Effects of Performing Dual Task on Temporospatial Gait Variables in Subjects With Subacute Stroke

아급성기 뇌졸중 환자의 이중 과제 수행이 보행의 시·공간적 변수에 미치는 영향

  • Jang, Young-Min (Department of Physical Therapy, National Rehabilitation Center)
  • 장영민 (국립재활원 물리치료실)
  • Received : 2017.10.31
  • Accepted : 2017.11.27
  • Published : 2017.12.31


Purpose: The purpose of this study was to examine the effects of performing a dual task on gait velocity, temporospatial variables, and symmetry in subjects with subacute stroke. Methods: The study included 14 independent community ambulators with gait velocity of 0.8m/s. The Korean mini-mental state examination, the Berg balance scale, the Trunk impairment scale, and the Fugl-Meyer assessment scale were used to recruit homogeneous subjects. Subjects performed a single task (10m ambulation at a comfortable speed) and a dual task (10m ambulation at a comfortable speed while carrying a water-filled glass). Gait variables were examined with the OptoGait system. Results: The findings of this study were as follows: 1) Gait velocity decreased significantly in the dual-task condition as compared to the single task condition. 2) There were no significant differences between the paretic and non-paretic stances. 3) Paretic swing decreased significantly in the dual-task condition as compared to the single task condition. 4) The non-paretic, double-limb support phase increased significantly in the dual-task condition as compared to the single- task condition. 5) There was no significant difference in temporal symmetry. 6) Non-paretic step length decreased significantly in the dual-task condition as compared to the single-task condition. 7) There was no significant difference in spatial symmetry. Conclusion: Performing dual tasks decreases gait velocity, paretic swing phase, and non-paretic step length, while it increases non-paretic double limb support. In addition, although there is no difference in temporospatial symmetry, there is high inter-subject variability in temporospatial symmetry. Thus, dual tasks should be selected in accordance with the functional level of the hemiplegic patient, and inter-subject variability of the individual should be considered when dual tasks are considered for gait-training of hemiplegic patients.


  1. Belgen B, Beninato M, Sullivan PE, et al. The association of balance capacity and falls self-efficacy with history of falling in community-dwelling people with chronic stroke. American Journal of Physical Medicine & Rehabilitation. 2006;87(4):554-561.
  2. Berg KO, Maki BE, Williams JI, et al. Clinical and laboratory measures of postural balance in an elderly population. American Journal of Physical Medicine & Rehabilitation. 1992;73(11):1073-1080.
  3. Bohannon RW, Leary KM. Standing balance and function over the course of acute rehabilitation. American Journal of Physical Medicine & Rehabilitation. 1995;76(11):994-996.
  4. Bowen A, Wenman R, Mickelborough J, et al. Dual-task effects of talking while walking on velocity and balance following a stroke. Age and Ageing. 2001;30(4): 319-323.
  5. Brown LA, Sleik RJ, Winder TR. Attentional demands for static postural control after stroke. American Journal of Physical Medicine & Rehabilitation. 2002;83(12): 1732-1735.
  6. Dennis A, Dawes H, Elsworth C, et al. Fast walking under cognitive-motor interference conditions in chronic stroke. Brain Research. 2009;1287(1):104-110.
  7. Desrosiers J, Noreau L, Rochette A. Predictors of handicap situation following post-stroke rehabilitation. Disability and Rehabilitation. 2002;24(15):774-785.
  8. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessment of the hemiplegic patient. American Journal of Physical Medicine & Rehabilitation. 1987;66(2):77-90.
  9. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Physical Therapy. 1983; 63(10):1606-1610.
  10. Hyndmann D, Ashburn A. People with stroke living in the community: attention deficits, balance, ADL ability and falls. Disability and Rehabilitation. 2003; 25(15):817-882.
  11. Hyndmann D, Ashburn A, Yardley L, et al. Interference between balance, gait and cognitive task performance among people with stroke living in the community. Disability and Rehabilitation. 2006;28(13-14):849-856.
  12. Kerr B, Condon SM, McDonald LA. Cognitive spatial processing and the regulation of posture. Journal of Experimental Psychology. 1985;11(5):617-622.
  13. Kim CM, Eng JJ. Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke. Gait & Posture. 2003;18(1):23-28.
  14. Lienhard K, Schneider D, Maffiuletti NA. Validity of the optogait photoelectric system for the assessment of spatiotemporal gait parameters. Medical Engineering and Physics. 2012;35(4):500-504.
  15. Lord S, Menz H, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Physical Therapy. 2003;83(3):237-252.
  16. Lord SE, Halligan PW, Wade DT. Visual gait analysis: the development of a clinical assessment and scale. Clincal Rehabilitation. 1998;12(2):107-119.
  17. Morioka S, Hiyamizu M, Yagi F. The effects of an attentional demand tasks on standing posture control. Journal of Physiological Anthropology and Applied Human Science. 2005;24(3):215-219.
  18. Navon D, Gopher D. On the economy of the human processing system. Psychological Review. 1979;86(3):214-255.
  19. Olney SJ, Griffin MP, McBride ID. Temporal, kinematic and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Physical Therapy. 1994;74(9):872-885.
  20. Olney SJ, Richard CL. Hemiparetic gait following stroke, part I: characteristics. Gait & Posture. 1996;4(2):136-148.
  21. Park JH, Kwon YC. Standardization of Korean version of the mini-mental state examination (MMSE-K) for use in the elderly. Part I. Development of the test for the elderly. The Korean Neuropsychiatric Association. 1989;28(1):125-135.
  22. Patterson KK, Gage WH, Brooks D, et al. Changes in gait symmetry and velocity after Stroke: a cross-sectional study from weeks to years after stroke. Neurorehabilitation and Neural Repair. 2010; 24(9):783-790.
  23. Patterson KK, Parafianowicz I, Danells CJ, et al. Gait asymmetry in community-ambulation stroke survivors. American Journal of Physical Medicine & Rehabilitation. 2008;89(2):304-310.
  24. Pellecchia GL, Shockley K, Turvey MT. Concurrent cognitive task modulates coordination dynamics. Cognitive Science. 2005;29(4):531-557.
  25. Perry J. Garrett M, Gronley JK, et al. Classification of walking handicap in the stroke population. Stroke. 1995; 26(6):982-989.
  26. Plummer-D' Amato P, Altmann LJP, Behrman AL, et al. Interference between cognition, double-limb support, and swing during gait in community-dwelling individuals poststroke. Neurorehabilitation and Neural Repair. 2010;24(6):542-549.
  27. Plummer-D' Amato P, Altmann LJP, Saracino D, et al. Interactions between cognitive tasks and gait after stroke: A dual task study. Gait & Posture. 2008;27(4):683-688.
  28. Plummer-D' Amato P, Gail E, Sarah W, et al. Cognitive-motor interference during functional mobility after stroke: state of the science and implication for future research. Archives of Physical Medicine and Rehabilitation. 2013;94(12):2565-2574.
  29. Richard CL, Olney SJ. Hemiparetic gait following stroke, part II: recovery and physical therapy. Gait & Posture. 1996;4(2):149-162.
  30. Seo HD, Kim NJ, Chung YJ. Reliability of the Korean version of the trunk impairment scale in patients with stroke. Physical Therapy Korea. 2008;15(4):87-94.
  31. Shumway-Cook A, Wollacott MH. Attentional demands and postural control: the effect of sensory context. Journals of Gerontology. 2000;55A(1):M10-M16.
  32. Shumway-Cook A, Wollacott MH. Motor control: translating research into clinical practice, 3rd ed. Philadelphia. Lippincott Williams & Wilkins. 2007.
  33. Simone OS, Meg EM, Robert I. Dual task interference during gait in people with Parkinson disease: effect of motor versus cognitive secondary tasks. Physical Therapy. 2002;82(9):888-897.
  34. Susan WM, Mark S, Jennie W, et al. Gait assessment in mild cognitive impairment and Alzheimer's disease: the effect of dual-task challenges across the cognitive spectrum. Gait & Posture. 2012;35(1):96-100.
  35. Yang YR, Chen YC, Lee CS, et al. Dual-task-related gait changes in individuals with stroke. Gait & Posture. 2007;25(2):185-190.