WALK BETTER, LIVE BETTER: EFFECTS OF DUAL-TASK GAIT TRAINING ON BALANCE AND FUNCTIONAL MOBILITY AFTER STROKE — A RANDOMIZED CONTROLLED TRIAL

Background

Stroke frequently results in persistent impairments in balance, gait, and functional mobility. Conventional rehabilitation primarily emphasizes single-task walking and functional exercises, whereas everyday walking commonly requires individuals to simultaneously manage cognitive and motor demands. Dual-task gait training may therefore provide an additional rehabilitation stimulus by integrating cognitive or motor challenges with walking practice. This study investigated the effects of structured dual-task gait training on balance and functional mobility following stroke compared with conventional rehabilitation.

Methods

A two-arm, parallel-group randomized controlled trial was conducted among 48 individuals following stroke, who were randomly allocated to a dual-task gait training group (DTG, n = 24) or conventional rehabilitation group (CRG, n = 24). Both groups received a structured four-week rehabilitation program consisting of 12 sessions. DTG received progressive dual-task gait training incorporating cognitive and motor challenges, whereas the CRG received conventional single-task rehabilitation. The primary outcomes were balance assessed using the Berg Balance Scale (BBS) and functional mobility assessed using the Timed Up and Go (TUG) test. Secondary outcomes included 10-Meter Walk Test (10MWT) walking speed, dual-task walking speed, and dual-task interference. Outcomes were assessed at baseline immediately after the intervention. The principal treatment effect was evaluated using the group × time interaction.

Results

Both groups demonstrated significant improvements following the intervention; however, the magnitude of improvement was greater in the DTG. BBS scores increased from 39.58 ± 5.26 to 48.63 ± 4.21 in the DTG compared with 39.71 ± 5.41 to 44.36 ± 4.69 in the CRG (group × time, p < 0.001). TUG completion time decreased from 19.72 ± 3.69 to 14.18 ± 2.76 seconds in the DTG and from 19.83 ± 3.91 to 16.92 ± 3.16 seconds in the CRG (p < 0.001). Walking speed increased from 0.60 ± 0.14 to 0.83 ± 0.16 m/s in the DTG and from 0.61 ± 0.13 to 0.73 ± 0.15 m/s in the CRG (p = 0.001). Dual-task walking speed increased from 0.42 ± 0.12 to 0.70 ± 0.14 m/s in the DTG compared with 0.43 ± 0.11 to 0.56 ± 0.13 m/s in the CRG (p < 0.001). Dual-task interference decreased from 29.8 ± 8.0% to 15.2 ± 6.1% in the DTG and from 30.4 ± 7.6% to 22.8 ± 6.9% in the CRG (p < 0.001). Treatment adherence was high in both groups, and no serious intervention-related adverse events were reported.

Conclusion

Structured dual-task gait training produced greater improvements in balance, functional mobility, walking speed, dual-task walking performance, and dual-task interference than conventional rehabilitation alone. The findings suggest that progressively integrating cognitive-motor challenges into gait practice may provide additional functional benefits for individuals following stroke, particularly in maintaining walking performance under divided-attention conditions. Larger trials with longer follow-up are warranted to determine the durability and broader functional impact of these improvements.