Effect of Dual-task Training With Cognitive Motor Task on Walking and Balance Functions in Patients With Chronic Stroke: Randomized Controlled Pilot Study

인지운동 이중과제 훈련이 뇌졸중 환자의 보행과 균형 기능에 미치는 영향: 무작위 대조군 예비연구

  • Sim, Sun-Mi (Dept. of Physical Therapy, Youseong Wellness Hospital) ;
  • Oh, Duck-Won (Dept. of Physical Therapy, College of Health Science, Cheongju University)
  • 심선미 (유성웰니스병원 물리치료실) ;
  • 오덕원 (청주대학교 보건의료대학 물리치료학과)
  • Received : 2015.01.08
  • Accepted : 2015.04.24
  • Published : 2015.05.21


The purpose of this study was to evaluate the effect of dual-task training with cognitive effort on the walking and balance functions of chronic stroke patients. The study included 14 chronic stroke patients, who were randomly divided into the experimental group (EG) and control group (CG), each with 7 patients. The EG performed the dual-task training with cognitive effort 3 times a week, 30 minutes for 4 weeks, where as the CG performed single-task training three times a week, for 30 minutes for 4 weeks. Outcome assessments were made with 10 m walk test, timed up and go test, 6 minutes walk test, and Berg balance scale. In within-group comparison, subjects from the EG showed significant differences in all variables (p<.05), while subjects from the CG showed only significant differences in 6 minutes walk test, and Berg balance scale (p<.05). Further, there was significant difference in the improvement rate of 10 m walk test. The findings suggest that the dual-task with cognitive effort may be beneficial for improving walking and balance functions of patients with chronic stroke.


  1. An HJ, Kim JI, Kim YR, et al. The effect of various dual task training methods with gait on the balance and gait of patients with chronic stroke. J Phys Ther Sci. 2014;26(8):1287-1291.
  2. Berg K, Wood-Dauphinee S, Williams JI, et al. Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304-311.
  3. Bowen A, Wenman R, Mickelborough J, et al. Dualtask effects of talking while walking on velocity and balance following a stroke. Age Ageing. 2001;30(4):319-323.
  4. 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.
  5. Carr JH, Shepherd RB. Stroke Rehabilitation: Guidelines for exercise and training to optimize motor skill. 1st ed. London, Butterworth-Heinemann, 2003: 159-191.
  6. Choi SS. The effect of dual tasks on gait and static standing in stroke patients. Daegu, Daegu University, Master Thesis. 2009.
  7. de Haart M, Geurts AC, Huidekoper SC, et al. Recovery of standing balance in postacute stroke patients: A rehabilitation cohort study. Arch Phys Med Rehabil. 2004;85(6):886-895.
  8. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4): 409-417.
  9. Dean CM, Richards CL, Malouin F. Walking speed over 10 metres overestimates locomotor capacity after stroke. Clin Rehabil. 2001;15(4):415-421.
  10. Dobkin BH. Short-distance walking speed and timed walking distance: Redundant measures for clinical trials? Neurology. 2006;66(4):584-586.
  11. Haggard P, Cockburn J, Cock J, et al. Interference between gait and cognitive tasks in a rehabilitating neurological population. J Neurol Neurosurg Psychiatry. 2000;69(4):479-486.
  12. Hecht H, Vogt S, Prinz W. Motor learning enhances perceptual judgment: A case for action-perception transfer. Psychol Res. 2001;65(1):3-14.
  13. Hwang EO, Oh DW, Kim SY. Community ambulation in patients with chronic post-stroke hemiparesis: Comparison of walking variables in five different community situations. Academy of Korean Physical Therapy Science. 2009;3(31): 31-39.
  14. Jeong WM, Lee JW. Cognitive exercise therapy: Focused application of rehabilitation therapy. J Rehabil Res. 2005;9(2):87-113.
  15. 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.
  16. Kim HH. Effects of treadmill gait training on gait patterns in hemiplegic patients: Comparison with conventional gait training. Seoul, Yonsei University, Master Thesis. 2003.
  17. Kwon YC, Park CH. Standardization of korean version of the mini-mental state examination (MMSE-K) for use in the elderly. J Korean Neuropsychiatr Assoc. 1989;28(1):125-135.
  18. Lord SE, McPherson K, McNaughton HK, et al. Community ambulation after stroke: How important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil. 2004;85(2):234-239.
  19. Maxwell JP, Master RSW. External versus internal focus instructions: Is the learner paying attention? International Journal of Applied Sports Sciences. 2002;14(2):70-88.
  20. Michel JA, Mateer CA. Attention rehabilitation following stroke and traumatic brain injury. A review. Eura Medicophys. 2006;42(1):59-67.
  21. Morioka S, Hiyamizu M, Yagi F. The effects of an attentional demand tasks on standing posture control. J Physiol Anthropol Appl Human Sci. 2005;24(3):215-219.
  22. Mossberg KA. Reliability of a timed walk test in persons with acquired brain injury. Am J Phys Med Rehabil. 2003;82(5):385-390.
  23. 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.
  24. Pellecchia GL. Dual-task training reduces impact of cognitive task on postural sway. J Mot Behav. 2005;37(3):239-246.
  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.
  26. Plummer-D'Amato P, Altmann LJ, Behrman AL, et al. Interference between cognition, double-limb support, and swing during gait in community- dwelling individuals poststroke. Neurorehabil Neural Repair. 2010;24(6):542-549.
  27. 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.
  28. Robinett CS, Vondran MA. Functional ambulation velocity and distance requirements in rural and urban communities. A clinical report. Phys Ther. 1988;68(9):1371-1373.
  29. Sharp SA, Brouwer BJ. Isokinetic strength training of the hemiparetic knee: Effects on function and spasticity. Arch Phys Med Rehabil. 1997;78(11): 1231-1236.
  30. 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.
  31. Skilbeck CE, Wade DT, Hewer RL, et al. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983;46(1):5-8.
  32. Taylor D, Stretton CM, Mudge S, et al. Does clinic- measured gait speed differ from gait speed measured in the community in people with stroke? Clin Rehabil. 2006;20(5):438-444.
  33. Wilkinson PR, Wolfe CD, Warburton FG, et al. A long-term follow-up of stroke patients. Stroke. 1997;28(3):507-512.
  34. 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.
  35. Wu C, Trombly CA, Lin K, et al. A kinematic study of contextual effects on reaching performance in persons with and without stroke: Influences of object availiability. Arch Phys Med Rehabil. 2000;81(1):95-101.
  36. Yang YR, Chen YC, Lee CS, et al. Dual-task-related gait changes in individuals with stroke. Gait Posture. 2007;25(2):185-190.

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