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Salihu AT, Hill KD, Jaberzadeh S. Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis. J Mot Behav 2024; 56:373-391. [PMID: 38189442 DOI: 10.1080/00222895.2023.2299706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Dattola S, Bonanno L, Ielo A, Quercia A, Quartarone A, La Foresta F. Brain Active Areas Associated with a Mental Arithmetic Task: An eLORETA Study. Bioengineering (Basel) 2023; 10:1388. [PMID: 38135979 PMCID: PMC10740510 DOI: 10.3390/bioengineering10121388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/10/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The neural underpinnings of mental calculation, the fundamentals of arithmetic representations and processes, and the development of arithmetic abilities have been explored by researchers over the years. In the present work, we report a study that analyzes the brain-activated areas of a group of 35 healthy subjects (9 males, 26 females, mean age ± SD = 18.23 ± 2.20 years) who performed a serial subtraction arithmetic task. In contrast to most of the studies in the literature based on fMRI, we performed the brain active source reconstruction starting from EEG signals by means of the eLORETA method. In particular, the subjects were classified as bad counters or good counters, according to the results of the task, and the brain activity of the two groups was compared. The results were statistically significant only in the beta band, revealing that the left limbic lobe was found to be more active in people showing better performance. The limbic lobe is involved in visuospatial processing, memory, arithmetic fact retrieval, and emotions. However, the role of the limbic lobe in mental arithmetic has been barely explored, so these interesting findings could represent a starting point for future in-depth analyses. Since there is evidence in the literature that the motor system is affected by the execution of arithmetic tasks, a more extensive knowledge of the brain activation associated with arithmetic tasks could be exploited not only for the assessment of mathematical skills but also in the evaluation of motor impairments and, consequently, in rehabilitation for motor disorders.
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Affiliation(s)
- Serena Dattola
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo c/da Casazza, SS. 113, 98124 Messina, Italy; (S.D.); (L.B.); (A.Q.)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo c/da Casazza, SS. 113, 98124 Messina, Italy; (S.D.); (L.B.); (A.Q.)
| | - Augusto Ielo
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo c/da Casazza, SS. 113, 98124 Messina, Italy; (S.D.); (L.B.); (A.Q.)
| | - Angelica Quercia
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy;
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Via Palermo c/da Casazza, SS. 113, 98124 Messina, Italy; (S.D.); (L.B.); (A.Q.)
| | - Fabio La Foresta
- DICEAM Department, Mediterranea University of Reggio Calabria, Via Graziella Feo di Vito, 89060 Reggio Calabria, Italy;
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Borji R, Laatar R, Zarrouk N, Sahli S, Rebai H. Cognitive-motor interference during standing stance across different postural and cognitive tasks in individuals with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 139:104562. [PMID: 37379660 DOI: 10.1016/j.ridd.2023.104562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with Down syndrome (DS) presented both cognitive and motor impairments that could influence each other. Therefore, exploring cognitive-motor interference during standing stance is relevant in this population. AIMS This study explored the dual task (DT) effects on postural balance during diverse cognitive tasks and sensory manipulations in individuals with DS, compared to those with typical development (TD). METHODS AND PROCEDURES Fifteen adolescents with DS (age = 14.26 ± 1.27 years; height = 1.50 ± 0.02; weight = 46.46 ± 4.03 kg; BMI =20.54 ± 1.51 kg/m2) and thirteen with TD (age = 14.07 ± 1.11 years; height = 1.50 ± 0.05; weight = 44.92 ± 4.15 kg; BMI =19.77 ± 0.94 kg/m2) participated in this study. Postural and cognitive performances for the selective span task (SST) and the verbal fluency (VF) were recorded during single task (ST) and DT conditions. Postural conditions were: firm eyes open (firm-EO), firm eyes closed (firm-EC) and foam-EO. Motor and cognitive DT costs (DTC) were calculated and analyzed across these different cognitive and postural conditions. OUTCOMES AND RESULTS In the DS group, postural performance was significantly (p < 0.001) altered during all DT conditions, compared to the ST situation. Moreover, the motor DTC was significantly (p < 0.001) higher while performing the VF task than the SST. However, in the control group, postural performance was significantly (p < 0.001) impaired only while performing the VF test in the DT-Firm EO condition. For both groups, cognitive performances were significantly (p < 0.05) altered in all DT conditions compared to the ST one. CONCLUSION Adolescents with DS are more prone to DT effects on postural balance than those with TD.
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Affiliation(s)
- Rihab Borji
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia.
| | - Rabeb Laatar
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Nidhal Zarrouk
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Sahli
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Haithem Rebai
- Laboratory 'Optimisation de la Performance Sportive, Centre National de Médecine et Sciences du Sport (CNMSS)', Tunis, Tunisia
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Wong AKO, Fung HJW, Pretty SP, Laing AC, Chan AH, Mathur S, Zabjek K, Giangregorio L, Cheung AM. Ankle flexor/extensor strength and muscle density are complementary determinants of balance during dual‐task engagement: The ankle quality study. JCSM CLINICAL REPORTS 2023. [DOI: 10.1002/crt2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Andy K. O. Wong
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Division of Epidemiology, Dalla Lana School of Public Health University of Toronto ON Toronto Canada
| | - Hugo J. W. Fung
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education University of Toronto ON Toronto Canada
| | - Steven P. Pretty
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
| | - Andrew C. Laing
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
| | - Adrian H. Chan
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Temerty Faculty of Medicine University of Toronto ON Toronto Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy Queen's University ON Kingston Canada
| | - Karl Zabjek
- Department of Physical Therapy, Rehabilitation Sciences Institute University of Toronto ON Toronto Canada
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences University of Waterloo ON Waterloo Canada
- Schlegel‐UW Research Institute for Aging University of Waterloo ON Waterloo Canada
| | - Angela M. Cheung
- Joint Department of Medical Imaging University Health Network ON Toronto Canada
- Schroeder Arthritis Institute & Toronto General Hospital Research Institute University Health Network ON Toronto Canada
- Division of Epidemiology, Dalla Lana School of Public Health University of Toronto ON Toronto Canada
- Temerty Faculty of Medicine University of Toronto ON Toronto Canada
- Centre of Excellence in Skeletal Health Assessment University of Toronto ON Toronto Canada
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Mariman JJ, Lorca E, Biancardi C, Burgos P, Álvarez-Ruf J. Brain’s Energy After Stroke: From a Cellular Perspective Toward Behavior. Front Integr Neurosci 2022; 16:826728. [PMID: 35651830 PMCID: PMC9149581 DOI: 10.3389/fnint.2022.826728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a neurological condition that impacts activity performance and quality of life for survivors. While neurological impairments after the event explain the performance of patients in specific activities, the origin of such impairments has traditionally been explained as a consequence of structural and functional damage to the nervous system. However, there are important mechanisms related to energy efficiency (trade-off between biological functions and energy consumption) at different levels that can be related to these impairments and restrictions: first, at the neuronal level, where the availability of energy resources is the initial cause of the event, as well as determines the possibilities of spontaneous recovery. Second, at the level of neural networks, where the “small world” operation of the network is compromised after the stroke, implicating a high energetic cost and inefficiency in the information transfer, which is related to the neurological recovery and clinical status. Finally, at the behavioral level, the performance limitations are related to the highest cost of energy or augmented energy expenditure during the tasks to maintain the stability of the segment, system, body, and finally, the behavior of the patients. In other words, the postural homeostasis. In this way, we intend to provide a synthetic vision of the energy impact of stroke, from the particularities of the operation of the nervous system, its implications, as one of the determinant factors in the possibilities of neurological, functional, and behavioral recovery of our patients.
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Affiliation(s)
- Juan José Mariman
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Enrique Lorca
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Escuela de Enfermería, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Carlo Biancardi
- Biomechanics Lab, Departamento de Ciencias Biológicas, CENUR Litoral Norte, Universidad de la República, Paysandú, Uruguay
| | - Pablo Burgos
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Neurociencias, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Joel Álvarez-Ruf
- Laboratorio de Cognición y Comportamiento Sensoriomotor, Departamento de Kinesiología, Facultad de Artes y Educación Física, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
- Laboratorio de Biomecánica Clínica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Joel Álvarez-Ruf,
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Salihu AT, Hill KD, Jaberzadeh S. Effect of cognitive task complexity on dual task postural stability: a systematic review and meta-analysis. Exp Brain Res 2022; 240:703-731. [PMID: 35034175 DOI: 10.1007/s00221-021-06299-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
The dual task experimental paradigm is used to probe the attentional requirements of postural control. However, findings of dual task postural studies have been inconsistent with many studies even reporting improvement in postural stability during dual tasking and thus raising questions about cognitive involvement in postural control. A U-shaped non-linear relationship has been hypothesized between cognitive task complexity and dual task postural stability suggesting that the inconsistent results might have arisen from the use of cognitive tasks of varying complexities. To systematically review experimental studies that compared the effect of simple and complex cognitive tasks on postural stability during dual tasking, we searched seven electronic databases for relevant studies published between 1980 to September 2020. 33 studies involving a total of 1068 participants met the review's inclusion criteria, 17 of which were included in meta-analysis (healthy young adults: 15 studies, 281 participants; Stroke patients: 2 studies, 52 participants). Narrative synthesis of the findings in studies involving healthy old adults was carried out. Our result suggests that in healthy population, cognitive task complexity may not determine whether postural stability increases or decreases during dual tasking (effect of cognitive task complexity was not statistically significant; P > 0.1), and thus the U-shaped non-linear hypothesis is not supported. Rather, differential effect of dual tasking on postural stability was observed mainly based on the age of the participants and postural task challenge, implying that the involvement of cognitive resources or higher cortical functions in the control of postural stability may largely depends on these two factors.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Shapour Jaberzadeh
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia
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Hyun SJ, Lee J, Lee BH. The Effects of Sit-to-Stand Training Combined with Real-Time Visual Feedback on Strength, Balance, Gait Ability, and Quality of Life in Patients with Stroke: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12229. [PMID: 34831986 PMCID: PMC8625418 DOI: 10.3390/ijerph182212229] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/11/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to investigate the effects of lower limbs muscles' strength, balance, walking, and quality of life through sit-to-stand training combined with real-time visual feedback (RVF-STS group) in patients with stroke and to compare the effects of classic sit-to-stand training (C-STS group). Thirty patients with stroke were randomly divided into two groups. The RVF-STS group received sit-to-stand training combined with real-time visual feedback using a Wii Balance Board (n = 15), and the C-STS group received classic sit-to-stand training (n = 15). All participants received training for 20 min once a day, 5 days a week for 6 weeks, and both groups underwent general physical therapy for 30 min before training. Before and after the training, the muscle strength of the hip flexor, abductor, and knee extensor were measured, and the Wii Balance Board was used to perform the center of pressure test and Berg Balance Scale to evaluate static and dynamic balance. Additionally, the 10 m walking test and the Timed Up and Go test were performed to evaluate gait function. The Stroke-Specific Quality of Life was used to measure the quality of life. The results showed that the lower extremity muscle strength, balance ability, walking ability, and quality of life of the RVF-STS group significantly improved in comparison of the pre- and post-differences (p < 0.05), and it also showed significant differences between groups (p < 0.05). This study showed that sit-to-stand training combined with real-time visual feedback was effective at improving the muscle strength of the lower extremities, balance, gait, and quality of life in patients with stroke. Therefore, repeating sit-to-stand training combined with real-time visual feedback could be used as an effective treatment method for patients with stroke.
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Affiliation(s)
- Seung-Jun Hyun
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Jin Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Korea;
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Zhou Q, Yang H, Zhou Q, Pan H. Effects of cognitive motor dual-task training on stroke patients: A RCT-based meta-analysis. J Clin Neurosci 2021; 92:175-182. [PMID: 34509248 DOI: 10.1016/j.jocn.2021.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/03/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
Based on a randomized controlled trial (RCT), this meta-analysis aimed to comprehensively analyze the effects of cognitive motor dual-task training (CMDT) on stroke patients. The electronic databases PubMed, Embase, and the Cochrane Library were searched for papers on the influence of CMDT on stroke patients. Weighted mean difference (WMD) and 95% confidence interval (95% CI) were used as effect sizes. Cochran's Q and I2 tests were performed for heterogeneity. Thirteen articles involving 326 patients were included in the study. The meta-analysis showed that CMDT significantly improved the walking balance of patients with stroke (P = 0.01). In addition, CMDT significantly improved the gait ability of patients with stroke (P < 0.0001). Furthermore, CMDT had a significant effect on the improvement of upper limb ability in patients with stroke (P < 0.00001). CMDT could significantly improve balance ability, gait, and upper limb function in patients with chronic stroke, which is worthy of clinical promotion.
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Affiliation(s)
- Qiang Zhou
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
| | - Hongchang Yang
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China.
| | - Quanfu Zhou
- Department of Physical Education, Nanjing Agricultural University, Nanjing, Jiangsu 210095, China
| | - Hongyao Pan
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
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9
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Ghorbanpour Z, Taghizadeh G, Hosseini SA, Pishyareh E, Ghomsheh FT, Bakhshi E, Mehdizadeh H. Overload of anxiety on postural control impairments in chronic stroke survivors: The role of external focus and cognitive task on the automaticity of postural control. PLoS One 2021; 16:e0252131. [PMID: 34292945 PMCID: PMC8297887 DOI: 10.1371/journal.pone.0252131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. Methods Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). Results Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. Conclusions The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.
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Affiliation(s)
- Zahra Ghorbanpour
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ebrahim Pishyareh
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
- * E-mail:
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Hajar Mehdizadeh
- Department of Neurosciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Kim H, Kim HK, Kim N, Nam CS. Dual Task Effects on Speed and Accuracy During Cognitive and Upper Limb Motor Tasks in Adults With Stroke Hemiparesis. Front Hum Neurosci 2021; 15:671541. [PMID: 34220473 PMCID: PMC8250862 DOI: 10.3389/fnhum.2021.671541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Adults with stroke need to perform cognitive-motor dual tasks during their day-to-day activities. However, they face several challenges owing to their impaired motor and cognitive functions. Objective This case-controlled pilot study investigates the speed and accuracy tradeoffs in adults with stroke while performing cognitive-upper limb motor dual tasks. Methods Ten adults with stroke and seven similar-aged controls participated in this study. The participants used a robotic arm for the single motor task and participated in either the serial sevens (S7) or the controlled oral word association test (COWAT) for single-cognitive task. For the dual task, the participants performed the motor and cognitive components simultaneously. Their speed and accuracy were measured for the motor and cognitive tasks, respectively. Results Two-sample t-statistics indicated that the participants with stroke exhibited a lower motor accuracy in the cross task than in the circle task. The cognitive speed and motor accuracy registered by the subjects with stroke in the dual task significantly decreased. There was a negative linear correlation between motor speed and accuracy in the subjects with stroke when the COWAT task was performed in conjunction with the cross task (ρ = -0.6922, p = 0.0388). Conclusions This study proves the existence of cognitive-upper limb motor interference in adults with stroke while performing dual tasks, based on the observation that their performance during one or both dual tasks deteriorated compared to that during the single task. Both speed and accuracy were complementary parameters that may indicate clinical effectiveness in motor and cognitive outcomes in individuals with stroke.
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Affiliation(s)
- Hogene Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
| | - Hyun-Ki Kim
- Department of Clinical Rehabilitation Research, National Rehabilitation Center, Seoul, South Korea
| | - Nayoung Kim
- Department of Industrial Engineering, North Carolina State University, Raleigh, NC, United States
| | - Chang S Nam
- Department of Industrial Engineering, North Carolina State University, Raleigh, NC, United States
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Mahmoudzadeh A, Nakhostin Ansari N, Naghdi S, Ghasemi E, Motamedzadeh O, Shaw BS, Shaw I. Role of Spasticity Severity in the Balance of Post-stroke Patients. Front Hum Neurosci 2021; 15:783093. [PMID: 34975436 PMCID: PMC8715739 DOI: 10.3389/fnhum.2021.783093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/24/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life. Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence. Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured. Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence. Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.
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Affiliation(s)
- Ashraf Mahmoudzadeh
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Ashraf Mahmoudzadeh,
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Ghasemi
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Motamedzadeh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Brandon S. Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
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Ralston JD, Raina A, Benson BW, Peters RM, Roper JM, Ralston AB. Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:411-438. [PMID: 33324120 PMCID: PMC7733539 DOI: 10.2147/mder.s279521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the utility of a head-mounted wearable inertial motion unit (IMU)-based physiological vibration acceleration (“phybrata”) sensor to support the clinical diagnosis of concussion, classify and quantify specific concussion-induced physiological system impairments and sensory reweighting, and track individual patient recovery trajectories. Methods Data were analyzed from 175 patients over a 12-month period at three clinical sites. Comprehensive clinical concussion assessments were first completed for all patients, followed by testing with the phybrata sensor. Phybrata time series data and spatial scatter plots, eyes open (Eo) and eyes closed (Ec) phybrata powers, average power (Eo+Ec)/2, Ec/Eo phybrata power ratio, time-resolved phybrata spectral density (TRPSD) distributions, and receiver operating characteristic (ROC) curves are compared for individuals with no objective impairments and those clinically diagnosed with concussions and accompanying vestibular impairment, other neurological impairment, or both vestibular and neurological impairments. Finally, pre- and post-injury phybrata case report results are presented for a participant who was diagnosed with a concussion and subsequently monitored during treatment, rehabilitation, and return-to-activity clearance. Results Phybrata data demonstrate distinct features and patterns for individuals with no discernable clinical impairments, diagnosed vestibular pathology, and diagnosed neurological pathology. ROC curves indicate that the average power (Eo+Ec)/2 may be utilized to support clinical diagnosis of concussion, while Eo and Ec/Eo may be utilized as independent measures to confirm accompanying neurological and vestibular impairments, respectively. All 3 measures demonstrate area under the curve (AUC), sensitivity, and specificity above 90% for their respective diagnoses. Phybrata spectral analyses demonstrate utility for quantifying the severity of concussion-induced physiological impairments, sensory reweighting, and subsequent monitoring of improvements throughout treatment and rehabilitation. Conclusion Phybrata testing assists with objective concussion diagnosis and provides an important adjunct to standard concussion assessment tools by objectively ascertaining neurological and vestibular impairments, guiding targeted rehabilitation strategies, monitoring recovery, and assisting with return-to-sport/work/learn decision-making.
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Affiliation(s)
| | - Ashutosh Raina
- Center of Excellence for Pediatric Neurology, Rocklin, CA 95765, USA.,Concussion Medical Clinic, Rocklin, CA 95765, USA
| | - Brian W Benson
- Benson Concussion Institute, Calgary, Alberta T3B 6B7, Canada.,Canadian Sport Institute Calgary, Calgary, Alberta T3B 5R5, Canada
| | - Ryan M Peters
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta T2N 1N4, Canada
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13
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Influence of leg length discrepancy on balance and gait in post-stroke patients: a correlational study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2020. [DOI: 10.1186/s43161-020-00012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A frequent complaint by stroke patients presenting for physiotherapy was perceived shortness of the affected lower limb and inability to weight bear onto the affected side. So, the present study aimed to evaluate influence of limb length discrepancy (LLD) on balance and gait parameters in patients with stroke.
Subjects and methods
Twenty participants were recruited based on the inclusion and exclusion criteria and were divided into two groups group A (LLD ≤ 1 cm) and group B (LLD > 1 cm). Postural sway was measured under wide base eyes open, wide base eyes closed, narrow base eyes open, and narrow base eyes closed conditions. Weight-bearing asymmetry and functional balance were assessed using the percentage body weight asymmetry and Berg balance scale. Also, step leg ratio and 10-M walk test was used to assess gait parameters.
Results
Intergroup comparison of postural sway exhibited a significant difference between groups in the AP direction in wide-based eyes open (WBEO), wide-based eyes closed (WBEC), narrow-based eyes open (NBEO), and narrow-based eyes closed (NBEC) conditions whereas only in NBEC condition in mediolateral direction; with group B (LLD > 1 cm) displaying a greater mean postural sway in all the conditions. The correlation of LLD with postural sway showed a significant positive correlation within AP direction under all the conditions and in WBEC and NBEC conditions in mediolateral direction. Intergroup comparison of step length ratio (SLR) showed a statistical difference between groups, and a negative correlation was found between LLD and SLR. A negative correlation was also seen between percentage weight-bearing asymmetry (PWBA) and speed as well as Berg’s balance scale (BBS), and a positive correlation was observed between BBS and speed.
Conclusion
Leg length discrepancy results in a significant decrease in balance control in the sagittal and frontal planes in patients with stroke. It also adds to the asymmetries in their gait. Therefore, LLD should be considered as a factor for balance and gait asymmetries in post-stroke patients.
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14
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Ha SY, Sung YH. Attentional concentration during physiotherapeutic intervention improves gait and trunk control in patients with stroke. Neurosci Lett 2020; 736:135291. [PMID: 32763360 DOI: 10.1016/j.neulet.2020.135291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
The restoration of motor function is important in daily life in patients with brain damage. Although attentional concentration can affect motor function, most physical therapists focus only on therapeutic exercise. Therefore, we investigated changes in motor function in patients with high attentional concentration during our intervention. A total of 21 subjects diagnosed with stroke participated in the study. They were divided into the high attentional concentration group and low attentional concentration group based on the self-programmed attention index. The subjects underwent trunk strengthening and gait training for 30 min per session, twice a day, 5 days a week, for a total of 4 weeks. All patients wore electroencephalogram (EEG) devices during the treatment to enable EEG examinations. Diagnostic ultrasound was used to measure muscles of the abdomen: external oblique abdominal, internal oblique abdominal, transversus abdominis, and rectus abdominal muscles. A trunk impairment scale was used to evaluate trunk control. We used Gaitrite to measure the spatial and temporal components during gait. The group with high attentional concentration showed significant differences in abdominal muscle strength and trunk control. In gait, there was a significant difference in swing cycle, stance cycle, single cycle, double support cycle, stance time, and double support time. Therefore, attentional concentration should be considered to improve motor function as a part of therapeutic exercises for stroke patients.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Republic of Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Republic of Korea; Department of Physical Therapy, College of Health Sciences, Kyungnam University, Republic of Korea.
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15
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Useros Olmo AI, Periañez JA, Martínez-Pernía D, Miangolarra Page JC. Effects of spatial working memory in balance during dual tasking in traumatic brain injury and healthy controls. Brain Inj 2020; 34:1159-1167. [PMID: 32658560 DOI: 10.1080/02699052.2020.1792984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this research was to assess cognitive-motor interactions though dual tasks of working memory in patients with traumatic brain injury (TBI) and control subjects. Methods: Twenty patients with chronic TBI with good functional level and 19 matched healthy controls performed dual working memory tasks (1-back numeric and 1-back spatial (S)) while sitting, standing, and walking. The center of pressure (COP) displacement amplitude, cadence, and error percentage (PER) were recorded as dependent variables. Results: The results revealed main effects of Group (TBI, controls) (p = .011) and Task factors (Single, Dual Standing 1-back, Dual Standing 1-back (S); p = .0001) for the COP. Patients showed greater displacement than controls (p = .011), and an analysis of the Task factor showed a minor displacement for the dual 1-back (S) task compared with the 1-back and single task (p = .002 and p = .001, respectively). Conclusions: Postural control during both standing and walking improved during performance of the spatial working memory task. In the dual task, both patients and controls showed a postural prioritization as an adaptive response to the increase in cognitive demand.
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Affiliation(s)
- Ana Isabel Useros Olmo
- Department of Physiotherapy, Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios la Salle, Universidad Autónoma de Madrid , Spain.,Hospital Beata María Ana, Unidad de daño Cerebral , Madrid, Spain
| | - Jose A Periañez
- Department Experimental Psychology, Complutense University of Madrid , Madrid, Spain
| | - David Martínez-Pernía
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Universidad , Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), Faculty of Medicine, University of Chile , Santiago, Chile
| | - Juan Carlos Miangolarra Page
- Universidad de Medicina Física y Rehabilitación de la Universidad Rey Juan Carlos , Madrid, Spain.,Servicio de Medicina Física y Rehabilitación del Hospital Universitario de Fuenlabrada , Madrid, Spain.,Consejería de Salud, Comunidad de Madrid, Servicio Madrileño de Salud (SERMAS) , Madrid, Spain.,de la Universidad Rey Juan Carlos , Madrid, Spain
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16
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Lee Y, Curuk E, Aruin AS. Effect of Light Finger Touch, a Cognitive Task, and Vision on Standing Balance in Stroke. J Mot Behav 2020; 53:157-165. [PMID: 32281912 DOI: 10.1080/00222895.2020.1742082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of the exploratory study was to investigate the individual and combined effects of light finger touch, a cognitive task, and vision on postural sway in individuals with stroke. Nine older adults with stroke stood on the force platform with eyes open and eyes closed, with and without a light finger touch contact with the stationary frame, and when counting backward from a randomly chosen three-digit number or without it. The center of pressure (COP) excursion, velocity, range and sway area was calculated. Participants demonstrated significantly larger postural sway when vision was not available (p < 0.05), smaller postural sway when using a finger touch contact (p < 0.05), and increased postural sway while performing the cognitive task (p < 0.05). When finger touch and a cognitive task was performed simultaneously, body sway decreased as compared to standing and performing a cognitive task in eyes open (p < 0.05) and eyes closed conditions. Results indicate that light touch in individuals with stroke mitigates the impact of cognitive load. The findings contribute to the understanding of the role of sensory integration in balance control of individuals with neurological impairments and older adults.
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Affiliation(s)
- Yunju Lee
- Department of Physical Therapy and School of Engineering, Grand Valley State University, Grand Rapids, Michigan
| | - Etem Curuk
- PhD Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois
| | - Alexander S Aruin
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
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17
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Cruz-Montecinos C, Carrasco JJ, Guzmán-González B, Soto-Arellano V, Calatayud J, Chimeno-Hernández A, Querol F, Pérez-Alenda S. Effects of performing dual tasks on postural sway and postural control complexity in people with haemophilic arthropathy. Haemophilia 2020; 26:e81-e87. [PMID: 32197275 DOI: 10.1111/hae.13955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION People with haemophilic arthropathy (PWHA) have impairments in postural control. However, little is known about the effects of demanding conditions, including the unipedal stance and dual tasks, on postural control in PWHA. AIM Determine the effects of performing dual tasks while in the one-leg stance on postural sway and postural control complexity in PWHA vs. healthy active (HAG) and non-active (HNAG) groups of individuals. METHODS Fifteen PWHA and 34 healthy subjects (18 active and 16 non-active) were recruited. Vertical (V), mediolateral (ML) and anteroposterior (AP) centre of mass signals were acquired using a 3-axis accelerometer placed at the L3/L4 vertebrae of subjects as they performed the one-leg stance under single and dual-task conditions. Sway balance and the complexity of postural control were studied via root mean square (RMS) acceleration and sample entropy, respectively. Increased complexity of postural sway was attributed to increased automatism of postural control. RESULTS RMS values for PWHA were higher than HAG under both conditions for the V and ML axes, and higher than HNAG under the dual-task condition for the ML axis. Sample entropy was lower in PWHA than healthy individuals under the dual-task condition for V and ML axes, and the single-task condition for the ML axis (P < .05). CONCLUSION PWHA had poorer postural sway and decreased postural control complexity when performing a one-leg stance than healthy people, especially when the dual-task condition was applied. These results may help to design new approaches to assess and improve postural control in PWHA.
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Affiliation(s)
- Carlos Cruz-Montecinos
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.,Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Juan J Carrasco
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Intelligent Data Analysis Laboratory, University of Valencia, Valencia, Spain
| | - Benjamín Guzmán-González
- Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Verónica Soto-Arellano
- Haemophilia and Inherited Bleeding Disorder Treatment Center, Roberto del Río Hospital, Santiago, Chile
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Felipe Querol
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain.,Haemostasis and Thrombosis Unit, Universitary and Polytechnic Hospital La Fe, Valencia, Spain
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18
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Kumar D, Sinha N, Dutta A, Lahiri U. Virtual reality-based balance training system augmented with operant conditioning paradigm. Biomed Eng Online 2019; 18:90. [PMID: 31455355 PMCID: PMC6712808 DOI: 10.1186/s12938-019-0709-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/16/2019] [Indexed: 11/27/2022] Open
Abstract
Background Stroke-related sensory and motor deficits often steal away the independent mobility and balance from stroke survivors. Often, this compels the stroke survivors to rely heavily on their non-paretic leg during weight shifting to execute activities of daily living (ADL), with reduced usage of the paretic leg. Increased reliance on non-paretic leg often leads to learned nonuse of the paretic leg. Therefore, it is necessary to measure the contribution of individual legs toward one’s overall balance. In turn, techniques can be developed to condition the usage of both the legs during one’s balance training, thereby encouraging the hemiplegic patients for increased use of their paretic leg. The aim of this study is to (1) develop a virtual reality (VR)-based balance training platform that can estimate the contribution of each leg during VR-based weight-shifting tasks in an individualized manner and (2) understand the implication of operant conditioning paradigm during balance training on the overall balance of hemiplegic stroke patients. Result Twenty-nine hemiplegic patients participated in a single session of VR-based balance training. The participants maneuvered virtual objects in the virtual environment using two Wii Balance Boards that measured displacement in the center of pressure (CoP) due to each leg when one performed weight-shifting tasks. For operant conditioning, the weight distribution across both the legs was conditioned (during normal trial) to reward participants for increased usage of the paretic leg during the weight-shifting task. The participants were offered multiple levels of normal trials with intermediate catch trial (with equal weight distribution between both legs) in an individualized manner. The effect of operant conditioning during the normal trials was measured in the following catch trials. The participants showed significantly improved performance in the final catch trial compared to their initial catch trial task. Also, the enhancement in CoP displacement of the paretic leg was significant in the final catch trial compared to the initial catch trial. Conclusion The developed system was able to encourage participants for improved usage of their paretic leg during weight-shifting tasks. Such an approach has the potential to address the issue of learned nonuse of the paretic leg in stroke patients.
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Affiliation(s)
- Deepesh Kumar
- Indian Institute of Technology Gandhinagar, Gandhinagar, India. .,National University of Singapore, The N.1 Institute for Health, 28 Medical Dr., Singapore, 117456, Singapore.
| | - Nirvik Sinha
- Indian Institute of Technology Kharagpur, Kharagpur, India
| | | | - Uttama Lahiri
- Indian Institute of Technology Gandhinagar, Gandhinagar, India
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19
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Kerzoncuf M, Viton JM, Pellas F, Cotinat M, Calmels P, Milhe de Bovis V, Delarque A, Bensoussan L. Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial. Arch Phys Med Rehabil 2019; 101:242-248. [PMID: 31469982 DOI: 10.1016/j.apmr.2019.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. DESIGN A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. SETTING Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. PARTICIPANTS People with hemiparesis with chronic post stroke lower limb spasticity (N=40). INTERVENTIONS Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. MAIN OUTCOME MEASURES The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. RESULTS Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (-0.7, P=.049 in the soleus muscles; -0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (-3.11±6.92) in comparison with the placebo group (+0.27±3.57). CONCLUSION Treating spasticity by injecting botulinum toxin into people's lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.
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Affiliation(s)
- Marjorie Kerzoncuf
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France.
| | - Jean-Michel Viton
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France
| | - Frédéric Pellas
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Maeva Cotinat
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France
| | - Paul Calmels
- Physical and Rehabilitation Medicine Department, University Hospital of Saint Etienne, Saint Etienne, France
| | - Virginie Milhe de Bovis
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France
| | - Alain Delarque
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France
| | - Laurent Bensoussan
- Aix Marseille University, APHM, INT, Inst Neurosci Timone, CHU Timone, Physical and Rehabilitation Medicine Department, Marseille, France
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20
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Jamali S, Azad A, Mehdizadeh H, Doostdar A, Hoseinpour F, Mehdizadeh M, Niazi-Khatoon J, Shokouhyan MR, Parnianpour M, Taghizadeh G, Khalaf K. Time-course investigation of postural sway variability: Does anxiety exacerbate the sensory reweighting impairment in chronic stroke survivors? Neuropsychologia 2019; 127:185-194. [PMID: 30858061 DOI: 10.1016/j.neuropsychologia.2019.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/07/2019] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
Although anxiety is one of the most prevalent psychological disorders in stroke survivors, its effect on sensory reweighting has not yet been fully studied. The aim of this work was to investigate how anticipation of collision avoidance events affects sensory reweighting in chronic stroke survivors with low and high levels of anxiety (LA-stroke and HA-stroke, respectively), as compared with healthy controls (HC), under the condition of perturbed proprioception. Eighteen LA-stroke and 18 HA-stroke survivors, as well as 18 gender- and age-matched HC, participated in this study. Postural sway variability (i.e. Root Mean Square (RMS) of the COP velocity) was measured for a duration of 180 s under two conditions: quiet standing and standing while predicting random virtual spheres to be avoided. Proprioceptive perturbation was simulated using bilateral Achilles tendon vibration at mid duration (60 s) for both conditions. The results showed that the HC were able to timely use visual anticipation to reduce the postural sway variability induced by tendon vibration. However, marked delay in using such anticipation was observed in stroke participants, especially in the HA-stroke group, as indicated by a significant decrease in the RMS of the COP velocity late in the vibration phase. This is the first study to consider the effect of anxiety while comparing sensory reweighting between stroke and healthy participants. The results indicated that chronic stroke survivors, particularly those with HA, could not efficiently use sensory reweighting to maintain balance in sensory conflicting conditions, which may subject them to loosing balance and/or falling. These findings are critical for future assessment and planning of rehabilitation interventions and balance in chronic stroke survivors.
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Affiliation(s)
- Shamsi Jamali
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Akram Azad
- Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hajar Mehdizadeh
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Asgar Doostdar
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hoseinpour
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Maryam Mehdizadeh
- Department of Neurosciences, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran; Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Niazi-Khatoon
- Department of Occupational Therapy, School of Allied Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran; Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science, Abu Dhabi, United Arab Emirates
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21
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Park J. Dual Task Training Effects on Upper Extremity Functions and Performance of Daily Activities of Chronic Stroke Patients. Osong Public Health Res Perspect 2019; 10:2-5. [PMID: 30847264 PMCID: PMC6396819 DOI: 10.24171/j.phrp.2019.10.1.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The purpose of this research was to study the influences of dual task training on upper extremity function and performance of daily activities of chronic stroke patients. Methods Dual task training was performed on 21 patients who had suffered a chronic stroke with hemiplegia. The dual task training was performed for 30 minutes per session, for 5 days a week, for 3 weeks. There were 5 evaluations carried out over 3 weeks before and after the intervention. Changes in upper extremity function were measured by using the Box and block test. Changes in the performance of daily activities were measured using the Korea-Modified Barthel Index. Results The mean upper limb function score of the chronic stroke patients increased significantly from 21.88 ± 19.99 before the intervention, to 26.22 ± 15.65 after the intervention (p < 0.05), and the mean daily activities score increased significantly from 65.82 ± 12.04, to 67.29 ± 12.90 (p < 0.05). Conclusion Dual task training effectively improved upper extremity function, and the performance of daily activities in chronic stroke patients.
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Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, Health Science College, Cheongju University, Cheongju, Korea
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22
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Coelho DB, Fernandes CA, Martinelli AR, Teixeira LA. Right in Comparison to Left Cerebral Hemisphere Damage by Stroke Induces Poorer Muscular Responses to Stance Perturbation Regardless of Visual Information. J Stroke Cerebrovasc Dis 2019; 28:954-962. [PMID: 30630757 DOI: 10.1016/j.jstrokecerebrovasdis.2018.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/22/2018] [Accepted: 12/14/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Fast and scaled muscular activation is required to recover body balance following an external perturbation. An issue open to investigation is the extent to which the cerebral hemisphere lesioned by stroke leads to asymmetric deficits in postural reactive responses. In this experiment, we aimed to compare muscular responses to unanticipated stance perturbations between individuals who suffered unilateral stroke either to the right or to the left cerebral hemisphere. METHODS Stance perturbations were produced by releasing a load attached to the participant's trunk, inducing fast forward body oscillation. Electromyography was recorded from the gastrocnemius medialis and biceps femoris muscles. Muscular activation from age-matched healthy individuals was taken as reference. RESULTS Analysis indicated that damage to the right hemisphere induced delayed activation onset, and lower rate and magnitude of activation of the proximal and distal muscles of the paretic leg. Those deficits were associated with stronger activation of the nonparetic leg. Comparisons between left hemisphere damage and controls showed deficits limited to activation of the biceps femoris of the paretic leg. Manipulation of visual information led to no significant effects on muscular responses. CONCLUSIONS These results suggest that right cerebral hemisphere damage by stroke leads to more severe deficits in the generation of reactive muscular responses to stance perturbation than damage to the left cerebral hemisphere regardless of visual information.
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Affiliation(s)
- Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, SP, Brazil; Biomedical Engineering, Federal University of ABC, São Bernardo do Campo, SP, Brazil.
| | - Corina Aparecida Fernandes
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, SP, Brazil
| | | | - Luis Augusto Teixeira
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, SP, Brazil
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23
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The duration effects of lumbar extensor muscle fatigue on postural control in soccer players. Med J Islam Repub Iran 2018; 31:112. [PMID: 29951413 PMCID: PMC6014804 DOI: 10.14196/mjiri.31.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Indexed: 12/04/2022] Open
Abstract
Background: The ability to maintain body position in space is called postural control. Muscular fatigue created after doing voluntary repeated contractions impairs postural control. Thus, the present study was conducted to compare the effects of fatigue of the lumbar
extensor muscles and duration of these effects on postural sway between soccer player and non-athlete participants.
Methods: A total of 15 male soccer players and 15 male non-athletes participated in this cross- sectional study. Lumbar extensor
fatigue is produced by a dynamometer and maintains 60% of the maximum voluntary isometric contraction in standing position. The
mean velocity and the total area of the participants were evaluated using force plate at baseline, immediately, 3, 6, and 9 minutes after
fatigue and compared between the 2 groups. Descriptive statistics, repeated measurement ANOVA, and independent t test were used for
data analysis.
Results: The results demonstrated that fatigue of the waist extensor muscles affects the postural sway (p= 0.001). Also, the total area
level was recovered earlier than the mean velocity after fatigue. The results revealed that total area and velocity with eyes closed decreased
in the soccer player group compared with the non-athlete group.
Conclusion: Lumbar extensors fatigue significantly changed the mean velocity and the total area in soccer players and non-athletes.
Lumbar fatigue had more effects on the total area than the mean velocity in the two groups.
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Martinelli AR, Coelho DB, Teixeira LA. Light touch leads to increased stability in quiet and perturbed balance: Equivalent effects between post-stroke and healthy older individuals. Hum Mov Sci 2018. [DOI: 10.1016/j.humov.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Right cerebral hemisphere specialization for quiet and perturbed body balance control: Evidence from unilateral stroke. Hum Mov Sci 2018; 57:374-387. [DOI: 10.1016/j.humov.2017.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 01/11/2023]
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Park J. Dual task training effects on balance and hand functions of stroke patients. J Phys Ther Sci 2017; 29:1878-1880. [PMID: 29184311 PMCID: PMC5684032 DOI: 10.1589/jpts.29.1878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/07/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this research is to take a look at the influences of the dual
task training on the hand function and the balance ability of the stroke patients.
[Subjects and Methods] The dual task training was applied to 2 stroke hemiplegia patients.
The dual task training had been carried out for 30 minutes by each session for 5 days a
week for 3 weeks. The evaluations had been carried out 5 times for 3 weeks before and
after the intervention. And the changes of the hand function had been measured by using
the box and block test. And, for the changes of the balancing ability, the Berg Balance
Scale was used. [Results] Both the hand function and the balancing ability of the subjects
were improved after the dual task training. [Conclusion] Through the results of the
research, it was able to confirm that the dual task training is effective for the
enhancements of the hand function and the balancing ability of the stroke patients.
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Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, Health Science College, Cheongju University: 298 Daesung-ro, Cheongwon-gu, Cheongju 363-764, Republic of Korea
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Mehdizadeh H, Khalaf K, Ghomashchi H, Taghizadeh G, Ebrahimi I, Taghavi Azar Sharabiani P, Mousavi SJ, Parnianpour M. Effects of cognitive load on the amount and temporal structure of postural sway variability in stroke survivors. Exp Brain Res 2017; 236:285-296. [PMID: 29138873 DOI: 10.1007/s00221-017-5126-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
This study aimed to investigate the variability in postural sway patterns during quiet standing in stroke survivors. The postural sway was measured in 19 stroke survivors, as well as 19 healthy demographically matched participants, at 3 levels of postural difficulty (rigid surface with closed and open eyes, and foam surface with closed eyes), and 3 levels of cognitive difficulty (without a cognitive task, easy and difficult cognitive tasks). Both linear analyses (the amount of postural sway variability, including the standard deviation of the COP velocity in both the anteroposterior (AP) and mediolateral (ML) directions), as well as non-linear analyses [the temporal structure of the COP variability, including % Recurrence, % Determinism, Shannon Entropy, Trend and the maximum diagonal line (D max)] were employed. The results revealed that the amount of variability of the postural sway of stroke survivors was significantly greater than that of healthy participants, along both the ML and AP directions, with the highest obtained during standing on foam with closed eyes. All measures of the temporal structure of the COP variability were significantly greater in stroke survivors, as compared to the control group, along the ML direction, but not along the AP direction. The cognitive error was significantly higher during difficult cognitive tasks, although it was neither affected by postural difficulty nor by group. The different results obtained for the amount and temporal structure of the COP variability in the AP and ML directions shed light on the intricate mechanisms employed by the CNS in post-stroke balance control, and suggest that effective rehabilitative and therapeutic strategies should be patient-specific, taking both the environment/surface as well as the specific protocols into consideration.
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Affiliation(s)
- Hajar Mehdizadeh
- Department of Neurosciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science, Technology and Research, Abu Dhabi, UAE
| | - Hamed Ghomashchi
- Faculty of Mechanical and Industrial Engineering, Islamic Azad University, Qazvin Branch, Qazvin, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Shahnazari Street, Mirdamad Boulevard, Tehran, Iran. .,Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ismaeil Ebrahimi
- Department of Physical Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran
| | | | | | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Zeinalzadeh A, Talebian S, Naghdi S, Salavati M, Nazary-Moghadam S, Zeynalzadeh Ghoochani B. Effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome. Physiother Theory Pract 2017; 34:276-285. [PMID: 29120261 DOI: 10.1080/09593985.2017.1391360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome (PFPS). METHODS Twenty-eight PFPS patients and 28 controls participated in the study. Postural control was assessed in isolation as well as with visual manipulation and cognitive loading on symptomatic limb. The outcome measures of postural control were quantified in terms of area, anterior-posterior (AP), medial-lateral (ML), and mean velocity (MV) of the displacements of center of pressure (COP). In addition, cognitive performance (auditory Stroop task) was measured in the forms of average reaction time and error ratio in baseline (sitting) and different postural conditions. RESULTS PFPS subjects showed greater increases in area (p = 0.01), AP (p = 0.01), and ML (p = 0.05) displacements of COP in the blindfolded tasks as compared to control group. However, cognitive load did not differently affect postural control in the two groups. Although PFPS and control group had similar reaction times in the sitting position (p = 0.29), PFPS subjects had longer reaction times than healthy subjects in dual task conditions (p = 0.04). CONCLUSION Visual inputs seem to be essential for discriminating postural control between PFPS and healthy individuals. PFPS patients biased toward decreasing cognitive performance more than healthy subjects when they perform the single leg stance and cognitive task concurrently.
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Affiliation(s)
- Afsaneh Zeinalzadeh
- a Department of Physical Therapy , Tehran University of Medical Sciences , Tehran , Iran
| | - Saeed Talebian
- a Department of Physical Therapy , Tehran University of Medical Sciences , Tehran , Iran
| | - Soofia Naghdi
- a Department of Physical Therapy , Tehran University of Medical Sciences , Tehran , Iran
| | - Mahyar Salavati
- b Department of Physiotherapy , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Salman Nazary-Moghadam
- c School of Paramedical Sciences , Mashhad University of Medical Sciences , Mashhad , Iran
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The effects of cognitive versus motor demands on postural performance and weight bearing asymmetry in patients with stroke. Neurosci Lett 2017; 659:75-79. [PMID: 28866051 DOI: 10.1016/j.neulet.2017.08.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/12/2017] [Accepted: 08/24/2017] [Indexed: 11/21/2022]
Abstract
While several studies have investigated the interaction between postural control and secondary cognitive tasks in stroke patients, little is known about the influence of secondary motor task on postural control in these patients. The current research was designed to further examine dual-task performance by comparing the effects of cognitive versus motor dual-tasks on postural performance and weight bearing asymmetry (WBA) in stroke patients (n=23) relative to healthy, matched controls (n=22). All participants stood on dual-force plate under 5 conditions: (1) free standing; (2) simple cognitive task (easy Stroop) while standing; (3) difficult cognitive task (difficult Stroop) while standing; (4) simple motor task (holding a tray while a cylinder lying on its flat side) while standing; and (5) difficult motor task (holding a tray while a cylinder lying on its round side) while standing. The center of pressure (COP) measures was greater in stroke patients than healthy controls. Also, the WBA of the patients was greater than the controls. The COP measures increased when moving from single-task to cognitive dual-task conditions. No significant effect of motor dual-tasking was seen when moving from single-task to motor dual-task conditions. However, in contrast to cognitive dual-tasking, stroke patients and healthy controls employed different strategies during simultaneous performance of postural and motor tasks. It can be suggested that performing a motor task while standing requires greater attentional resources compared to performing a cognitive task while standing and this resulted in greater dual-task interference on motor performance in the stroke patients.
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Ghai S, Ghai I, Effenberg AO. Effects of dual tasks and dual-task training on postural stability: a systematic review and meta-analysis. Clin Interv Aging 2017; 12:557-577. [PMID: 28356727 PMCID: PMC5367902 DOI: 10.2147/cia.s125201] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The use of dual-task training paradigm to enhance postural stability in patients with balance impairments is an emerging area of interest. The differential effects of dual tasks and dual-task training on postural stability still remain unclear. A systematic review and meta-analysis were conducted to analyze the effects of dual task and training application on static and dynamic postural stability among various population groups. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, from inception until June 2016, on the online databases Scopus, PEDro, MEDLINE, EMBASE, and SportDiscus. Experimental studies analyzing the effects of dual task and dual-task training on postural stability were extracted, critically appraised using PEDro scale, and then summarized according to modified PEDro level of evidence. Of 1,284 records, 42 studies involving 1,480 participants met the review’s inclusion criteria. Of the studies evaluating the effects of dual-task training on postural stability, 87.5% of the studies reported significant enhancements, whereas 30% of the studies evaluating acute effects of dual tasks on posture reported significant enhancements, 50% reported significant decrements, and 20% reported no effects. Meta-analysis of the pooled studies revealed moderate but significant enhancements of dual-task training in elderly participants (95% CI: 1.16–2.10) and in patients suffering from chronic stroke (−0.22 to 0.86). The adverse effects of complexity of dual tasks on postural stability were also revealed among patients with multiple sclerosis (−0.74 to 0.05). The review also discusses the significance of verbalization in a dual-task setting for increasing cognitive–motor interference. Clinical implications are discussed with respect to practical applications in rehabilitation settings.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University, Hannover, Germany; Department of Sports Science, University of Waikato, Hamilton, New Zealand
| | - Ishan Ghai
- School of Engineering & Life Sciences, Jacobs University, Bremen, Germany
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Schinkel-Ivy A, Huntley AH, Inness EL, Mansfield A. Timing of reactive stepping among individuals with sub-acute stroke: effects of 'single-task' and 'dual-task' conditions. Heliyon 2016; 2:e00186. [PMID: 27861645 PMCID: PMC5103078 DOI: 10.1016/j.heliyon.2016.e00186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/23/2016] [Accepted: 10/21/2016] [Indexed: 10/26/2022] Open
Abstract
Performance decrements in balance tasks are often observed when a secondary cognitive task is performed simultaneously. This study aimed to determine whether increased cognitive load resulted in altered reactive stepping in individuals with sub-acute stroke, compared to a reactive stepping trial with no secondary task. The secondary purpose was to determine whether differences existed between the first usual-response trial, subsequent usual-response trials, and the dual-task condition. Individuals with sub-acute stroke were exposed to external perturbations to elicit reactive steps. Perturbations were performed under a usual-response (single-task) and dual-task condition. Measures of step timing and number of steps were based on force plate and video data, respectively; these measures were compared between the usual-response and dual-task trials, and between the first usual-response trial, later usual-response trials (trials 2-5) and a dual-task trial. A longer time of unloading onset and greater number of steps were identified for the first usual-response trial compared to later usual-response trials. No significant differences were identified between usual-response and dual-task trials. Although improvements were observed from the first to subsequent usual-response lean-and-release trials, performance then tended to decrease with the introduction of the dual-task condition. These findings suggest that when introduced after usual-response trials, the dual-task trial may represent the first trial of a new condition, which may be beneficial in reducing the potential for adaptation that may occur after multiple repetitions of a reactive stepping task. Therefore, these findings may lend support to the introduction of a new condition (i.e. a dual-task trial) in addition to usual-response trials when assessing reactive balance in individuals with stroke.
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Affiliation(s)
- Alison Schinkel-Ivy
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; School of Physical and Health Education, Nipissing University, 100 College Drive, Box 5002, North Bay, Ontario P1B 8L7, Canada
| | - Andrew H Huntley
- Human Health and Nutritional Sciences, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Elizabeth L Inness
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute-University Health Network, 550 University Ave, Toronto, Ontario M5G 2A2, Canada; Department of Physical Therapy, University of Toronto, 500 University Ave, Toronto, Ontario M5G 1V7, Canada; Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
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Bhatt T, Subramaniam S, Varghese R. Examining interference of different cognitive tasks on voluntary balance control in aging and stroke. Exp Brain Res 2016; 234:2575-84. [PMID: 27302401 DOI: 10.1007/s00221-016-4662-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/26/2016] [Indexed: 11/26/2022]
Abstract
This study compared the effect of semantic and working memory tasks when each was concurrently performed with a voluntary balance task to evaluate the differences in the resulting cognitive-motor interference (CMI) between healthy aging and aging with stroke. Older stroke survivors (n = 10), older healthy (n = 10) and young adults (n = 10) performed the limits of stability, balance test under single task (ST) and dual task (DT) with two different cognitive tasks, word list generation (WLG) and counting backwards (CB). Cognitive ability was evaluated by recording the number of words and digits counted while sitting (ST) and during balance tasks (DT). The balance and cognitive costs were computed using [(ST-DT)/ST] × 100 for all the variables. Across groups, the balance cost was significantly higher for the older stroke survivors group in the CB condition than older healthy (p < 0.05) and young adult groups (p < 0.05) but was similar between these two groups for the WLG task. Similarly, the cognitive cost was significantly higher in older stroke survivors than in older healthy (p < 0.05) and young adults (p < 0.01) for both the cognitive tasks. The working memory task resulted in greater CMI than the semantic one, and this difference seemed to be most apparent in older stroke survivors. Young adults showed the least CMI, with a similar performance on the two memory tasks. On the other hand, healthy aging and stroke impact both semantic and working memory. Stroke-related cognitive deficits may further significantly decrease working memory function.
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Affiliation(s)
- Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA.
| | - Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
| | - Rini Varghese
- Department of Physical Therapy, University of Illinois at Chicago, 1919, W Taylor St, Chicago, IL, 60612, USA
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Alfieri FM, Riberto M, Lopes JAF, Filippo TR, Imamura M, Battistella LR. Postural Control of Healthy Elderly Individuals Compared to Elderly Individuals with Stroke Sequelae. Open Neurol J 2016; 10:1-8. [PMID: 27053967 PMCID: PMC4797679 DOI: 10.2174/1874205x01610010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/01/2015] [Accepted: 09/11/2015] [Indexed: 11/22/2022] Open
Abstract
A stroke and aging process can modify the postural control. We aimed to compare the postural control of health elderly individuals to that of individuals with stroke sequelae. This cross-sectional transversal study was made with individuals capable of walking without any assistance and that were considered clinically stable. The study had 18 individuals in the group with stroke sequelae (SG) and 34 in the healthy elderly control group (CG). The participants were evaluated for the timed up and go test (TUG) and force platform. The SG showed the worst results in relation to the time of execution of the TUG and the force platform evaluation. The displacement of center of pressure was worse for both groups in the eyes-closed situation, especially in the anteroposterior direction for the CG. The GS showed worse results in the static and dynamic postural control. The healthy elderly showed more dependence on sight to maintain their static balance and there was no difference in the balance tests in relation to the side affected by the stroke.
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Affiliation(s)
- Fábio Marcon Alfieri
- Clinical Research Center - Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, São Paulo, São Paulo, Brazil; Health Promotion Course and Physical Therapy Faculty - São Paulo Adventist University Center, São Paulo, Brazil
| | - Marcelo Riberto
- Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - José Augusto Fernandes Lopes
- Clinical Research Center - Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Thais Raquel Filippo
- Clinical Research Center - Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Marta Imamura
- Clinical Research Center - Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, São Paulo, São Paulo, Brazil
| | - Linamara Rizzo Battistella
- Clinical Research Center - Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, São Paulo, São Paulo, Brazil
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Hussein ZA. Effect of using visual cognitive task on gait in children with spastic diplegia. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2016. [DOI: 10.4103/1110-6611.174716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Choi JH, Kim BR, Han EY, Kim SM. The effect of dual-task training on balance and cognition in patients with subacute post-stroke. Ann Rehabil Med 2015; 39:81-90. [PMID: 25750876 PMCID: PMC4351499 DOI: 10.5535/arm.2015.39.1.81] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 09/29/2014] [Indexed: 01/08/2023] Open
Abstract
Objective To investigate the effect of dual-task training on the recovery of balance ability and cognitive function in patients with subacute stroke. Methods Twenty patients (12 males and eight females; average age, 59.70 years) with subacute stroke were enrolled in this study. All participants were randomly assigned to one of two groups, the dual-task group (n=10) or the control group (n=10). The dual task was simultaneous balance and cognitive training using the BioRescue. All patients were evaluated with posturographic parameters and the Berg Balance Scale for balance ability, a computerized neuropsychological test and the Korean version of the Mini-Mental State Examination for cognitive function, the Fugl-Meyer Assessment for motor function, and the Korean-Modified Barthel Index for activities of daily living (ADL) function before and after 4 weeks of rehabilitation. Results The dual-task group showed significant improvements in the pressure of the weight distribution index (WDI), surface area, and length of the stability index during the eyes-open condition; surface area of the limit of stability (LOS) on the hemiparetic and intact sides, and the auditory continuous performance test and backward visual span test after rehabilitation. Although no significant difference was observed for the changes in balance ability or cognitive, motor, and ADL functions between the groups, changes in the WDI pressure during the eyes-open condition and in the area ratio of LOS (hemiparetic/intact) showed a tendency to improve in the dual-task group. Conclusion Our findings suggest that dual-task training could be as effective as conventional balance training for improving balance and cognition in subacute post-stroke patients.
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Affiliation(s)
- Jun Hwan Choi
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Bo Ryun Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Mi Kim
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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Mehdizadeh H, Taghizadeh G, Ghomashchi H, Parnianpour M, Khalaf K, Salehi R, Esteki A, Ebrahimi I, Sangelaji B. The effects of a short-term memory task on postural control of stroke patients. Top Stroke Rehabil 2015; 22:335-41. [DOI: 10.1179/1074935714z.0000000039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pohl PS, Kemper S, Siengsukon CF, Boyd L, Vidoni ED, Herman RE. Dual-Task Demands of Hand Movements for Adults with Stroke: A Pilot Study. Top Stroke Rehabil 2015; 18:238-47. [DOI: 10.1310/tsr1803-238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Choi W, Lee G, Lee S. Effect of the cognitive-motor dual-task using auditory cue on balance of surviviors with chronic stroke: a pilot study. Clin Rehabil 2014; 29:763-70. [DOI: 10.1177/0269215514556093] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 09/25/2014] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the effect of a cognitive-motor dual-task using auditory cues on the balance of patients with chronic stroke. Design: Randomized controlled trial. Setting: Inpatient rehabilitation center. Subjects: Thirty-seven individuals with chronic stroke. Interventions: The participants were randomly allocated to the dual-task group ( n=19) and the single-task group ( n=18). The dual-task group performed a cognitive-motor dual-task in which they carried a circular ring from side to side according to a random auditory cue during treadmill walking. The single-task group walked on a treadmill only. All subjects completed 15 min per session, three times per week, for four weeks with conventional rehabilitation five times per week over the four weeks. Main measures: Before and after intervention, both static and dynamic balance were measured with a force platform and using the Timed Up and Go (TUG) test. Results: The dual-task group showed significant improvement in all variables compared to the single-task group, except for anteroposterior (AP) sway velocity with eyes open and TUG at follow-up: mediolateral (ML) sway velocity with eye open (dual-task group vs. single-task group: 2.11 mm/s vs. 0.38 mm/s), ML sway velocity with eye close (2.91 mm/s vs. 1.35 mm/s), AP sway velocity with eye close (4.84 mm/s vs. 3.12 mm/s). After intervention, all variables showed significant improvement in the dual-task group compared to baseline. Conclusion: The study results suggest that the performance of a cognitive-motor dual-task using auditory cues may influence balance improvements in chronic stroke patients.
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Affiliation(s)
- Wonjae Choi
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
- Institute of Rehabilitation Science, Seoul, South Korea
| | - GyuChang Lee
- Department of Physical Therapy, College of Natural Science, Kyungnam University, Changwon-si, South Korea
| | - Seungwon Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, South Korea
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Postural perturbations induced by a moving virtual environment are reduced in persons with brain injury when gripping a mobile object. J Neurol Phys Ther 2014; 38:125-33. [PMID: 24572500 DOI: 10.1097/npt.0000000000000035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Gripping a mobile (unfixed) object increases standing postural stability in healthy individuals. We tested whether the same strategy is effective for stabilizing upright posture perturbed by a moving environment (virtual perturbation) in participants with traumatic brain injury (TBI). METHODS Fifteen participants with mild-to-moderate postural deficits after TBI and a comparison group of 15 age-matched healthy subjects participated in the study. Participants stood for 1 minute in front of a large screen with a projected three-dimensional image of a boat; for 30 seconds the boat remained stationary (no visual stimulation condition), and for 30 seconds the boat rocked on the water at a speed of 15°/s (visual stimulation condition). The visual stimulation was applied in pseudorandom order (during either the first or second half of the 1-minute trial). To analyze postural stability, the displacement and velocity of the center of mass in the sagittal and frontal planes were compared between groups and across 4 experimental conditions, including standing with/without visual stimulation and with/without gripping a 300-g object (short wooden stick) in the dominant hand. RESULTS Participants with TBI showed greater instability under all experimental conditions. The visual stimulation significantly increased postural oscillations in the sagittal plane by 35% to 63% across groups. Gripping a stick significantly reduced the stimulation-induced instability in the sagittal plane by 19% to 29%, although not to the level of the no-stimulation condition in either group. CONCLUSION The stabilizing effect of gripping an external object in participants with TBI was confirmed. A possibility of using this effect as a balance aid strategy requires further investigation.
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Cho KH, Lee HJ, Lee WH. Test-retest reliability of the GAITRite walkway system for the spatio-temporal gait parameters while dual-tasking in post-stroke patients. Disabil Rehabil 2014; 37:512-6. [PMID: 24957081 DOI: 10.3109/09638288.2014.932445] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the test-retest reliability of spatio-temporal gait parameters during performance of single- and dual-tasking in post-stroke patients. METHOD This study was conducted using a single-group repeated-measures design, involving a baseline measurement session and a follow-up session two days later. Forty-three chronic stroke patients (>6 months) participated in this study. Spatio-temporal gait parameters under the single- and dual-task conditions at a self-selected comfortable gait speed were measured using the GAITRite walkway system. Intraclass correlation coefficients [ICC(2,1)] were calculated for determination of reliability between sessions. The level of agreement between the two sessions was determined using Bland-Altman 95% limits of the agreement plots. RESULTS In all gait parameters, a significant difference was observed between the single- and dual-task conditions (p < 0.05). For the single condition, ICC (95% CI) was very good for all measures, ranging from 0.98 to 0.99 (0.97-0.99). In addition, for the dual-task condition, ICC (95% CI) was good to very good for all measures, ranging from 0.69 to 0.90 (0.49-0.99). CONCLUSIONS The results of current study demonstrated that the test-retest reliability of the GAITRite system for measurement of spatio-temporal gait parameters under single- and dual-task conditions was good to very good. Therefore, we suggest that measurement of spatio-temporal gait parameters under a dual-task condition using the GAITRite system would be useful for clinical assessment in post-stroke patients. IMPLICATIONS FOR REHABILITATION Improvement of walking ability provides opportunities for stroke patients to participate in the community. Our finding, additional cognitive tasks can interfere with the independently basic activities of daily living in stroke patients, may provide basic information for use in development of rehabilitation programs for stroke patients. Spatio-temporal gait parameters under the dual-task condition measured using the GAITRite system may be useful for clinical assessment in post-stroke patients.
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Affiliation(s)
- Ki Hun Cho
- Department of Rehabilitative & Assistive Technology, Korea National Rehabilitation Research Institute , Seoul, Republic of Korea and
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Shin S, Chung HR, Fitschen PJ, Kistler BM, Woo Park H, Wilund KR, Sosonff JJ. Postural control in hemodialysis patients. Gait Posture 2014; 39:723-7. [PMID: 24189110 PMCID: PMC3946821 DOI: 10.1016/j.gaitpost.2013.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/12/2013] [Accepted: 10/08/2013] [Indexed: 02/02/2023]
Abstract
The current investigation examined whether patients undergoing hemodialysis (HD) have reduced standing postural control performance during simultaneous cognitive task performance (i.e. dual task cost (DTC)) compared to age-gender matched controls. 19 persons undergoing HD and 19 age, gender, and body mass index (BMI) matched controls participated in the investigation. All participants performed 2 trials of quiet standing balance and 2 postural trials in which they performed a cognitive task. Postural control was indexed with various measures of the center of pressure (COP) trajectory. The change in postural control with a cognitive task (e.g. dual task cost DTC) was quantified as a change in the center of COP parameters of postural control from quiet standing to the cognitive condition. The primary observations were that (1) HD patients had significantly greater postural sway than age, gender, BMI matched controls (p's < 0.05); (2) HD patients had a greater DTC than the controls during quiet standing (p's < 0.05). The observations highlight that HD participants have poor postural control that is further exacerbated by a simultaneous performance of a cognitive task. It is possible that this impaired postural control places HD participants at elevated fall risk. Further study is necessary to determine contributing factors to an increased DTC in this population and whether targeted interventions such as exercise can reduce DTC.
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Affiliation(s)
- Sunghoon Shin
- Department of Biomedical Engineering, Kyung Hee Univeristy, Yongin, Korea
| | - Hae Ryong Chung
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Peter J. Fitschen
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, US
| | - Brandon M. Kistler
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Hyun Woo Park
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Kenneth R. Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
| | - Jacob J Sosonff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, US
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Kim D, Ko J, Woo Y. Effects of dual task training with visual restriction and an unstable base on the balance and attention of stroke patients. J Phys Ther Sci 2014; 25:1579-82. [PMID: 24409024 PMCID: PMC3885843 DOI: 10.1589/jpts.25.1579] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of the
visual restriction and unstable base dual-task training (VUDT), the visual restriction
dual-task training (VDT), and the unstable base dual-task training (UDT) on the balance
and attention of chronic stroke patients. [Subjects and Methods] The subjects were 38
chronic stroke patients, who were divided into two groups of 13 patients each and one
group of 12 patients. They were given dual-task training for 30 minutes per session, three
times a week, for eight weeks. Their balance was measured using the center of pressure
(COP) migration distances, functional reach test (FRT), and Berg balance scale (BBS), and
attention was measured with the Trail Making Tests and the Stroop test. [Results] In
comparisons within each group, all the three groups showed significant differences before
and after the training (p<0.05), and in the comparisons among the three groups, the
VUDT group showed more significant differences compared with the other two groups in all
tests (p<0.05). [Conclusion] Dual-task training applied with visual restriction and an
unstable base in which the subjects attempted to maintain their balance was effective in
improving the balance and attention of stroke patients, and the VUDT was more effective
than VDT or UDT.
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Affiliation(s)
- Donghoon Kim
- Department of Rehabilitation Medicine, Karis Hospital, Republic of Korea
| | - Jooyeon Ko
- Bundang CHA Medical Center, Republic of Korea
| | - Youngkeun Woo
- Department of Physical Therapy, JeonJu University, Republic of Korea
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Bourlon C, Lehenaff L, Batifoulier C, Bordier A, Chatenet A, Desailly E, Fouchard C, Marsal M, Martinez M, Rastelli F, Thierry A, Bartolomeo P, Duret C. Dual-tasking postural control in patients with right brain damage. Gait Posture 2014; 39:188-93. [PMID: 23916691 DOI: 10.1016/j.gaitpost.2013.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/30/2013] [Accepted: 07/01/2013] [Indexed: 02/02/2023]
Abstract
The control of dual-tasking effects is a daily challenge in stroke neurorehabilitation. It maybe one of the reasons why there is poor functional prognosis after a stroke in the right hemisphere, which plays a dominant role in posture control. The purpose of this study was to explore cognitive motor interference in right brain-lesioned and healthy subjects maintaining a standing position while performing three different tasks: a control task, a simple attentional task and a complex attentional task. We measured the sway area of the subjects on a force platform, including the center of pressure and its displacements. Results showed that stroke patients presented a reduced postural sway compared to healthy subjects, who were able to maintain their posture while performing a concomitant attentional task in the same dual-tasking conditions. Moreover, in both groups, the postural sway decreased with the increase in attentional load from cognitive tasks. We also noticed that the stability of stroke patients in dual-tasking conditions increased together with the weight-bearing rightward deviation, especially when the attentional load of the cognitive tasks and lower limb motor impairments were high. These results suggest that stroke patients and healthy subjects adopt a similar postural regulation pattern aimed at maintaining stability in dual-tasking conditions involving a static standing position and different attention-related cognitive tasks. Our results indicate that attention processes might facilitate static postural control.
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Affiliation(s)
- Clémence Bourlon
- Service de Rééducation et de Réadaptation Fonctionnelle, Clinique Les Trois Soleils, Boissise le Roi, France.
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Harvey N, Ada L. Suitability of Nintendo Wii Balance Board for rehabilitation of standing after stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x12y.0000000032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Bourlon C, Lehenaff L, Batifoulier C, Bordier A, Chatenet A, Desailly E, Fouchard C, Marsal M, Martinez M, Rastelli F, Thierry A, Bartolomeo P, Duret C. Interaction entre performances posturales et cognitives chez des patients cérébrolésés droits : une étude en double tâche. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bourlon C, Lehenaff L, Batifoulier C, Bordier A, Chatenet A, Desailly E, Fouchard C, Marsal M, Martinez M, Rastelli F, Thierry A, Bartolomeo P, Duret C. Interaction between postural and cognitive performances in right brain damaged patients: A dual task study. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Plummer P, Eskes G, Wallace S, Giuffrida C, Fraas M, Campbell G, Clifton KL, Skidmore ER. Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Arch Phys Med Rehabil 2013; 94:2565-2574.e6. [PMID: 23973751 DOI: 10.1016/j.apmr.2013.08.002] [Citation(s) in RCA: 172] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 12/29/2022]
Abstract
Cognitive-motor interference (CMI) is evident when simultaneous performance of a cognitive task and a motor task results in deterioration in performance in one or both of the tasks, relative to performance of each task separately. The purpose of this review is to present a framework for categorizing patterns of CMI and to examine the specific patterns of CMI evident in published studies comparing single-task and dual-task performance of cognitive and motor tasks during gait and balance activities after stroke. We also examine the literature for associations between patterns of CMI and a history of falls, as well as evidence for the effects of rehabilitation on CMI after stroke. Overall, this review suggests that during gait activities with an added cognitive task, people with stroke are likely to demonstrate significant decrements in motor performance only (cognitive-related motor interference), or decrements in both motor and cognitive performance (mutual interference). In contrast, patterns of CMI were variable among studies examining balance activities. Comparing people poststroke with and without a history of falls, patterns and magnitude of CMI were similar for fallers and nonfallers. Longitudinal studies suggest that conventional rehabilitation has minimal effects on CMI during gait or balance activities. However, early-phase pilot studies suggest that dual-task interventions may reduce CMI during gait performance in community-dwelling stroke survivors. It is our hope that this innovative and critical examination of the existing literature will highlight the limitations in current experimental designs and inform improvements in the design and reporting of dual-task studies in stroke.
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Affiliation(s)
- Prudence Plummer
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Gail Eskes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Wallace
- Department of Speech Language Pathology, Duquesne University, Pittsburgh, PA
| | - Clare Giuffrida
- Department of Occupational Therapy, Rush University Medical Center, Chicago, IL
| | - Michael Fraas
- Department of Communication Sciences and Disorders, Western Washington University, Bellingham, WA
| | - Grace Campbell
- School of Nursing, University of Pittsburgh, Pittsburgh, PA
| | - Kerry-Lee Clifton
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth R Skidmore
- Departments of Occupational Therapy and Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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Houwink A, Steenbergen B, Prange GB, Buurke JH, Geurts ACH. Upper-limb motor control in patients after stroke: attentional demands and the potential beneficial effects of arm support. Hum Mov Sci 2013; 32:377-87. [PMID: 23642704 DOI: 10.1016/j.humov.2012.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 01/24/2012] [Accepted: 01/28/2012] [Indexed: 11/18/2022]
Abstract
The goal of this study was to investigate the attentional load of using the upper limb in moderately and mildly affected patients after stroke, with and without arm support. Ten patients with stroke (4 mild and 6 moderate paresis) and ten healthy, gender- and age-matched control subjects performed a dual-task experiment that consisted of a circle drawing task and an auditive Stroop task. Complexity of the motor task was manipulated by supporting the arm against gravity. Individual motor (area×speed) and cognitive (accuracy/reaction time) scores during the dual-task conditions were converted into percentage scores relative to the respective single-task scores and then combined in a single measure of net dual-task performance. Without arm support, only moderately affected patients showed significantly greater side differences in dual-task performance to the detriment of the affected upper limb. With arm support, no side differences were found for any of the three groups. Thus, the hypothesis that patients with moderate upper-limb paresis suffer from a lack of automaticity of motor control was substantiated by the dual-task condition. Furthermore, supporting the arm reduced the attentional load of using the affected side.
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Affiliation(s)
- Annemieke Houwink
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Department of Rehabilitation, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Rudin-Brown CM, Filtness AJ, Allen AR, Mulvihill CM. Performance of a cognitive, but not visual, secondary task interacts with alcohol-induced balance impairment in novice and experienced motorcycle riders. ACCIDENT; ANALYSIS AND PREVENTION 2013; 50:895-904. [PMID: 22906824 DOI: 10.1016/j.aap.2012.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/28/2012] [Accepted: 07/17/2012] [Indexed: 06/01/2023]
Abstract
The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders' focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders' performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future 'drink riding' policy considerations are discussed.
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Affiliation(s)
- Christina M Rudin-Brown
- Human Factors Team, Monash University Accident Research Centre, Monash Injury Research Institute, Building 70, Wellington Road, Clayton, VIC 3800, Australia.
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Bensoussan L, Duclos Y, Rossi-Durand C. Modulation of human motoneuron activity by a mental arithmetic task. Hum Mov Sci 2012; 31:999-1013. [PMID: 23159444 DOI: 10.1016/j.humov.2012.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 02/06/2012] [Accepted: 02/15/2012] [Indexed: 10/27/2022]
Abstract
This study aimed to determine whether the performance of a mental task affects motoneuron activity. To this end, the tonic discharge pattern of wrist extensor motor units was analyzed in healthy subjects while they were required to maintain a steady wrist extension force and to concurrently perform a mental arithmetic (MA) task. A shortening of the mean inter-spike interval (ISI) and a decrease in ISI variability occurred when MA task was superimposed to the motor task. Aloud and silent MA affected equally the rate and variability of motoneuron discharge. Increases in surface EMG activity and force level were consistent with the modulation of the motor unit discharge rate. Trial-by-trial analysis of the characteristics of motor unit firing revealed that performing MA increases activation of wrist extensor SMU. It is suggested that increase in muscle spindle afferent activity, resulting from fusimotor drive activation by MA, may have contributed to the increase in synaptic inputs to motoneurons during the mental task performance, likely together with enhancement in the descending drive. The finding that a mental task affects motoneuron activity could have consequences in assessment of motor disabilities and in rehabilitation in motor pathologies.
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Affiliation(s)
- Laurent Bensoussan
- Pôle de Médecine Physique et de Réadaptation, Aix-Marseille Université, Assistance publique des Hopitaux de Marseille, CHU Timone, Marseille, France
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