Physical Therapy Department, Kio University, Nara, Japan.
Physiother Theory Pract. 2012 May;28(4):292-8. doi: 10.3109/09593985.2011.600424. Epub 2011 Oct 18.
Stroke patients are at a higher risk of falling than the community-dwelling elderly, and many falls are due to contact with an obstacle. This study compared the effects of the simultaneous addition of a cognitive task during obstacle crossing between stroke patients and community-dwelling older adults (control subjects). Participants comprised 20 stroke patients who could walk with or without supervision and 20 control subjects matched for age and height with the stroke patients. Participants were asked to cross a 4-cm-high obstacle while walking at a self-selected speed. The number of failures and the spatial and temporal parameters were compared between a single-task condition (i.e., crossing task only) and a dual-task condition (i.e., verbal fluency task: listing vegetables or animals). Under the dual-task condition, six stroke patients (30%) and three community-dwelling elderly individuals (15%) failed to complete the motor task. Task failure was only due to heel-obstacle contact after toe clearance. In both groups, obstacle-heel distance after clearance was reduced, and the time from heel contact to toe clearance and stride time were significantly increased under dual-task condition versus single-task condition. In addition, group-task interaction for the time from heel contact to toe clearance of the obstacle was significant; this increase in time was significantly greater under dual-task condition in stroke patients than in control subjects. Obstacle crossing in stroke patients involved an increase in crossing performance time and a risk of heel-obstacle contact after crossing. These tendencies appeared stronger under the dual-task condition.
脑卒中患者比社区居住的老年人更容易摔倒，很多摔倒都是因为与障碍物接触。本研究比较了脑卒中患者和社区居住的老年人（对照组）在过障碍物时同时进行认知任务对其的影响。参与者包括 20 名可以在监督下或不监督下行走的脑卒中患者和 20 名与脑卒中患者年龄和身高匹配的对照组。参与者被要求在以自我选择的速度行走时越过 4 厘米高的障碍物。比较了单任务条件（即仅过障碍物任务）和双任务条件（即语言流畅性任务：列举蔬菜或动物）下的失败次数和时空参数。在双任务条件下，6 名脑卒中患者（30%）和 3 名社区居住的老年人（15%）未能完成运动任务。任务失败仅归因于足跟着地后与障碍物接触。在两组中，障碍物与脚跟之间的距离在清除障碍物后减小，并且双任务条件下从脚跟接触到足趾清除以及步幅时间明显长于单任务条件。此外，组间任务对障碍物足趾清除时间的相互作用显著；在脑卒中患者中，双任务条件下的时间增加明显大于对照组。脑卒中患者的过障碍物涉及到穿越时间的增加和穿越后脚跟与障碍物接触的风险。这些趋势在双任务条件下更为明显。
