The Effect of Various Dual Task Training Methods with Gait on the Balance and Gait of Patients with Chronic Stroke

Abstract

[Purpose] This study examined the effects of various dual task gait training methods (motor dual task gait training, cognitive dual task gait training, and motor and cognitive dual task gait training) on the balance and gait abilities of chronic stroke patients. [Subjects and Methods] Thirty-three outpatients performed dual task gait training for 30 minutes per day, three times a week, for eight weeks from June to August, 2012. Balance ability was measured pre-and posttest using the stability test index, the weight distribution index, the functional reach test, the timed up and go test, and the four square step test. Gait ability was measured by the 10 m walk test and a 6 min walk test before and after the training. The paired t-test was used to compare measurements before and after training within each group, and ANOVA was used to compare measurements before and after training among the groups. [Results] Comparisons within each group indicated significant differences in all variables between before and after the training in all three groups. Comparison between the groups showed that the greatest improvements were seen in all tests, except for the timed up and go test, following motor and cognitive dual task gait training. [Conclusion] In a real walking environment, the motor and cognitive dual task gait training was more effective at improving the balance and gait abilities of chronic stroke patients than either the motor dual task gait training or the cognitive dual task gait training alone.

Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis

“…Of the 42 studies, three were RCTs,34–36 and 39 were CCTs. Eight studies evaluated the effects of dual-task training on postural stability 34–36,48,61–64. Eight studies evaluated the effects of dual tasks on participants suffering from neurological diseases, such as degenerative cerebellar disorder, Parkinson’s disease, and multiple sclerosis 21,65,66.…”

“…Four studies incorporated only female participants,35,79,85,86 and two studies incorporated only male participants 34,89. Three studies did not specify the gender of the included participants 48,61,80. The included studies provided data on 1,480 participants (n=796 females/581 males).…”

“…The change in modulation of motor activity has been suggested to allow automatization by “structural displacement”,43,44 where a shift in the operation control of motor planning and executive control occurs from higher cognitive centers to basic noncognitive centers 45,46. This training maneuver has recently drawn a lot of interest as compared to its older counterpart and speculations persist as to which protocol overlays beneficial effects on postural stability among different population groups 47,48. Recent review studies evaluating the effects of dual-task training in elderly38,49 and population groups with neurological diseases50,51 conclusively report the beneficial effects of dual-task training for enhancing cognitive abilities and stability, whereas some review studies report no identifiable benefits 33,52.…”

Association between dual-task performance and balance during gait in community-dwelling elderly people after stroke

“…In the elderly population, it has been shown that the inability to perform dual tasks affects gait balance [20], and thus may further increase the risk of falls [19,21,22]. After brain injury, individuals may also be susceptible to this risk since cortical and subcortical areas are required to implement multitasking [23].…”

Retraining Automaticity: Recovering the Procedural Memory of Walking after Stroke

“…In other words, gait training by itself may be beneficial, yet this approach allows the learner to internalize the focus of attention on the movement itself. Dual task training forces an external focus of attention, which has proven to be a superior form of training for stroke and many other impaired and un-impaired (athletics, developmental learning, etc) conditions [75,81,82].…”