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Title: Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke : a randomized controlled study
Authors: Pang, MYC 
Yang, L 
Ouyang, H 
Lam, FMH 
Huang, M 
Jehu, DA
Issue Date: Dec-2018
Source: Stroke, Dec. 2018, v. 49, no. 12, p. 2990-2998
Abstract: Background and Purpose-Functional community ambulation requires the ability to perform mobility and cognitive task simultaneously (dual-tasking). This single-blinded randomized controlled study aimed to examine the effects of dual-task exercise in chronic stroke patients.
Methods-Eighty-four chronic stroke patients (24 women; age, 61.2±6.4 years; time since stroke onset, 75.3±64.9 months) with mild to moderate motor impairment (Chedoke-McMaster leg motor score: median, 5; interquartile range, 4-6) were randomly allocated to the dual-task balance/mobility training group, single-task balance/mobility group, or upperlimb exercise (control) group. Each group exercised for three 60-minute sessions per week for 8 weeks. The dual-task interference effect was measured for the time to completion of 3 mobility tests (forward walking, timed-up-and-go, and obstacle crossing) and for the correct response rate during serial-3-subtractions and verbal fluency task. Secondary outcomes included the Activities-specific Balance Confidence Scale, Frenchay Activities Index, and Stroke-specific Quality of Life Scale. The above outcomes were measured at baseline, immediately after, and 8 weeks after training. Fall incidence was recorded for a 6-month period posttraining.
Results-Only the dual-task group exhibited reduced dual-task interference in walking time posttraining (forward walking combined with verbal fluency [9.5%, P=0.014], forward walking with serial-3-subtractions [9.6%, P=0.035], and the timed-up-and-go with verbal fluency [16.8%, P=0.001]). The improvements in dual-task walking were largely maintained at the 8-week follow-up. The dual-task cognitive performance showed no significant changes. The dual-task program reduced the risk of falls and injurious falls by 25.0% (95% CI, 3.1%-46.9%; P=0.037) and 22.2% (95% CI, 4.0%-38.4%; P=0.023), respectively, during the 6-month follow-up period compared with controls. There was no significant effect on other secondary outcomes (P>0.05).
Conclusions-The dual-task program was effective in improving dual-task mobility, reducing falls and fall-related injuries in ambulatory chronic stroke patients with intact cognition. It had no significant effect on activity participation or quality of life.
Keywords: Cognition
Publisher: Lippincott Williams & Wilkins
Journal: Stroke 
ISSN: 0039-2499
EISSN: 1524-4628
DOI: 10.1161/STROKEAHA.118.022157
Rights: © 2018 American Heart Association, Inc.
This is the accepted version of the publication Pang, M. Y. C., Yang, L., Ouyang, H., Lam, F. M. H., Huang, M., & Jehu, D. A. (2018). Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke: a randomized controlled study. Stroke, 49(12), 2990-2998.
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