The effect of Tai Chi training on the dual-tasking performance of stroke survivors: a randomized controlled trial.

OBJECTIVE: To compare the effect of Tai Chi training with conventional exercise on dual-tasking performance among stroke survivors. DESIGN: An assessor-blinded, randomized controlled trial. SUBJECTS: Community-dwelling stroke survivors. SETTING: Community centers and university. INTERVENTIONS: Subjects in the Tai Chi group and the conventional exercise group were trained with the corresponding exercises for 12 weeks (1 hour/session, 2/week). No training was given to the controls. MAIN MEASURES: An auditory Stroop test, a turning-while-walking test, and a dual-tasking condition that combined the two tests were conducted at baseline, after the intervention, and one month later. RESULTS: Forty-seven subjects were randomized into Tai Chi group ( n = 15), conventional exercise group ( n = 17), or control group ( n = 15). There was no significant difference in the outcome measures among the three groups after the intervention and at the one month follow-up assessment. Within-group comparisons showed improvements in dual-tasking performance after Tai Chi training and further improvement during the follow-up period (composite score on the auditory Stroop test: pre-assessment: 73.1 ± 27.6, post-assessment: 89.9 ± 23.4, follow-up assessment: 91.7 ± 26.9; completion time of the turning-while-walking test: pre-assessment: 17.7 ± 6.9 seconds, post-assessment: 15.6 ± 5.2 seconds, follow-up assessment: 14.9 ± 4.9 seconds). CONCLUSION: Tai Chi training does not have superior effect on dual-tasking performance compared with conventional exercise among stroke survivors. Further studies with larger sample size, longer training, and follow-up periods are needed.

Compromised cognition, but not stepping-down performance, when dual-tasking in stroke survivors.

Descending stairs is an indicator of independence among stroke survivors, but is demanding in terms of both neuromuscular control and cognitive functioning. Previous studies found a compromised performance when stepping down with a concurrent cognitive task among healthy older adults, but whether stroke survivors react similarly is not known. This cross-sectional study thus investigated how stroke survivors responded to a dual-task that involved stepping down and compared their performance with that of control subjects. Thirty-four healthy individuals and 26 stroke survivors reacted to an auditory Stroop test while stepping off a 19-cm high platform. The auditory Stroop test was evaluated with a composite score (dividing accuracy by averaged reaction time). Stepping down performances were quantified with subjects' sway amplitudes in anteroposterior and mediolateral directions after landing and sway velocities of their center of pressure. Stroke survivors demonstrated significantly lower composite scores when dual-tasking (76.4 ± 31.2) than when single-tasking (90.0 ± 25.6), while no significant change in stepping down performance was observed. Stroke survivors also swayed significantly more and with a higher velocity than controls when dual-tasking. The results suggested that stroke survivors adopted a posture-first strategy to deal with this dual-tasking challenge. This study raised the awareness on dual-tasking ability among stroke survivors.

Students' interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction.

BACKGROUND: Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE. METHOD: This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis. RESULTS: CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R2=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R2=.057) to IPE, suggesting between-network validity. CONCLUSIONS: Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students' data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students' social interactions in IPE.Key MessagesThe Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students' data in IPE in Hong Kong.Social interaction anxiety and social phobia negatively predicted students' behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline.Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

Effect of Tai Chi Training on Dual-Tasking Performance That Involves Stepping Down among Stroke Survivors: A Pilot Study.

Descending stairs demands attention and neuromuscular control, especially with dual-tasking. Studies have demonstrated that stroke often degrades a survivor's ability to descend stairs. Tai Chi has been shown to improve dual-tasking performance of healthy older adults, but no such study has been conducted in stroke survivors. This study investigated the effect of Tai Chi training on dual-tasking performance that involved stepping down and compared it with that of conventional exercise among stroke survivors. Subjects were randomized into Tai Chi (n = 9), conventional exercise (n = 8), and control (n = 9) groups. Those in the former two groups received 12-week training. Assessments included auditory Stroop test, stepping down test, and dual-tasking test involving both simultaneously. They were evaluated before training (time-1), after training (time-2), and one month after training (time-3). Tai Chi group showed significant improvement in the auditory Stroop test from time-1 to time-3 and the performance was significantly better than that of the conventional exercise group in time-3. No significant effect was found in the stepping down task or dual-tasking in the control group. These results suggest a beneficial effect of Tai Chi training on cognition among stroke survivors without compromising physical task performance in dual-tasking. The effect was better than the conventional exercise group. Nevertheless, further research with a larger sample is warranted.

The performance of stroke survivors in turning-while-walking while carrying out a concurrent cognitive task compared with controls.

BACKGROUND: Turning-while-walking is one of the commonest causes of falls in stroke survivors. It involves cognitive processing and may be challenging when performed concurrently with a cognitive task. Previous studies of dual-tasking involving turning-while-walking in stroke survivors show that the performance of physical tasks is compromised. However, the design of those studies did not address the response of stroke survivors under dual-tasking condition without specifying the task-preference and its effect on the performance of the cognitive task. OBJECTIVE: First, to compare the performance of single-tasking and dual-tasking in stroke survivors. Second, to compare the performance of stroke survivors with non-stroke controls. METHODS: Fifty-nine stroke survivors and 45 controls were assessed with an auditory Stroop test, a turning-while-walking test, and a combination of the two single tasks. The outcome of the cognitive task was measured by the reaction time and accuracy of the task. The physical task was evaluated by measuring the turning duration, number of steps to turn, and time to complete the turning-while-walking test. RESULTS: Stroke survivors showed a significantly reduced accuracy in the auditory Stroop test when dual-tasking, but there was no change in the reaction time. Their performance in the turning-while-walking task was similar under both single-tasking and dual-tasking condition. Additionally, stroke survivors demonstrated a significantly longer reaction time and lower accuracy than the controls both when single-tasking and dual-tasking. They took longer to turn, with more steps, and needed more time to complete the turning-while-walking task in both tasking conditions. CONCLUSIONS: The results show that stroke survivors with high mobility function performed the auditory Stroop test less accurately while preserving simultaneous turning-while-walking performance. They also demonstrated poorer performance in both single-tasking and dual-tasking as compared with controls.