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Feasibility of Dual-Task Gait Training for Community-Dwelling Adults after Stroke: A Case Series

DOI: 10.1155/2014/538602

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This case series explored the feasibility and efficacy of cognitive-motor dual-task gait training in community-dwelling adults within 12 months of stroke. A secondary aim was to assess transfer of training to different dual-task combinations. Seven male participants within 12 months of stroke participated in 12 sessions of dual-task gait training. We examined single and dual-task performance in four different dual-task combinations at baseline, after 6 and 12 sessions, and if possible, at 1-month followup. Feasibility was assessed by asking participants to rate mental and physical fatigue, perceived difficulty, anxiety, and fear of falling at the end of each session. Five of the seven participants demonstrated reduced dual-task cost in gait speed in at least one of the dual-task combinations after the intervention. Analysis of the patterns of interference in the gait and cognitive tasks suggested that the way in which the participants allocated their attention between the simultaneous tasks differed across tasks and, in many participants, changed over time. Dual-task gait training is safe and feasible within the first 12 months after stroke, and may improve dual-task walking speed. Individuals with a combination of physical and cognitive impairments may not be appropriate for dual-task gait training. 1. Introduction Cognitive-motor dual-task interference, defined as the decrement in performance that occurs when cognitive and motor tasks are performed simultaneously, has been well established in people after stroke [1–9]. This growing body of research has demonstrated significant dual-task decrements in gait speed [1, 5, 8], stride length [5, 8], cadence [6, 8], stride duration [2, 4, 8], and double limb support duration [1, 7]. In other words, compared to single-task walking, when individuals with stroke perform a cognitive task while walking they are less stable and take shorter, slower steps, resulting in a dramatic cost on gait speed. Gait-related dual-task deficits persist in community-dwelling stroke survivors many months after discharge from rehabilitation [3, 5, 8]. Since walking in the community is often performed concurrently with cognitive tasks, such as remembering directions or engaging in social interactions, a reduced capacity for dual-task walking may restrict the degree to which a person is able to physically function and participate in their life roles. Conventional rehabilitation does not appear to adequately address gait-related dual-task interference. For example, in a longitudinal study of cognitive-motor interference, Cockburn and


[1]  A. Bowen, R. Wenman, J. Mickelborough, J. Foster, E. Hill, and R. Tallis, “Dual-task effects of talking while walking on velocity and balance following a stroke,” Age and Ageing, vol. 30, no. 4, pp. 319–323, 2001.
[2]  J. Cockburn, P. Haggard, J. Cock, and C. Fordham, “Changing patterns of cognitive-motor interference (CMI) over time during recovery from stroke,” Clinical Rehabilitation, vol. 17, no. 2, pp. 167–173, 2003.
[3]  A. Dennis, H. Dawes, C. Elsworth et al., “Fast walking under cognitive-motor interference conditions in chronic stroke,” Brain Research, vol. 1287, pp. 104–110, 2009.
[4]  P. Haggard, J. Cockburn, J. Cock, C. Fordham, and D. Wade, “Interference between gait and cognitive tasks in a rehabilitating neurological population,” Journal of Neurology Neurosurgery and Psychiatry, vol. 69, no. 4, pp. 479–486, 2000.
[5]  D. Hyndman, A. Ashburn, L. Yardley, and E. Stack, “Interference between balance, gait and cognitive task performance among people with stroke living in the community,” Disability and Rehabilitation, vol. 28, no. 13-14, pp. 849–856, 2006.
[6]  S. Kemper, J. McDowd, P. Pohl, R. Herman, and S. Jackson, “Revealing language deficits following stroke: the cost of doing two things at once,” Aging, Neuropsychology, and Cognition, vol. 13, no. 1, pp. 115–139, 2006.
[7]  P. Plummer-D'Amato, L. J. P. Altmann, A. L. Behrman, and M. Marsiske, “Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke,” Neurorehabilitation and Neural Repair, vol. 24, no. 6, pp. 542–549, 2010.
[8]  P. Plummer-D'Amato, L. J. P. Altmann, D. Saracino, E. Fox, A. L. Behrman, and M. Marsiske, “Interactions between cognitive tasks and gait after stroke: a dual task study,” Gait and Posture, vol. 27, no. 4, pp. 683–688, 2008.
[9]  P. Plummer, G. Eskes, S. Wallace, 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, vol. 94, pp. 2565–2574, 2013.
[10]  P. Silsupadol, A. Shumway-Cook, V. Lugade 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, vol. 90, no. 3, pp. 381–387, 2009.
[11]  P. Silsupadol, K.-C. Siu, A. Shumway-Cook, and M. H. Woollacott, “Training of balance under single- and dual-task conditions in older adults with balance impairment,” Physical Therapy, vol. 86, no. 2, pp. 269–281, 2006.
[12]  C. G. Canning, L. Ada, and E. Woodhouse, “Multiple-task walking training in people with mild to moderate Parkinson's disease: a pilot study,” Clinical Rehabilitation, vol. 22, no. 3, pp. 226–233, 2008.
[13]  S. G. Brauer and M. E. Morris, “Can people with Parkinson's disease improve dual tasking when walking?” Gait and Posture, vol. 31, no. 2, pp. 229–233, 2010.
[14]  J. J. Evans, E. Greenfield, B. A. Wilson, and A. Bateman, “Walking and talking therapy: improving cognitive-motor dual-tasking in neurological illness,” Journal of the International Neuropsychological Society, vol. 15, no. 1, pp. 112–120, 2009.
[15]  Y.-R. Yang, Y.-C. Chen, C.-S. Lee, S.-J. Cheng, and R.-Y. Wang, “Dual-task-related gait changes in individuals with stroke,” Gait and Posture, vol. 25, no. 2, pp. 185–190, 2007.
[16]  E. A. Maylor and A. M. Wing, “Age differences in postural stability are increased by additional cognitive demands,” Journals of Gerontology B Psychological Sciences and Social Sciences, vol. 51, no. 3, pp. P143–P154, 1996.
[17]  R. Holtzer, J. Verghese, X. Xue, and R. B. Lipton, “Cognitive processes related to gait velocity: results from the Einstein aging study,” Neuropsychology, vol. 20, no. 2, pp. 215–223, 2006.
[18]  A. M. Gentile, “Skill acquisition: action, movement, and neuromotor processes,” in Movement Science: Foundations For Physical Therapy Rehabilitation, J. Carr and R. Shepherd, Eds., Aspen Publishers, Gaithersburg, Md, USA, 2000.
[19]  K.-C. Siu, R. D. Catena, L.-S. Chou, P. van Donkelaar, and M. H. Woollacott, “Effects of a secondary task on obstacle avoidance in healthy young adults,” Experimental Brain Research, vol. 184, no. 1, pp. 115–120, 2008.
[20]  N. Shkuratova, M. E. Morris, and F. Huxham, “Effects of age on balance control during walking,” Archives of Physical Medicine and Rehabilitation, vol. 85, no. 4, pp. 582–588, 2004.
[21]  S. O'Shea, M. E. Morris, and R. Iansek, “Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks,” Physical Therapy, vol. 82, no. 9, pp. 888–897, 2002.
[22]  J. Perry, M. Garrett, J. K. Gronley, and S. J. Mulroy, “Classification of walking handicap in the stroke population,” Stroke, vol. 26, no. 6, pp. 982–989, 1995.
[23]  V. E. Kelly, A. A. Janke, and A. Shumway-Cook, “Effects of instructed focus and task difficulty on concurrent walking and cognitive task performance in healthy young adults,” Experimental Brain Research, vol. 207, no. 1-2, pp. 65–73, 2010.
[24]  D. Podsiadlo and S. Richardson, “The timed “Up and Go”: a test of basic functional mobility for frail elderly persons,” Journal of the American Geriatrics Society, vol. 39, no. 2, pp. 142–148, 1991.
[25]  L. E. Powell and A. M. Myers, “The Activities-specific Balance Confidence (ABC) scale,” Journals of Gerontology A Biological Sciences and Medical Sciences, vol. 50, no. 1, pp. M28–M34, 1995.
[26]  R. Trigg and V. A. Wood, “The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients,” Clinical Rehabilitation, vol. 14, no. 3, pp. 288–299, 2000.
[27]  Z. S. Nasreddine, N. A. Phillips, V. Bédirian et al., “The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment,” Journal of the American Geriatrics Society, vol. 53, no. 4, pp. 695–699, 2005.
[28]  J. R. Stroop, “Studies of interference in serial verbal reactions,” Journal of Experimental Psychology, vol. 18, no. 6, pp. 643–662, 1935.
[29]  W. C. Shipley, “A self-administering scale for measuring intellectual impairment and deterioration,” The Journal of Psychology, vol. 9, no. 2, pp. 371–377, 1940.
[30]  A. R. Fugl Meyer, L. Jaasko, and I. Leyman, “The post stroke hemiplegic patient. I. A method for evaluation of physical performance,” Scandinavian Journal of Rehabilitation Medicine, vol. 7, no. 1, pp. 13–31, 1975.
[31]  J. A. Yesavage, T. L. Brink, and T. L. Rose, “Development and validation of a geriatric depression screening scale: a preliminary report,” Journal of Psychiatric Research, vol. 17, no. 1, pp. 37–49, 1982.
[32]  A. Schmid, P. W. Duncan, S. Studenski et al., “Improvements in speed-based gait classifications are meaningful,” Stroke, vol. 38, no. 7, pp. 2096–2100, 2007.
[33]  E. M. Botner, W. C. Miller, and J. J. Eng, “Measurement properties of the activitites-specific balance confidence scale among individuals with stroke,” Disability and Rehabilitation, vol. 27, no. 4, pp. 156–163, 2005.
[34]  A. M. Myers, P. C. Fletcher, A. H. Myers, and W. Sherk, “Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale,” Journals of Gerontology A Biological Sciences and Medical Sciences, vol. 53, no. 4, pp. M287–M294, 1998.
[35]  M. Beninato, L. G. Portney, and P. E. Sullivan, “Using the international classification of functioning, disability and health as a framework to examine the association between falls and clinical assessment tools in people with stroke,” Physical Therapy, vol. 89, no. 8, pp. 816–825, 2009.
[36]  U.-B. Flansbjer, A. M. Holmb?ck, D. Downham, C. Patten, and J. Lexell, “Reliability of gait performance tests in men and women with hemiparesis after stroke,” Journal of Rehabilitation Medicine, vol. 37, no. 2, pp. 75–82, 2005.
[37]  E. Nordin, N. Lindel?f, E. Rosendahl, J. Jensen, and L. Lundin-Olsson, “Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and fall history in evaluating fall risk in residential care facilities,” Age and Ageing, vol. 37, no. 4, pp. 442–448, 2008.
[38]  P. Plummer-D'Amato, B. Brancato, M. Dantowitz, S. Birken, C. Bonke, and E. Furey, “Effects of gait and cognitive task difficulty on cognitive-motor interference in aging,” Journal of Aging Research, vol. 2012, Article ID 583894, 8 pages, 2012.
[39]  P. Plummer-D'Amato, L. J. P. Altmann, and K. Reilly, “Dual-task effects of spontaneous speech and executive function on gait in aging: exaggerated effects in slow walkers,” Gait and Posture, vol. 33, no. 2, pp. 233–237, 2011.
[40]  P. Plummer-D'Amato and L. J. P. Altmann, “Relationships between motor function and gait-related dual-task interference after stroke: a pilot study,” Gait and Posture, vol. 35, no. 1, pp. 170–172, 2012.
[41]  K.-C. Siu, L.-S. Chou, U. Mayr, P. van Donkelaar, and M. H. Woollacott, “Does inability to allocate attention contribute to balance constraints during gait in older adults?” Journals of Gerontology A Biological Sciences and Medical Sciences, vol. 63, no. 12, pp. 1364–1369, 2008.
[42]  P. Plummer-D'Amato, A. Kyvelidou, D. Sternad, B. Najafi, R. M. Villalobos, and D. Zurakowski, “Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial,” BMC Neurology, vol. 12, p. 129, 2012.
[43]  G. Yogev-Seligmann, Y. Rotem-Galili, A. Mirelman, R. Dickstein, N. Giladi, and J. M. Hausdorff, “How does explicit prioritization alter walking during dual-task performance? Effects of age and sex on gait speed and variability,” Physical Therapy, vol. 90, no. 2, pp. 177–186, 2010.
[44]  J. H. Hollman, J. W. Youdas, and D. J. Lanzino, “Gender differences in dual task gait performance in older adults,” American Journal of Men's Health, vol. 5, no. 1, pp. 11–17, 2011.
[45]  P. Plummer-D’Amato, R. Villalobos, M. Vayda, et al., “Feasibility of training dual task walking after stroke,” Archives of Physical Medicine and Rehabilitation, vol. 92, no. 10, pp. 1717–1718, 2011.


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