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Olsen S, Alder G, Rashid U, Gomes E, Aislabie M, Chee F, Smith C, Kean B, Towersey N, Signal N. Challenge Level Contributes to the Efficacy of Treadmill Interventions after Stroke: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1729. [PMID: 38137177 PMCID: PMC10741427 DOI: 10.3390/brainsci13121729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes following treadmill training (TT) and comparison interventions in people with stroke. Randomized controlled trials were included if they: (i) investigated interventions of TT or bodyweight-supported TT (BWSTT); (ii) made comparisons with other physiotherapy interventions, other types of TT, or no intervention; (iii) studied people with stroke; (iv) reported sufficient data on challenge and amount parameters; and (v) measured walking speed or endurance. Completeness of reporting was evaluated using the TIDieR-Rehab checklist and risk of bias was assessed using the revised Cochrane risk-of-bias tool. The review included 26 studies; 15 studies compared TT or BWSTT with other physiotherapy interventions and 11 studies compared different types of TT. Meta-analyses provided evidence with low to moderate certainty that greater differences in challenge and dosage between treadmill and comparison physiotherapy interventions produced greater effects on walking endurance (p < 0.01). However, challenge and dosage did not influence walking speed outcomes. The analysis of intervention amount was limited by the lack of studies that manipulated the amount of intervention. Overall, the findings indicate that, after stroke, some of the efficacy of TT on walking endurance can be explained by the challenge level during training. This supports the implementation of TT at higher challenge levels in stroke rehabilitation practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Emeline Gomes
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Madeleine Aislabie
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Fran Chee
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Caitlin Smith
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Brody Kean
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Nicola Towersey
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
| | - Nada Signal
- Rehabilitation Innovation Centre, Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 0627, New Zealand; (G.A.); (U.R.); (E.G.); (N.T.); (N.S.)
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Effect of Dual-Task Training on Gait and Balance in Stroke Patients: An Updated Meta-analysis. Am J Phys Med Rehabil 2022; 101:1148-1155. [PMID: 35363622 DOI: 10.1097/phm.0000000000002016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The main purpose of this meta-analysis was to evaluate the effect of dual-task training on gait and balance improvement in stroke patients. DESIGN The PubMed, Embase, Cochrane Library, MEDLINE, CINAHL, CNKI, Wan Fang, and VIP databases were searched from inception to January 28, 2021, for randomized controlled trials investigating the effect of dual-task training on gait and balance intervention in stroke patients. RESULTS A total of 17 studies with 575 stroke patients that compared the efficacy and safety of dual-task training with those of conventional physical therapy or single-task training were included in this meta-analysis. The meta-analysis showed that the data were as follows under the dual-task training: step length (mean difference = 2.7, 95% confidence interval = 1.33 to 4.08, P = 0.0001); cadence (mean difference = 5.06, 95% confidence interval = 3.37 to 6.75, P < 0.00001); stride length (mean difference = 7.34, 95% confidence interval = 5.47 to 9.22, P < 0.00001); 10-meter walk test times (mean difference = -2.36, 95% confidence interval = -3.70 to -1.02), P = 0.0006); Berg Balance Scale (mean difference = 3.8, 95% confidence interval = 0.04 to 7.55, P = 0.05); Fugl-Meyer motor assessment of lower extremities (mean difference = 2.27, 95% confidence interval = -1.04 to 5.59, P = 0.18). CONCLUSIONS This meta-analysis showed that dual-task training can improve stroke patients' step length, cadence, stride length, and 10-meter walk test. However, possible advantages in improving balance function need further exploration.
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Lee Y, Kim K. The influence of Gait Training Combined with Portable Functional Electrical Stimulation on motor function, balance and gait ability in stroke patients. J Back Musculoskelet Rehabil 2022; 35:1171-1178. [PMID: 35754258 DOI: 10.3233/bmr-210154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Problems with motor functions, balance and gait ability commonly occur in stroke patients and cause asymmetric posture imbalance and gait patterns. OBJECTIVE We examined the effects of gait training (GT) combined with portable functional electrical stimulation (FES) on motor functions, balance and gait ability of stroke patients. METHODS A single blind, randomized control trial was conducted with 34 post stroke patients who were randomly allocated to two groups: 1) FES + GT group (n= 17) and the placebo FES + GT (PLBO + GT) group (n= 17). All interventions were given for 30 minutes, 5 days a week for 4 weeks. Fugl-Meyer assessment (FMA) was used to measure motor function of lower extremity. Performance oriented mobility assessment (POMA) was used to balance and gait ability. OptoGait was used to analyze gait ability. RESULTS Both groups showed significant improvements in motor function, balance and gait ability. The FES + GT group showed significantly greater improvement in motor function, balance and gait abilities after four weeks compared to the PLBO + GT group. CONCLUSION It was found that the gait training applied with FES is effective in improving the motor function, balance and gait abilities of stroke patients.
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Affiliation(s)
- Yangjin Lee
- Department of Physical Therapy, Kyungbuk College, Gyeongsangbuk-do, Korea
| | - Kyunghun Kim
- Department of Physical Therapy, Gimcheon University, Gyeongsangbuk-do, Korea
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Balinski M, Madhavan S. "Magic" Number of Treadmill Sessions Needed to Achieve Meaningful Change in Gait Speed After Stroke: A Systematic Review. Am J Phys Med Rehabil 2022; 101:826-835. [PMID: 34799509 PMCID: PMC9108112 DOI: 10.1097/phm.0000000000001920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The purpose of this systematic review was to determine the number of treadmill training sessions needed to make a meaningful change in gait speed for chronic stroke survivors. Relevant databases were searched up through February 2020. Articles were included if they fit the following criteria: stroke onset more than 5 mos, intention to treat with traditional treadmill training, and gait speed included as an outcome. Change in gait speed after intervention was used to classify treadmill groups as responders (at least 0.1 m/sec change) or nonresponders (less than 0.1 m/sec change). Seventeen articles met our criteria, resulting in a total of 19 intervention groups. Ten groups were classified as responders and completed a mean of 30.5 sessions within 6 wks, whereas nonresponders completed 20.4 sessions within 10 wks, indicating that at least 30 treadmill sessions (preferably in a period of 10 wks and at least 40 mins per session) is necessary to reach a meaningful change in gait speed. Although these trends were noted between the responder and nonresponder groups, no firm conclusions can be drawn regarding the "magic" number of sessions chronic stroke survivors should perform given the low correlation between number of sessions and change in gait speed.
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Affiliation(s)
- Mariah Balinski
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- Graduate Program in Rehabilitation Science, College of Applied Health Sciences, University of Illinois, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Chiaramonte R, Bonfiglio M, Leonforte P, Coltraro GL, Guerrera CS, Vecchio M. Proprioceptive and Dual-Task Training: The Key of Stroke Rehabilitation, A Systematic Review. J Funct Morphol Kinesiol 2022; 7:jfmk7030053. [PMID: 35893327 PMCID: PMC9326539 DOI: 10.3390/jfmk7030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
This systematic review aims to reveal the effectiveness of proprioceptive exercise combined with dual-task training in stroke patients. The research was conducted using PubMed, Cochrane Library, Web of Science, and Scopus databases to evaluate studies of rehabilitation interventions with proprioceptive and dual-task exercises in patients with stroke. The keywords for the search were: "stroke" AND "proprioception" OR "proprioceptive" AND "rehabilitation" OR "training" OR "exercises" AND "dual-task" OR "task-performance" with the following inclusion criteria: comparative studies of rehabilitation interventions with proprioceptive and dual-task exercises in stroke patients. Of the 104,014 studies identified, 23 were included according to the inclusion criteria. Proprioceptive and dual-task exercises stimulate and promote postural balance, gait, and quality of life and reduce the risk of falls in stroke patients compared with traditional rehabilitation programs. In conclusion, this systematic review suggests that proprioceptive exercise combined with dual-task training is needed to improve balance and recover gait. Moreover, it provides a comprehensive overview of the literature on the various proprioceptive treatments with contextual dual-task exercises for imbalance after stroke, providing a guide for choosing a complete rehabilitation protocol that combines these two techniques.
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Affiliation(s)
- Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (P.L.); (C.S.G.)
- Correspondence: or (R.C.); (M.V.); Tel.: +39-(0)3782703 (M.V.); Fax: +39-0957315384 (R.C.)
| | - Marco Bonfiglio
- Provincial Health Department of Siracusa, 96014 Sicily, Italy;
| | - Pierfrancesco Leonforte
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (P.L.); (C.S.G.)
| | | | - Claudia Savia Guerrera
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (P.L.); (C.S.G.)
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University of Catania, 95123 Catania, Italy; (P.L.); (C.S.G.)
- Rehabilitation Unit, AOU Policlinico Vittorio Emanuele, 95123 Catania, Italy;
- Correspondence: or (R.C.); (M.V.); Tel.: +39-(0)3782703 (M.V.); Fax: +39-0957315384 (R.C.)
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Zhang X, Xu F, Shi H, Liu R, Wan X. Effects of dual-task training on gait and balance in stroke patients: A meta-analysis. Clin Rehabil 2022; 36:1186-1198. [PMID: 35469457 DOI: 10.1177/02692155221097033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effects of dual-task training on gait and balance in stroke patients.Data sources: A systematic review of PubMed, Web of Science, Embase and Cochrane Library from their inception through 20 August 2021. REVIEW METHODS The bibliography was screened to identify randomized controlled trials that applied dual-task training to rehabilitation function training in stroke patients. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the Cochrane tool of bias. The primary outcome was the gait and balance parameters. RESULTS A total of 1992 studies were identified and 15 randomized controlled trials were finally included (512 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on rehabilitation training was found. Compared to patients who received conventional rehabilitation therapy, those who received dual-task training showed greater improvement in step length (MD = 3.46, 95% CI [1.01, 5.92], P = 0.006), cadence (MD = 4.92, 95% CI [3.10, 6.74], P < 0.001) and berg balance scale score (MD = 3.10, 95% CI [0.11, 6.09], P = 0.040). There were no differences in the improvements in gait speed (MD = 2.89, 95% CI [ - 2.02, 7.80], P = 0.250) and timed up and go test (MD = -2.62, 95% CI [ - 7.94, 2.71], P = 0.340) between dual-task and control groups. CONCLUSION Dual-task training is an effective training for rehabilitation of stroke patients in step length and cadence, however, the superiority of dual-task training for improving balance function needs further discussion.
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Affiliation(s)
- Xueyi Zhang
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Feng Xu
- People's Hospital of Queshan, Henan, China
| | - Huijuan Shi
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Ruijiao Liu
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Xianglin Wan
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
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Marzolini S, Wu C, Hussein R, Xiong LY, Kangatharan S, Peni A, Cooper CR, Lau KS, Nzodjou Makhdoom G, Pakosh M, Zaban SA, Nguyen MM, Banihashemi MA, Swardfager W. Associations Between Time After Stroke and Exercise Training Outcomes: A Meta-Regression Analysis. J Am Heart Assoc 2021; 10:e022588. [PMID: 34913357 PMCID: PMC9075264 DOI: 10.1161/jaha.121.022588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Knowledge gaps exist regarding the effect of time elapsed after stroke on the effectiveness of exercise training interventions, offering incomplete guidance to clinicians. Methods and Results To determine the associations between time after stroke and 6-minute walk distance, 10-meter walk time, cardiorespiratory fitness and balance (Berg Balance Scale score [BBS]) in exercise training interventions, relevant studies in post-stroke populations were identified by systematic review. Time after stroke as continuous or dichotomized (≤3 months versus >3 months, and ≤6 months versus >6 months) variables and weighted mean differences in postintervention outcomes were examined in meta-regression analyses adjusted for study baseline mean values (pre-post comparisons) or baseline mean values and baseline control-intervention differences (controlled comparisons). Secondary models were adjusted additionally for mean age, sex, and aerobic exercise intensity, dose, and modality. We included 148 studies. Earlier exercise training initiation was associated with larger pre-post differences in mobility; studies initiated ≤3 months versus >3 months after stroke were associated with larger differences (weighted mean differences [95% confidence interval]) in 6-minute walk distance (36.3 meters; 95% CI, 14.2-58.5), comfortable 10-meter walk time (0.13 m/s; 95% CI, 0.06-0.19) and fast 10-meter walk time (0.16 m/s; 95% CI, 0.03-0.3), in fully adjusted models. Initiation ≤3 months versus >3 months was not associated with cardiorespiratory fitness but was associated with a higher but not clinically important Berg Balance Scale score difference (2.9 points; 95% CI, 0.41-5.5). In exercise training versus control studies, initiation ≤3 months was associated with a greater difference in only postintervention 6-minute walk distance (baseline-adjusted 27.3 meters; 95% CI, 6.1-48.5; fully adjusted, 24.9 meters; 95% CI, 0.82-49.1; a similar association was seen for ≤6 months versus >6 months after stroke (fully adjusted, 26.6 meters; 95% CI, 2.6-50.6). Conclusions There may be a clinically meaningful benefit to mobility outcomes when exercise is initiated within 3 months and up to 6 months after stroke.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Healthy Living for Pandemic Event Protection (HL–PIVOT) NetworkTorontoONCanada
- Rehabilitation Sciences InstituteUniversity of TorontoONCanada
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Che‐Yuan Wu
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | | | - Lisa Y. Xiong
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Suban Kangatharan
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | - Ardit Peni
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
| | | | - Kylie S.K. Lau
- Department of Human BiologyUniversity of TorontoONCanada
| | | | - Maureen Pakosh
- Library & Information ServicesUniversity Health NetworkToronto Rehabilitation InstituteTorontoONCanada
| | - Stephanie A. Zaban
- Faculty of Kinesiology and Physical EducationUniversity of TorontoONCanada
| | - Michelle M. Nguyen
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
| | - Mohammad Amin Banihashemi
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
- Institute of Medical ScienceUniversity of TorontoTorontoONCanada
| | - Walter Swardfager
- KITE Research Institute, Toronto Rehabilitation Institute ‐ University Health NetworkTorontoONCanada
- Department of Pharmacology and ToxicologyUniversity of TorontoONCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoONCanada
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Huber SK, Knols RH, Arnet P, de Bruin ED. Motor-cognitive intervention concepts can improve gait in chronic stroke, but their effect on cognitive functions is unclear: A systematic review with meta-analyses. Neurosci Biobehav Rev 2021; 132:818-837. [PMID: 34815131 DOI: 10.1016/j.neubiorev.2021.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022]
Abstract
Motor-cognitive intervention concepts are promising to counteract residual gait and cognitive impairments in chronic stroke. There is, however, considerable variation in motor-cognitive intervention types, which may lead to different effects. This systematic review strived to summarize and compare the effects of different motor-cognitive intervention concepts on gait and cognitive functions in chronic stroke. The systematic search identified twenty-nine articles, which were allocated to three types of motor-cognitive training concepts; SEQUENTIAL, SIMULTANEOUS-ADDITIONAL, and SIMULTANEOUS-INCORPORATED. Random-effects meta-analyses revealed that motor-cognitive interventions may be better than non-combined training approaches for improving gait function in chronic stroke (e.g. gait speed: g = 0.43, 95 % CI [0.22, 0.64], p < 0.0001). SIMULTANEOUS-INCORPORATED motor-cognitive training seems the most promising concept. As very few articles measured both, spatiotemporal gait parameters and cognitive outcomes, future studies are warranted to investigate the effects of motor-cognitive intervention concepts on gait control and cognitive functions in chronic stroke.
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Affiliation(s)
- Simone K Huber
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Physiotherapy Occupational Therapy, Nursing and Allied Health Professions Office, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Arnet
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland; Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; OST - Eastern Swiss University of Applied Sciences, Department of Health, St.Gallen, Switzerland
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Zhou Q, Yang H, Zhou Q, Pan H. Effects of cognitive motor dual-task training on stroke patients: A RCT-based meta-analysis. J Clin Neurosci 2021; 92:175-182. [PMID: 34509248 DOI: 10.1016/j.jocn.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/03/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
Based on a randomized controlled trial (RCT), this meta-analysis aimed to comprehensively analyze the effects of cognitive motor dual-task training (CMDT) on stroke patients. The electronic databases PubMed, Embase, and the Cochrane Library were searched for papers on the influence of CMDT on stroke patients. Weighted mean difference (WMD) and 95% confidence interval (95% CI) were used as effect sizes. Cochran's Q and I2 tests were performed for heterogeneity. Thirteen articles involving 326 patients were included in the study. The meta-analysis showed that CMDT significantly improved the walking balance of patients with stroke (P = 0.01). In addition, CMDT significantly improved the gait ability of patients with stroke (P < 0.0001). Furthermore, CMDT had a significant effect on the improvement of upper limb ability in patients with stroke (P < 0.00001). CMDT could significantly improve balance ability, gait, and upper limb function in patients with chronic stroke, which is worthy of clinical promotion.
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Affiliation(s)
- Qiang Zhou
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
| | - Hongchang Yang
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China.
| | - Quanfu Zhou
- Department of Physical Education, Nanjing Agricultural University, Nanjing, Jiangsu 210095, China
| | - Hongyao Pan
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
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Baek CY, Chang WN, Park BY, Lee KB, Kang KY, Choi MR. Effects of Dual-Task Gait Treadmill Training on Gait Ability, Dual-Task Interference, and Fall Efficacy in People With Stroke: A Randomized Controlled Trial. Phys Ther 2021; 101:6145043. [PMID: 33611557 DOI: 10.1093/ptj/pzab067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of dual-task gait training using a treadmill on gait ability, dual-task interference, and fall efficacy in people with stroke. METHODS Patients with chronic stroke (N = 34) were recruited and randomly allocated to the experimental or control group. Both groups underwent gait training on a treadmill and a cognitive task. In the experimental group, gait training was conducted in conjunction with the cognitive task, whereas in the control group, the training and the cognitive task were conducted separately. Each intervention was provided for 60 minutes, twice a week, for a period of 6 weeks for both groups. The primary outcomes were as follows: gait parameters (speed, stride, variability, and cadence) under single-task and dual-task conditions, correct response rate (CRR) under single-task and dual-task conditions, and dual-task cost (DTC) in gait parameters and CRR. The secondary outcome was the Fall Efficacy Scale. RESULTS Dual-task gait training using a treadmill improved all gait parameters in the dual-task condition, speed, stride, and variability in the single-task condition, and CRR in both conditions. A difference between the groups was observed in speed, stride, and variability in the dual-task condition. Furthermore, dual-task gait training on a treadmill improved DTC in speed, variability, and cadence along with that in CRR, indicating true improvement of DTC, which led to significant improvement in DTC in speed and variability compared with single-task training. CONCLUSIONS Dual-task gait treadmill training was more effective in improving gait ability in dual-task training and dual-task interference than single-task training involving gait and cognitive task separately in people with chronic stroke.
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Affiliation(s)
- Chang Yoon Baek
- Department of Rehabilitation Medicine, National Health Insurance Ilsan Hospital, Goyang, South Korea
| | - Woo Nam Chang
- Department of Physical Therapy, Yongin University, Yongin, South Korea
| | - Beom Yeol Park
- Department of Competence Support Team, Daycare Center for People With Disabilities, Goyang, South Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyoung Yee Kang
- Department of Rehabilitation Medicine, National Health Insurance Ilsan Hospital, Goyang, South Korea
| | - Myung Ryul Choi
- Department of Rehabilitation Health, Goyang Sports Rehabilitation Center, Goyang, South Korea
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Plummer P, Zukowski LA, Feld JA, Najafi B. Cognitive-motor dual-task gait training within 3 years after stroke: A randomized controlled trial. Physiother Theory Pract 2021; 38:1329-1344. [PMID: 33459115 DOI: 10.1080/09593985.2021.1872129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Dual-task gait training may improve dual-task gait speed after stroke, but the effects on the relative amount of dual-task interference are unclear.Objective: To compare the efficacy of dual-task gait training (DTGT) and single-task gait training (STGT) on cognitive-motor dual-task interference after stroke.Methods: 36 adults within 3 years of stroke were randomized 1:1 to STGT or DTGT, 3 times a week for 4 weeks. The primary outcomes were the relative dual-task effect on gait speed (DTEg, %) and cognitive task performance (DTEc, %) during walking at preferred and fast speed in two different dual-task conditions (auditory Stroop, auditory clock task).Results: There were no treatment effects on DTEg or DTEc in either group for either dual-task at either walking speed. Across all participants, there were significant improvements in both single and dual-task gait speed in all conditions, without any relative change in the dual-task effect. Subgroup analysis suggested that those with greater interference at baseline may benefit more from DTGT.Conclusions: DTGT and STGT improved single and dual-task gait speed but did not change the amount of relative interference. The findings may be confounded by an unexpectedly small amount of gait-related dual-task interference at baseline.
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Affiliation(s)
- Prudence Plummer
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Lisa A Zukowski
- Department of Physical Therapy, High Point University, One University Parkway, High Point, NC, USA
| | - Jody A Feld
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Bijan Najafi
- Baylor College of Medicine, McNair Campus, Houston, TX, USA
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12
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The Effect of Motor and Cognitive Tasks on Gait in People with Stroke. J Stroke Cerebrovasc Dis 2019; 28:104330. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 12/12/2022] Open
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