Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
Arch Phys Med Rehabil. 2013 Apr;94(4):680-6. doi: 10.1016/j.apmr.2012.11.023. Epub 2012 Nov 24.
To evaluate fall risk in stroke patients based on single- and dual-task gait analyses, and to investigate the difference between 2 cognitive tasks in the dual-task paradigm.
Prospective cohort study.
Rehabilitation hospitals.
Subacute stroke patients (N=32), able to walk without physical/manual help with or without walking aids, while performing a verbal task.
Not applicable.
Functional gait measures were Functional Ambulation Categories (FAC) and use of a walking aid. Gait measures were evaluated by an electronic walkway system under single- and dual-task (DT) conditions. For the single-task, subjects were instructed to walk at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects had to walk while simultaneously enumerating as many different animals as possible. For the other DT (counting dual task), participants had to walk while performing serial subtractions. After inclusion, participants kept a 6-month falls diary.
Eighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers (SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used a walking aid and more frequently needed an observatory person for walking safely (FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting dual task could distinguish potential Fs from NFs: decrement in stride length percentage (P=.043) and nonparetic step length percentage (P=.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly higher percentage of decrement for paretic step length (P=.023) than SFs.
Examining the decrement of spatial gait characteristics (stride length and paretic and nonparetic step length) during a DT addressing working memory can identify fall-prone subacute stroke patients.
基于单任务和双任务步态分析评估脑卒中患者的跌倒风险，并探讨双任务范式中两种认知任务的差异。
前瞻性队列研究。
康复医院。
亚急性脑卒中患者（N=32），能够在没有身体/手动帮助或使用助行器的情况下行走，并同时进行口头任务。
不适用。
功能性步态测量包括功能性步行能力分类（FAC）和助行器的使用。步态测量通过电子步道系统在单任务和双任务（DT）条件下进行评估。在单任务中，要求患者以其惯用速度行走。其中一个 DT 是言语流畅性双重任务，要求患者在行走的同时尽可能多地列举不同的动物。对于另一个 DT（计数双重任务），参与者必须在行走的同时进行连续减法。纳入后，参与者保留了 6 个月的跌倒日记。
32 名纳入患者中有 18 名（56.3%）跌倒。10 名（31.3%）为单跌倒者（SFs），8 名（25%）为多跌倒者（MFs）。跌倒者（Fs）比非跌倒者（NFs）更频繁地使用助行器，更频繁地需要观察员以安全行走（FAC 评分为 3）。在计数双重任务中，两个步态降低参数可以将潜在的 Fs 与 NFs 区分开来：步长百分比降低（P=.043）和非瘫痪侧步长百分比降低（P=.047）。关于 NFs、SFs 和 MFs 三组的划分，只有 MFs 的瘫痪侧步长降低百分比显著高于 SFs（P=.023）。
在双任务中检查空间步态特征（步长和瘫痪侧和非瘫痪侧步长）的降低可以识别易跌倒的亚急性脑卒中患者。
