Effects of Dual-Task and Progressive Wall Squat Training in Stroke Survivors

A stroke is a neurological disorder in which clots or ruptured vessels obstruct blood vessels, causing abnormal blood flow in the brain. This may lead to the unexpected death of brain cells and aggravate illnesses like depression and dementia.It is a disease with significant health and social consequences because of its high frequency and rate. Stroke is thought to affect 9.2% of the population in Europe, with a rate of 191.9 per 100,000 people annually. According to estimates, between 25 and 74% of those who survive this illness need assistance or become totally reliant on their everyday activities.The primary long-term effects of a stroke are dysphagia, paralysis, motor impairments, cognitive decline, and speech difficulties.

Dual-task training entails doing a motor task and a cognitive task at the same time. This method's justification is that a lot of daily tasks necessitate multitasking, and dual-task training can improve both cognitive and motor abilities by promoting brain plasticity and the interaction of the two systems. In the dual task training, cognitive task (like naming animals or counting backwards) is combined with a lower limb strengthening exercise called wall squats. Both tasks gradually increase in difficulty and intensity based on how well each person performs. By testing the muscle strength, endurance, and coordination of stroke survivors as well as their attention, memory, and executive function, this training seeks to improve their cognitive abilities, balance, and functional mobility.

• Group A (Other), also known as Dual task training (Wall squats + cognitive training along with routine rehabilitation: Progressive wall squat exercises will commence with a knee flexion angle of 135°, instructed to hold this position for 20 seconds, exercise progresses, the knee joint angle will be decreased by 10° until reaching the 95° stage or until participants can no longer maintain the knee joint angle within 5° of the target value due to volitional fatigue. Cognitive tasks during the intervention, including the recall of words and counting forward (1, 4, 7, 10...) and backward (...10, 7, 4, 1) by adding 3 to the digits. Sustained stretching (with a hold time of 10 seconds per stretch, totaling 10 repetitions per session) and active range of motion exercises (10 repetitions per session) targeting both the upper and lower extremities in routine rehabilitation.
• Group B (Other), also known as single-task intervention (Wall squats) along with routine rehabilitation: Progressive wall squat exercises will commence with a knee flexion angle of 135°, instructed to hold this position for 20 seconds, exercise progresses, the knee joint angle will be decreased by 10° until reaching the 95° stage or until participants can no longer maintain the knee joint angle within 5° of the target value due to volitional fatigue. Sustained stretching (with a hold time of 10 seconds per stretch, totaling 10 repetitions per session) and active range of motion exercises (10 repetitions per session) targeting both the upper and lower extremities in routine rehabilitation.

Primary outcomes

• MOCA (Montreal Cognitive Assessment) [8 weeks]: A well-liked screening method for identifying the presence of cognitive impairment is the MoCA. It takes about ten minutes to finish. It assesses language, abstract reasoning, executive function, orientation, delayed recall, attention, and visuospatial skills. The MoCA is more sensitive and specific than the MMSE because it covers a wider range of domains.
• Tinneti POMA (Balance, gait) [8 weeks]: The Tinetti Scale is a tool for assessing gait and balance. The test is used clinically to evaluate changes in gait time and balance, as well as to ascertain a subject's current level of mobility. The two sub-scales that make up the total POMA (POMA-T) are the gait evaluation scale (also known as the POMA-G) and the balance evaluation scale (also known as the POMA-B). The maximum score is 28 points; specifically, the POMA-B has a maximum score of 16 and the POMA-G has a maximum score of 12.
• Rivermead mobility index [8 weeks]: RMI is a measure that evaluates a patient's degree of mobility .There are 14 questions on it, along with a section on observations. This index evaluates an individual's ability to do tasks like getting out of bed, sitting, maintaining balance, standing up, standing unassisted, moving around, walking indoors and outside, climbing and descending stairs, picking up objects off the floor, taking a shower, and running. Every activity receives one point, if at all possible. If the score is less than 14, it suggests that the person has mobility problems; if the score is 15, it means they don't have any problems at all

Sex: All, ages: 45 Years to 65 Years

Inclusion Criteria:

* Age: Stroke patients aged 45 to 65 years.
* Individuals with a single ischemic stroke.
* Within the first 2 months post-stroke. (Subacute stage)
* Medically stable without acute conditions interfering with exercise.
* Mini-Mental State Examination (MMSE) score≥24
* Ability to walk 10m without assistance

Exclusion Criteria:

* Unstable Medical Conditions (cardiovascular, respiratory, or other medical conditions)
* Recent Stroke or Medical Event
* Other Neurological Conditions such as Presence of other neurological conditions (e.g., Parkinson's disease).
* Uncontrolled Hypertension: Systolic BP >160 mm Hg or diastolic BP >100 mm Hg

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• Aruba Saeed, PhD, Principal investigator, Riphah International University Pakistan