Efficacy of dual-task exercise on improving walking ability in chronic stroke patients.

INTRODUCTION : Independent walking is possible in the majority of the patients following stroke, but the patients rarely return to the pre-stroke status. The gait of the people following stroke is characterized by problems with initiation, timing, grading of muscle activity, hyper tonicity and influenced by mechanical changes in soft tissue. Gait speed, stride length, and cadence are reduced relative to normal values. Common kinematic deviation during the stance phase of gait cycle are; decreased pelvic force angles, decreased lateral pelvic tilt displacement, changed knee extension, and decreased plantar flexion angles with the swing phase being characterized by decreased hip flexion, knee extension and dorsi flexion angles. Conventional physiotherapy for gait training is generally recognized as beneficial in patients with stroke (Ernst E A Review of stroke rehabilitation and physiotherapy - Stroke 1990). The often study to compare efficacy of Dual Task walking Training with conventional walking training protocol for hemiplegic patients. AIM OF THE STUDY : To find out the “Efficacy of Dual Task Exercise Walking Training on improving walking ability in Chronic Stroke patients.” METHODS : Study Design - Experimental study Design. Sample Size - 30 Subjects with Hemiplegia allocated into Two groups each containing 15 subjects. Study Population - Subjects who are diagnosed as Hemiplegia referred by neurologist were taken as population of the study. Sampling Method - 30 Subjects who are diagnosed as Hemiplegia referred by neurologist were selected as samples for the study from the population using conventional sampling. Study Setting - Department of physiotherapy, Madha medical college and hospital, Thandalam and BM physiotherapy clinic, Perungalathur. Study Duration : 3 times a week, Total duration of study was 4 weeks. Selection Criteria : Inclusion criteria - 1. Age between 35 years – 55years, 2. Both male and female are included, 3. Subjects with Hemiplegia from a single stroke occurs at least a year earlier, 4. Subjects are able to walk 10 meter independently without a assistive device, 5. Subjects with Functional use of involved upper extremity, 6. Subjects should medically stable, 7. Subjects have an ability to understand instructions and follow commands. Exclusion Criteria - 1. Subjects with Past history of seizures, 2. Subjects with Severe multi infract sites, 3. Subjects with Traumatic brain injuries, 4. Subjects with Severe cardiovascular problems, 5. Subjects with Visual – perceptual problems, 6. Subjects with Demyelinating disease, 7. Subjects with Degenerative changes in lower extremity joints. RESULTS : From the statistical analysis it is clear that dual task gait training achieved significant results than conventional gait training done using parallel bar and mirror. Dual task gait training showed significant improvement in all the measurement parameters;-walking speed, cadence and stride length. All subjects successfully completed the study protocol. In the experimental group, the attendance rate was 100% for the 4-week training program. All participants were able to perform the exercises as planned. These results show that after the ball exercise training, significant improvement was found in all selected gait variables. On the contrary, improved gait performance was not shown in the control group. CONCLUSIONS : The results of this study showed that a 4-week ball exercise program is an effective way of improving the walking ability of a selected group of limited community ambulatory and full community ambulatory subjects with chronic stroke.