Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Where Does HIT Fit? An Examination of the Affective Response to High-Intensity Intervals in Comparison to Continuous Moderate- and Continuous Vigorous-Intensity Exercise in the Exercise Intensity-Affect Continuum Benefits of cognitive-motor intervention in MCI and mild to moderate Alzheimer disease Effectiveness of Neuromuscular Electrical Stimulation on Lower Limbs of Patients With Hemiplegia After Chronic Stroke: A Systematic Review. Clomipramine in obsessive-compulsive disorder Effects of transcranial direct current stimulation over the supplementary motor area body weight-supported treadmill gait training in hemiparetic patients after stroke A pilot placebo-controlled, double-blind, and randomized study on the cognition-enhancing benefits of a proprietary chicken meat ingredient in healthy subjects The Effect of Body Weight Support Treadmill Training on Gait Recovery, Proximal Lower Limb Motor Pattern, and Balance in Patients with Subacute Stroke The effects of action observation training and mirror therapy on gait and balance in stroke patients Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial The Effects of Exercise with TENS on Spasticity, Balance, and Gait in Patients with Chronic Stroke: A Randomized Controlled Trial Use of Virtual Reality to Enhance Balance and Ambulation in Chronic Stroke: A Double-Blind, Randomized Controlled Study
Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov Affect experienced during an exercise session is purported to predict future exercise behaviour . Compared to continuous moderate-intensity exercise ( CMI ) , the affective response to continuous vigorous-intensity exercise ( CVI ) has consistently been shown to be more aversive . The affective response , and overall tolerability to high-intensity interval training ( HIT ) , is less studied . To date , there has yet to be a comparison between HIT , CVI , and CMI . The purpose of this study was to compare the tolerability and affective responses during HIT to CVI and CMI . This study utilized a repeated measures , r and omized , counter-balanced design . Forty-four participants visited the laboratory on four occasions . Baseline fitness testing was conducted to establish peak power output in Watts ( Wpeak ) . Three subsequent visits involved a single bout of a ) HIT , corresponding to 1-minute at ∼100 % Wpeak and 1-minute at ∼20 % Wpeak for 20 minutes , b ) CMI , corresponding to ∼40 % Wpeak for 40 minutes , and c ) CVI , corresponding to ∼80 % Wpeak for 20 minutes . The order of the sessions was r and omized . Affective responses were measured before , during and after each session . Task self-efficacy , intentions , enjoyment and preference were measured after sessions . Participants reported greater enjoyment of HIT as compared to CMI and CVI , with over 50 % of participants reporting a preference to engage in HIT as opposed to either CMI or CVI . HIT was considered more pleasurable than CVI after exercise , but less pleasurable than CMI at these times . Despite this participants reported being just as confident to engage in HIT as they were CMI , but less confident to engage in CVI . This study highlights the utility of HIT in inactive individuals , and suggests that it may be a viable alternative to traditionally prescribed continuous modalities of exercise for promoting self-efficacy and enjoyment of exercise Objective : To evaluate the efficacy of a cognitive-motor program in patients with early Alzheimer disease ( AD ) who are treated with a cholinesterase inhibitor ( ChEI ) .  Methods : Patients with mild cognitive impairment ( MCI ) ( 12 ) , mild AD ( 48 ) , and moderate AD ( 24 ) ( Global Deterioration Scale stages 3 , 4 , and 5 ) were r and omized to receive psychosocial support plus cognitive-motor intervention ( experimental group ) or psychosocial support alone ( control group ) . Cognitive-motor intervention ( CMI ) consisted of a 1-year structured program of 103 sessions of cognitive exercises , plus social and psychomotor activities . The primary efficacy measure was the cognitive subscale of the AD Assessment Scale ( ADAS-cog ) . Secondary efficacy measures were the Mini-Mental State Examination , the Functional Activities Question naire , and the Geriatric Depression Scale . Evaluations were conducted at 1 , 3 , 6 , and 12 months by blinded evaluators . Results : Patients in the CMI group maintained cognitive status at month 6 , whereas patients in the control group had significantly declined at that time . Cognitive response was higher in the patients with fewer years of formal education . In addition , more patients in the experimental group maintained or improved their affective status at month 12 ( experimental group , 75 % ; control group , 47 % ; p = 0.017 ) . Conclusions : A long-term CMI in ChEI-treated  early Alzheimer disease patients produced additional mood and cognitive benefits OBJECTIVE To investigate the effectiveness of neuromuscular electrical stimulation ( NMES ) with or without other interventions in improving lower limb activity  after chronic stroke . DATA SOURCES Electronic data bases , including PubMed , EMBase , Cochrane Library , PEDro ( Physiotherapy Evidence Data base ) , and PsycINFO , were search ed from the inception to January 2017 . STUDY SELECTION We selected the r and omized controlled trials ( RCTs ) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment . DATA EXTRACTION The primary outcome was defined as lower limb motor function , and the secondary outcomes included gait speed , Berg Balance Scale , timed Up and Go , 6-minute walk test , Modified Ashworth Scale , and range of motion . DATA SYNTHESIS Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles . Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function ( st and ard mean difference 0.42 , 95 % confidence interval 0.26 - 0.58 ) , especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks . NMES also had significant benefits on gait speed , balance , spasticity , and range of motion but had no significant difference in walking endurance after NMES . CONCLUSIONS NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors . These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities The effects of clomipramine hydrochloride ( CMI ) versus placebo upon DSM-III-defined obsessive-compulsive disorder ( OCD ) were assessed in a 10-week double-blind multicenter trial and in a corresponding 1-year double-blind extension study . The NIMH global O-C scale , a 15-point ordinal severity scale , incorporating categorical features specific to OCD , was used to evaluate the severity of obsessive compulsive symptoms over the course of treatment , and a physician 's rating of global therapeutic effect was used to assess overall change from baseline . In the core study , patients receiving placebo demonstrated minor and non systematic changes , whereas patients who received CMI had clinical ly and statistically significant reductions in the global severity of their disorder . Findings from the extension study were consistent with continuing efficacy for CMI , whereas corresponding data for patients receiving long-term placebo were difficult to interpret . Based upon shifts in categorical severity , symptoms for over half those patients who received CMI were rendered sub clinical or within a range of normal functioning . In contast , less than 5 % of patients receiving placebo had their symptoms reduced to a sub clinical level . Generally , both treatments were well tolerated . Previous studies have indicated therapeutic potential for CMI  in obsessive compulsive disorder . These findings confirm and extend previous observations Transcranial direct current stimulation ( tDCS ) is used in a variety of disorders after stroke including upper limb motor dysfunctions , hemispatial neglect , aphasia , and apraxia , and its effectiveness has been demonstrated . Although gait ability is important for daily living , there were few reports of the use of tDCS to improve balance and gait ability . The supplementary motor area ( SMA ) was reported to play a potentially important role in balance recovery after stroke . We aim ed to investigate the effect of combined therapy body weight-supported treadmill training ( BWSTT ) and tDCS on gait function recovery of stroke patients . Thirty stroke in patients participated in this study . The two BWSTT periods of 1weeks each , with real tDCS ( anode : front of Cz , cathode : inion , 1mA , 20min ) on SMA and sham stimulation , were r and omized in a double-blind crossover design . We measured the time required for the 10 m Walk Test ( 10MWT ) and Timed Up and Go ( TUG ) test before and after each period . We found that the real tDCS with BWSTT significantly improved gait speed ( 10MWT ) and applicative walking ability ( TUG ) , compared with BWSTT+sham stimulation periods ( p<0.05 ) . Our findings demonstrated the feasibility and efficacy of tDCS in gait training after stroke . The facilitative effects of tDCS on SMA possibly improved postural control during BWSTT . The results indicated the implication s for the use of tDCS in balance and gait training rehabilitation after stroke Background It has long been postulated that the relative abundance of specific nutrients can affect cognitive processes and emotions . Newly described influences of dietary factors on neuronal function and synaptic plasticity have revealed some of the vital mechanisms that could be responsible for the action of diet on brain health and cognitive function . Here , through a double-blind , r and omized , placebo-controlled trial , we asked if the newly discovered chicken meat ingredient-168 ( CMI-168 ) could be beneficial to the cognitive function in healthy adults . Methods Normal , healthy subjects were supplemented with either placebo or CMI-168 for 6 weeks . The subjects were given a series of cognitive tests to examine their levels of cognitive functioning at the beginning and end of supplementation , as well as two weeks after termination of supplementation . The combination of these tests , namely Digit Span Backwards , Letter-Number Sequencing , and the Rey Auditory Verbal Learning Test ( RAVLT ) , was used to assess the subjects ’ attention and working memory . For all comparisons , the probability level of p < 0.05 was taken as statistically significant using repeated measure 2-way ANOVA followed by Bonferroni post-hoc test . Results Overall , subjects supplemented with CMI-168 showed significantly ( p < 0.01 ) better performance in all cognitive tests after 6 weeks ’ supplementation compared to control and such superior performance was maintained even 2 weeks after termination of supplementation . Conclusions The present study reveals the cognition-enhancing properties of a recently developed chicken meat ingredient , likely arising from the promotion of attention and prefrontal cortex functions Objective . Gait performance is an indicator of mobility impairment after stroke . This study evaluated changes in balance , lower extremity motor function , and spatiotemporal gait parameters after receiving body weight supported treadmill training ( BWSTT ) and conventional overground walking training ( CT ) in patients with subacute stroke using 3D motion analysis . Setting . Inpatient department of rehabilitation medicine at a university-affiliated hospital . Participants . 24 subjects with unilateral hemiplegia in the subacute stage were r and omized to the BWSTT ( n = 12 ) and CT ( n = 12 ) groups . Parameters were compared between the two groups . Data from twelve age matched healthy subjects were recorded as reference . Interventions . Patients received gait training with BWSTT or CT for an average of 30 minutes/day , 5 days/week , for 3 weeks . Main Outcome Measures . Balance was measured by the Brunel balance assessment . Lower extremity motor function was evaluated by the Fugl-Meyer assessment scale . Kinematic data were collected and analyzed using a gait capture system before and after the interventions . Results . Both groups improved on balance and lower extremity motor function measures ( P < 0.05 ) , with no significant difference between the two groups after intervention . However , kinematic data were significantly improved ( P < 0.05 ) after BWSTT but not after CT .  Maximum hip extension and flexion angles were significantly improved ( P < 0.05 ) for the BWSTT group during the stance and swing phases compared to baseline . Conclusion . In subacute patients with stroke , BWSTT can lead to improved gait quality when compared with conventional gait training . Both methods can improve balance and motor function [ Purpose ] The aim of this study was to evaluate the effects of action observation training and mirror therapy to improve on balance and gait function of stroke patients . [ Subjects and Methods ] The participants were r and omly allocated to one of three groups : The action observation training with activity group practice d additional action observation training with activity for three 30-minute session for six weeks ( n=12 ) . The mirror therapy with activity group practice d additional mirror therapy with activity for three 30-minute sessions for six weeks ( n=11 ) . The only action observation training group practice d additional action observation training for three 30-minute sessions for weeks ( n=12 ) . All groups received conventional therapy for five 60-minute sessions over a six-week period . [ Results ] There were significant improvements in balance and gait function . The action observation training with activity group significantly improved subjects ’ static balance . The action observation training with activity group and the mirror therapy with activity group significantly improved subjects ’ gait ability . [ Conclusion ] The activation of mirror neurons combined with a conventional stroke physiotherapy program enhances lower-extremity motor recovery and motor functioning in stroke patients Objectives : To investigate the effects of motor imagery training on the balance and gait abilities of post-stroke patients . Design : R and omized controlled trial . Setting : Outpatient rehabilitation centre . Subjects : Twenty-eight individuals with chronic stroke . Interventions : The experimental group ( n = 15 ) performed motor imagery training involving imagining normal gait movement for 15 minutes embedded in gait training for 30 minutes ( 45 minutes/day , 3 times/week ) ; the control group ( n = 13 ) performed gait training only ( 30 minutes/day , 3 times/week ) . Main measures : Balance and gait abilities were measured by the Functional Reach Test , Timed Up- and -Go Test , 10-m Walk Test and Fugl-Meyer assessment before and after interventions . Results : All measurements improved significantly compared with baseline values in the experimental group . In the control group , there were significant improvements in all parameters except the Fugl-Meyer assessment . All parameters of the experimental group increased significantly compared to those of the control group as follows : Functional Reach Test ( control vs. experimental : 28.1 ± 3.1 vs. 37.51 ± 3.0 ) , Timed Up- and -Go Test ( 20.7 ± 4.0 vs. 13.2 ± 2.2 ) , 10-m Walk Test ( 17.4 ± 4.6 vs. 16.0 ± 2.7 ) and Fugl-Meyer assessment ( 12.0 ± 2.9 vs. 17.6 ± 1.3 ) . Conclusions : Gait training with motor imagery training improves the balance and gait abilities of chronic stroke patients significantly better than gait training alone Background Transcutaneous electrical nerve stimulation ( TENS ) is a useful modality for pain control .  TENS has recently been applied to decrease spasticity . The purpose of this study is to determine whether the addition of TENS to an exercise program reduces spasticity and improves balance and gait in chronic stroke patients . Material / Methods This was a single-blinded , multicenter , r and omized controlled trial . Thirty-four ambulatory individuals with chronic stroke participated and were r and omly allocated to the TENS or Placebo group . The TENS group performed therapeutic exercise with TENS while the placebo ( non-stimulation ) TENS group performed therapeutic exercise with placebo TENS . Participants in both groups followed the same 30-min exercise regimen 5 times per week for a period of 6 weeks . Spasticity ( modified Ashworth scale ) , static ( balance system ) , and dynamic balance ( timed up and go test ) , and gait ability ( gait analyzer ) were measured at 1 week before and 1 week after the intervention . Results Significant differences were observed between the 2 groups . Spasticity improved by 0.80 points in the TENS group . Anterior-posterior and medial-lateral sway velocity among static balance parameters and dynamic balance showed significant differences between the TENS and Placebo TENS groups ( p=.000 ) . Gait speed and cadence were enhanced significantly in the TENS group ( p=.000 ) . Step and stride length on the paretic side showed a significant difference in the TENS group ( p=.000 ) , while only velocity showed a significant difference in the Placebo TENS group ( p=.004 ) . Conclusions A combination of therapeutic exercise and TENS may reduce spasticity and improve balance , gait , and functional activity in chronic stroke patients Kim JH , Jang SH , Kim CS , Jung JH , You JH : Use of virtual reality to enhance balance and ambulation in chronic stroke : A double-blind , r and omized controlled study . Objective : To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke . Design : Twenty-four adults with hemiparetic stroke were r and omly assigned to either an experimental group ( n = 12 ) or a control group . Both groups underwent conventional physical therapy , 40 mins a day , 4 days a week for 4 wks . The experimental group received an additional 30 mins of virtual reality therapy each session . Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests . Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale , and spatiotemporal parameters were obtained using GAITRite . Analysis of variance and correlation statistics were performed at P < 0.05 . Results : In the balance test , the experimental group had improved Berg Balance Scale scores , balance and dynamic balance angles ( ability to control weight shifting ) compared with the controls ( P < 0.05 ) . In the gait performance test , the experimental group showed significant improvements in velocity , Modified Motor Assessment Scale scores , cadence , step time , step length , and stride length ( P < 0.05 ) . Improvement in dynamic balance angles was correlated with velocity and cadence ( P < 0.01 ) . Conclusions : This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy
Cognitive motor interference is effective for improving gait and balance function for stroke in the short term .
However , only little evidence supports assumptions regarding CMI 's long-term benefits
BACKGROUND AND PURPOSE An increasing interest in the potential benefits of cognitive motor interference ( CMI ) for stroke has recently been observed , but the efficacy of CMI for gait and balance is controversial .
A systematic review and meta- analysis of r and omized controlled trials was performed to estimate the effect of CMI on gait and balance in patients with stroke .