Efficacy of cognitive dual-task training on balance in patients with stroke

Abstract

Background: Stroke is a major cause of long-term disability and the second leading cause of death worldwide. Among stroke patients, balance and mobility impairments are evident due to both motor and cognitive dysfunctions. Cognitive Dual-Task training (CDTT) integrates cognitive challenges with motor activities, which is known to be effective in improving balance and gait, as evidenced by several scientific studies that have established its benefits. This study was therefore aimed to evaluate the efficacy of cognitive dual-task training on balance in patients with stroke. Methodology: A double-blinded randomized controlled trial was conducted with 40 participants randomly allocated and divided into control group (n=20), each receiving conventional physiotherapy, and experimental group (n=20), each receiving cognitive dual task training along with conventional physiotherapy for 3 days a week for 4 weeks. The primary outcome was balance (BBS), and the secondary outcomes included mobility and gait (TUG and Gait parameters). An intention-to-treat analysis using the LOCF method was employed. Data were analyzed using SPSS 25.0, employing both parametric and non-parametric tests. Result: Both groups demonstrated significant improvements in balance and mobility following the intervention. However, the experimental group showed significantly greater gains. Median BBS scores increased from 41.0 to 48.0 (p = 0.000) in the experimental group and from 44.0 to 47.0 in the control group (p = 0.000), with between-group differences favoring the experimental group (p < 0.05). TUG times improved significantly in both groups (experimental: 32.74 s to 28.01 s; control: 39.12 s to 37.03 s), with a greater improvement in the experimental group (p = 0.043). Gait parameters (step length, stride length, gait speed, cadence) also showed significantly greater improvements in the experimental group (p < 0.05 for all). Conclusion: CDTT was more effective than conventional therapy alone in enhancing balance, mobility, and gait in patients with stroke. Incorporating cognitive tasks into balance training may provide superior functional outcomes and should be considered in stroke rehabilitation programs. Keywords: Stroke, Balance, Cognitive Dual-task training, CDTT, Dual-Task training, Gait.