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

      Affiliations

    • Schwartz Movement Analysis & Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
    • Corresponding Author InformationReprint 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • NeuroMuscular Research Center, Boston University, Boston, MA
    • Sister Kenny Rehabilitation Institute, Sister Kenny Research Center, Minneapolis, MN

References 

  1. Wild D, Nayak US, Isaacs B. Prognosis of falls in old people at home. J Epidemiol Community Health. 1981;35:200–204
  2. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–1707
  3. Nyberg L, Gustafson Y. Patient falls in stroke rehabilitation: a challenge to rehabilitation strategies. Stroke. 1995;26:838–842
  4. Belgen B, Beninato M, Sullivan PE, Narielwalla K. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. Arch Phys Med Rehabil. 2006;87:554–561
  5. de Haart M, Geurts AC, Huidekoper SC, Fasotti L, van Limbeek J. Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke. 2002;33:542–547
  6. Ramnemark A, Nilsson M, Borssén B, Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000;31:1572–1577
  7. Mulley G, Espley AJ. Hip fracture after hemiplegia. Postgrad Med J. 1979;55:264–265
  8. Melton LJ. Hip fractures: a worldwide problem today and tomorrow. Bone. 1993;14(Suppl 1):S1–S8
  9. Stavrou ZP, Erginousakis DA, Loizides AA, Tzevelekos SA, Papagiannakos KJ. Mortality and rehabilitation following hip fracture: a study of 202 elderly patients. Acta Orthop Scand. 1997;68(Suppl 275):89–91
  10. Peszczynski M. The fractured hip in hemiplegic patients. Geriatrics. 1957;12:687–690
  11. King MB, Tinetti ME. A multifactorial approach to reducing injurious falls. Clin Geriatr Med. 1996;12:745–759
  12. Melzer I, Oddsson LI. The effect of a cognitive task on voluntary step execution in healthy elderly individuals. J Am Geriatr Soc. 2004;52:1255–1262
  13. Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med. 1989;320:1055–1059
  14. Maki BE, McIlroy WE. Postural control in the older adult. Clin Geriatr Med. 1996;12:635–658
  15. Thelen DG, Wojcik LA, Schultz AB, Ashton-Miller JA, Alexander NB. Age differences in using a rapid step to regain balance during a forward fall. J Gerontol A Biol Sci Med Sci. 1997;52:M8–M13
  16. Melzer I, Kurz I, Shahar D, Levi M, Oddsson L. Application of the Voluntary Step Execution Test to identify elderly fallers. Age Ageing. 2007;36:532–537
  17. Hyndman D, Ashburn A, Yardley L, Stack E. Interference between balance, gait and cognitive task performance among people with stroke living in the community. Disabil Rehabil. 2006;28:849–856
  18. Bowen A, Wenman R, Mickelborough J, Foster J, Hill E, Tallis R. Dual-task effects of talking while walking on velocity and balance following a stroke. Age Ageing. 2001;30:319–323
  19. Yang YR, Chen YC, Lee CS, Cheng SJ, Wang RY. Dual-task–related gait changes in individuals with stroke. Gait Posture. 2007;25:185–190
  20. Haggard P, Cockburn J, Cock J, Fordham C, Wade D. Interference between gait and cognitive tasks in a rehabilitating neurological population. J Neurol Neurosurg Psychiatry. 2000;69:479–486
  21. Neumann O. Automatic processing: a review of recent findings and a plea for an old theory. In:  Prinz W,  Sanders AF editor. Cognition and motor processes. New York: Springer-Verlag; 1984;p. 255–293
  22. Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the state of patients for the clinician. J Psych Res. 1975;12:189–198
  23. Melzer I, Shtilman I, Rosenblatt N, Oddsson LI. Reliability of voluntary step execution behavior under single and dual task conditions. J Neuroengineering Rehabil. 2007;29:4–16
  24. Jensen AR, Rohwer WD. The Stroop color-word test: a review. Acta Psychol (Amst). 1966;25:36–93
  25. Berg KO, Wood-Dauphniee SL, Williams JT, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989;41:304–311
  26. Bensoussan L, Viton JM, Schieppati M, et al. Changes in postural control in hemiplegic patients after stroke performing a dual task. Arch Phys Med Rehabil. 2007;88:1009–1015
  27. Plummer-D'Amato P, Altmann LJ, Saracino D, Fox E, Behrman AL, Marsiske M. Interactions between cognitive tasks and gait after stroke: a dual task study. Gait Posture. 2008;27:683–688
  28. Michel-Pellegrino V, Hewson DJ, Drieux M, Duchêne J. Evaluation of the risk of falling in institution-dwelling elderly: clinical tests versus biomechanical analysis of stepping-up. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:6122–6125
  29. Van den Bogert AJ, Pavol MJ, Grabiner MD. Response time is more important than walking speed for the ability of older adults to avoid a fall after a trip. J Biomech. 2002;35:199–205
  30. Dickstein R, Shefi S, Marcovitz E, Villa Y. Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Arch Phys Med Rehabil. 2004;85:261–267
  31. Kirker SG, Simpson DS, Jenner JR, Wing AM. Stepping before standing: hip muscle function in stepping and standing balance after stroke. J Neurol Neurosurg Psychiatry. 2000;68:458–464
  32. Samusik J. Conduction in the motor neurons of the peripheral nerves in hemiplegia of cerebral origin. Neurol Neurochir Pol. 1984;18:333–338
  33. Chokroverty S, Medina J. Electrophysiological study of hemiplegia (Motor nerve conduction velocity, brachial plexus latency, and electromyography). Arch Neurol. 1978;35:360–363
  34. Lampl Y, Gilad R, Eshel Y, Sarova-Pinhas I. Strokes mimicking peripheral nerve lesions. Clin Neurol Neurosurg. 1995;97:203–207
  35. Jokinen H, Kalska H, Mäntylä R, et al. White matter hyperintensities as a predictor of neuropsychological deficits post-stroke. J Neurol Neurosurg Psychiatry. 2005;76:1229–1233
  36. Hoff EI, Blokland A, Rutten K, Steinbusch HW, van Oostenbrugge RJ. Dissociable effects in reaction time performance after unilateral cerebral infarction: a comparison between the left and right frontal cortices in rats. Brain Res. 2006;1069:182–189
  37. Engardt M, Olsson E. Body weight-bearing while rising and sitting down in patients with stroke. Scand J Rehabil Med. 1992;24:67–74
  38. Neckel N, Pelliccio M, Nichols D, Hidler J. Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke. J Neuroeng Rehabil. 2006;3:17
  39. Ryan AS, Dobrovolny CL, Smith GV, Silver KH, Macko RF. Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients. Arch Phys Med Rehabil. 2002;83:1703–1707
  40. Carin-Levy G, Greig C, Young A, Lewis S, Hannan J, Mead G. Longitudinal changes in muscle strength and mass after acute stroke. Cerebrovasc Dis. 2006;21:201–207
  41. Li KZ, Lindenberger U, Freund AM, Baltes PB. Walking while memorizing: age-related differences in compensatory behavior. Psychol Sci. 2001;12:230–237
  42. Rapp MA, Krampe RT, Baltes PB. Adaptive task prioritization in aging: selective resource allocation to postural control is preserved in Alzheimer disease. Am J Geriatr Psychiatry. 2006;14:52–61
  43. Lövdén M, Schellenbach M, Grossman-Hutter B, Krüger A, Lindenberger U. Environmental topography and postural control demands shape aging-associated decrements in spatial navigation performance. Psychol Aging. 2005;20:683–694
  44. Huxhold O, Li SC, Schmiedek F, Lindenberger U. Dual-tasking postural control: aging and the effects of cognitive demand in conjunction with focus of attention. Brain Res Bull. 2006;69:294–305
  45. Sullivan KJ, Knowlton BJ, Dobkin BH. Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery. Arch Phys Med Rehabil. 2002;83:683–691
  46. Nnodim JO, Strasburg D, Nabozny M, et al. Dynamic balance and stepping versus tai chi training to improve balance and stepping in at-risk older adults. J Am Geriatr Soc. 2006;54:1825–1831
  47. Rogers MW, Johnson ME, Martinez KM, et al. Step training improves the speed of voluntary step initiation in aging. J Gerontol A Biol Sci Med Sci. 2003;58:46–51
  48. Silsupadol P, Siu KC, Shumway-Cook A, Woollacott MH. Training of balance under single- and dual-task conditions in older adults with balance impairment. Phys Ther. 2006;86:269–281

 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

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