Effects of Progressive Combined Cognitive Training and Rhythmic Auditory Stimulation in Treadmill Training on Walking Automaticity, Executive Function, and Dual-task Coordination for Patients With Chronic Stroke
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Stroke
- Sponsor
- Chang Gung University
- Enrollment
- 80
- Locations
- 1
- Primary Endpoint
- Stride time variability (%)
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The objective of this study is to compare the effects of progressive combined cognitive training and rhythmic auditory stimulation to treadmill training (combined group), cognitive treadmill training (cognitive group), rhythmic auditory stimulation to treadmill training (rhythmic group), and treadmill walking alone (treadmill group) on walking automaticity, executive function, and dual-task coordination for patients with chronic stroke (Aim 1). The second aim of this study is to investigate the factors affecting the results of interventions (Aim 2). The third aim of the study is to examine the characteristics of stroke population who are appropriate for progressive combined cognitive training and rhythmic auditory stimulation to treadmill training.
Detailed Description
A single-blinded, randomized controlled trial will be conducted at medical centers. Eighty stroke patients will be randomized to one of the four groups. All groups will receive interventions 30 minutes per time, 3 times a week, for 4 weeks. The combined group will undertake progressive treadmill walking speed and rhythmic auditory stimulation while performing a cognitive task. The cognitive group will receive cognitive training while walking on the treadmill. The rhythmic group will hear rhythmic auditory stimulation while treadmill walking. The treadmill group will train only in progressive treadmill walking. A blinded assessor will administer three assessments. All participants will be examined for gait and cognitive performance under single-task (walking only, Stroop task only) and dual-task conditions (walking while performing the Stroop task) at baseline, post-intervention, and one-month follow-up. The primary outcome measures of gait and cognition are gait speed and cognitive score of the Stroop task under single- and dual-task conditions. The secondary outcome measures are the Mini-BESTest, Walking Ability Questionnaire, 6-minute Walk Test, and Stroke Impact Scale. Repeated measure ANOVA will be used to compare measurements at baseline, after training, and follow-up between and within the groups.
Investigators
Li-Ling Chuang
Associated Professor
Chang Gung University
Eligibility Criteria
Inclusion Criteria
- •diagnosed with first-time stroke;
- •more than 6 months after stroke onset;
- •able to walk 10 meters;
- •no severe vision, hearing, or speech impairments;
- •understand and follow the instructions and sign the Informed Consent Form;
- •older than 20 years old.
Exclusion Criteria
- •orthopedic problems affecting walking or other diseases that may interfere with study participation;
- •a score of less than 24 on the mini-mental state examination (MMSE);
- •severe balance disorder with a total score of less than 45 points Berg Balance Scale.
Outcomes
Primary Outcomes
Stride time variability (%)
Time Frame: 5 minutes
The stride time is the duration of one cycle (from heel strike to heel strike of the same side). Stride time variability (%) is the coefficient of variation of stride time or cycle duration in percent.
Walking speed (m/s)
Time Frame: 5 minutes
Participants will walk 10 meters at their preferred speed with and without the Stroop task twice, respectively. The spatiotemporal gait parameters will be examined using Physilog® sensors (Gait Up, Switzerland) and analyzed by the Gait Analysis Package software on the USB key. Walking speed (m/s) is the mean speed of forward walking, calculated in meters per second.
Gait asymmetry (%)
Time Frame: 5 minutes
Gait asymmetry will be assessed by comparing left and right swing time, in percent. A perfect symmetry outputs a value of 0%.
Cognitive composite score
Time Frame: 5 minutes
The Stroop task is the commonly utilized dual-task paradigm and measures executive function and response inhibition, which plays a vital role during walking. Therefore, the Stroop task will be selected to assess cognitive dual-task walking. The Stroop task will be performed while sitting and walking to assess executive function under single-task and dual-task conditions. The following is the formula for calculating the cognitive composite score: Cognitive composite score of the Stroop task = \[Accuracy(%)/Reaction time(milliseconds)\] \* 100. The better the cognitive performance of the Stroop task, the higher the cognitive composite score. The instructions for the dual-task walking (walking + Stroop) are designed to encourage neutral prioritization between the two tasks ("walk at the preferred speed while performing the Stroop task as accurately and quickly as you can").
Secondary Outcomes
- Outdoor walking assessment(15 minutes)
- Task-specific dual-task interference(5 minutes)
- Walking ability questionnaire(5 minutes)
- 6-minute Walking test, 6MWT(6 minutes)
- Mini-Balance Evaluation System Test, Mini-BESTest(10 minutes)
- Stroke impact scale, SIS(10 minutes)
- Dual-task automaticity(5 minutes)