• 대한통합의학회지
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• 제9권2호
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• pp.23-33
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• 2021

Purpose : This study aimed to investigate the effects of dual-task training according to the variability of the walking environment on balance, gait, and function in patients with stroke. Methods : Twenty-five patients with stroke were randomly assigned to experimental group I (n=12) and experimental group II (n=13). Experimental group I and II performed obstacle and non-obstacle walking training, respectively, along with cognitive tasks for 21 minutes per session, 3 times a week for 6 weeks. Both groups received additional general physical therapy for 30 minutes per session. The functional reach test (FRT), gait analyzer (G-Walk), and functional independence measure (FIM) were used to evaluate balance, gait and function of pre- and post-interventions, respectively, while gait cadence, gait velocity, and stride length were evaluated using a gait analyzer. Results : In the within-group comparison of FRT, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of gait cadence, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of gait velocity, all the two groups showed significant post-intervention improvements (p<.05). In within-group comparison of stride length, experimental group I showed significant post-intervention improvements (p<.05), while experimental group II did not show significant post-intervention improvements (p>.05). In within-group comparison of FIM scores, experimental group I showed significant post-intervention improvements (p<.05), while experimental group II did not show significant post-intervention improvements (p>.05). There was a significant difference in the change of FIM scores pre- and post-intervention (p<.05) in the between-group comparison. Conclusion : The results of this study show that dual-task training with cognitive tasks and walking training can improve the balance, gait and function of patients with stroke, and obstacle walking training is effective for improving functions including activities of daily living compared to non-obstacle walking training.

• 재활치료과학
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• 제5권1호
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• pp.23-32
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• 2016

목적 : 본 연구는 이중과제 훈련을 뇌졸중 환자에게 적용하여 미치는 효과를 살펴본 국외 연구에 대해서 분석하는 것이다. 연구방법 : 2007년부터 2015년까지 국외 학회지에 게재된 논문을 Pubmed를 통하여 검색을 실시했다. 분류 및 선정과 배제조건을 통해 총 5개의 실험연구 논문을 포함논문으로 선정하였다. 결과 : 선정된 5편의 문헌은 모두 사전사후 대조군 설계로, PEDro score은 6점 이상으로 높은 편에 속했다. 사용된 중재에서 채택된 운동과제는 모두 보행과제였으며, 인지과제는 다양한 과제를 포함하여 범위가 넓었다. 사용된 평가도구는 표준화된 평가도구부터 조작적 정의에 의한 평가가 사용되었고, 더 나아가 이중과제 훈련을 위하여 고안된 평가도구도 포함되어 다양한 측면을 평가하는 것이 가능하였다. 고찰 : 본 연구를 통하여 이중과제 훈련이 뇌졸중 환자의 운동 및 인지기능의 향상 뿐 만 아니라 이중과제 수행에 긍정적인 영향을 주는 것을 확인할 수 있었지만, 이와 같은 결과를 통하여 현재까지 진행된 뇌졸중 환자 대상의 이중과제 훈련의 제한점 또한 알 수 있었다. 이러한 결과는 작업치료 분야에 적용을 위하여 보완점을 제시하는 기초자료로서의 역할과 효과적 치료를 알리는 데 도움이 될 것으로 사료된다.

• PNF and Movement
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• 제10권1호
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• pp.25-33
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• 2012

Purpose : The purpose of this study was to compare the effect of treadmill training and cognitive task with in the course of treadmill training at the same time with chronic stroke patients. Methods : Fourteen chronic stroke patients participated. Participants were randomly assigned to the control and experimental group(7 experimental, 7 control). All of participants were in-patients at local hospital and had been receiving a traditional rehabilitation program, five days a week. The both groups have undergone 4weeks. The experimental group trained in treadmill and cognitive task at the same time, but control group trained only treadmill. 10m walking test, Timed Up & Go (TUG) test and 6 Minutes walking(6M walking) test to measure the walking speed, dynamic balance and waling endurance ability were carried out before and after the training. Results : The result of the study were as follow:10m walking test were significantly increased both groups(p<.01), but not significant between groups(p>.05). TUG test were significantly increased both groups(p<.001) and between groups(p<.01). 6M walking test were significantly increased both groups(p<.001), but not significant between groups(p>.05). Conclusion : Ahead of return to the community to patients with stroke, cognitive task with in the course of treadmill training at the same time was effective in improving the dynamic balance ability.

• PNF and Movement
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• 제15권3호
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• pp.361-371
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• 2017

Purpose: The purpose of this study was to examine the effects of performing a dual task on gait velocity, temporospatial variables, and symmetry in subjects with subacute stroke. Methods: The study included 14 independent community ambulators with gait velocity of 0.8m/s. The Korean mini-mental state examination, the Berg balance scale, the Trunk impairment scale, and the Fugl-Meyer assessment scale were used to recruit homogeneous subjects. Subjects performed a single task (10m ambulation at a comfortable speed) and a dual task (10m ambulation at a comfortable speed while carrying a water-filled glass). Gait variables were examined with the OptoGait system. Results: The findings of this study were as follows: 1) Gait velocity decreased significantly in the dual-task condition as compared to the single task condition. 2) There were no significant differences between the paretic and non-paretic stances. 3) Paretic swing decreased significantly in the dual-task condition as compared to the single task condition. 4) The non-paretic, double-limb support phase increased significantly in the dual-task condition as compared to the single- task condition. 5) There was no significant difference in temporal symmetry. 6) Non-paretic step length decreased significantly in the dual-task condition as compared to the single-task condition. 7) There was no significant difference in spatial symmetry. Conclusion: Performing dual tasks decreases gait velocity, paretic swing phase, and non-paretic step length, while it increases non-paretic double limb support. In addition, although there is no difference in temporospatial symmetry, there is high inter-subject variability in temporospatial symmetry. Thus, dual tasks should be selected in accordance with the functional level of the hemiplegic patient, and inter-subject variability of the individual should be considered when dual tasks are considered for gait-training of hemiplegic patients.

• Physical Therapy Rehabilitation Science
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• 제10권4호
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• pp.493-502
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• 2021

Objective: Older adults with mild cognitive impairment (MCI) are more likely to progress to dementia. Motor-cognitive training is applied as a dual-task to improve the cognitive and physical functions of older adults with MCI. The purpose of the study was to know the recent trends in motor training types and outcome measures used for motor-cognitive training in older adults with MCI. Design: Aliterature review Methods: This literature review was conducted in Pubmed, MEDLINE® and Google Scholar with the following key words: older adults, mild cognitive impairment, motor-cognitive training, cognition, and dual-task. The 7 studies were found with the search tool and all studies were randomized controlled trials. Results: In motor-cognitive training in older adults with MCI, 6 studies applied aerobic exercise. And 3 out of 6 studies also applied strengthening exercises. One study applied dual tasks without aerobic exercise. In the 6 studies, overall cognitive and executive function were used as outcome measures, and physical function was evaluated as gait performance. Memory and physical frailty were also used as measurement tools. As a result of all studies, when motor-cognitive training was applied, cognition and physical performance showed significant results. Conclusions: A recent five-year study applied mainly aerobic exercise and strength training to older adults with MCI and found it to improve cognitive and physical performance.

• 재활치료과학
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• 제9권2호
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• pp.7-25
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• 2020

목적 : 본 연구는 뇌졸중 환자를 대상으로 한 이중과제 훈련(Dual-task training)의 효과를 알아본 연구들을 분석하는 것을 목적으로 한다. 연구방법 : NDSL, RISS, PubMed, CoChrane, EMBASE를 통해 지난 10년 간 국내외 학술지에 게재된 논문들을 검색하였고, 최종적으로 10개의 논문을 선정하였다. 이를 전통적 단일계층 근거 모형에 따른 질적평가를 시행하고, Comprehensive Meta Analysis 3.0 프로그램을 통해 메타분석을 시행하였다. 결과 : 선정된 10편의 논문의 질적 수준은 모두 전통적 단일계층 근거 모형의 I과 II에 해당되어 높은 편에 속했다. 이중과제 훈련을 구성하고 있는 운동과제로는 7편의 문헌에서 보행 또는 균형 과제를 선택했으며, 3편의 연구에서 상지운동 관련 과제를 선정하였다. 메타분석을 실시한 결과 일상생활활동 수행능력이 0.65, 인지기능이 0.64로 보통(medium) 효과크기로, 하지운동 기능과 상지운동 기능은 각각 0.34와 0.22로 작은(small) 효과크기를 보였다. 일상생활활동 수행능력과 인지기능의 효과크기만 통계학적으로 유의미하였다(p<0.05). 결론 : 본 연구를 통해 이중과제 훈련이 뇌졸중 환자의 일상생활활동 수행능력 및 인지기능 회복에 유용한 중재기법이 될 수 있음을 확인하였다. 이는 국내 임상 환경에서 뇌졸중 환자에게 적절한 중재방법을 선정할 때 도움이 될 만한 자료로 활용될 수 있을 것이다.

• The Journal of Korean Physical Therapy
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• 제23권5호
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• pp.1-5
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• 2011

Purpose: This study was designed to investigate the changes of postural sway and muscle activation while standing upright and performing a dual task. Methods: Nine healthy adults were recruited and provided their written informed consent. They performed a balance task with and without a cognitive task on a force flatform (Good balance, Metitur Ltd., Filand). Postural sway was measured as medio-lateral and anterior-posterior distance and the velocity of the center of pressure and muscle activations of the ankle dorsi- and plantar-muscle was measured. The recruits completed three trials and the data was analyzed by a paired t-test. Results: There were significant differences in the medio-lateral and anterior-posterior distance and the velocity of the center of pressure, and significant increases in the muscle activities of the tibialis anterior. Conclusion: These findings revealed that performing a dual task increases postural sway and muscle activation of the ankle when simultaneously maintaining balance and performing another cognitive task. Future studies should focus on balance training with a dual task for patients.

• PNF and Movement
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• 제7권4호
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• pp.31-36
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• 2009

Many daily activities require people to complete a motor task while walking. Substantial gait decrements during simultaneous attention to a variety of cognitive tasks have been shown by a group of severely injured neurological patients of mixed etiology. And previous studies have shown that the attentional load of a walking-associated task increased with its level of difficulty. The purpose of this study was to analyze subjects' gait changes are affected by the effects of arithmetic task difficulty and performance level. Participants performed a walking task alone, three different Arithmetic tasks while seated, and among them, two kinds of the simillar Arithmetic tasks in combination with walking. Reaction time and accuracy were recorded for two of the Arithmetic tasks. The mean values of the gait were measured using a Timed Up and Go test among 11 with post-stroke patients while walking with and without forward counting (WFC) and backward counting(WBC).There was significant Arithmetic Task Difficulty level between the 10-forward counting task condition(FC) and the 10-backward counting task condition(BC)(p=0.008). The mean values of T.U.G time were significantly higher under backward counting dual-task condition than during a simple walking task(p=0.009) and WFC(p=0.009). The change in T.U.G time during WFC was higher when compared with the change during a simple walking, but there was no significant difference (p=0.246). This study suggesting that a high interference could be linked with a high level of difficulty, whereas adaptive task enabled participants to perfectly share their attention between two concurrent tasks. Future research should determine whether dual task training can reduce gait decrements in dual task situations in people after stroke. And the dual-task-based exercise program is feasible and beneficial for improving walking ability in subjects with stroke.

• 성인간호학회지
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• 제27권6호
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• pp.707-717
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• 2015

Purpose: This study was to develop and verify the effects of the exercise-cognitive combined dual-task training program on cognitive function and depression of the elderly with mild cognitive impairment (MCI). Methods: A non-equivalent control group pretest-posttest design was used. The participants were assigned into two groups: an experimental group receiving an exercise-cognitive combined dual-task (n=20) and a control group receiving a simple-task (n=18). After 8 weeks of intervention (2 days per week), the change in depression and cognitive functions were compared between the groups. Results: General cognitive function (t=-2.81, p=.011), frontal cognitive function (Z=-3.50, p<.001), attention/working memory function (U=-2.91, p=.004), depression (t=4.96, p<.001) of the experimental group were significantly increased than those of the control group. Conclusion: The findings of the study showed that an exercise-cognitive combined dual-task program for MCI was effective in improving general cognitive function, frontal and executive function, attention/working memory function, and reducing depression.

• Physical Therapy Rehabilitation Science
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• 제6권3호
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• pp.134-139
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• 2017

Objective: Dual-task interference is defined as decrements in performance observed when people attempt to perform two tasks concurrently, such as a verbal task and walking. The purpose of this study was to investigate the changes of gait ability according to the dual task interference in chronic stroke survivors. Design: Cross-sectional study. Methods: Ten chronic stroke survivors (9 male, 1 female; mean age, 55.30 years; mini mental state examination, 19.60; onset duration, 56.90 months) recruited from the local community participated in this study. Gait ability (velocity, paretic side step, and stride time and length) under the single- and dual-task conditions at a self-selected comfortable walking speed was measured using the motion analysis system. In the dual task conditions, subjects performed three types of cognitive tasks (controlled oral word association test, auditory clock test, and counting backwards) while walking on the track. Results: For velocity, step and stride length, there was a significant decrease in the dual-task walking condition compared to the single walking condition (p<0.05). In particular, higher reduction of walking ability was observed when applying the counting backward task. Conclusions: Our results revealed that the addition of cognitive tasks while walking may lead to decrements of gait ability in stroke survivors. In particular, the difficulty level was the highest for the calculating task. We believe that these results provide basic information for improvements in gait ability and may be useful in gait training to prevent falls after a stroke incident.