Papers by Abiodun Akinwuntan
Physical therapy, Mar 7, 2023
Objective The purpose of this study was to examine the association between frailty and the quanti... more Objective The purpose of this study was to examine the association between frailty and the quantity and quality of free-living walking and the mediating effect of frailty on the relationship between disability and walking performance in people with multiple sclerosis (MS). Methods Ninety-nine people with relapsing–remitting MS (mean age = 49.3 [SD = 9.8] years; 73.7% women; Expanded Disability Status Scale [EDSS] score range = 2.0–6.0) wore a triaxial accelerometer for 7 days. Recorded measures reflected the quantity (daily step counts, number of 30-second walking bouts, and signal vector magnitude [SVM]) and quality (gait speed, step cadence, step and stride regularity, and sample entropy) of walking. For each walking quality measure, the typical (median), best (90th percentile), and worst (10th percentile) values were calculated. Frailty was evaluated through a 38-item frailty index. Results Participants were classified as not frail (n = 31), moderately frail (n = 34), and severely frail (n = 34) on the basis of established procedures. Patients who were moderately and severely frail exhibited poorer performance in all measures of walking quantity and quality, except for sample entropy, than individuals who were not frail. No differences in free-living walking performance were observed between the moderately and severely frail groups. Frailty did not mediate the relationship between disability (EDSS) and measures of walking quality. Conversely, frailty had a significant mediating effect on the relationship between disability and measures of walking quantity, such as daily step counts (indirect effect: b = −220.42, 95% CI = −452.03 to −19.65) and SVM (indirect effect: b = −1.00, 95% CI = −1.86 to −0.30). Conclusion Frailty is associated with poorer free-living walking performance in people with MS. The study findings suggest that frailty, rather than disability, may be primarily responsible for the lower amount of physical activity performed by people with MS in the real world. Impact The observation that frailty and disability are differently related to measures of walking quality and quantity underscores the importance of a targeted approach to rehabilitation in people with MS.
Multiple sclerosis and related disorders, 2021
Background: Daytime sleepiness is a common symptom of multiple sclerosis (MS) that may jeopardize... more Background: Daytime sleepiness is a common symptom of multiple sclerosis (MS) that may jeopardize safe driving. The aim of this study was to compare daytime sleepiness, recorded in real-time through eyelid tracking, in a simulated drive between individuals with MS (iwMS) and healthy controls. Methods: Fifteen iwMS (age = median (Q1-Q3), 55 (50-55); EDSS = 2.5 (2-3.5); 12 (80%) female) were matched for age, sex, education, and cognitive status with 15 controls. All participants completed self-reported fatigue and sleepiness scales including the Modified Fatigue Impact Scale (MFIS), Pittsburg Sleep Quality Inventory (PSQI), and Epworth Sleepiness Scale (ESS). Percentage of eyelid closure (PERCLOS) was extracted from a remote eye tracker while completing a simulated drive of 25 minutes. Results: Although iwMS reported more symptoms of fatigue (MFIS, p =0.003) and poorer sleep quality (PSQI, p = 0.008), they did not report more daytime sleepiness (ESS, p = 0.45). Likewise, there were no differences between groups in real-time daytime sleepiness, indexed by PERCLOS (p = 0.82). Both groups exhibited more realtime daytime sleepiness as they progressed through the drive (time effect, p< 0.0001). The interaction effect of group*time (p = 0.05) demonstrated exacerbated symptoms of daytime sleepiness towards the end of the drive in iwMS compared to controls. PERCLOS correlated strongly (Spearman ρ = 0.76, p = 0.001) with distance out of lane in iwMS. Conclusion: IwMS show exacerbated symptoms of daytime sleepiness during monotonous, simulate drive. Future studies are warranted to investigate the effect of MS on daytime sleepiness during real-world driving.
Annals of physical and rehabilitation medicine, Jul 1, 2018
Archives of Physical Medicine and Rehabilitation, Oct 1, 2016
Frontiers in Bioengineering and Biotechnology, Jul 29, 2021
Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postura... more Accurate quantification of the impact of visual, somatosensory, and vestibular systems on postural control may inform tailor-made balance intervention strategies. The aim of this proof-of-concept study was to determine the safety, sense of presence, system usability, and face validity of a newly developed Virtual Reality Comprehensive Balance Assessment and Training (VR-ComBAT) in healthy young individuals. The VR-ComBAT included six balance condition: (1) stable surface with fixed virtual reality (VR) surroundings; (2) stable surface with blacked out VR surroundings; (3) stable surface with VR visual conflict; (4) unstable surface with fixed VR surroundings; (5) unstable surface with blacked out VR surroundings; and (6) unstable surface with VR visual conflict. Safety was evaluated using the number of adverse events, including scores on the Simulator Sickness Questionnaire. Sense of presence was evaluated using the igroup Presence Questionnaire (iPQ). System usability was assessed using the Systems Usability Scale (SUS). Friedman analyses with post hoc Wilcoxon Signed Rank tests were employed to demonstrate face validity by quantifying center of pressure (COP) changes in mean distance, mean velocity, and mean frequency in the anteroposterior (AP) and mediolateral (ML) direction across the six conditions. Twenty-three participants (27.4 ± 8.0 years old; 13 women) reported no adverse events. Participants scores on average 44.9 ± 9.6 on the iPQ and 79.7 ± 9.9 on the SUS. Post hoc analyses showed significant changes in COP-based measures when compared to baseline. The mean frequency change of COP showed direction-dependence in which increased frequency change in AP was observed while decreased change in ML was noted. The VR-ComBAT provides a safe, feasible, and cost-effective VR environment that demonstrates consistent sensory re-weighting between visual, somatosensory, and vestibular systems. Future studies should investigate whether VR-ComBAT can be used to inform precision rehabilitation of balance and fall prevention in older adults without and with neurological conditions.
Multiple sclerosis and related disorders, Feb 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Accident Analysis & Prevention, 2020
Patients with PD often exhibit difficulties with visual search that may impede their ability to r... more Patients with PD often exhibit difficulties with visual search that may impede their ability to recognize landmarks and cars while driving. The main objective of this study was to investigate visual search performances of both billboards and cars in patients with PD using a driving simulator. A second objective was to examine the role of cognitive functions in performing the visual search task while driving. Nineteen patients with PD (age: 68 ± 8yo, sex (Men/Women): 15/4) and 14 controls (age: 60 ± 11yo, sex: 7/7) first performed a battery of cognitive tests (e.g. MOntreal Cognitive Assessment (MOCA), Trail Making Test and Dot Cancellation test). They then drove in a simulator and were instructed to follow a lead vehicle while searching for billboards with the letter A (stationary target) or red cars (moving target) among other distractors. Accuracy and response times of visual search were the main outcome variables. Standard deviation of lateral position (SDLP) was the secondary outcome. During driving, patients were less accurate in identifying the targets, particularly for the stationary billboards located in the outer periphery. Within the group of patients, significant correlations were found between several measures of cognitive tests and simulator-based visual search accuracy. By contrast, only the score on the MOCA test correlated significantly with visual search accuracy in controls. Findings suggest that patients with PD have impaired visual search for stationary targets while driving a simulator, which is likely due to cognitive deficits. Future studies should be conducted in a larger sample size to determine whether a visual search task on a driving simulator may predict on-road driving performances.
Behavioural Brain Research, Jun 1, 2017
The relationship between cognitive workload and cognitive impairments in Parkinson's disease (PD)... more The relationship between cognitive workload and cognitive impairments in Parkinson's disease (PD) is currently not well known. This study compared cognitive workload during saccadic tasks between patients with PD and controls. Sixteen controls, 11 patients with no obvious cognitive impairment (PD-NCI) (MOCA score ≥ 26), and 10 PD patients with cognitive impairment (PD-CI) (MOCA score < 26) performed prosaccade and antisaccade tasks. Cognitive workload, extracted via pupil recording, and other eye metrics were compared between the three groups. PD-NCI patients exhibited greater cognitive workload than controls in the prosaccade task. PD-CI patients also showed more cognitive workload in the prosaccade task than PD-NCI patients and controls. No other differences in eye metrics were found between the three groups. Cognitive workload could be used to differentiate between different cognitive states in PD. The causal relationship between increased cognitive workload and cognitive decline in PD-NCI should be the focus of future studies.
Archives of Physical Medicine and Rehabilitation, Dec 1, 2022
Archives of Physical Medicine and Rehabilitation
Archives of Physical Medicine and Rehabilitation, Oct 1, 2016
Regression analysis demonstrated a linear relationship between the number of benchmarks recovered... more Regression analysis demonstrated a linear relationship between the number of benchmarks recovered by week 6 and degree of residual disability on the DRS (Adjusted R-square Z 0.6381; P < 0.0001). For each benchmark detected, the DRS score decreased (i.e., improved) by 1.7 points on average. while nearly half of the MCS+ subgroup (46.2%) recovered all 6 benchmarks, approximately 1 in 10 subjects in the MCS-(8.82%) and VS (11.4%) subgroups did so (see table 5). Degree of disability at week 6 indexed by the mean DRS differed significantly in favor of the MCS+ subgroup (MCS+ Z 12; MCS-Z 17; VS Z 23; Kruskal-Wallis Test Z P<0.001), as did the percentage of participants who emerged from MCS (MCS+ Z 73.1%; MCS-Z 38.2%; VS Z 14.3%; c2MH Z 21.20, 1 d.f., P < 0.0001). Conclusions: Significant functional recovery is common in patients with prolonged traumatic DoC following discharge from the intensive care setting. Patients in MCS with evidence of language function are most likely to recover other high-level behaviors linked to improvement in functional status. These findings should be considered in the context of early decision-making in the ICU concerning intensity of care and indications for rehabilitative treatment.
HAL (Le Centre pour la Communication Scientifique Directe), Sep 22, 2019
igure 1. Example of a target-present trial. Gray circle represents the pre-identified target and ... more igure 1. Example of a target-present trial. Gray circle represents the pre-identified target and the gray square represents the target. 20°m
Frontiers in Aging Neuroscience, Aug 30, 2017
Purpose: To investigate the effect of cognitive demand on functional visual field performance in ... more Purpose: To investigate the effect of cognitive demand on functional visual field performance in drivers with glaucoma. Method: This study included 20 drivers with open-angle glaucoma and 13 age-and sex-matched controls. Visual field performance was evaluated under different degrees of cognitive demand: a static visual field condition (C1), dynamic visual field condition (C2), and dynamic visual field condition with active driving (C3) using an interactive, desktop driving simulator. The number of correct responses (accuracy) and response times on the visual field task were compared between groups and between conditions using Kruskal-Wallis tests. General linear models were employed to compare cognitive workload, recorded in real-time through pupillometry, between groups and conditions. Results: Adding cognitive demand (C2 and C3) to the static visual field test (C1) adversely affected accuracy and response times, in both groups (p < 0.05). However, drivers with glaucoma performed worse than did control drivers when the static condition changed to a dynamic condition [C2 vs. C1 accuracy; glaucoma: median difference (Q1-Q3) 3 (2-6.50) vs. controls: 2 (0.50-2.50); p = 0.05] and to a dynamic condition with active driving [C3 vs. C1 accuracy; glaucoma: 2 (2-6) vs. controls: 1 (0.50-2); p = 0.02]. Overall, drivers with glaucoma exhibited greater cognitive workload than controls (p = 0.02). Conclusion: Cognitive demand disproportionately affects functional visual field performance in drivers with glaucoma. Our results may inform the development of a performance-based visual field test for drivers with glaucoma.
Accident Analysis & Prevention, May 1, 2023
016839012018MATC Final Report, Year 1Data was not collected during phase I of this project. It wi... more 016839012018MATC Final Report, Year 1Data was not collected during phase I of this project. It will be collected and archived in future phases.PDFTech ReportMATC-KUMC: 155-125-1121-0005-155-169A3551747107Age groupsAged driversCognitionDriver performanceEvaluation and assessmentHazardous materialsRisk assessmentSafetyCrashesRiskTrucking safetyTruck driversVisionSafety and SecuritySafety and Human factorsCrashesFitness to driveslushingcognitive and visual skillsUnited StatesUniversity of Nebraska-Lincoln. Mid-America Transportation CenterBhattacharya, Shelley B.Akinwuntan, AbiodunDevos, Hannes{54823}Ribas, FernandaGibson, RobertDevos, IarinaUniversity of Kansas. Medical CenterUniversity of Nebraska. Mid-America Transportation CenterUniversity Transportation Centers Program (U.S.)United States. Department of Transportation. Office of the Assistant Secretary for Research and TechnologyUS Transportation CollectionDriving is a highly dynamic task that requires intact cognitive and visual skills to perform safely. Driving trucks loaded with hazardous materials requires even more careful planning and consideration to avoid unanticipated shifts in the center of gravity associated with sharp turns while speeding (slushing) or liquid surge associated with sharp braking. Such planning and consideration are highly dependent on cognitive and visual skills for accuracy. In the first year of this proposal, we developed a driving fitness assessment battery that consisted of tests that have been shown in the geriatric literature to be reliable and valid measures of driving-related cognitive and visual skills in older adults. These tests consist of the Snellen Maze Test, Trails A and B, Range of Motion and Gait Speed. Cognitively, the Mini Mental Status Examination (MMSE) has had significant limitations in driving fitness; therefore, alternative cognitive tools such as the Saint Louis University Mental Status (SLUMS) and Montreal Cognitive Assessment (MoCA) exam were included, if appropriate. Drivers with a Commercial Driver\u2019s License (CDL) will be recruited and given this battery of tests to: 1) Assess their cognitive and visual fitness, 2) establish the usefulness and effectiveness of these tests to drivers before embarking on the journey, and 3) identify potential risk factors that contribute to unsafe driving. This is Year 1 of a five-year grant. Over the course of the grant, we anticipate the study will be helpful in identifying drivers who have cognitive and/or visual impairments that may make driving a truck, especially one carrying hazardous materials, unsafe. A unique aspect of this part of the study is the possibility of improving driving fitness by offering drivers with demonstrated cognitive and visual deficits the opportunity to retrain and improve such skills in a technologically advanced high-fidelity simulator.75
Physiotherapy, May 1, 2015
Background: Driving is a very important mode of mobility and it is associated with independence, ... more Background: Driving is a very important mode of mobility and it is associated with independence, self-esteem, and high quality of life. Impaired driving ability is common in persons with Multiple Sclerosis (MS), with failure rates on fitness-to-drive evaluations varying between 19% and 42%. The major concern for those who fail is "what help is available to help them return to driving?" An extensive review of the literature did not yield any driving-specific rehabilitation program for persons with MS. Purpose: The purpose of this study was therefore to determine the potential of using a simulator-based program to improve driving-related skills in persons with relapsingremitting MS whose disease severity was rated as being between 1 and 7 according to the Expanded Disability Status Scale (EDSS). Methods: Thirty-six participants (age 46 ± 11 years; 30 women) each received 5 hours of individualized training in a high fidelity driving simulator. The individualized training program focused on the specific driving difficulties that participants exhibited during an on-road driving test. Six other participants (age 48 ± 13 years; 5 women) did not receive training because of issues with simulation sickness. Data of performance on a driving evaluation before and after training were compared between those who received training and those who did not. Results: No significant differences were observed between the groups before and after training. However, 4 of the 7 participants in the training group who failed the road test at pre-training passed at post-training, while the only participant in the group that did not receive training who failed at pre-training still failed post-training. The training group also improved on a visual and two cognitive tests, and reported less fatigue after training. The improvements were most pronounced among those with an EDSS score between 3 and 7. Conclusion(s): This study demonstrates the potential of using a simulator to improve driving-related visual, cognitive, and on-road skills in individuals with relapsing-remitting MS, particularly those with an EDSS score >3. Implications: This is the first study to show that it is feasible to offer MS patients a meaningful rehabilitation program that is capable of improving some driving-related visual and cognitive skills and ultimately, on-road driving performance. Future studies are needed to further explore the potentially clinically important findings of this feasibility study.
Journal of the American Geriatrics Society, Apr 13, 2023
International Journal of Neuroscience, Apr 7, 2020
Background:Pupillary response reflects cognitive workload during processing speed, working memory... more Background:Pupillary response reflects cognitive workload during processing speed, working memory, and arithmetic tasks in Parkinson’s disease (PD). Abstract reasoning, a higher-order cognitive function that relates different objects, events, or thoughts in a similar manner, may also be compromised in PD. The aim of this study was to compare pupillary response as a measure of cognitive workload while completing a verbal abstract reasoning test between patients with PD and age-matched controls.Methods:Nineteen non-demented individuals with PD (66.6 ± 8.9 years) and 10 healthy controls (65.3 ± 7.3 years) were recruited. A remote eye tracker recorded the pupillary response at 60 Hz, while the participants were performing the Similarities test of Wechsler Adult Intelligence Scale-IV. Outcome measures included pupillary response, evaluated by the Index of Cognitive Activity (ICA), and behavioral responses of the Similarities test.Results:The PD group (scaled scores = 8.9 ± 2.2) did not show impairment in behavioral performance on Similarities test compared with healthy controls (scaled scores = 8.8 ± 2.3; p = .91). However, the PD group (ICA = .32 ± .09) demonstrated significantly greater cognitive workload during the Similarities test compared to controls (ICA = .24 ± .08; p = .03).Conclusions:Non-demented individuals with PD exerted greater cognitive workload to complete a verbal abstract reasoning task despite similar behavioral performance compared to healthy controls. Clinical utilities of pupillary response to detect and monitor early impairment in higher-order executive function will be the subject of further study in the PD population.
Frontiers in Bioengineering and Biotechnology, Apr 27, 2021
Background: Individuals with Parkinson's disease (PD) may need to spend more mental and physical ... more Background: Individuals with Parkinson's disease (PD) may need to spend more mental and physical effort (i.e., cognitive workload) to maintain postural control. Pupillary response reflects cognitive workload during postural control tasks in healthy controls but has not been investigated as a measure of postural demand in PD. Objectives: To compare pupillary response during increased postural demand using vision occlusion and dual tasking between individuals with PD and healthy controls. Methods: Thirty-three individuals with PD and thirty-five healthy controls were recruited. The four conditions lasted 60 s and involved single balance task with eyes open; single balance task with eyes occluded; dual task with eyes open; dual task with eyes occluded. The dual task comprised the Auditory Stroop test. Pupillary response was recorded using an eye tracker. The balance was assessed by using a force plate. Two-way Repeated Measures ANOVA and LSD post-hoc tests were employed to compare pupillary response and Center of Pressure (CoP) displacement across the four conditions and between individuals with PD and healthy controls. Results: Pupillary response was higher in individuals with PD compared to healthy controls (p = 0.009) and increased with more challenging postural conditions in both groups (p < 0.001). The post-hoc analysis demonstrated increased pupillary response in the single balance eyes occluded (p < 0.001), dual task eyes open (p = 0.01), and dual task eyes occluded (p < 0.001) conditions compared to single task eyes open condition. Conclusion: Overall, the PD group had increased pupillary response with increased postural demand compared to the healthy controls. In the future, pupillary response can be a potential tool to understand the neurophysiological underpinnings of falls risk in the PD population.
Transportation Research Part F: Traffic Psychology and Behaviour
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Papers by Abiodun Akinwuntan