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Vecchio M, Chiaramonte R, De Sire A, Buccheri E, Finocchiaro P, Scaturro D, Letizia Mauro G, Cioni M. Do proprioceptive training strategies with dual-task exercises positively influence gait parameters in chronic stroke? A systematic review. J Rehabil Med 2024; 56:jrm18396. [PMID: 39145519 PMCID: PMC11337222 DOI: 10.2340/jrm.v56.18396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/09/2024] [Indexed: 08/16/2024] Open
Abstract
OBJECTIVE This study aims to assess the impact of proprioceptive training strategies with dual-task exercises on gait in people with chronic stroke. STUDY DESIGN Systematic review. PATIENTS Chronic stroke. METHODS Searches were conducted in accordance with PRISMA guidelines and PICOS criteria. PubMed, Web of Science, and Scopus databases were systematically searched from November 2020 to February 2022, for eligible clinical trials. Two independent reviewers thoroughly screened potential articles for relevance and assessed the methodology quality. In accordance with the GRADE, PICOS criteria, and Cochrane risk of bias tools, the authors included articles concerning the effectiveness of dual-task in proprioceptive training on gait parameters in people with chronic stroke. RESULTS Of 3075 identified studies, 11 articles met the inclusion criteria: 7 were randomized clinical trials, 1 was not randomized, and 3 were observational studies. The overall quality of evidence, assessed using the GRADE framework, was high, indicating a high level of confidence in the systematic review's findings. The papers involved 393 stroke patients; 241 underwent dual-task in proprioceptive training, with 152 participants in other stroke rehabilitation; within the dual-task group, 71 engaged in cognitive tasks, and 170 participated in motor tasks. dual-task in proprioceptive training improved gait speed, cadence, stride time, stride length, and step length. The best effects were observed with training 3 times a week for 4 weeks, with each session lasting 30 minutes, on speed, cadence, stride length, and step length. CONCLUSION Current evidence suggests that proprioceptive training strategies with dual-task exercises improved walking abilities in people with chronic stroke. Specifically, it enhanced gait speed, a key indicator of clinical severity.
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Affiliation(s)
- Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; Rehabilitation Unit, "AOU Policlinico G. Rodolico-San Marco", Catania, Italy
| | - Rita Chiaramonte
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.
| | - Alessandro De Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy; Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Enrico Buccheri
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Patrizia Finocchiaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Dalila Scaturro
- Department of Surgery, Oncology and Stomatology, University of Palermo, Palermo, Italy
| | - Giulia Letizia Mauro
- Department of Surgery, Oncology and Stomatology, University of Palermo, Palermo, Italy
| | - Matteo Cioni
- Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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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: 4] [Impact Index Per Article: 2.0] [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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Kim SM, Jang SH. The effect of a trunk stabilization exercise program using weight loads on balance and gait in stroke patients: A randomized controlled study. NeuroRehabilitation 2022; 51:407-419. [DOI: 10.3233/nre-220143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The effects of trunk stabilization exercise programs and exercises applying weight loads for stroke patients are well presented. However, there is not enough objective research to prove the effects of trunk stabilization exercise programs using weight loads for stroke patients. OBJECTIVE: In this study, a trunk stabilization exercise program using weight loads was performed to investigate its impact on the balance and gait ability of stroke patients. METHODS: Thirty patients with stroke were randomly divided into three groups. Experiment group 1 followed a trunk stabilization exercise program using weight loads, experiment group 2 followed a trunk stabilization exercise program, and the control group followed general physiotherapy. Patients’ balance ability was assessed using balance measurement equipment BT-4 (postural sway area (PSA), postural sway length (PSL), limit of stability (LOS)), Berg Balance Scale (BBS), and Time Up and Go test (TUG). Gait speed was measured to examine gait ability. RESULT: After the intervention, the PSA, PFSL in experimental groups 1 and 2 decreased but that of the control group increased. BBS, TUG, and LOS scores of experimental group 1 were significantly improved compared to experimental group 2 and the control group. Also, gait speed was significantly improved in experimental group 1 compared to experimental group 2 and the control group. CONCULSION: This study may be used as a basic material for an effective trunk stabilization exercise method for stroke patients and might be of significance as an intervention method for stroke patients requiring long-term treatment.
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Affiliation(s)
- Sun-Min Kim
- Department of Physical Therapy, Graduate school of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, South Korea
| | - Sang-Hun Jang
- Department of Physical Therapy, Graduate school of Physical Therapy, Korea National University of Transportation, Jeungpyeong-gun, South Korea
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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: 14] [Impact Index Per Article: 7.0] [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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Effects of Aquatic Exercise and Land-Based Exercise on Cardiorespiratory Fitness, Motor Function, Balance, and Functional Independence in Stroke Patients-A Meta-Analysis of Randomized Controlled Trials. Brain Sci 2021; 11:brainsci11081097. [PMID: 34439716 PMCID: PMC8394174 DOI: 10.3390/brainsci11081097] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of aquatic exercise (AE) and land-based exercise (LE) on cardiorespiratory fitness, motor function, balance, and functional independence in stroke patients. Design: Through searching PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP and Wanfang Database, only randomized controlled trials (RCTs) were collected to study the effects of AE and LE on cardiorespiratory fitness, motor function, balance, and functional independence in patients with stroke. The included studies were evaluated for methodological quality by the Cochrane bias risk assessment tool, and statistical analysis was carried out by the Review Manage 5.3 and Stata 15.1 software. Results: The RCTs were collected between the earliest available date and April 2021. Eleven RCTs were included, including five studies with low risk and six studies with moderate risk. The total sample size used in the study was 369, which included 187 patients undertaking AE and 182 patients undertaking LE. The results of the meta-analysis showed that AE can significantly improve patients’ Berg Balance Scale (BBS) (MD = 5.19, 95% CI: 2.66 to 7.71, p < 0.0001), peak oxygen uptake (VO2peak) (MD = 3.49, 95% CI: 0.17 to 6.8, p = 0.04), Fugl–Meyer Assessment (FMA) (MD = 3.84, 95% CI: 1.64 to 6.04, p = 0.0006), and Functional Independence Measure (FIM) (MD = 6.1, 95% CI: 4.05 to 8.15, p < 0.00001). However, there was no statistically significant difference between the two exercise modes in the Timed Up and Go Test (TUGT) (MD = −2.52, 95% CI: −5.95 to 0.91, p = 0.15) or the Functional Ambulation Category scale (FAC) (MD = 0.28, 95% CI: −0.21 to 0.76, p = 0.26). Conclusion: Based on the improvement in the Berg Balance Scale, peak oxygen uptake, Fugl–Meyer Assessment, and Functional Independence Measure, we can state that aquatic exercise offers better advantages than land-based exercise for patients’ balance, motor function, cardiorespiratory fitness, and functional independence.
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Saleh MSM, Rehab NI, Aly SMA. Effect of aquatic versus land motor dual task training on balance and gait of patients with chronic stroke: A randomized controlled trial. NeuroRehabilitation 2019; 44:485-492. [DOI: 10.3233/nre-182636] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Nagwa Ibrahim Rehab
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt
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Plummer P, Iyigün G. Effects of Physical Exercise Interventions on Dual–Task Gait Speed Following Stroke: A Systematic Review and Meta–Analysis. Arch Phys Med Rehabil 2018; 99:2548-2560. [DOI: 10.1016/j.apmr.2018.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
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He Y, Yang L, Zhou J, Yao L, Pang MYC. Dual-task training effects on motor and cognitive functional abilities in individuals with stroke: a systematic review. Clin Rehabil 2018; 32:865-877. [PMID: 29473480 DOI: 10.1177/0269215518758482] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This systematic review aimed to examine the effects of dual-task balance and mobility training in people with stroke. Methods: 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 Center for Evidence-Based Medicine. Results: About 13 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. Conclusion: 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.
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Affiliation(s)
- Ying He
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Kunming Medical University, Kunming, China
| | - Lei Yang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
- Institute of Disaster Management and Reconstruction, Sichuan University—The Hong Kong Polytechnic University, Chengdu, China
| | - Jing Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Kunming Medical University, Kunming, China
| | - Liqing Yao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Marco Yiu Chung Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Kim M, Shim J, Yu K, Kim J. Effects of ball kicking dual task training on gait performance and balance in individuals with chronic hemiparetic stroke. ACTA ACUST UNITED AC 2016. [DOI: 10.14474/ptrs.2016.5.4.170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Minseong Kim
- Department of Physical Therapy, The Graduate School of Baekseok University, Seoul, Republic of Korea
| | - Jaehun Shim
- Department of Physical Therapy, The Graduate School of Baekseok University, Seoul, Republic of Korea
| | - Kyunghoon Yu
- Department of Physical Therapy, The Graduate School of Baekseok University, Seoul, Republic of Korea
| | - Jiwon Kim
- Department of Physical Therapy, The Graduate School of Baekseok University, Seoul, Republic of Korea
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Kim K, Lee DK, Kim EK. Effect of aquatic dual-task training on balance and gait in stroke patients. J Phys Ther Sci 2016; 28:2044-7. [PMID: 27512261 PMCID: PMC4968503 DOI: 10.1589/jpts.28.2044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/07/2016] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effect of aquatic dual-task
training on balance and gait in stroke patients. [Subjects and Methods] Twenty stroke
patients were divided into the experimental (n=10) and control (n=10) groups. Both groups
underwent neurodevelopmental treatment. The experimental group additionally underwent
aquatic dual-task training for 30 minutes a day, 5 days a week, for 6 weeks. Balance was
measured using the Berg balance scale, Five Times Sit-to Stand Test, and Functional Reach
Test. Gait was measured using the 10-Meter Walk Test, Timed Up and Go Test, and Functional
Gait Assessment. [Results] For intragroup comparison, the experimental group showed a
significant change after the experiment in all balance and gait assessment tests. For
intergroup comparison, the experimental group showed relatively more significant change
after the experiment in all balance and gait assessment tests. [Conclusion] Our results
showed that aquatic dual-task training has a positive effect on balance and gait in stroke
patients.
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Affiliation(s)
- Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Dong-Kyu Lee
- Department of Rehabilitation Science, Graduate School, Daegu University, Republic of Korea; Department of Physical Therapy, Sunhan Hospital, Republic of Korea
| | - Eun-Kyung Kim
- Department of Physical Therapy, Seonam University, Republic of Korea
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Yu KH, Jeon HS. The Effects of Dual-Task Gait Training on Gait Performance under Cognitive Tasks in Chronic Stroke. ACTA ACUST UNITED AC 2015. [DOI: 10.18857/jkpt.2015.27.5.364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kyung-hoon Yu
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Korea
- Department of Physical Therapy, The Graduate School, Yonsei University, Seoul, Korea
| | - Hye-seon Jeon
- Department of Physical Therapy, College of Health Science, Yonsei University, Seoul, Korea
- Department of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University, Seoul, Korea
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Song GB, Park EC. Effect of dual tasks on balance ability in stroke patients. J Phys Ther Sci 2015; 27:2457-60. [PMID: 26357425 PMCID: PMC4563289 DOI: 10.1589/jpts.27.2457] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of training using dual tasks on balance ability in stroke patients. [Subjects] Forty stroke patients were divided into a dual-task training group (N = 20) and a single task training group (N = 20) randomly. [Methods] The subjects in the single-task traing group stood in a comfortable position, faced a therapist, then threw a Swiss ball back and forth. They then performed balance training in which they raised and lowered their ankles while facing forward or moved objects from one table to another. The DTG performed dual tasks, which involved performing a task on an unstable surface using a balance pad. Both groups received training 30 min per day, five times per week, for eight weeks. [Results] The DTG showed significant increases in weight distribution rate, anterior limit of stability, posterior limit of stability, and BBS scores compared with the STG. [Conclusion] According to the results of this study, dual-task training and single-task training were effective in improving balance in stroke patients, dual task training is more effective for increasing balance ability.
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Affiliation(s)
- Gui Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
| | - Eun Cho Park
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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