To study the efficacy of dual task training with variable priority instructional set and fixed priority instructional set in improving balance and motor functions in chronic Middle cerebral artery stroke patients.
Hospital based Rehabilitation (Physical therapy Department).
Two chairs of 46 cm of seating height with and without armrest, an inch Tape/Ruler, Obstacle (shoe box of 10c.m. high x 19c.m. wide x 33 c.m. long), Bed/couch of suitable height, Footstool or step of 15cm height, Dessert spoon, Ball, Polystyrene cup, Jelly beans, Comb, Tape recorder/Radio/Mobile phone.
30 Chronic M.C.A. stroke patients divided in to two groups with 15 subjects in each group took part in this study. Both of the groups were having proportion of 9 males and 6 females with 8 right and 7 left sided hemiplegics in group one and 7 right sided and 8 left sided hemiplegics in group two. Age group taken was between 45- 85 years with mean age of 63.0 in group one and mean age of 63.8 in group two. Comparison of duration (in months) since stroke showed mean and standard deviation of 39.33 and 27.1 for group one and mean and standard deviation of 42.6 and 29.5 for group two and the p value was 0.75 which shows there was no significant difference between two groups.
Subjects were assessed by using two physical performance measures before giving the treatment protocol i.e. readings on Berg balance scale and Motor assessment scales were taken. In the training session, subjects have undergone balance training of forty five minutes session, five times a week for a period of three weeks. Group one (=15 subjects) was trained under dual task balance training under a fixed priority instructional set, during each session, attention was focused on both postural and cognitive task at all the time and activities are divided in to stance and gait activities. In stance activities subjects were instructed to do semi tandem stand, eyes open, arm alteration with cognitive task as spell words forward from l-x and in other activity subject has to draw letter with affected foot and cognitive task was name any word start with letter l-x. In gait activity subjects were asked to perform tandem/semi tandem walking while counting backward from 200-90, obstacle crossing while counting backward from 200-90, semi tandem/Tandem walking with auditory tone discrimination & obstacle crossing with auditory tone discrimination (low volume vs. high), whereas in other group two subjects were given same training as group one but with half training session focusing attention on postural task performance and half training session with attention on cognitive task performance i.e. with variable priority instructional set, with this specific protocol each patients of both the group received 15 minutes of conventional exercises of affected upper extremity which includes range of motion exercises (active for unaffected joints and passive for affected joints having improper range), passive stretching of tight muscles and grip strengthening exercises.
after 3 weeks of training programme there was significant difference in pre and post assessment and training scores in balance and motor recovery. Improvement was seen in both of the groups but more improvement was noted in group two with variable priority instructional set as compared to group one with fixed priority instructional set.
Exercise programmes can be carried out safely in Chronic MCA stroke patients. The balance and functional independence of Ambulatory Chronic MCA stroke patients can be improved by specific type of balance training. As doing concurrent tasks posses great difficulty with chronic stroke patients in day today environment therefore a Balance training program which focuses on dual task with increasing difficulty and shifting priorities between two tasks is efficacious in improving balance and functional recovery in chronic ambulatory stroke patients.
Dual Task, Balance, Motor Recovery, Chronic MCA stroke
