Stroke
Conditions
Keywords
Exercise, Balance, Gait, Community, Rehabilitation, Dual-task
Brief summary
Background Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration. Study Aim The aim of this Introduction Many individuals after stroke continue to cope with residual physical impairments after discharge from hospital. One of the major problems encountered by people after stroke is community reintegration. Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There has been an increasing awareness of the importance of dual-task gait performance in community-dwelling individuals with stroke in the past few years. There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration. Study Aim This will be a single-blinded randomized controlled trial (RCT).The aim of this study is to examine the efficacy of a dual-task exercise program on cognitive-motor interference in balance and walking tasks, balance self-efficacy, participation in everyday activities, community reintegration and incidence of falls among individuals with chronic stroke.
Detailed description
Introduction Many individuals after stroke continue to cope with residual physical impairments after discharge from hospital. One of the major problems encountered by people after stroke is community reintegration. Functional community ambulation not only requires a critical level of postural control and walking skills, but also the ability to engage in cognitive tasks while walking (i.e., dual-task walking) and adapt to the constantly-changing environmental contexts. There has been an increasing awareness of the importance of dual-task gait performance in community-dwelling individuals with stroke in the past few years. There is evidence showed that dual-task balance and gait performance is significantly impaired after stroke. Increasing evidence also suggests that dual-task balance and gait performance is useful for predicting falls among individuals with stroke. Considering the high clinical relevance of dual-task balance and gait performance, it is essential that stroke rehabilitation adequately addresses dual-task deficits. Developing specific dual-task balance and gait training to enhance dual-task performance is thus necessary to promote community ambulation and reintegration. Study Aim The aim of this study is to examine the efficacy of a dual-task exercise program on cognitive-motor interference in balance and walking tasks, balance self-efficacy, participation in everyday activities, community reintegration and incidence of falls among individuals with chronic stroke. Study design This will be a single-blinded randomized controlled trial (RCT). After baseline evaluation, subjects will be randomly allocated to one of the three groups: (1) dual-task training group, (2) single-task training group, (3) strengthening and flexibility exercise group (controls), using a 1:1:1 randomization sequence. Measurements Outcomes will be used to compare the therapeutic effects of the 3 treatment groups. The outcome measurements (except data on incidence of falls) will take place at 3 time points: (1) within one week before initiation of intervention (baseline), (2) within one week after completion of training, (3) 8 weeks after completion of training. The fall data will be collected on a monthly basis until 6 months after termination of the intervention period. All assessments will be performed by a researcher who is blinded to group allocation.
Interventions
BEHAVIORALDual-task training group
Balance and gait exercises while simultaneously engaging in a secondary cognitive task.
BEHAVIORALSingle-task training group
Balance/gait exercises and cognitive exercises done separately.
BEHAVIORALFlexibility and strength training group
Whole-body flexibility exercises, upper limb strengthening exercises.
Sponsors
West China Hospital
The Hong Kong Polytechnic University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* diagnosis of a stroke * more than 6 months of stroke onset * aged 50 years or above * community-dwelling * medically stable * score ≥21 on the Montreal Cognitive Assessment (MoCA) * score ≤ 25 on the Mini Balance Evaluation Systems Test (Mini-BESTest) * able to ambulate without physical assistance of another person as determined during the 10-meter walk test * ability to follow 3-step commands
Exclusion criteria
* having neurological conditions other than stroke * not community-dwelling prior to the stroke event * significant receptive and expressive aphasia * severe and uncorrected hearing or visual deficits * serious musculoskeletal disorders (e.g. amputation) * serious cardiovascular conditions affecting the ability to participate in exercise training * pain experienced at rest or movement * other serious illnesses that preclude participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed-up-and-go test with and without dual-task | week 0 | A walking test |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sensory organization test with and without dual-task | week 0 | A standing balance test |
| Obstacle crossing with and without dual-task | week 0 | A walking test |
| Mini-Balance Evaluations Systems Test | week 0 | A balance test |
| Activities-specific balance confidence scale | week 0 | A questionnaire |
| Stroke Specific Quality of Life Scale | week 0 | A questionnaire |
| Motricity Index | week 0 | A muscle strength test |
| 10-meter walk test with and without dual-task | week 0 | A walking test |
| Frenchay Activities Index | week 0 | A questionnaire |
| Tinetti Assessment Tool (Gait) | week 0 | A walking test |
| Incidence of fall | week 0-6 months after training | fall follow-up using log book and monthly telephone calls |
| Global Rating of Change score | week 8 | A questionnaire |
| Upper limb muscle strength | week 0 | dynamometry test |
| Chedoke Arm and Hand Activity Inventory | week 0 | An arm function test |
Countries
Hong Kong
Contacts
Primary ContactEcho Ouyang, BSc
Backup ContactMarco YC Pang, PhD
Outcome results
None listed