırasıyla r=-0.35, p=0.05, r=-0,39, p=0,028).
SONUÇ: Bu bulgular, AIS hastalarının sağlıklı yaşıtlarına kıyasla çift görevli becerilerinde bozulma olduğunu ve hem biyomekanik değişikliklerin hem de ikili görev sırasında artan kortikal katkının fonksiyonel mobiliteyi etkileyebileceğini düşündürmektedir. Bu nedenle, rehabilitasyon protokollerine çift görevli yürüyüş ve sensörimotor entegrasyon eğitiminin dahil edilmesinin faydalı olabileceğine inanıyoruz. 

Keywords

• Adölesan idiopatik skolyozu
• ikili görev
• tekli görev
• yürüyüş
• radyoloji

Supporting Institution

Yok

Ethical Statement

Bu çalışma Karamanoğlu Mehmetbey Üniversitesi Etik Kurulu tarafından onaylanmıştır (tarih: 27.02.2024, sayı: 01-2024/06).

Thanks

Dil konusunda değerli yardımlarından dolayı Sayın Emre Basaran'a teşekkür ederiz.

Dual-Task Effect in Adolescent Idiopathic Scoliosis and Correlation with Spinal Deformity

Abstract

OBJECTIVE: Patients with adolescent idiopathic scoliosis (AIS) experience various difficulties with daily activities. Many such activities involve 
multitasking that consists of simultaneous motor and/or cognitive components. The purpose of this study was to compare the walking 
performance and dual-task effect (DTE), which requires the ability to perform two tasks concurrently, of AIS patients with those of healthy 
controls and to investigate their correlation with spinal deformity. 
MATERIALS and METHODS: Thirty-two AIS patients and 34 healthy controls were included in this cross-sectional case-control study. The Expanded Timed Up and Go (ETUG) test and the Tandem Gait (TG) were used to assess functional mobility. The motor-motor and cognitive-motor dual-task performances were recorded to determine the corresponding DTEs. Radiological assessments of the scoliosis group were extracted from the radiographs, while the angle of trunk rotation was measured using a scoliometer. These spinal parameters were analyzed to identify any correlations with DTEs. 
RESULTS: We found that patients with AIS were slower with single motor tasks, by TG, but not by ETUG, compared to healthy controls (p=0.001, p=0.501, respectively). They exhibited an increase in both cognitive-motor and motor-motor DTEs (p<0.001, p=0.010, respectively). Among the spinal parameters examined, lumbar lordosis measurements were moderately correlated with motor-motor DTE (r=-0.48, p=0.005), while angle of trunk rotation and apical vertebral translation were weakly correlated with cognitive-motor DTE (r=-0.35, p=0.05, r=-0.39, p=0.028, respectively). 
CONCLUSION: These findings suggest impaired dual tasking among AIS patients compared to healthy peers, and both biomechanical changes and increased cortical contribution may influence functional mobility. Thus, we believe that including dual-task gait and sensorimotor integration training in management protocols may be beneficial for achieving better outcomes. 

Keywords

• Adolescent idiopathic scoliosis
• dual task
• single task
• gait
• radiology

Supporting Institution

Non

Ethical Statement

The study was approved by Karamanoğlu Mehmetbey University Ethics Committee (date: 27.02.2024, no: 01- 2024/06).

Thanks

We would like to thank M. Emre Basaran for his valuable help with language.

References

1. Thomas JJ, Stans AA, Milbrandt TA, Kremers HM, Shaughnessy WJ, Larson AN. Trends in Incidence of Adolescent Idiopathic Scoliosis: A Modern US Population-based Study. J Pediatr Orthop. 2021; 41: 327-32. doi: 10.1097/BPO.0000000000001808.
2. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013; 7: 3-9. doi: 10.1007/s11832-012-0457-4.
3. Yilmaz H, Zateri C, Kusvuran Ozkan A, Kayalar G, Berk H. Prevalence of adolescent idiopathic scoliosis in Turkey: an epidemiological study. Spine J. 2020; 20: 947-55. doi: 10.1016/j.spinee.2020.01.008.
4. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis and spinal disorders. 2018; 13: 3. doi: 10.1186/s13013-017-0145-8.
5. Khorramroo F, Rajabi R, Mousavi SH. Gait kinetics in individuals with scoliosis: a systematic review and meta analysis. BMC Musculoskelet Disord. 2025; 26: 710. doi: 10.1186/s12891-025-08941-0.
6. Liang ZT, Guo CF, Li J, Zhang HQ. The role of endocrine hormones in the pathogenesis of adolescent idiopathic scoliosis. FASEB J. 2021; 35: e21839. doi: 10.1096/fj.202100759R.
7. Addai D, Zarkos J, Bowey AJ. Current concepts in the diagnosis and management of adolescent idiopathic scoliosis. Childs Nerv Syst. 2020; 36: 1111-9. doi: 10.1007/s00381-020-04608-4.
8. Dayer R, Haumont T, Belaieff W, Lascombes P. Idiopathic scoliosis: etiological concepts and hypotheses. J Child Orthop. 2013; 7: 11-6. doi: 10.1007/s11832-012-0458-3.

9. Zaydman AM, Strokova EL, Pahomova NY, Gusev AF, Mikhaylovskiy MV, Shevchenko AI, et al. Etiopathogenesis of adolescent idiopathic scoliosis: Review of the literature and new epigenetic hypothesis on altered neural crest cells migration in early embryogenesis as the key event. Med Hypotheses. 2021; 151: 110585. doi: 10.1016/j.mehy.2021.110585.
10. Paramento M, Passarotto E, Maccarone MC, Agostini M, Contessa P, Rubega M, et al. Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review. PLoS One. 2024; 19: e0303086. doi: 10.1371/journal.pone.0303086.
11. Wang D, Tsang R, Li Q, Chen F, Vasanthi RK, Purushothaman VK, et al. Sensory integration and spinal structure in AIS: is there a functional-structural association? J Orthop Surg Res. 2025; 20: 771. doi: 10.1186/s13018-025-06172-6.
12. Gomez Cristancho DC, Jovel Trujillo G, Manrique IF, Perez Rodriguez JC, Diaz Orduz RC, Berbeo Calderon ME. Neurological mechanisms involved in idiopathic scoliosis. Systematic review of the literature. Neurocirugia (Engl Ed). 2023; 34: 1-11. doi: 10.1016/j.neucie.2022.02.009.
13. Simoneau M, Lamothe V, Hutin E, Mercier P, Teasdale N, Blouin J. Evidence for cognitive vestibular integration impairment in idiopathic scoliosis patients. BMC Neurosci. 2009; 10: 102. doi: 10.1186/1471-2202-10-102.
14. Khorramroo F, Mousavi SH, Rajabi R. Effects of spinal deformities on lower limb kinematics during walking: a systematic review and meta-analysis. Sci Rep. 2025; 15: 4608. doi: 10.1038/s41598-025-88886-5.
15. Garg B, Gupta M, Mehta N, Malhotra R. Influence of Etiology and Onset of Deformity on Spatiotemporal, Kinematic, Kinetic, and Electromyography Gait Variables in Patients with Scoliosis-A Prospective, Comparative Study. Spine (Phila Pa 1976). 2021; 46: 374-82. doi: 10.1097/BRS.0000000000003796.
16. Cinar E, Weedon BD, Esser P, Joshi S, Liu YC, Delextrat A, et al. Dual-Task Effect on Gait in Healthy Adolescents: Association between Health-Related Indicators and DT Performance. J Mot Behav. 2021; 53: 707-16. doi: 10.1080/00222895.2020.1844616.
17. Aguiar SA, Gramani-Say K, Lopes AG, Barela JA. Dual task interferes with sensorimotor coupling in postural control. Psychology & Neuroscience. 2014; 7: 593–9. doi: 10.3922/j.psns.2014.4.19.
18. Lajoie Y, Teasdale N, Bard C, Fleury M. Attentional demands for static and dynamic equilibrium. Exp Brain Res. 1993; 97: 139-44. doi: 10.1007/BF00228824.
19. Brown LA, McKenzie NC, Doan JB. Age-dependent differences in the attentional demands of obstacle negotiation. J Gerontol A Biol Sci Med Sci. 2005; 60: 924-7. doi: 10.1093/gerona/60.7.924.
20. Kim DS, Park SH, Goh TS, Son SM, Lee JS. A meta-analysis of gait in adolescent idiopathic scoliosis. J Clin Neurosci. 2020; 81: 196-200. doi: 10.1016/j.jocn.2020.09.035.
21. Yagci G, Metin G, Erel S, Erbahceci F. Dual Task Performance in Adolescents With Idiopathic Scoliosis. Perceptual and motor skills. 2023; 130: 1889-900. doi: 10.1177/00315125231182276.
22. Ye X, Lou D, Ding X, Xie C, Gao J, Lou Y, et al. A clinical study of the coronal plane deformity in Parkinson disease. Eur Spine J. 2017; 26: 1862-70. doi: 10.1007/s00586-017-5018-6.
23. Tamura K, Kocher M, Finer L, Murata N, Stickley C. Reliability of clinically feasible dual-task tests: Expanded timed get up and go test as a motor task on young healthy individuals. Gait Posture. 2018; 60: 22-7. doi: 10.1016/j.gaitpost.2017.11.002.
24. Howell DR, Brilliant AN, Meehan WP, 3rd. Tandem Gait Test-Retest Reliability Among Healthy Child and Adolescent Athletes. J Athl Train. 2019; 54: 1254-9. doi: 10.4085/1062-6050-525-18.
25. Van Deventer KA, Seehusen CN, Walker GA, Wilson JC, Howell DR. The diagnostic and prognostic utility of the dual-task tandem gait test for pediatric concussion. J Sport Health Sci. 2021; 10: 131-7. doi: 10.1016/j.jshs.2020.08.005.
26. Kelly VE, Janke AA, Shumway-Cook A. Effects of instructed focus and task difficulty on concurrent walking and cognitive task performance in healthy young adults. Exp Brain Res. 2010; 207: 65-73. doi: 10.1007/s00221-010-2429-6.
27. Schober P, Boer C, Schwarte LA. Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg. 2018; 126: 1763-8. doi: 10.1213/ANE.0000000000002864.
28. Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J. The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part II: Perception of health, self and body image, and participation in physical activities. Spine (Phila Pa 1976). 1994; 19: 1562-72. https: //pubmed.ncbi.nlm.nih.gov/7939992.
29. Kramers-de Quervain IA, Muller R, Stacoff A, Grob D, Stussi E. Gait analysis in patients with idiopathic scoliosis. Eur Spine J. 2004; 13: 449-56. doi: 10.1007/s00586-003-0588-x.
30. Mahaudens P, Thonnard JL, Detrembleur C. Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis. Spine J. 2005; 5: 427-33. doi: 10.1016/j.spinee.2004.11.014.
31. Eyvazov K, Samartzis D, Cheung JP. The association of lumbar curve magnitude and spinal range of motion in adolescent idiopathic scoliosis: a cross-sectional study. BMC Musculoskelet Disord. 2017; 18: 51. doi: 10.1186/s12891-017-1423-6.
32. Daryabor A, Arazpour M, Sharifi G, Bani MA, Aboutorabi A, Golchin N. Gait and energy consumption in adolescent idiopathic scoliosis: A literature review. Ann Phys Rehabil Med. 2017; 60: 107-16. doi: 10.1016/j.rehab.2016.10.008.
33. Suh SW, Kim WS. Lower limb joint burden during walking in adolescent idiopathic scoliosis: investigation of mechanical work during walking. Spine J. 2023; 23: 1692-9. doi: 10.1016/j.spinee.2023.06.393.
34. Howell DR, Wilson JC, Brilliant AN, Gardner AJ, Iverson GL, Meehan WP, 3rd. Objective clinical tests of dual-task dynamic postural control in youth athletes with concussion. J Sci Med Sport. 2019; 22: 521-5. doi: 10.1016/j.jsams.2018.11.014.
35. Boutabla A, Revol R, Carvalho MF, Grouvel G, Corre J, Cugnot JF, et al. Gait impairments in patients with bilateral vestibulopathy and chronic unilateral vestibulopathy. Front Neurol. 2025; 16: 1547444. doi: 10.3389/fneur.2025.1547444.
36. Hagmann-von Arx P, Manicolo O, Lemola S, Grob A. Walking in School-Aged Children in a Dual-Task Paradigm Is Related to Age But Not to Cognition, Motor Behavior, Injuries, or Psychosocial Functioning. Front Psychol. 2016; 7: 352. doi: 10.3389/fpsyg.2016.00352.
37. Wickens CD. Multiple resources and mental workload. Hum Factors. 2008; 50: 449-55. doi: 10.1518/001872008X288394.
38. Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City, Japan. Eur Spine J. 2011; 20: 274-9. doi: 10.1007/s00586-010-1657-6.
39. Raso VJ, Lou E, Hill DL, Mahood JK, Moreau MJ, Durdle NG. Trunk distortion in adolescent idiopathic scoliosis. J Pediatr Orthop. 1998; 18: 222-6. https: //pubmed.ncbi.nlm.nih.gov/9531406.
40. Kawkabani G, Saliby RM, Mekhael M, Rachkidi R, Massaad A, Ghanem I, et al. Gait kinematic alterations in subjects with adult spinal deformity and their radiological determinants. Gait Posture. 2021; 88: 203-9. doi: 10.1016/j.gaitpost.2021.06.003.
41. Hiraga CY, Garry MI, Carson RG, Summers JJ. Dual-task interference: attentional and neurophysiological influences. Behav Brain Res. 2009; 205: 10-8. doi: 10.1016/j.bbr.2009.07.019.