Comparison of the Effects of Bimanual, Finger and VR Exercises in PwMCI

MoCA

Montreal Cognitive Assessment Scale: MoCA is a short screening test for Mild Cognitive Impairment and Alzheimer's Disease to measure cognitive functions. The test is administered using pen and paper and takes approximately 10-20 minutes. It has 7 subheadings and these are listed as follows: (1) visuospatial/executive functions (clock drawing and cube copying, tracing test (part B) - 5 points); (2) naming (learning and repeating a list of 5 words - 3 points); (3) memory (5 points for recall); (4) attention (target-orientated clapping - 6 points); (5) language (fluency - 3 points); (6) abstract thinking (similarity between words - 2 points); and (7) orientation (knowledge of day, month, year and place - 6 points). The score range is 0 to 30, with higher scores indicating better performance. Values below 26 points indicate a risk of cognitive impairment and provide information about a possible MCI.

Cognitive functions-Trail Making Test (A-B)

Trail Making Test (A-B): Trail Making Test (TMT) is a complex visual screening test with motor components and is sensitive to frontal region functions (12, 13). Motor speed, agility and careful participation are required to be successful in this test. This first version of the IST consists of two parts (forms), A and B. In Part A, the participants will be asked to connect the circles with numbers (1-2-3-4-......) on the test form by drawing a line consecutively and in the correct order. In Part B, the participants will be asked to connect the circles containing numbers and letters (1-A,2-B,3-C- ......) on the test form by drawing a line in a consecutive and correct order in accordance with the order of one number and one letter. The time will be recorded for both A and B tests.

Cognitive functions-Digit Span Test/Digit Symbol Substitution Test

Digit Span Test (DST): In the DST, participants will be asked to repeat the read digits in sequence. The test continues with growing digits. Then, in the second part of the test, they will be asked to repeat the spoken digits backwards and the number of correct ones will be recorded. Digit Symbol Substitution Test (DSST): DSST is a test used to evaluate psychomotor performance. The participants will be asked to draw the symbol determined for each number in the boxes left blank for 90 seconds. The total number of correct shapes will be recorded.

Cognitive Functions-Verbal Fluency Test/Serial Subtraction Test

Verbal Fluency Test - Phonemic: The participant is asked to count the words starting with the letters we have determined (letters A and S) within 1 minute. The number of correct and incorrect words spoken will be determined. Serial Subtraction Test: The participant is asked to count backwards by subtracting 7 from a number between 200-300 within 1 minute. The number of correct and incorrect counts will be determined.

Choice Stepping Reaction Time Mat (CSRT)

Lower extremity reaction time: Step taking reaction time will be evaluated on the Choice Stepping Reaction Time Mat (CSRT) with Flash/response facilitation (stepping as fast as possible in the direction of the lit green arrow) and Inhibitor/response inhibition (staying in place when the purple arrow is lit and stepping with the green arrow). Accordingly, reaction time, movement time and response/operation time (sum of reaction time and movement time) will be evaluated in all tests. Upper extremity reaction time: While the participant is in a sitting position, he/she will be asked to touch the buttons (Blaze Pods) on the table as fast as possible when the light is on and the reaction time will be recorded. The test will be performed separately for right and left extremities.

Grip Strength

Hand held dynamometer: A hand held dynamometer will be used to measure grip strength, which begins to decline with ageing. The participant will sit with the shoulder in adduction, elbow in 90 degree flexion, forearm and wrist in neutral position. The therapist will then place the dynamometer in the hand of the person being tested and ask them to squeeze as hard as possible. The participants will be asked to grasp the grip with all their strength for both hands and the average of the three repetitions will be taken.

Fine motor skills

Purdue Pegboard Test: The total duration of the test, including the introduction time, is 5-10 minutes. The materials required are a rectangular pegboard with 25 holes along two rows and a stopwatch. At the end of the application, a total of five different scores will be obtained with measurements such as right hand, left hand, both hands together, combined task and sum of scores. During the application, the person will be asked to insert the nails into the holes and the total number will be calculated after 30 or 60 s depending on the task. Individuals will be given 30 seconds for right hand, left hand and double hand evaluation, while the individual will be given 60 seconds for the evaluation test performed by stacking them one on top of the other with the coordinated movement of both hands, which is called combined movement.

Gross motor skills

Box and Block Test: The materials required for the test consist of a stopwatch, a wooden box with a centre compartment and 150 wooden cubes. The total duration of the test is 2-5 minutes. Participants will be asked to pass the cubes one by one from one compartment to the other compartment within 60 seconds and the number of cubes will be noted. This test will be applied separately for both extremities.

Gait characteristics

10 Metre Walk Test: The 10 Metre Walk Test will be used to determine walking speed. Within the scope of the test, an area of 10 metres will be determined and the time taken to walk this distance will be recorded. A mobile application (OneStep) will be used to record walking speed. The individuals will be asked to walk a distance of 10 metres by placing the phone in the right pocket of their trousers. Time to perform the test, number of steps, step duration, step length, cadence and walking speed values will be recorded.