Speed of Voluntary Stepping in Chronic Stroke Survivors Under Single- and Dual-Task Conditions: A Case-Control Study

Melzer, Itshak; Tzedek, Irit; Or, Michal; Shvarth, Gali; Nizri, Oranit; Ben-Shitrit, Keren; Oddsson, Lars E.

doi:10.1016/j.apmr.2008.12.012

« Previous Next »Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 6 , Pages 927-933, June 2009

Speed of Voluntary Stepping in Chronic Stroke Survivors Under Single- and Dual-Task Conditions: A Case-Control Study

Itshak Melzer, PhD
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Reprint requests to Itshak Melzer, PhD, PT, Schwartz Movement Analysis & Rehabilitation Laboratory, Dept of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva 84105, Israel
Irit Tzedek, MPT
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Hydrotherapy Center in Sha'ar HaNegev, Israel
Michal Or, PT
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Gali Shvarth, PT
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Oranit Nizri, PT
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Keren Ben-Shitrit, PT
- Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Lars E. Oddsson, PhD
- NeuroMuscular Research Center, Boston University, Boston, MA
- Sister Kenny Rehabilitation Institute, Sister Kenny Research Center, Minneapolis, MN

Abstract

Melzer I, Tzedek I, Or M, Shvarth G, Nizri O, Ben-Shitrit K, Oddsson LE. Speed of voluntary stepping in chronic stroke survivors under single- and dual-task conditions: a case-control study.

Objective

To investigate voluntary step behavior of chronic stroke survivors during single- and dual-task conditions and compare the results to healthy age- and sex-matched controls.

Design

Case-control.

Setting

Laboratory-based study.

Participants

Chronic stroke survivors (n=16) and healthy controls (n=16).

Interventions

Not applicable.

Main Outcome Measures

Forward and backward rapid voluntary stepping were performed as a reaction time task under 2 conditions: (1) awaiting a cutaneous cue (single task), and (2) awaiting a cutaneous cue while performing an attention-demanding task. Step initiation, preparatory and swing phases, foot-off time, and foot-contact time were extracted from center of pressure and ground reaction forceplate data.

Results

Chronic stroke survivors were significantly slower than healthy controls in all step parameters under single- and dual-task conditions. For dual compared with single task, the foot-contact time increased from 1295ms to 1445ms (12%) in chronic stroke survivors and from 876ms to 1006ms (15%) in controls.

Conclusions

The significant increase in step phase's duration during single- and dual-task conditions may be a factor contributing to the large number of falls seen in stroke patients. The interference effects of attention-demanding task were similar between groups, suggesting that both groups used similar strategies. Future research should determine whether step training can improve step decrements in chronic stroke survivors.

Key Words: Accidental falls, Rehabilitation, Stroke

List of Abbreviations: ANOVA, analysis of variance, APA, anticipatory postural adjustments, BBS, Berg Balance Scale, COP, center of pressure

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00155-5

doi:10.1016/j.apmr.2008.12.012