Dual Task Gait Training for Stroke

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Original Editor - Gunilla Buitendag

Top Contributors - Gunilla Buitendag, Kim Jackson and Aminat Abolade  

Description
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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
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Falls are a major hazard post-stroke with higher rates compared to healthy adults of the same age[3][4]. 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[5][6]. Thus, a decrease of dual-task ability and reduction in adaptions of our changing environments potentially causes an increase of falls[7].

Dual-task interference is particularly susceptible to 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].

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[11]. More recently, Pang et al. indicated that a CDTT intervention had encouraging results for improving dual-task mobility and potentially preventing falls[12]. Current research on dual-task training shows favourable effects on gait competence and decreased falls in the general elderly population[13][14][15]. Dual tasking is imperative since single-task gait training alone does not vanquish cognitive-motor interferences encountered under dual-task conditions[6].

Outcome Measures[edit | edit source]

Outcome measures include variations of the Time-Up and Go Test including motor or cognitive dual-tasking. Both these tests have high inter and intra-rater reliability scores [16].

Resources[edit | edit source]

[17]

References[edit | edit source]

  1. ↑ 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
  2. ↑ 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/
  3. ↑ 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/
  4. ↑ 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
  5. ↑ 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
  6. ↑ 6.0 6.1 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/
  7. ↑ 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
  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. ↑ 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. ↑ Kim G, Han M, Lee H. Effect of Dual-task Rehabilitative Training on Cognitive and Motor Function of Stroke Patients. Journal of Physical Therapy Science [serial online] 2014 [cited 2020 Feb 03]; 26(1):1-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927016/
  12. ↑ Pang M, Yang L, Ouyang H, Lam F, Huang M, Jehu D. Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke. Stroke [serial online] 2018 [cited 2020 Feb 03]; 49(12):2990-2998. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30571419
  13. ↑ Wollesen B, Mattes K, Schulz S, Bischoff L, Seydell L, Bell JW et al. Effects of Dual-Task Management and Resistance Training on Gait Performance in Older Individuals: A Randomized Controlled Trial. Frontiers in Aging Neuroscience [serial online] 2017 [cited 2020 Feb 03]; 9:415. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733355/
  14. ↑ Brustio P, Rabaglietti E, Formica S, Liubicich E. Dual-task training in older adults: The effect of additional motor tasks on mobility performance. Science Direct [serial online] 2018 [cited 2020 Feb 02]; 75: 119-124. Available from: https://www.sciencedirect.com/science/article/pii/S0167494317303400?via%3Dihub
  15. ↑ Silsupadol P, Shumway-Cook A, Lugade V, van Donkelaar P, Chou L, Mayr U et al. 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 [serial online] 2009 [cited 2020 Feb 03]; 90(3): 381-387. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768031/
  16. ↑ 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 [serial online] 2010 [cited 2020 Nov 17]; 24(9):831-842. Available from: https://pubmed.ncbi.nlm.nih.gov/20562166/
  17. ↑ 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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