Effects of dual task training on balance and activities of daily livings (adls)

Abstract

Objective - To study the efficacy of dual task training with variable priority instructional set and fixed priority instructional set in improving balance and Activities of Daily Living(ADLS) in Patients with Parkinson’s Disease. Methodology – 30 Parkinson’s disease patients were divided in to two groups with 15 subjects in each group took part in this study. Both of the groups were having proportion of 8 males and 7 females with Hoehn & Yahr scale stage 1-3 in group A and group B. Age group taken was between 50- 80 years with mean age of 66.27 in group A and mean age of 66.67 in group B. Comparison of Disease duration(in yrs.) showed mean and standard deviation of 3.8 and2.18 for group A and mean and standard deviation of 4 and 2.24 for group B and the p value was 0.80 which shows there was no significant difference between two groups. Subjects were assessed by using two physical performance measures before giving the treatment protocol i.e. readings on Berg balance scale(BBS) and UPDRS scale part II (ADL’S) section were taken. In the training session, subjects have undergone balance training of forty five minutes session, five times a week for a period of three weeks. Group A (=15 subjects) was trained under dual task balance training under a fixed priority instructional set , during each session, attention was focused on both postural and cognitive task at all the time and activities are divided in to stance and gait activities. In stance activities subjects were instructed to do semi tandem stand, eyes open, arm alteration with cognitive task as spell words forward from l-x and in other activity subject has to draw letter with the foot and cognitive task was name any word start with letter l-x . In gait activity subjects were asked to perform tandem / semi tandem walking while counting backward from 200-90, obstacle crossing while counting backward from 200-90, semi tandem / Tandem walking with auditory tone discrimination & obstacle crossing with auditory tone discrimination ( low volume vs. high),whereas in other group B subjects were given same training as group A but with half training session focusing attention on postural task performance and half training session with attention on cognitive task performance i.e. with variable priority instructional set. Results – After 3 weeks of training programme there was significant difference in pre and post assessment and training scores in balance and Activities of daily living skills recovery. Improvement was seen in both of the groups but more improvement was noted in group B with variable priority instructional set as compared to group A with fixed priority instructional set. Conclusion - Exercise programmes can be carried out safely in Parkinson’s disease patients. The balance and functional independence of Ambulatory Parkinson’s Disease patients can be improved by specific type of balance training. As doing concurrent tasks posse’s great difficulty with Parkinson’s disease patients in day today environment therefore a balance training program which focuses on dual task with increasing difficulty and shifting priorities between two tasks is efficacious in improving balance and functional recovery in Parkinson’s Disease patients.