Abstract
Objectives
To investigate the effects of dual-task balance training on static and dynamic balance,
functional mobility, cognitive level, and sleep quality in individuals with transfemoral
amputation.
Design
Randomized controlled clinical trial.
Participants
Transfemoral amputees (N=20).
Interventions
Participants were randomly assigned to the single-task gait and balance training group
(n=10) or the dual-task gait and balance training group (n=10). Training was given
in sessions of 60 min/d, 3 d/wk for 4 weeks. The single-task training group performed
traditional gait and balance exercises, and the dual-task training group practiced
cognitive and motor tasks while performing gait and balance exercises.
Main Outcome Measures
The 1-leg stance test and the Four Square Step Test were used for balance assessment.
The timed Up and Go test and 10-m walk test were used for gait assessment. Three test
conditions to evaluate the training effects were single walking, walking while performing
a cognitive task (serial subtraction), and walking while performing a motor task (tray
carrying). The Montreal Cognitive Assessment scale was used for cognitive assessment
and the Pittsburgh Sleep Quality Index for sleep quality assessment.
Results
Balance and mobility improved in both groups. Dual-task balance performance, functional
mobility, and gait speed improved more in the dual-task training group after training
(P<.05). Cognitive status and sleep quality improved significantly in the dual-task
group (P<.05).
Conclusions
Dual-task training was more effective than single-task training in the improvement
of dual-task performance and cognitive status. The inclusion of dual-task exercises
in the rehabilitation program of transfemoral amputees will provide a different perspective
because of increased task automation.
Keywords
List of abbreviations:
CDT (cognitive dual task), DTT (dual-task training), FSST (Four Square Step Test), MDT (motor dual task), MoCA (Montreal Cognitive Assessment), OLST (1-leg stance test), RCT (randomized controlled trial), ST (single task), STT (single-task training), TFA (transfemoral amputee), TUGT (timed Up and Go test)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Physical capacity and walking ability after lower limb amputation: a systematic review.Clin Rehabil. 2006; 20: 999-1016
- Does having a computerized prosthetic knee influence cognitive performance during amputee walking?.Arch Phys Med Rehabil. 2006; 87: 989-994
- A pilot study comparing the cognitive demand of walking for transfemoral amputees using the Intelligent Prosthesis with that using conventionally damped knees.Clin Rehabil. 2000; 14: 518-522
- Enabling factors related to prosthetic use by people with transtibial and transfemoral amputation.Arch Phys Med Rehabil. 1999; 80: 706-713
- The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation.Arch Phys Med Rehabil. 2001; 82: 1238-1244
- Orthotics and prosthetics in rehabilitation-e-book.St. Louis, MO: Elsevier Health Sciences, 2013
- Dual-task assessment of reorganization of postural control in persons with lower limb amputation.Arch Phys Med Rehabil. 1991; 72: 1059-1064
- Assessment of motor recovery and decline.Gait Posture. 2002; 16: 198-210
- Training of balance under single- and dual-task conditions in older adults with balance impairment.Phys Ther. 2006; 86: 269-281
- Variability and stability analysis of walking of transfemoral amputees.Med Eng Phys. 2010; 32: 1009-1014
- An investigation of the effects of dual task on gait in people with trasfemoral amputation.Turk J Physiother Rehabil. 2017; 28: 118-124
- Sleep quality is associated with walking under dual-task, but not single-task performance.Gait Posture. 2016; 49: 127-131
- Frontal lobe function, sleep loss and fragmented sleep.Sleep Med Rev. 2001; 5: 463-475
- The role of executive function and attention in gait.Mov Disord. 2008; 23 ([quiz 472]): 329-342
- Multitasking: association between poorer performance and a history of recurrent falls.J Am Geriatr Soc. 2007; 55: 570-576
- Relationship between dual-task related gait changes and intrinsic risk factors for falls among transitional frail older adults.Aging Clin Exp Res. 2005; 17: 270-275
- Comparing the effects of dual-task gait testing in new and established ambulators with lower extremity amputations.PM R. 2018; 10: 1012-1019
- Effect of balance exercise on balance control in unilateral lower limb amputees.Indian J Occup Ther. 2009; 41: 63-68
- Gait training interventions for lower extremity amputees: a systematic literature review.Technol Innov. 2016; 18: 99
- Training for attentional control in dual task settings: a comparison of young and old adults.J Exp Psychol Appl. 1995; 1: 50
- Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial.Arch Phys Med Rehabil. 2009; 90: 381-387
- The utility of the two-minute walk test as a measure of mobility in people with lower limb amputation.Arch Phys Med Rehabil. 2020; 101: 1183-1189
- The influence of preamputation pain on postamputation stump and phantom pain.Pain. 1997; 72: 393-405
- Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?.Arch Phys Med Rehabil. 2004; 85: 815-822
- The effect of a dual task on gait speed in community dwelling older adults: a systematic review and meta-analysis.Gait Posture. 2016; 44: 250-258
- The effect of directing attention during walking under dual-task conditions in Parkinson's disease.Parkinsonism Relat Disord. 2005; 11: 95-99
- Goal-directed secondary motor tasks: their effects on gait in subjects with Parkinson disease.Arch Phys Med Rehabil. 2000; 81: 110-116
- Cognitive motor interference while walking: a systematic review and meta-analysis.Neurosci Biobehav Rev. 2011; 35: 715-728
- Cognitive and motor dual task gait training improve dual task gait performance after stroke-a randomized controlled pilot trial.Sci Rep. 2017; 7: 4070
- Timed walking test—an all-embracing outcome measure for lower-limb amputees?.Clin Rehabil. 1996; 10: 227-232
- Cognitive and motor mechanisms underlying older adults' ability to divide attention while walking.Phys Ther. 2011; 91: 1039-1050
- Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients.J Phys Ther Sci. 2014; 26: 1-6
- The timed "up and go" test: reliability and validity in persons with unilateral lower limb amputation.Arch Phys Med Rehabil. 1999; 80: 825-828
- Physical, mental, and social predictors of functional outcome in unilateral lower-limb amputees.Arch Phys Med Rehabil. 2003; 84: 803-811
- Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation.Gait Posture. 2014; 39: 424-429
- Reliability and validity of a dual-task force platform assessment of balance performance: effect of age, balance impairment, and cognitive task.J Am Geriatr Soc. 2002; 50: 157-162
- Transfemoral interfaces with vacuum assisted suspension comparison of gait, balance, and subjective analysis: ischial containment versus brimless.Gait Posture. 2014; 40: 315-320
- Power of discrimination of Montreal Cognitive Asssessment (MOCA) Scale in Turkish patients with mild cognitive impairement and Alzheimer’s disease.Turk J Geriatr. 2010; 13: 166-171
- Determining sleep quality and its associated factors in patients with lower limb amputation.Turk J Phys Med Rehab. 2015; 61: 241-246
- A training program to improve gait while dual tasking in patients with Parkinson's disease: a pilot study.Arch Phys Med Rehabil. 2012; 93: 176-181
- Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial.Gait Posture. 2009; 29: 634-639
- Training elders with transfemoral amputations.Top Geriatr Rehabil. 2003; 19: 183-190
- Balance training in amputees: comparison of the outcome of two rehabilitation approaches.J Arthroplasty Arthroscopic. 2001; 12: 194-198
- Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks.Phys Ther. 2002; 82: 888-897
- The effect of various dual task training methods with gait on the balance and gait of patients with chronic stroke.J Phys Ther Sci. 2014; 26: 1287-1291
- Dual-task training in older adults: the effect of additional motor tasks on mobility performance.Arch Gerontol Geriatr. 2018; 75: 119-124
- Applied statistics and validity-reliability with examples from sports, health and education sciences.Ankara, Turkey: Detay Publishing, 2010
- Effects of dual-task balance training on postural performance in patients with multiple sclerosis: a double-blind, randomized controlled pilot trial.Clin Rehabil. 2017; 31: 234-241
- Risk factors for falls in people with a lower limb amputation: a systematic review.PM R. 2017; 9: 170-180.e1
- A review of clinical outcome assessment instruments for gait, balance, and fall risk in persons with lower extremity amputation.Top Geriatr Rehabil. 2014; 30: 70-76
- The effect of cognitive impairment on prosthesis use in older adults who underwent amputation due to vascular-related etiology: a systematic review of the literature.Prosthet Orthot Int. 2018; 42: 144-152
Article info
Publication history
Published online: July 09, 2020
Footnotes
Clinical Trial Registration No.: NCT03094208.
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
