Pumpho Ampha, Chaikeeree Nithinun, Saengsirisuwan Vitoon, Boonsinsukh Rumpa
Faculty of Physical Therapy, Srinakharinwirot University, Nakhonnayok, Thailand.
Department of Physical Therapy, School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand.
Front Neurol. 2020 Apr 23;11:262. doi: 10.3389/fneur.2020.00262. eCollection 2020.
The Timed Up and Go Test (TUG) with serial subtraction is commonly used to assess cognitive-dual task performance during walking for fall prediction. Some stroke patients cannot perform number subtraction and it is unclear which cognitive task can be used to substitute for the subtraction task in the TUG test. The aim of this study was to determine the type of cognitive task that produced the highest decrease on both motor and cognitive performances during TUG-dual in stroke patients. A total of 23 persons with stroke but capable of completing subtraction (ST) and 19 persons with subtraction operation difficulties (SOD) participated. Both groups have a similar age range (ST: 59.3 ± 10.4 years and SOD: 62.0 ± 6.8 years) and stroke onset duration (ST: 44.13 ± 62.29 months and SOD: 42.34 ± 39.69 months). The participants performed TUG without a cognitive task (TUG-single) followed by a cognitive task when seated (cognitive-single). In addition, TUG with a cognitive task (TUG-dual) was performed, with the activity randomly selected from four cognitive tasks, including alternate reciting, auditory working memory, clock task, and phonologic fluency. The main outcome variables-TUG duration measured by OPAL accelerometer and cognitive-dual task effect (DTE)-were analyzed using repeated-measures analyses of variance (ANOVA). The number of correct responses when seated were significantly lower in the SOD as compared to the ST ( < 0.05) during all cognitive tasks, except the phonologic fluency. During TUG-cognitive, TUG duration in the ST was significantly longer for all cognitive tasks compared with TUG-single ( < 0.0001), whereas TUG duration in the SOD was significantly increased only during the phonologic fluency task ( < 0.01). In the ST, there was a significant difference in cognitive DTE between the subtraction and the phonologic fluency tasks ( < 0.01). The highest cognitive cost was found in the subtraction task, whereas the highest cognitive benefit was shown in the phonologic fluency task. No significant cognitive DTE was found among the cognitive tasks in the SOD. For stroke persons with SOD, phonologic fluency is suitable to be used in the TUG-cognitive assessment. In contrast, subtraction (by 3s) is recommended for the assessment of TUG-cognitive in stroke persons who can perform subtraction.
带连续减法的计时起立行走测试（TUG）通常用于评估行走过程中的认知双重任务表现，以预测跌倒风险。一些中风患者无法进行数字减法运算，目前尚不清楚在TUG测试中可用哪种认知任务来替代减法任务。本研究的目的是确定在中风患者的TUG双重任务中，哪种认知任务会使运动和认知表现下降幅度最大。共有23名能够完成减法运算的中风患者（ST组）和19名存在减法运算困难的患者（SOD组）参与。两组患者的年龄范围相似（ST组：59.3±10.4岁，SOD组：62.0±6.8岁），中风发病时长也相近（ST组：44.13±62.29个月，SOD组：42.34±39.69个月）。参与者先进行无认知任务的TUG测试（TUG单任务），然后坐着进行认知任务（认知单任务）。此外，还进行了带有认知任务的TUG测试（TUG双重任务），该认知任务从四个认知任务中随机选择，包括交替背诵、听觉工作记忆、时钟任务和语音流畅性任务。主要结局变量——通过OPAL加速度计测量的TUG时长和认知双重任务效应（DTE）——采用重复测量方差分析（ANOVA）进行分析。在所有认知任务中，除语音流畅性任务外，SOD组坐着时的正确反应次数均显著低于ST组（<0.05）。在TUG-认知测试中，与TUG单任务相比，ST组在所有认知任务中的TUG时长均显著更长（<0.0001），而SOD组仅在语音流畅性任务期间TUG时长显著增加（<0.01）。在ST组中，减法任务和语音流畅性任务之间的认知DTE存在显著差异（<0.01）。减法任务的认知成本最高，而语音流畅性任务的认知收益最高。在SOD组的认知任务中未发现显著的认知DTE。对于有减法运算困难的中风患者，语音流畅性适合用于TUG-认知评估。相比之下，对于能够进行减法运算的中风患者，建议采用（逐次减3）减法运算来评估TUG-认知。
