Multi-task Gait Training Mode to Enhance Walking Function in Patients With Chronic Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The objective of this study is to investigate psychometric properties of dual-task walking
      assessments and compare effects of multi-task walking interventions on walking for patients
      with chronic stroke. Specifically, we will investigate psychometric properties (i.e.
      reliability, validity, and responsiveness) of dual-task walking assessments with the Stroop
      task for chronic stroke individuals (Aim 1). The second aim of this study is to compare the
      effects of multi-task walking training mode to traditional rehabilitation in patients with
      chronic stroke (Aim 2). The third aim of this study is to compare the immediate, retained,
      and transfer effect of multi-task overground walking training to multi-task treadmill walking
      training on walking function, cognitive performance, task coordination, and community
      ambulation in patients with chronic stroke (Aim 3).
    

Detailed description: 
      Only 7% patients can walk safely in the community. Functional community ambulation requires
      the ability of walking while performing other tasks. It is emergent to establish dual-task
      walking assessment with good psychometric properties and to identify the most effective
      approach that enhances dual-task walking performance for stroke patients. Our ongoing study
      found that motor tasks combined with cognitive dual-task training (multi-tasking ) have more
      improvements on cognitive performance of the Stroop task while walking than cognitive
      dual-task training alone. Therefore, combined motor and cognitive elements to walking
      training might be considered as a novel therapeutic strategy to promote functional ambulation
      and recovery of stroke patients. This combined strategy is based on attentional capacity
      sharing theory and the research advances on dual-task to enhance active participation and
      cognitive involvement, strengthen dual-task walking ability, then transfer to promote
      community ambulation and participation. However, lacking prospective, controlled trials
      quantify gait and cognition under dual-task conditions after multi-task walking training.
      Specifically, we will investigate psychometric properties of dual-task walking assessments
      for chronic stroke individuals. The second aim is to compare the immediate, retained, and
      transfer effects of of multi-task overground walking training to multi-task treadmill walking
      and traditional rehabilitation on walking function, cognitive performance, task coordination,
      and community ambulation in patients with chronic stroke. A metric analysis and comparative
      efficacy research will be conducted. Sixty chronic stroke patients will receive dual-task
      walking assessments twice at pretreatment with a 1-week interval for test-retest assessment
      and investigation of the reliability and validity of outcome measures. The primary outcome
      measure of the dual-task walking assessments will include walking at preferred speed and fast
      speed and simultaneously perform the Stroop task. Concurrent validity will be studied to
      validate the dual-task walking measures with each other and with the item 14 of the
      mini-Balance Evaluation Systems test (Mini-BESTest), dual-task Timed-up-and-Go test
      (dual-TUG), and 6-min walk test obtain concurrently for assessing dual-task ability. In
      addition, we will compare dual-task walking performance between fallers and non-fallers to
      examine discriminant validity of dual-task walking assessments. A comparative efficacy
      research is a single-blind, randomized controlled trial, which will be conducted at medical
      centers. Sixty ambulatory stroke patients will be randomized to multi-task overground walking
      training or multi-task treadmill walking training or traditional rehabilitation. All three
      groups will receive interventions 3 times a week for 4 weeks. The multi-task overground
      walking training group will undertake overground walking training while concurrently perform
      motor and cognitive tasks. The multi-task treadmill walking training group will train the
      same set of motor and cognitive tasks while walking on the treadmill. Traditional
      rehabilitation will train strength, balance, and gait. A blinded assessor will administer
      three assessments All participants will be examined gait and cognitive performance under
      single-task (walking only, cognitive tasks only) and dual-task conditions (walking while
      performing the Stroop task) at baseline, post intervention, and 1-month follow-up. The
      primary outcome measure of gait and cognition is gait speed and composite score of accuracy
      and reaction time of the cognitive tasks under single- and dual-task conditions. The
      secondary outcome measures will be the Mini-BESTest, single- and dual-TUG, Functional Gait
      Assessment, 6-minute Walk Test, physical activity monitor, and Stroke Impact Scale. Repeated
      measure ANOVA will be used to compare measurements at baseline, after training, and follow-up
      among the groups.
    

Intervention name(s): The multi-task overground walking training; The multi-task treadmill walking training; Traditional rehabilitation
Intervention type(s): Other; Device; Other
Intervention description(s): The multi-task overground walking training group will undertake overground walking training while concurrently perform motor and cognitive tasks for 30 minutes per session, 3 times a week for 4 weeks.; The multi-task treadmill walking training group will train the same set of motor and cognitive tasks while walking on the treadmill for 30 minutes per session, 3 times a week for 4 weeks.; Traditional rehabilitation will train strength, balance, and gait for 30 minutes per session, 3 times a week for 4 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: multi-task training; community ambulation; cognition