Dual Task Gait Training for Stroke: Difference between revisions

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== Description<br>  ==
== Description<br>  ==


Dual tasking is necessary for community ambulation e.g. walking while crossing busy streets or conversing, as well as carrying various items. Dual tasking while walking is also a major risk factor for falls.<br>  
Falls are a major hazard post-stroke with higher rates compared to healthy adults of the same age<ref name=":0">Weerdesteyn V, Niet M, van Duijnhoven H, Geurts A. Falls in individuals with stroke. Journal of Rehabilitation Research & Development [serial online] 2008 [cited 2020 Feb 03]; 45(8): 1195-1214. Available from: <nowiki>https://pubmed.ncbi.nlm.nih.gov/19235120/</nowiki></ref><ref>Veerbeek J, van Wegen E, van Peppen R, Hendriks H, Rietberg M, van der Wees P, et al. Clinical Practice Guideline in Physiotherapy management of patients with Stroke. [Online]. 2014 [cited 2020 Feb 03]; Available from: URL: <nowiki>https://www.dsnr.nl/wp-content/uploads/2012/03/stroke_practice_guidelines_2014.pdf</nowiki></ref>. Dual tasking while walking is a major risk factor for falls<ref name=":0" />. In daily living, walking and balancing are performed while executing simultaneous tasks. E.g. frequently encountered scenarios include conversing, carrying a bag, texting or making a phone call while walking, as well as obstacles, uneven terrains and crossing busy streets<ref>Donovan K, Lord S, McNaughton H, Weatherall M. Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors. Clinical Rehabilitation [serial online] 2008 [cited 2020 Feb 03]; 22(6): 556-563. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/18511535</nowiki></ref>. Thus, a decrease of dual-task ability and reduction in adaptions of our changing environments potentially cause more falls<ref>Yang Y, Chen Y, Lee C, Cheng S, Wang R. Dual-task-related gait changes in individuals with stroke. Gait and Posture [serial online] 2007 [cited 2020 Feb 03]; 25(2):185-190. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/16650766</nowiki></ref>. <br>  


== Indication<br>  ==
== Indication<br>  ==


add text here relating to the indication for the intervention<br>  
Training sessions for chronic stroke ambulators should include motor and cognitive functions relevant for ADLs to maximize community ambulation<ref>An H, Kim J, Kim Y, Lee K, Kim D, Yoo K et al. 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 [serial online] 2014 [cited 2020 Feb 03]; 26(8):1287-1291. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155238/</nowiki></ref>. 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. <ref>Plummer-D'Amato P, Altmann L, Behrman A, Marsiske M. Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke. Neurorehabilitation and Neural Repair [serial online] 2010 [cited 2020 Feb 03]; 24(6):542-549. Available from: <nowiki>https://journals.sagepub.com/doi/10.1177/1545968309357926</nowiki></ref><ref>Plummer P, Eskes G, Wallace S, Giuffrida C, Fraas M, Campbell G et al. Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Archives of Physical Medicine and Rehabilitation [serial online] 2013 [cited 2020 Feb 03]; ;94(12):2565-2574. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842379/</nowiki></ref>
 
Dual-task interference is particularly susceptible in patients with neurological deficits because of compromised executive control<ref>Plummer P, Eskes G. Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Front Hum Neurosci [serial online] 2015 [cited 2020 Feb 03]; 9: 225. Available from <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412054/</nowiki></ref>. Research suggests that stroke patients prioritize cognitive tasks when walking in attention demanding environments causing reduced speed, cadence, stride length and swing phase<ref name=":1">Plummer-D’Amato P, Altmann L, Saracino D, Fox E, Behrman A, Marsiske M. Interactions between cognitive tasks and gait after stroke: A dual task study. Gait & Posture [serial online] 2008 [cited 2020 Feb 03]; 27(4):683-688. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913384/</nowiki></ref>. These effects have shown to persist well beyond discharge, even when gait in isolation improves<ref>Dennis A, Dawes H, Elsworth C, Collett J, Howells K, Wade D et al. Fast walking under cognitive-motor interference conditions in chronic stroke. Brain Research [serial online] 2009 [cited 2020 Feb 03]; 1287: 104-110. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/19527695</nowiki></ref><ref name=":1" />.<br>  


== Clinical Presentation  ==
== Clinical Presentation  ==

Revision as of 00:23, 19 November 2021

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Description
[edit | edit source]

Falls are a major hazard post-stroke with higher rates compared to healthy adults of the same age[1][2]. Dual tasking while walking is a major risk factor for falls[1]. In daily living, walking and balancing are performed while executing simultaneous tasks. E.g. frequently encountered scenarios include conversing, carrying a bag, texting or making a phone call while walking, as well as obstacles, uneven terrains and crossing busy streets[3]. Thus, a decrease of dual-task ability and reduction in adaptions of our changing environments potentially cause more falls[4].

Indication
[edit | edit source]

Training sessions for chronic stroke ambulators should include motor and cognitive functions relevant for ADLs to maximize community ambulation[5]. 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. [6][7]

Dual-task interference is particularly susceptible in patients with neurological deficits because of compromised executive control[8]. Research suggests that stroke patients prioritize cognitive tasks when walking in attention demanding environments causing reduced speed, cadence, stride length and swing phase[9]. These effects have shown to persist well beyond discharge, even when gait in isolation improves[10][9].

Clinical Presentation[edit | edit source]

add text here relating to the clinical presentation of the condition, including pre- and post- intervention assessment measures. 

[11]

Resources[edit | edit source]

add appropriate resources here, including text links or content demonstrating the intervention or technique

References[edit | edit source]

  1. ↑ 1.0 1.1 Weerdesteyn V, Niet M, van Duijnhoven H, Geurts A. Falls in individuals with stroke. Journal of Rehabilitation Research & Development [serial online] 2008 [cited 2020 Feb 03]; 45(8): 1195-1214. Available from: https://pubmed.ncbi.nlm.nih.gov/19235120/
  2. ↑ Veerbeek J, van Wegen E, van Peppen R, Hendriks H, Rietberg M, van der Wees P, et al. Clinical Practice Guideline in Physiotherapy management of patients with Stroke. [Online]. 2014 [cited 2020 Feb 03]; Available from: URL: https://www.dsnr.nl/wp-content/uploads/2012/03/stroke_practice_guidelines_2014.pdf
  3. ↑ Donovan K, Lord S, McNaughton H, Weatherall M. Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors. Clinical Rehabilitation [serial online] 2008 [cited 2020 Feb 03]; 22(6): 556-563. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18511535
  4. ↑ Yang Y, Chen Y, Lee C, Cheng S, Wang R. Dual-task-related gait changes in individuals with stroke. Gait and Posture [serial online] 2007 [cited 2020 Feb 03]; 25(2):185-190. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16650766
  5. ↑ An H, Kim J, Kim Y, Lee K, Kim D, Yoo K et al. 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 [serial online] 2014 [cited 2020 Feb 03]; 26(8):1287-1291. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155238/
  6. ↑ Plummer-D'Amato P, Altmann L, Behrman A, Marsiske M. Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke. Neurorehabilitation and Neural Repair [serial online] 2010 [cited 2020 Feb 03]; 24(6):542-549. Available from: https://journals.sagepub.com/doi/10.1177/1545968309357926
  7. ↑ Plummer P, Eskes G, Wallace S, Giuffrida C, Fraas M, Campbell G et al. Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Archives of Physical Medicine and Rehabilitation [serial online] 2013 [cited 2020 Feb 03]; ;94(12):2565-2574. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842379/
  8. ↑ Plummer P, Eskes G. Measuring treatment effects on dual-task performance: a framework for research and clinical practice. Front Hum Neurosci [serial online] 2015 [cited 2020 Feb 03]; 9: 225. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412054/
  9. ↑ 9.0 9.1 Plummer-D’Amato P, Altmann L, Saracino D, Fox E, Behrman A, Marsiske M. Interactions between cognitive tasks and gait after stroke: A dual task study. Gait & Posture [serial online] 2008 [cited 2020 Feb 03]; 27(4):683-688. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2913384/
  10. ↑ Dennis A, Dawes H, Elsworth C, Collett J, Howells K, Wade D et al. Fast walking under cognitive-motor interference conditions in chronic stroke. Brain Research [serial online] 2009 [cited 2020 Feb 03]; 1287: 104-110. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19527695
  11. ↑ Mission Gait. Timed Up and Go (TUG) Variations. Available from: https://www.youtube.com/watch?v=s-BCK7T_BYI [last accessed 18/11/2021]
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