The Effects of Dual-task Action Observation Physical Training on the Walking Ability and Activities of Daily Living in Chronic Stroke Patients

이중과제 동작관찰 신체훈련이 만성 뇌졸중 환자의 보행 능력과 일상생활 활동에 미치는 영향

  • Received : 2016.04.04
  • Accepted : 2016.05.13
  • Published : 2016.05.31


PURPOSE: The purpose of this study was to determine the efficacy of dual-task action observation training (AOT) and single-task AOT related with daily living task on walking ability and ADL performance in chronic stroke patients. METHODS: Twenty-seven chronic stroke subjects were included in the study. They were randomly assigned to three task categorieds as follows: whole dual-task AOT or partial dual-task AOT or single-task AOT rehabilitation. Whole dual-task AOT observed the movement at once and partial dual-task AOT observed the movement divided into 4 parts related functional gait and activities of daily living task for 2 minutes 30 seconds. Single-task AOT observed the movement related functional gait for 2 minutes 30 seconds. Both groups had physical training session for 12 minutes 30 seconds. The study was conducted for four weeks, with three training sessions a week, for twelve weeks. All subjects were evaluated for their walking ability and activities of daily living through devices, 10m walking test (10MWT), dynamic gait index (DGI), and Korea-Modified Barthel Index (K-MBI). RESULTS: A significant improvement of walking ability and ADL performance happened among dual-task AOT subjects, compared with a single-task AOT subjects, during the 4-weeks course treatment. The results of the study showed statistically significant differences in 10MWT (p<0.05) and DGI (p<0.05), and K-MBI (p<0.05). CONCLUSION: Our results indicated that dual-task AOT has a positive additional impact on recovery of walking ability and ADL performance in chronic stroke patients.


Action Observation;Activities of daily living;Dual-task;Gait;Stroke


  1. Bae SY, Kuk EJ. The Effects of Action Observation Physical Training on the Upper Extremity Function and Activity of Daily Living of Chronic Hemiplegic Patients. Kor J Neural Rehabil. 2012;2(2):1-9.
  2. Buccino G, Binkofski F, Fink GR et al. Action observation activates premotor and parietal areas in a somatotopic manner: an fMRI study. Eur J Neurosci. 2001;13(2): 400-4.
  3. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cogn Behav Neurol. 2006;19(1):55-63.
  4. Celnik P, Webster B, Glasser DM et al. Effects of action observation on physical training after stroke. Stroke. 2008;39(6):1814-20.
  5. Chen G, Patten C. Treadmill training with harness support: selection of parameters for individuals with poststroke hemiparesis. J Rehabil Res Dev. 2006;43(4):485.
  6. Dobkin BH. Rehabilitation after stroke. N Engl J Med. 2005;352(16):1677-84.
  7. Ewan LM, Kinmond K, Holmes PS. An observation-based intervention for stroke rehabilitation: experiences of eight individuals affected by stroke. Disabil Rehabil. 2010;32(25):2097-106.
  8. Franceschini M, Agosti M, Cantagallo A et al. Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med. 2010;46(4): 517-23.
  9. Fulk GD, Echternach JL. Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke. J Neurol Phys Ther. 2008;32(1):8-13.
  10. Gatti R, Tettamanti A, Gough P et al. Action observation versus motor imagery in learning a complex motor task: a short review of literature and a kinematics study. Neurosci Lett. 2013;540:37-42.
  11. Granger CV, Albrecht GL, Hamilton BB. Outcome of comprehensive medical rehabilitation: measurement by PULSES profile and the Barthel Index. Arch Phys Med Rehabil. 1979;60(4):145-54.
  12. Hickok G. Eight problems for the mirror neuron theory of action understanding in monkeys and humans. J Cogn Neurosci. 2009;21(7):1229-43.
  13. Hill K, Ellis P, Bernhardt J et al. Balance and mobility outcomes for stroke patients: a comprehensive audit. Aust J Physiother. 1997;43(3):173-80.
  14. Horak FB. Assumptions underlying motor control for neurologic rehabilitation. In M. J. Lister, Contemporary Management of Motor Control Problems: Proceedings of II STEP conference(pp.11-27). Alexandria: Foundation of Physical Therapy. 1991.
  15. Iacoboni M, Molnar-Szakacs I, Gallese V et al. Grasping the intentions of others with one's own mirror neuron system. PLoS Biol. 2005;3(3):e79.
  16. Jonsdottir J, Gattaneo D. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil. 2007;88(11):1410-5.
  17. Jorgensen HS, Nakayama H, Raaschou HO et al. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76(1): 27-32.
  18. Kandel ER, Schwartz JH, Jessell TM. Principles of neural science. McGraw-hill New York, 2000.
  19. Kang KY. Effects of Observed Action Gait Training on Spatio-temporal Parameter and Motivation of Rehabilitation in Stroke Patients. J Korean Soc Phys Med. 2013;8(3):351-60.
  20. Keysers C, Gazzola V. Social neuroscience: mirror neurons recorded in humans. Curr Biol. 2010;20(8):R353-4.
  21. Kim JK, Lee HM. The Effect of Action Observation Training on Sit to Walk with Chronic Stroke Patients. J Kor Phys Ther. 2015;27(6):413-8.
  22. Kim SM. Neural anatomy and physiology. Seoul: Jungdammedia Publishing Company, 2010.
  23. Kizony R, Levin MF, Hughey L et al. Cognitive load and dual-task performance during locomotion poststroke: a feasibility study using a functional virtual environment. Phys Ther. 2010;90(2):252-60.
  24. Martineau J, Andersson F, Barthelemy C et al. Atypical activation of the mirror neuron system during perception of hand motion in autism. Brain Res. 2010;1320:168-75.
  25. Miller EL, Murray L, Richards L et al. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient a scientific statement from the American Heart Association. Stroke. 2010;41(10): 2402-48.
  26. O'Shea S, Morris ME, Iansek R. Dual task interference during gait in people with Parkinson disease: effects of motor versus cognitive secondary tasks. Phys The. 2002; 82(9):888-97.
  27. Page SJ, Levine P, Sisto S et al. A randomized efficacy and feasibility study of imagery in acute stroke. Clin Rehabil. 2001;15(3):233-40.
  28. Park HR, Kim JM, Lee MK et al. Clinical feasibility of action observation training for walking function of patients with post-stroke hemiparesis: a randomized controlled trial. Clin Rehabil. 2014;28(8):794-803.
  29. Pohl M, Mehrholz J, Ritschel C et al. Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients A Randomized Controlled Trial. Stroke. 2002;33(2):553-8.
  30. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-92.
  31. Rizzolatti G, Fogassi L, Gallese V. Neurophysiological mechanisms underlying the understanding and imitation of action. Nat Rev Neurosci. 2001;2(9): 661-70.
  32. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemio. 1989;42(8):703-9.
  33. Van Merrienboer JJG, Ayres P. Research on cognitive load theory and its design implication for E-learning. Edu Technol Res Dev. 2005;53(3):5-13.
  34. Yang YP, Kim JY, Han MR et al. The Effect of Action Observation Training on Affected Side Upper Limb Dexterity in Stroke Patient: Single-subject research design. J Korean Soc Phys Med. 2012;7(1):111-8.
  35. Yang YR, Chen YC, Lee CS et al. Dual-task-related gait changes in individuals with stroke. Gait posture. 2007; 25(2):185-90.

Cited by

  1. Comparison of Cognitive Task-Directed Motor Control Ability in Younger and Older Subjects vol.12, pp.1, 2017,
  2. The Effect of Action Observation with Observation Type on Limits of Stability and Dynamic Gait Ability in Stroke Patients vol.12, pp.1, 2017,