Abstract
Objectives
To evaluate fall risk in stroke patients based on single- and dual-task gait analyses,
and to investigate the difference between 2 cognitive tasks in the dual-task paradigm.
Design
Prospective cohort study.
Setting
Rehabilitation hospitals.
Participants
Subacute stroke patients (N=32), able to walk without physical/manual help with or
without walking aids, while performing a verbal task.
Interventions
Not applicable.
Main Outcome Measures
Functional gait measures were Functional Ambulation Categories (FAC) and use of a
walking aid. Gait measures were evaluated by an electronic walkway system under single-
and dual-task (DT) conditions. For the single-task, subjects were instructed to walk
at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects
had to walk while simultaneously enumerating as many different animals as possible.
For the other DT (counting dual task), participants had to walk while performing serial
subtractions. After inclusion, participants kept a 6-month falls diary.
Results
Eighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers
(SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used
a walking aid and more frequently needed an observatory person for walking safely
(FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting
dual task could distinguish potential Fs from NFs: decrement in stride length percentage
(P=.043) and nonparetic step length percentage (P=.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly
higher percentage of decrement for paretic step length (P=.023) than SFs.
Conclusions
Examining the decrement of spatial gait characteristics (stride length and paretic
and nonparetic step length) during a DT addressing working memory can identify fall-prone
subacute stroke patients.
Keywords
List of abbreviations:
CMI (cognitive-motor interference), DT (dual task), F (faller), FAC (Functional Ambulation Categories), MF (multiple faller), MI (Motricity Index), MMSE (Mini-Mental State Examination), NF (nonfaller), SF (single faller), ST (single task), SWWT (“Stops walking when talking” test)To read this article in full you will need to make a payment
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References
- Falls in individuals with stroke.J Rehabil Res Dev. 2008; 45: 1195-1214
- Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies.Stroke. 1995; 26: 838-842
- Incidence and consequences of falls due to stroke: a systematic inquiry.BMJ. 1995; 311: 83-86
- The effect of spasticity, sense and walking aids in falls of people after chronic stroke.Disabil Rehabil. 2007; 29: 679-687
- Prediction of falling among stroke patients in rehabilitation.J Rehab Med. 2011; 43: 876-883
- Gait assessment for neurologically impaired patients. Standards for outcome assessment.Phys Ther. 1986; 66: 1530-1539
- ‘Stops walking when talking’ as a predictor of falls in people with stroke living in the community.J Neurol Neurosurg Psych. 2004; 75: 994-997
- How to identify potential fallers in a stroke unit: validity indexes of 4 test methods.J Rehabil Med. 2006; 38: 186-191
- Attention and the control of posture and gait: a review of an emerging area of research.Gait Posture. 2002; 16: 1-14
- Interactions between cognitive tasks and gait after stroke: a dual task study.Gait Posture. 2008; 27: 683-688
- Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke.Neurorehab Neural Repair. 2010; 24: 542-549
- Dual task effects of talking while walking on velocity and balance following a stroke.Age Ageing. 2001; 30: 319-323
- Interference between gait and cognitive tasks in a rehabilitating neurological population.J Neurol Neurosurg Psych. 2000; 69: 479-486
- Is automaticity of walking regained after stroke?.Disabil Rehabil. 2006; 28: 97-102
- Interference between balance, gait and cognitive task performance among people with stroke living in the community.Disabil Rehabil. 2006; 28: 849-856
- Do dual tasks have an added value over single tasks for balance assessment in fall prevention programs? A mini-review.Gerontology. 2008; 54: 40-49
- Changes in step-width during dual-task walking predicts falls.Gait Posture. 2010; 32: 92-97
- Recurrent falls and dual task-related decrease in walking speed: is there a relationship?.J Am Geriatr Soc. 2008; 56: 1265-1269
- Gait variability while dual-tasking: fall predictor in older inpatients?.Aging Clin Exp Res. 2008; 20: 123-130
- Dual-task-related gait changes in the elderly: does the type of cognitive task matter?.J Mot Behav. 2005; 37: 259-264
- Cognitive processes related to gait velocity: results from the Einstein aging study.Neuropsych. 2006; 20: 215
- Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Mobility after stroke: reliability of measures of impairment and disability.Int Disabil Stud. 1990; 12: 6-9
- Concurrent related validity of the GAITRite-walkway system for quantification of the spatial and temporal parameters of gait.Gait Posture. 2003; 17: 68-74
- Reliability of the GAITRite-walkway system for the quantification of temporo-spatial parameters of gait in young and older people.Gait Posture. 2004; 20: 20-25
- Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation.Disabil Rehabil. 2011; 19: 1848-1853
- Dual-task-related gait changes in individuals with stroke.Gait Posture. 2007; 25: 185-190
- Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature.Gerontologist. 2006; 46: 367-376
- The influence of walking aids on hemiplegic gait.Physiother Theory Pract. 1994; 10: 77-86
- Hemiplegic gait of stroke patients: the effect of using a cane.Arch Phys Med Rehabil. 1999; 80: 777-784
- Incidence and consequence of falls in inpatient rehabilitation of stroke patients.Exp Aging Res. 2005; 31: 457-469
- Falls and injury prevention should be part of every stroke rehabilitation plan.Clin Rehabil. 2005; 19: 441-451
- Executive functions and the frontal lobes: a lifespan perspective.New York: Psychology Pr;. 2008;
- Working memory.Science. 1992; 255: 556-559
- Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention.Cerebrovasc Dis. 2006; 23: 203-210
- Predictors of falls among right-hemisphere stroke patients in the rehabilitation setting.Arch Phys Med Rehabil. 1993; 74: 621-626
- Self-organized control of bipedal locomotion by neural oscillators in unpredictable environment.Biol Cybern. 1991; 65: 147-159
- Walking while talking: effect of task prioritization in the elderly.Arch Phys Med Rehabil. 2007; 88: 50-53
- Recovery of walking function in stroke patients: the Copenhagen Stroke Study.Arch Phys Med Rehabil. 1995; 76: 27-32
- Falls in frequent neurological diseases.J Neurol. 2004; 251: 79-84
- The dual-task methodology and assessing the attentional demands of ambulation with walking devices.Phys Ther. 1992; 72: 306-312
Article info
Publication history
Published online: November 26, 2012
Footnotes
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.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
