Dual-task Gait Training for Stroke


Original Editor - Gunilla Buitendag

Top Contributors - Gunilla Buitendag  

Description[edit | edit source]

In daily living, walking and balancing are performed while executing simultaneous tasks. For example, frequently encountered scenarios include conversing, carrying a bag, texting or making a phone call while walking, as well as crossing busy streets[1]. Training sessions for chronic stroke ambulators should include motor and cognitive functions relevant for ADLs to maximize community ambulation[2].

Indication[edit | edit source]

Falls are a major hazard post-stroke with higher rates compared to healthy adults of the same age[3]. A clear link has been established between dual-task mobility, gait deficits, restricted community participation and falls in stroke patients, compared to the healthy population[4][5]. Thus, a decrease of dual-task ability and reduction in adaptions of our changing environments potentially causes an increase of falls[6].

Dual-task interference is particularly susceptible to patients with neurological deficits because of compromised executive control[7]. Research suggests that stroke patients prioritize cognitive tasks when walking in attention demanding environments causing reduced speed, cadence, stride length and swing phase[8]. These effects have shown to persist well beyond discharge, even when gait in isolation improves[9].

Researchers have explored the effects of gait on dual-task training, involving Motor Dual-Task Training (MDTT) and Cognitive Dual-Task Training (CDTT), in chronic stroke patients at risk of falling. Kim et al. found that CDTT has positive effects on cognition and walking ability in chronic stroke walkers[10]. More recently, Pang et al. indicated that a CDTT intervention had encouraging results for improving dual-task mobility and potentially preventing falls[11]. Current research on dual-task training shows favourable effects on gait competence and decreased falls in the general elderly population[12][13][14]. Dual tasking is imperative since single-task gait training alone does not vanquish cognitive-motor interferences encountered under dual-task conditions[5].

Outcome Measures[edit | edit source]

Outcome measures include variations of the Timed Up and Go Test including a motor dual task (TUG Manual) or cognitive dual-tasking (TUG Cognitive). Both these tests have high inter and intra-rater reliability scores [15].

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References[edit | edit source]

  1. Donovan K, Lord SE, McNaughton HK, Weatherall M. Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors. Clinical rehabilitation. 2008 Jun;22(6):556-63.
  2. An HJ, Kim JI, Kim YR, Lee KB, Kim DJ, Yoo KT, Choi JH. The effect of various dual task training methods with gait on the balance and gait of patients with chronic stroke. Journal of physical therapy science. 2014;26(8):1287-91.
  3. Weerdesteijn VG, Niet MD, Van Duijnhoven HJ, Geurts AC. Falls in individuals with stroke.
  4. Plummer-D'Amato P, Altmann LJ, Behrman AL, Marsiske M. Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke. Neurorehabilitation and neural repair. 2010 Jul;24(6):542-9.
  5. 5.0 5.1 Plummer P, Eskes G, Wallace S, Giuffrida C, Fraas M, Campbell G, Clifton K, Skidmore ER. Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Archives of physical medicine and rehabilitation. 2013 Dec 1;94(12):2565-74.
  6. Yang YR, Chen YC, Lee CS, Cheng SJ, Wang RY. Dual-task-related gait changes in individuals with stroke. Gait & posture. 2007 Feb 1;25(2):185-90.
  7. Plummer P, Eskes G. Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Frontiers in human neuroscience. 2015 Apr 28;9:225.
  8. Plummer-D’Amato P, Altmann LJ, Saracino D, Fox E, Behrman AL, Marsiske M. Interactions between cognitive tasks and gait after stroke: a dual task study. Gait & posture. 2008 May 1;27(4):683-8.
  9. Dennis A, Dawes H, Elsworth C, Collett J, Howells K, Wade DT, Izadi H, Cockburn J. Fast walking under cognitive-motor interference conditions in chronic stroke. Brain research. 2009 Sep 1;1287:104-10.
  10. Kim GY, Han MR, Lee HG. Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients. Journal of physical therapy science. 2014;26(1):1-6.
  11. Kim GY, Han MR, Lee HG. Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients. Journal of physical therapy science. 2014;26(1):1-6.
  12. Wollesen B, Mattes K, Schulz S, Bischoff LL, Seydell L, Bell JW, von Duvillard SP. Effects of dual-task management and resistance training on gait performance in older individuals: a randomized controlled trial. Frontiers in aging neuroscience. 2017 Dec 13;9:415.
  13. Brustio PR, Rabaglietti E, Formica S, Liubicich ME. Dual-task training in older adults: The effect of additional motor tasks on mobility performance. Archives of gerontology and geriatrics. 2018 Mar 1;75:119-24.
  14. Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou LS, Mayr U, Woollacott MH. Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Archives of physical medicine and rehabilitation. 2009 Mar 1;90(3):381-7.
  15. Hofheinz M, Schusterschitz C. Dual task interference in estimating the risk of falls and measuring change: a comparative, psychometric study of four measurements. Clinical rehabilitation. 2010 Sep;24(9):831-42.
  16. Mission Gait. Timed Up and Go (TUG) Variations. Available from: https://www.youtube.com/watch?v=s-BCK7T_BYI [last accessed 18/11/2021]