| Objective:In this study,a cognitive dual task training program was designed for stroke patients,through 8-week cognitive dual task training to explore its effectiveness on gait function,balance function,fall prediction and activities of daily living of stroke patients under single-task and dual-task conditions.The purpose of this study is to provide a safe and effective clinical walking function training for stroke patients,which is closer to daily life.Method:In this study,26 patients with motor dysfunction of walking control in convalescent were selected from the Rehabilitation Department of Huadong Hospital from 2019.10 to 2020.11.They were randomly divided into cognitive dual task training group(DT group)and single-task gait training group(ST group)with 13 cases in each group.The DT group received cognitive dual-task gait training on the C-Mill treadmill,while the ST group received the same number of single-task gait training on the C-Mill treadmill.The walking tasks of the two groups were the same,including target matching walking training,obstacle avoidance and obstacle crossing walking training.The DT group received cognitive task training in five different areas.Each group was trained for 8 weeks,5 times a week,once a day,35 min each time.The subjects were evaluated at baseline,4 weeks after training and 8 weeks after training,including 10-meter walking test(10MWT)under single-task and two dual-task conditions,sensory organization test((SOT))in Neurocom Balance Manager balance test system,Time up and go test(TUGT)under single-task and two dual-task conditions,Tinetti Balance and Gait Analysis,and Instrumental activities of daily living scale(IADL).None of the subjects dropped out during the study,and all 26 subjects completed the study.The statistical method was two-factor repeated measurement analysis of variance,and the significant level was defined as P < 0.05.Result:1.Result of Walking functionAfter training,the speed of DT group and ST group under Single task 10 MWT was significantly higher than that of baseline(p < 0.001),There was no significant difference between groups;the speed of the two groups under the Cognitive-dual task10 MWT after training was significantly higher than that of the baseline(p < 0.001,p< 0.001),and there was interaction between groups and time,and there were significant differences between the two groups at 4th and 8th weeks after training(p <0.05,p < 0.05).The speed of the two groups under the Motor-dual task 10 MWT after training was significantly higher than that before training(p < 0.001),and there was interaction between groups and time,There was no significant difference between groups.The CO-DTE%(the ability to perform cognitive gait dual tasks)of the two groups after training was significantly higher than that of the baseline(p < 0.001),and there was an interaction between groups and time,and there was a difference between groups at 8th weeks after training(p < 0.05).The MO-DTE% of the two groups was significantly higher than that of the baseline(p < 0.001),and there was an interaction between groups and time,and there was a difference between groups at 8th week(p < 0.05).2.Results of Balance functionIn the static balance index of sensory organization test,the equilibrium scores and balance strategy scores of the two groups increased with the extension of training time(p < 0.001).There was an interaction between group and time in the 3 item of equilibrium score,and there was significant difference between the two groups at the8 th week(p < 0.05).Among the dynamic balance indexes,the equilibrium scores and balance strategy scores of the two groups increased with the prolongation of training time(p < 0.001).There were significant differences in items 6 between the DT group and the ST group at the 8th week(p < 0.05).There was an interaction between groups and time in the scores of balance strategy,and there were differences in d and f items between groups in the 8th week(p < 0.05,p<0.01).3.Results of Fall predictionThe time spent on single task TUGT in both groups was lower than that before training(p < 0.001).There was interaction among time groups,and there was no difference between groups.After training,the time of Cognitive dual task TUGT in both groups was lower than that before training(p < 0.001,p < 0.001).There was interaction among time groups,and there was no difference between groups.After training,the time of Motor dual task TUGT in both groups was lower than that before training(p < 0.001).There was interaction among time groups,and there was no difference between groups.Tinetti Balance and Gait Analysis increased with the prolongation of training time in both groups(p < 0.001).There was time-group interaction,and there were differences between groups at 8 weeks after training(p < 0.05).4.Results of activities of daily livingThe scores of Instrumental activities of daily living(IADL)after training in both groups were higher than those before training(p < 0.001).There was interaction among time groups,and there was significant difference between groups at 8 weeks after training(p < 0.05).Conclusion:1.Compared with single task walking training,cognitive walking dual task training can more effectively improve the walking function of stroke patients,including single task walking ability and dual task walking ability.2.Cognitive walking dual task training can effectively improve the balance ability and postural stability of stroke patients.3.Cognitive walking dual task training can effectively prevent falls in stroke patients,improve the activities of daily living of stroke patients,and help patients better review their family and society.4.Cognitive walking dual task training is a safe and effective rehabilitation training method,which is better than walking training under the condition of single task,and is worth popularizing and using in clinic. |
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