Training Dual-Task Walking After Stroke

Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously. Deficits in dual-tasking may severely compromise the ability to participate fully in community living. Unfortunately, current rehabilitation practice for stroke fails to adequately address dual-task limitations; individuals with stroke continue to exhibit clinically significant dual-task costs on gait at discharge. As a result, many stroke survivors are living in the community with residual deficits that may increase disability in the real world and lead to falls with devastating consequences. To address this issue, the proposed study investigates the efficacy of dual-task gait training on attention allocation and locomotor performance in community-dwelling stroke survivors. Because walking in the real world often requires time-critical tasks and obstacle avoidance, the investigators will test the impact of dual-task gait training on cognitive-motor interference during walking at preferred speed and at maximal speed (Aim 1), and on locomotor control during obstacle negotiation (Aim 2). The investigators will also evaluate the effects of the intervention on community reintegration and participation (Aim 3).

Twelve 30-minute sessions plus 10-minute stretching and warm up, provided 3 times per weeks for 4 weeks. Up to 6 weeks are allowed to complete the 12 sessions.

Spontaneous physical activity will be assessed with an activity monitor (PAMSys) worn for two consecutive days at each assessment timepoint.

Inclusion Criteria: Within 3 years of stroke onset Living in the community, operationally defined as living in one's own home, or the home of a friend, relative, or caregiver Walking speed 0.6-1.1 m/s determined during 10-meter walk test Walk without the assistance of another person Medically stable and approved for participation by study physician Intact global cognition indicated by score > 23 on Montreal Cognitive Assessment Living in the community prior to stroke Exclusion Criteria: Pre-existing neurological disorders (e.g., Parkinson's disease, Multiple Sclerosis, dementia, traumatic brain injury) Previous stroke with residual motor deficit Uncontrolled hypertension Inability to follow 3-step command Primary uncontrolled hearing impairment Severe uncontrolled visual impairment Any speech-language impairment affecting ability to respond verbally to auditory stimuli Timed Up and Go test > 15 seconds Lower extremity amputation Any orthopedic problem affecting gait Concurrent participation in another clinical trial

Plummer-D'Amato P, Kyvelidou A, Sternad D, Najafi B, Villalobos RM, Zurakowski D. Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial. BMC Neurol. 2012 Oct 31;12:129. doi: 10.1186/1471-2377-12-129.