W.N. Chan1,2, W.N.W. Tsang1,2
1The Open University of Hong Kong, Department of Physiotherapy, School of Nursing and Health Studies, Hong Kong, Hong Kong, 2The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, Hong Kong
Background: Dual-tasking is common in everyday life. It can be challenging when the physical task demands attentional resources such as turning-while-walking or stepping down, and to people with impairment (e.g. stroke survivors). Tai Chi has been shown to improve dual-tasking performance in healthy older adults. However, only few studies concerned people with stroke, and none of them involved dual-tasking related to turning-while-walking or stepping down, which are common in daily life.
Purpose: To investigate the effects of Tai Chi training on two different dual-tasking conditions namely, auditory Stroop test combined with either turning-while-walking (condition A) or stepping down (condition B), in people with stroke.
Methods: Community-dwelling stroke survivors were randomized into Tai Chi, conventional exercise, or control groups. Subjects in the former two groups were trained with corresponding exercises for 12 weeks (1 hour/session, 2x/week). No training was given to the controls. All subjects were tested with two dual-tasking conditions (condition A and condition B), before (pre-assessment), after (post-assessment), and 1-month after (follow-up assessment) the intervention period. Auditory Stroop test performance was presented with a composite score (accuracy divided by averaged reaction time). Turning-while-walking performance was measured by turning duration, number of turning steps, and completion time. Stepping down performance was evaluated by center of pressure sway amplitude and velocity. Two-way mixed ANOVAs (3x3) determined any significant group-effect, task-effect, or interaction-effect. Statistical significance level was set at p ≤ 0.05. This study was approved by Ethics Committee of the Hong Kong Polytechnic University. Informed consent was obtained from each subject prior to data collection.
Results: Forty-seven subjects were included in this study. Forty subjects (Tai Chi=13, conventional exercise=15, control=12) completed the whole process and was assessed under condition A, while seventeen of them (Tai Chi=7, conventional exercise=4, control=6) were assessed under condition B. In condition A, although no group-effect was observed, Tai Chi group showed a significant improvement in the composite score of the auditory Stroop test throughout the study period (pre-assessment: 73.1±27.6, post-assessment: 89.9±23.4, follow-up assessment: 91.7±26.9) and a significant decrease in completion time of the turning-while-walking test from pre-assessment (17.7±6.9 sec) to follow-up assessment (14.9±4.9 sec). In condition B, a significant interaction-effect was found in composite score of the auditory Stroop test. Tai Chi group showed a significant improvement in this test from pre-assessment (64.6±22.7) to follow-up assessment (94.4±20.6). They also performed significantly better than the conventional exercise group (55.7±11.1) in the follow-up assessment.
Conclusion(s): Tai Chi training improves the ability of dual-tasking in community-dwelling stroke survivors. Its effect is better than that of the conventional exercise when the dual-tasking involved stepping-down, while no such difference was observed when the dual-tasking involved turning-while-walking. Research on the effects of Tai Chi training on different physical activity conditions with concurrent cognitive task and its underlying mechanism are warranted.
Implications: Tai Chi training improves the ability of dual-tasking that involves turning-while-walking and stepping down in community-dwelling stroke survivors. Its beneficial effects vary with different types of dual-taking conditions.
Funding, acknowledgements: This study was unfunded.
Keywords: Tai Chi, Stroke, Dual-tasking
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: the Hong Kong Polytechnic University
Committee: Ethics Committee of the Hong Kong Polytechnic University
Ethics number: HSEARS20131023003
All authors, affiliations and abstracts have been published as submitted.
