The Effects of Dual-Task Gait Training on Gait Performance under Cognitive Tasks in Chronic Stroke

Abstract

Purpose: Walking in the dual-task condition is a critical skill for hemiplegic patients to live in real-life situations. The purpose of this study was to compare the effect of dual-task gait training and general gait training on gait parameters and cognitive function in patients with chronic stroke during dual-task walking. Methods:The study included 23 patients with chronic hemiparetic stroke who were randomly divided into experimental (dual-task gait training) and control (general walking training) groups. The 11 subjects in the experimental group and nine subjects in the control group received dual-task gait training (walking while handling a ball, crossing obstacles, picking up various objects, and problem solving simple cognitive tasks and general over-ground gait training, respectively, for 30 minutes per day 5 days per week for 4 weeks. Spatiotemporal parameters and cognitive tasks in the dual-task gait condition were measured. Statistical analysis of the changes between the pre-and post-intervention measurement variables was performed using ANCOVA. Results: In the gait condition under cognitive tasks, the changes pre-and post-intervention in gait velocity, stride length, double support limb, and step symmetry were significantly greater in the dual-task gait training group; however, the dual-task gait training group showed no significant improvement compared to the general gait training group in terms of the assessment of cognitive tasks. Conclusion:The findings suggest that dual-task gait training may be beneficial for walking ability in dual-task walking condition. This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License (Http:// creativecommons.org/license/by-nc/3.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited.

Changes of Gait Variability by the Attention Demanding Task in Elderly Adults

“…Attention demanding task based on working memory has the most influence on the interference between cognitive and gait function. 31,32 Therefore, changes in gait variability by attention demanding task with gait might be useful as intervention strategies to rehabilitate or train people who are at risk for falling.…”

Effects of ball kicking dual task training on gait performance and balance in individuals with chronic hemiparetic stroke

“…Persons who had been diagnosed with stroke at least 6 months ago, thus indicating a chronic stroke, persons who were able to follow instructions and with an Mini-Mental State Examination score of greater than 24 [7], and those who were able to ambulate at least 10 m independently with or without an assistive device were selected to participate in the study [15]. Persons with a heart or orthopedic disorder and those with visual or auditory problems were excluded from this study [15]. The general characteristics of subjects are listed in Table 1.…”

“…Therefore, enhanced gait and balance abilities developed through performing dual tasks may assist a more stable and safe return to the community [9]. Study results showing positive effects of cognitive-interference training on gait performance and the ability to perform the activities of daily living in patients with neurological deficits exhibit the need for dual-task training [4,15]. In addition, since the ability to perform daily life activities is dependent upon balance abilities and risk of falls, there is a need for improvement of balance through a combined exercise program with cognitive training tasks [16].…”

“…If automatic movement arises through repetitive gait training, the effectiveness of cognitive interference training, dual-task performance focused on task-oriented gait training may improve gait speed and coordination [17,18]. In addition, other studies have reported the improvement of gait and balance through training with use of a ball or rings, or obstacle courses or the performance of dual-task training with virtual reality have reported improved balance and gait in persons affected by stroke [9,11,12,15,16]. Wulf et al [19] reported that training with use of a balance pad and/or similar equipment using an external focus was more effective on producing postural control compared to training with an internal focus using one's ankles.…”