The Effects Of Dual Task Training On Stroke Patients

Objectives:The overall aim of this project were to investigate the efficacy of a dual-task exercise program in people with stroke.The specific objective of each study was as follows:Study 1:To evaluate the evidence related to the effects of dual-task balance and mobility training in people with stroke;and Study 2:To examine the efficacy of a dual task training on walking and balance ability(in ST/DT condition)of patients with subacute stroke.Methods:Study 1:An extensive electronic databases literature search was conducted using MEDLINE,PubMed,EBSCO,The Cochrane Library,Web of Science,SCOPUS and Wiley Online Library.Randomized controlled studies that assessed the effects of dual-task training in stroke patients were included for the review(last search in December 2017).The methodological quality was evaluated using the Cochrane Collaboration recommendation,and level of evidence was determined according to the criteria described by the Oxford Centre for Evidence-Based Medicine.Study 2:A total of 46 individuals with sub-acute stroke were randomly allocated to dual-task(DT)balance and mobility training group and single-task(ST)balance and mobility controlgroup.The training volume was three sessions per week,4 weeks duration.Twenty-three participants in each group received their respective training for three 45-minute sessions per week for 4 weeks.The ST/DT gait performance,the degree of DT interference[i.e.,DT effect percentage(DTE%)]in walking time and in cognitive performance(correct response rate of verbal fluency task and serial-3-subtraction task),as well as the secondary outcomes,including:the Mini-Balance Evaluation Systems Test(Mini-BESTest),Activities-specific balance confidence scale(ABC),Frenchay Activities Index(FAI),and SF-12 were measured at baseline and 4 weeks after training.Results:Study 1:Thirteen articles involving 457 participants were included in this systematic review.All had substantial risk of bias and thus provided level Ⅱb evidence only.Dual-task mobility training was found to induce more improvement in single-task walking function(standardized effect size=0.14-2.24),when compared with single-task mobility training.Its effect on dual-task walking function was not consistent.Cognitive-motor balance training was effective in improving single-task balance function(standardized effect size=0.27-1.82),but its effect on dual-task balance ability was not studied.The beneficial effect of dual-task training on cognitive function was provided by one study only and thus inconclusive.Study 2:After 4 weeks training,the DT group and control gruop both showed a significant improvement in ST/DT walking ability,balance function,and disability level(p<0.05).When compared with control gruop,the DT group showed that more significantion in ST/DT condition 10m walk speed(p<0.01)and the time taken of TUG under DT condition(walking+3s and walking+motor)(p<0.01).However,only the DT group showed a significant reduction in DTE%of walking time(walking+3s)(p<0.001).For secondary outcomes,the Mini-Balance Evaluation Systems Test percentage(p<0.001),the Activities-Specific Balance Confidence score(p<0.001)and SF-12(p<0.05)score showed significant effects.Conclusions:Study 1:There is some evidence that dual-task training can improve single-task walking and balance function in individuals with stroke.However,any firm recommendation cannot be made due to the weak methodology of the studies reviewed.Study 2:Adding DT training to routine physical therapy in people with sub-acute stroke is feasible and may have potential value for improving ST/DT walking ability,balance function,and disability level.The long term effect of dual-task training in people with sub-acute stroke needs to be further explored.