目的：探讨基于眼动追踪技术的足踝运动认知双重任务评估系统的可靠性和有效性。方法：采用足踝运动认 知双重任务评估系统对健康受试者的眼动和足踝运动功能评测，1 周后进行重测，计算组内相关系数（ICC）和进 行 Bland-Altman 分析；用该系统对脑卒中患者进行眼动和足踝运动功能评测，并完成认知和运动功能临床评估，分 析评测参数与临床评分的相关性。结果：健康受试者足踝运动认知双重任务测试的重测 ICCTMT-A 任务 =0.509~0.897， ICCTMT-B 任务 =0.493~0.987。Bland-Altman 分析显示，眼动注视次数、眼跳幅度、速度峰个数及平均速度 4 个主要参数 的重测信度均具有较好的一致性。脑卒中患者的效度结果显示，眼动注视次数、注视的空间密度与蒙特利尔认知评 估量表（MoCA）评分呈负性相关；足踝运动平均速度与下肢运动功能评分、10 米步行平均速度呈正性相关，与计 时起立行走 - 减法计算测试耗时、双任务成本百分比呈负性相关。结论：基于眼动追踪技术的足踝运动认知双重任 务评估系统具有良好的信效度，其中眼动注视次数、注视的空间密度是反映认知功能的稳定参数，足踝运动平均速 度是反映运动功能和双任务成本的稳定参数。该系统为脑卒中患者足踝运动认知功能评估提供了新技术，有望应用 到运动认知功能研究和康复治疗中。

Objective: To explore the reliability and effectiveness of a dual task evaluation system for foot and ankle motor cognition based on eye tracking technology. Methods: The motor functions of eye, foot and ankle of healthy subjects were tested and evaluated by foot and ankle motor cognition dual task evaluation system, and they were retested 1 week later. Intraclass correlation coefficient (ICC) and Bland-Altman analysis were calculated. The system was used to evaluate the motor functions of eye, foot and ankle of stroke patients, the clinical evaluation of cognitive and motor function was performed, and the correlation between evaluation parameters and clinical scores were analyzed. Results: The retested reliability of ICCTMT-A task and ICCTMT-B task were 0.509~0.897 and 0.493~0.987 respectively in the dual task of foot and ankle motor cognition in healthy subjects. Bland-Altman analysis showed that the retested reliability of eye fixations, saccade amplitude, velocity peaks and average velocity had good consistency. The validity results of stroke patients showed that the number of eye fixation and the spatial density of fixation were negatively correlated with the Montreal cognitive assessment (MoCA) score. The average foot and ankle movement speed was positively correlated with the lower limb motor function score and the average 10-meter walking speed, and negatively correlated with the time consuming and the percentage of dual task cost. Conclusion: The dual task evaluation system for foot and ankle motor cognition based on eye tracking technology has good reliability and validity, in which the count of eye fixation and the fixation density are stable parameters reflecting cognitive function, and the average foot and ankle movement speed are stable parameters reflecting motor function and dual task cost. This system provides a new technique for the assessment of motor and cognitive function of foot and ankle of stroke patients, and is expected to be applied to the research and rehabilitation of motor and cognitive function.

基金项目：首都卫生发展科研专项项目（首发 2022-2Z-2242）；国家重点研发计划重点专项（2022YFC3601100） 

Foundation Item: Special Project for Capital Health Development and Scientific Research (Capital Development 2022-2Z-2242);  Special Project of National Key R & D Plan (2022YFC3601100) 

通讯作者：高硕，Email：shuo_gao@buaa.edu.cn；李翀，Email：chongli@mail.tsinghua.edu.cn；潘钰，Email：panyu@btch.edu.cn 

Corresponding Author: GAO Shuo, Email: shuo_gao@buaa.edu.cn; LI Chong, Email: chongli@mail.tsinghua.edu.cn; PAN Yu,  Email: panyu@btch.edu.cn 

引用格式：王小蒙，赵子贺，彭博，等 . 基于眼动追踪技术足踝运动认知双重任务评估系统的信效度研究 [J]. 机器人外科学杂志（中 英文），2025，6（1）：81-89. 

Citation: WANG X M, ZHAO Z H, PENG B, et al. Reliability and validity of a dual task evaluation system for foot and ankle motor  cognition based on eye tracking technology[J]. Chinese Journal of Robotic Surgery, 2025, 6(1): 81-89.

[1] Beeri M S, Leurgans S E, Bennett D A, et al. Diverse motor performances are related to incident cognitive impairment in community-dwelling older adults[J]. Front Aging Neurosci, 2021. DOI: 10.3389/fnagi.2021.717139.eCollection 2021. 

[2] Ho J Q, Verghese J, Abramowitz M K. Walking while talking in older adults with chronic kidney disease[J]. Clin J Am Soc Nephrol, 2020, 15(5): 665-672. 

[3] Kobayashi T, Orendurff M S, Hunt G, et al. The effects of an articulated ankle-foot orthosis with resistance-adjustable joints on lower limb joint kinematics and kinetics during gait in individuals post-stroke[J]. Clin Biomech (Bristol, Avon), 2018, 59: 47-55. 

[4] Jung S H, Hasegawa N, Mancini M, et al. Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson’s disease[J]. NPJ Parkinsons Dis, 2020, 6(1): 31. 

[5] Pang M Y C, YANG L, OUYANG H X, et al. Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke[J]. Stroke, 2018, 49(12): 2990-2998. 

[6] 魏家航 , 吕晨燕 , 张赓华 , 等 . 眼动仪在神经康复中的应用现状及研究进展 [J]. 机器人外科学杂志 ( 中英文 ), 2022, 3(3): 229-234. 

[7] Singh T, Perry C M, Fritz S L, et al. Eye movements interfere with limb motor control in stroke survivors[J]. Neurorehabil Neural Repair, 2018, 32(8): 724-734. 

[8] Alves J, Vourvopoulos A, Bernardino A, et al. Eye gaze correlates of motor impairment in VR observation of motor actions[J]. Methods Inf Med, 2016, 55(1): 79-83. 

[9] Sakurai R, Bartha R, Montero-Odasso M. Entorhinal cortex volume is associated with dual-task gait cost among older adults with MCI: Results from the Gait and Brain Study[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(5): 698-704. 

[10] Montero-Odasso M, Almeida Q J, Bherer L, et al. Consensus on shared measures of mobility and cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA)[J]. J Gerontol A Biol Sci Med Sci, 2019, 74(6): 897-909. 

[11] Gerke O. Reporting standards for a Bland-Altman agreement analysis: A review of methodological reviews[J]. Diagnostics (Basel), 2020, 10(5): 334. 

[12] Mansournia M A, Waters R, Nazemipour M, et al. Bland-Altman methods for comparing methods of measurement and response to criticisms[J]. Glob Epidemiol, 2021, 3: 100045. 

[13] Clark K, Birch-Hurst K, Pennington C R, et al. Test-retest reliability for common tasks in vision science[J]. J Vis, 2022, 22(8): 18. 

[14] Zammarchi G, Conversano C. Application of eye tracking technology in medicine: a bibliometric analysis[J]. Vision (Basel), 2021, 5(4): 56. 

[15] Opeonya J, Doan D N T, Kim S G, et al. Saccadic eye movement in mild cognitive impairment and Alzheimer’s disease: A systematic review and Meta-analysis[J]. Neuropsychol Rev, 2022, 32(2): 193-227. 

[16] Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, et al. The Trail Making Test[J]. Assessment, 2017, 24(2): 183-196. 

[17] GUO Y. A selective review of the ability for variants of the Trail Making Test to assess cognitive impairment[J]. Appl Neuropsychol Adult, 2022, 29(6): 1634-1645. 

[18] Meadmore K L, Exell T A, Burridge J H, et al. Upper limb and eye movement coordination during reaching tasks in people with stroke[J]. Disabil Rehabil, 2018, 40(20): 2424-2432. 

[19] Doğan N. Bland-Altman analysis: A paradigm to understand correlation and agreement[J]. Turk J Emerg Med, 2018, 18(4): 139-141. 

[20] Piche E, Gerus P, Chorin F, et al. The effect of different dual tasks conditions on gait kinematics and spatio-temporal walking parameters in older adults[J]. Gait Posture, 2022, 95: 63-69. 

[21] Ehsani H, Mohler M J, O’connor K, et al. The association between cognition and dual-tasking among older adults: the effect of motor function type and cognition task difficulty[J]. Clin Interv Aging, 2019, 14: 659-669. 

[22] Gills J L, Glenn J M, Madero E N, et al. Validation of a digitally delivered visual paired comparison task: reliability and convergent validity with established cognitive tests[J]. Geroscience, 2019, 41(4): 441-454. 

[23] NIE J, QIU Q, Phillips M, et al. Early diagnosis of mild cognitive impairment based on eye movement parameters in an aging Chinese population[J]. Front Aging Neurosci, 2020, 12: 221. 

[24] Kahya, Lyons K E, Pahwa R, et al. Reliability and validity of pupillary response during dual-task balance in Parkinson disease[J]. Arch Phys Med Rehabil, 2021, 102(3): 448-455.