Effectiveness Between-Motor-Dual-Task-Specific Training and Task-Oriented-Circuit Training Along with Conventional Physiotherapeutic Intervention in Ambulation of Stroke Patients: A Quasi-Experimental study

Abstract

Introduction: As a leading cause of disability, motor control, balance and gait are often afflicted by stroke. Although rehabilitation strategies such as Motor-Dual-Task Specific Training (MDTT) and Task-Oriented Circuit Training (TOCT) promise to enhance ambulation, few studies have compared them to conventional physiotherapy. Aim: The purpose of this study was to determine if either MDTT or TOCT is more effective than the other in increasing gait speed, balance and functional mobility (ambulatory functions) in persons post stroke. Objectives: To compare the impact of MDTT and TOCT on gait speed, balance and functional mobility and ambulatory ability, assessed by means of the Timed Up and Go Test (TUG), Berg Balance Scale (BBS) and Barthel Index (BI). Methodology: Forth patients were recruited in this quasi-experimental study from the Centre for Rehabilitation of the Paralyzed (CRP), Savar, Dhaka. We randomly assigned participants to the MDTT group (n=20) or TOCT group (n=20). Each group received their intervention over a 6-week period, 4 sessions per week. The 10MWT, TUG, BBS and BI were used to assess ambulation outcomes before and after the intervention. We used non-parametric tests (the Mann-Whitney U and Wilcoxon Signed-Rank) using a standard level of significance, defined as p < 0.05. Result: All MDTT and TOCT groups demonstrated significant improvement at 6 weeks. Gait speed (10MWT) improved in the MDTT group from 3.53 ± 3.36 m/s, TUG time decreased from 40.03 ± 35.17 sec, BBS score increased from 42.60 ± 4.48 and BI from 68.25 ± 13.60 (p < 0.05 for all). The TOCT group also improved in gait speed (from 2.79 ± 1.73 m/s), TUG (from 31.71 ± 18.65 sec), BBS (from 42.55 ± 4.15) and BI (from 69.75 ± 10.94) (p < 0.05, for all). TOCT had slightly better 10MWT, TUG, balance and BI scores than between groups (not statistically significant, p > 0.05). Conclusion: There is strong evidence to show that when MDTT or TOCT are combined with conventional physiotherapy, both MDTT and TOCT are effective at improving ambulatory outcomes for stroke rehabilitation. The results suggest that MDTT & TOCT is more effective than either endurance training or flexibility training in improving gait speed, balance and functional mobility. These findings lend support to the use of task specific strategies relevant to a particular patient's needs in stroke rehabilitation. Keywords: Stroke, rehabilitation, ambulation, motor-dual-task training, task-oriented circuit training, gait, balance and physiotherapy.