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Effects of Dual-Task Training on Balance and Gait Performance in Patients With Stroke

이중과제 훈련이 뇌졸중 환자의 균형 및 보행에 미치는 영향

  • Jung, Se-Ra (Dept. of Rehabilitation Science, The Graduate School, Jeonju University) ;
  • Won, Jong-Im (Dept. of Physical Therapy, College of Medical Science, Jeonju University)
  • 정세라 (전주대학교 대학원 재활과학과) ;
  • 원종임 (전주대학교 의과학대학 물리치료학과)
  • Received : 2014.04.07
  • Accepted : 2014.05.07
  • Published : 2014.05.21

Abstract

The purpose of this study was to examine the effects of dual-task training (cognitive and exercise tasks) on the balance and gait performance of chronic stroke patients. Eighteen subjects with chronic stroke were divided equally into two groups, an experimental group and a control group. Subjects in both groups participated in an exercise program, performing the same tasks, for 45 minutes per day, three times per week for four weeks. The experimental group also performed additional cognitive task. The experimental group showed a more significant improvement than the control group on the Berg Balance Scale, the Timed Up and Go Test, the Korean Activities-Specific Balance Confidence Scale, and the Functional Gait Assessment (p<.05). The cognitive task error rates in the final week were significantly less than in the first week in the experimental group (p<.01). These results suggest that dual-task training for chronic stroke patients is effective in improving balance, gait, and cognitive abilities.

References

  1. Balasubramanian CK, Bowden MG, Neptune RR, et al. Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis. Arch Phys Med Rehabil. 2007;88(1):43-49. https://doi.org/10.1016/j.apmr.2006.10.004
  2. Beninato M, Portney LG, Sullivan PE. Using the International Classification of Functioning, Disability and Health as a framework to examine the association between falls and clinical assessment tools in people with stroke. Phys Ther. 2009;89(8):816-825. http://dx.doi.org/10.2522/ptj.20080160 https://doi.org/10.2522/ptj.20080160
  3. Bensoussan L, Viton JM, Schieppati M, et al. Changes in postural control in hemiplegic patients after stroke performing a dual task. Arch Phys Med Rehabil. 2007;88(8):1009-1015. https://doi.org/10.1016/j.apmr.2007.05.009
  4. Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly: Validation of an instrument. Can J Public Health. 1992;83 Suppl 2:S7-S11.
  5. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Phys Ther. 2008;88(5):559-566. http://dx.doi.org/10.2522/ptj.20070205 https://doi.org/10.2522/ptj.20070205
  6. Bonan IV, Yelnik AP, Colle FM, et al. Reliance on visual information after stroke. Part II: Effectiveness of a balance rehabilitation program with visual cue deprivation after stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2004;85(2):274-278. https://doi.org/10.1016/j.apmr.2003.06.016
  7. Brown LA, Sleik RJ, Winder TR. Attentional demands for static postural control after stroke. Arch Phys Med Rehabil. 2002;83(12):1732-1735. https://doi.org/10.1053/apmr.2002.36400
  8. Campbell C, Rowse J, Ciol M, et al. The effect of cognitive demands on timed up and go performance in older adults with and without parkinson disease. J Neurol Phys Ther. 2003;27(1):2-7.
  9. Canning CG. The effect of directing attention during walking under dual-task conditions in parkinson's disease. Parkinsonism Relat Disord. 2005; 11(2):95-99.
  10. Cohen H, Blatchly CA, Gombash LL. A study of the clinical test of sensory interaction and balance. Phys Ther. 1993;73(6):346-351.
  11. Dennis A, Dawes H, Elsworth C, et al. Fast walking under cognitive-motor interference conditions in chronic stroke. Brain Res. 2009;1287:104-110. http://dx.doi.org/10.1016/j.brainres.2009.06.023 https://doi.org/10.1016/j.brainres.2009.06.023
  12. Deutsch, JE, Merians AS, Adamovich S, et al. Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restor Neurol Neurosci. 2004;22(3-5):371-386.
  13. Dias D, Lains J, Pereira A, et al. Can we improve gait skills in chronic hemiplegics? A randomized control trial with gait trainer. Eura Medicophys. 2007;43(4):499-504.
  14. Geurts AC, de Haart M, van Nes IJ, et al. A review of standing balance recovery from stroke. Gait Posture. 2005;22(3):267-281. https://doi.org/10.1016/j.gaitpost.2004.10.002
  15. Hochstenbach J, Donders R, Mulder T, et al. Long-term outcome after stroke: A disability-orientated approach. Int J Rehabil Res. 1996;19(3):189-200. https://doi.org/10.1097/00004356-199609000-00001
  16. Horak FB, Macpherson JM. Postural orientation and equilibrium. In: Rowell LB, Shepherd JT, eds. Handbook of Physiology: Section 12: Exercise: Regulation and integration of multiple systems. New York, Oxford University Press, 1996: 255-292.
  17. Hunt SM, McKenna SP, Williams J. Reliability of a population survey tool for measuring perceived health problems: A study of patients with osteoarthrosis. J Epidemiol Community Health. 1981;35(4):297-300. https://doi.org/10.1136/jech.35.4.297
  18. Hyndman D, Ashburn A, Yardley L, et al. Interference between balance, gait and cognitive task performance among people with stroke living in the community. Disabil Rehabil. 2006; 28(13-14):849-856. https://doi.org/10.1080/09638280500534994
  19. Ikai T, Kamikubo, T, Takehara I, et al. Dynamic postural control in patients with hemiparesis. Am J Phys Med Rehabil. 2003;82(6):463-469.
  20. Kizony R, Levin MF, Hughey L, et al. Cognitive load and dual-task performance during locomotion poststroke: A feasibility study using a functional virtual environment. Phys Ther. 2010;90(2): 252-260. http://dx.doi.org/10.2522/ptj.20090061 https://doi.org/10.2522/ptj.20090061
  21. Kramer AF, Larish JF, Strayer DL. Training for attentional control in dual task settings: A comparison of young and old adults. J Exp Psychol Appl. 1995;1(1):50-76. https://doi.org/10.1037/1076-898X.1.1.50
  22. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: The "get-up and go" test. Arch Phys Med Rehabil. 1986;67(6):387-389.
  23. Mauritz KH. Gait training in hemiplegia. Eur J Neurol. 2002;9 Suppl 1:23-29.
  24. O'Shea S, Morris ME, Iansek R. Dual task interference during gait in people with parkinson disease: Effects of motor versus cognitive secondary tasks. Phys Ther. 2002;82(9):888-897.
  25. Plummer-D'Amato P, Altmann LJ, Saracino D, et al. Interactions between cognitive tasks and gait after stroke: A dual task study. Gait Posture. 2008;27(4):683-688. https://doi.org/10.1016/j.gaitpost.2007.09.001
  26. Podsiadlo D, Richardson S. The timed "up & go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  27. Rochester L, Hetherington V, Jones D, et al. Attending to the task: Interference effects of functional tasks on walking in parkinson's disease and the roles of cognition, depression, fatigue and balance. Arch Phys Med Rehabil. 2004;85(10):1578-1585. https://doi.org/10.1016/j.apmr.2004.01.025
  28. Roerdink M, Lamoth CJ, Kwakkel G, et al. Gait coordination after stroke: Benefits of acoustically paced treadmill walking. Phys Ther. 2007;87(8): 1009-1022. https://doi.org/10.2522/ptj.20050394
  29. Shumway-Cook A, Baldwin M, Polissar NL, et al. Predicting the probability for falls in community-dwelling older adults. Phys Ther. 1997;77(8): 812-819.
  30. Silsupadol P, Shumway-Cook A, Lugade V, et al. Effects of single-task versus dual-task training on balance performance in older adults: A double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2009;90(3):381-387. http://dx.doi.org/10.1016/j.apmr.2008.09.559 https://doi.org/10.1016/j.apmr.2008.09.559
  31. Silsupadol P, Siu KC, Shumway-Cook A, et al. Training of balance under single-and dual-task conditions in older adults with balance impairment. Phys Ther. 2006;86(2):269-281.
  32. Steffen TM, Hacker TA, Mollinger L. Age-and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002;82(2): 128-137.
  33. Tyson SF, Hanley M, Chillala J, et al. Balance disability after stroke. Phys Ther. 2006;86(1):30-38.
  34. van de Port IG, Kwakkel G, Schepers VP, et al. Predicting mobility outcome one year after stroke: A prospective cohort study. J Rehabil Med. 2006;38(4):218-223. https://doi.org/10.1080/16501970600582930
  35. Verghese J, Buschke H, Viola L, et al. Validity of divided attention tasks in predicting falls in order individuals: A preliminary study. J Am Geriatr Soc. 2002;50(9):1572-1576. https://doi.org/10.1046/j.1532-5415.2002.50415.x
  36. Won JI. Effects of using a mobile phone on postural control. Phys Ther Korea. 2012;19(3):61-71. http://dx.doi.org/10.12674/ptk.2012.19.3.061 https://doi.org/10.12674/ptk.2012.19.3.061
  37. Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture. 2002; 16(1):1-14.
  38. Wrisley DM, Marchetti GF, Kuharsky DK, et al. Reliability, internal consistency, and validity of data obtained with the functional gait assessment. Phys Ther. 2004;84(10):906-918.
  39. Yang YR, Chen YC, Lee CS, et al. Dual-task-related gait changes in individuals with stroke. Gait Posture. 2007a;25(2):185-190. https://doi.org/10.1016/j.gaitpost.2006.03.007
  40. Yang YR, Wang RY, Chen YC, et al. Dual-task exercise improves walking ability in chronic stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2007b;88(10):1236-1240. https://doi.org/10.1016/j.apmr.2007.06.762
  41. Yoo IY. Effects of fall prevention program applying HSEP on physical balance and gait, leg strength, fear of falling and falls efficacy of community-dwelling elderly. Korean Geriatr Soc. 2009;29(1):259-273.

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