Cognitive-Motor Interference During Functional Mobility After Stroke: State of the Science and Implications for Future Research (original) (raw)
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Dual task interference while walking in chronic stroke survivors
Physical Therapy Rehabilitation Science
Objective: Dual-task interference is defined as decrements in performance observed when people attempt to perform two tasks concurrently, such as a verbal task and walking. The purpose of this study was to investigate the changes of gait ability according to the dual task interference in chronic stroke survivors. Design: Cross-sectional study. Methods: Ten chronic stroke survivors (9 male, 1 female; mean age, 55.30 years; mini mental state examination, 19.60; onset duration, 56.90 months) recruited from the local community participated in this study. Gait ability (velocity, paretic side step, and stride time and length) under the single-and dual-task conditions at a self-selected comfortable walking speed was measured using the motion analysis system. In the dual task conditions, subjects performed three types of cognitive tasks (controlled oral word association test, auditory clock test, and counting backwards) while walking on the track. Results: For velocity, step and stride length, there was a significant decrease in the dual-task walking condition compared to the single walking condition (p<0.05). In particular, higher reduction of walking ability was observed when applying the counting backward task. Conclusions: Our results revealed that the addition of cognitive tasks while walking may lead to decrements of gait ability in stroke survivors. In particular, the difficulty level was the highest for the calculating task. We believe that these results provide basic information for improvements in gait ability and may be useful in gait training to prevent falls after a stroke incident.
Frontiers in Neurology, 2020
Background: Walking in the community can be challenging for stroke survivors. The fact that community walking often requires performing another task while walking further adds to this challenge and can lead to a deterioration of performance in one or both tasks. Objective: To review the existing literature about cognitive-locomotor dual-task interference (DTI) magnitude and pattern while walking in patients with stroke and to explore the influence of tasks' nature on DTI. Moreover, this review investigated the differences in DTI between stroke survivors and age-matched healthy adults. Methods: The literature search was conducted in 4 databases (MEDLINE, CINAHL, EMBASE and PEDro). Two authors independently identified relevant studies based on predetermined selection criteria. Among these criteria, studies had to include both locomotor and cognitive DTI. Methodological quality of the studies was independently assessed by two raters using a standardized checklist. Studies were categorized according to the nature of the locomotor and the cognitive tasks. Results: A total of twenty studies, with good to high methodological quality, were selected. Task combinations, outcome measures and participants characteristics varied widely from one study to another. Despite heterogeneous results across studies, mutual DTI (decrements in both locomotor and cognitive performance) was the most frequently observed pattern in participants with stroke. Interestingly, this DTI pattern was systematically obtained when participants had to avoid obstacles while walking. DTI seemed also to be influenced by the nature of the cognitive task. Compared to age-matched healthy participants, stroke survivors had greater DTI. Mutual interferences were also more frequently observed in stroke survivors than in age-matched healthy adults. Conclusions: DTI magnitude and pattern in persons with stroke varied considerably across studies. Multiple factors, including nature of the tasks, may influence dual-task abilities when assessing individuals with stroke. Consequently, dual-task assessments should be performed in similar contexts of individuals' daily lives to ensure ecological validity.
Cognitive motor interference while walking: A systematic review and meta-analysis
Neuroscience and Biobehavioral Reviews, 2011
Dual-task methodology has been increasingly used to assess cognitive motor interference while walking. However, whether the observed dual-task-related gait changes are systematically related to methodological variations remains unclear and researchers still lack knowledge of what cognitive task to use in different groups for clinical purposes or for research. We systematically reviewed experimental studies that measured gait performance with and without performing concurrent cognitive task. Our results suggest that cognitive tasks that involve internal interfering factors seem to disturb gait performance more than those involving external interfering factors. Meta-analysis results show that the overall effect of different cognitive tasks was prominent in gait speed. In healthy participants, meta-regression analysis suggests strong associations between age and speed reduction under dual-task conditions and between the level of cognitive state and speed reduction under dual-task conditions. Standardizing research methodologies, as well as improving their ecological validity, enables better understanding of dualtask-related gait changes in different populations and improves, in turn, our understanding of neural mechanisms and gait control in general in content.
Interactions between cognitive tasks and gait after stroke: A dual task study
Gait & Posture, 2008
This study investigated the interactions between gait and three different cognitive tasks in people after stroke. Thirteen people post-stroke who were living in the community, were able to walk 10 m without physical assistance, and could respond verbally to auditory stimuli participated. Participants performed a walking task alone, three different cognitive tasks while seated, and each cognitive task in combination with walking. Gait data were acquired continuously for approximately 3 min. Reaction time and accuracy were recorded for two of the cognitive tasks (visuospatial task, working memory task). Speech samples from the spontaneous speech task were analyzed on several dimensions of language. Significant dual task effects were observed for gait speed, stride time, average stride length, and cadence, but not for stride time variability. Speech produced more gait interference than memory and visuospatial tasks. Interference effects on cognition were minimal; only speech was significantly affected by concurrent walking. Narratives in the dual task condition had more pauses, shorter sentences, but more utterances with new information. Even though participants in this study were mobility-impaired, they prioritized the cognitive tasks. Future research should determine whether dual task training can reduce gait decrements in dual task situations in people after stroke.
Cognitive motor interference for gait and balance in stroke: a systematic review and meta‐analysis
Background and purpose: An increasing interest in the potential benefits of cognitive motor interference (CMI) for stroke has recently been observed, but the efficacy of CMI for gait and balance is controversial. A systematic review and meta-analysis of randomized controlled trials was performed to estimate the effect of CMI on gait and balance in patients with stroke. Methods: Articles in Medline, EMBASE, the Cochrane Library, Web of Science, CINAHL, PEDro and the China Biology Medicine disc were searched from 1970 to July 2014. Only randomized controlled trials examining the effects of CMI for patients with stroke were included, and no language restrictions were applied. Main outcome measures included gait and balance function. Results: A total of 15 studies composed of 395 participants met the inclusion criteria, and 13 studies of 363 participants were used as data sources for the meta-analysis. Pooling revealed that CMI was superior to the control group for gait speed [mean difference (MD) 0.19 m/s, 95% confidence interval (CI) (0.06, 0.31), P = 0.003], stride length [MD 12.53 cm, 95% CI (4.07, 20.99), P = 0.004], cadence [MD 10.44 steps/min, 95% CI (4.17, 16.71), P = 0.001], centre of pressure sway area [MD À1.05, 95% CI (À1.85, À0.26), P = 0.01] and Berg balance scale [MD 2.87, 95% CI (0.54, 5.21), P = 0.02] in the short term. Conclusion: Cognitive motor interference is effective for improving gait and balance function for stroke in the short term. However, only little evidence supports assumptions regarding CMI's long-term benefits.
Gait & Posture, 2013
Successful aging has become one of the most important aspects of health care in the 21st century. As people live longer risks of cumulative illness, chronic disability increase [1,2]. Mobility limitations and cognitive impairments, both common with aging, reduce levels of physical and mental activity, are prognostic of future adverse health events, and are associated with an increased fall risk [2]. Importantly, the link between cognitive impairment, mobility limitations and the tendency to falls is recognized in the literature [3]. Maintaining stability during walking through the environment is a complex, multi-dimensional process requiring higher level motor control, and cognitive flexibility to address balance threats, while attending to environmental demands and concurrent cognitive tasks [2]. A key factor in locomotor control is executive cognitive functioning and deficits are associated with increased risk of falling [3,4]. Various dual task (DT) studies have affirmed that difficulty in assigning attention to each task simultaneously may contribute significantly to increased fall risks. Poor DT performance in either the motor or cognitive task could be caused by altered prioritization between the two tasks [5]. The most common and consistent finding of DT studies has been the reduction of gait speed [3], likely as a strategy for concurrent task processing or to avoid stability threat. Reduced speed is commonly observed in elderly, and when negotiating obstacles, irregular or unpredictable terrain [6]. Dual-task studies have utilized cognitive tasks, like animal enumeration or number subtraction that are typically only assessed qualitatively, do not involve the visuomotor system and are limited in recruitment of individual brain areas. Visualspatial processing of object locations/motions and their spatial relations with respect to body and space are key aspects of balance and locomotor skills, and evidence supports visual-spatial processing as an important aspect of cognition to explore in mobility decline [7,8].
Cognitive-Motor Interference during Walking in Older Adults with Probable Mild Cognitive Impairment
Frontiers in Aging Neuroscience, 2017
Although several studies have shown that dual-tasking (DT) mobility is impaired in Alzheimer's disease, studies on the effects of DT conditions in probable Mild Cognitive Impairment (pMCI) have not yielded unequivocal results. The objectives of the study were to (1) examine the effect of a concurrent task on a complex walking task in adults with cognitive impairment; and (2) determine whether the effect varied with different difficulty levels of the concurrent task. Furthermore, the study was designed to evaluate the Trail-Walking Test (TWT) as a potential detection tool for MCI. We examined DT performance in 42 young adults (mean age 23.9 ± 1.98), and 43 older adults (mean age 68.2 ± 6.42). The MoCA was used to stratify the subjects into those with and without pMCI. DT was assessed using the TWT: participants completed 5 trials each of walking along a fixed pathway, stepping on targets with increasing sequential numbers (i.e., 1-2-…-15), and increasing sequential numbers and letters (i.e., 1-A-2-B-3-…-8). Motor and cognitive DT effects (DTE) were calculated for each task. ROC curves were used to distinguish younger and healthy older adults from older adults with pMCI. The TWT showed excellent test-retest reliability across all conditions and groups (ICC : 0.83-0.97). SEM% was also low (<11%) as was the MDC95% (<30%). Within the DT conditions, the pMCI group showed significantly longer durations for all tasks regardless of the cognitive load compared to the younger and the healthy older adults. The motor DTEs were greatest for the complex condition in older adults with pMCI more so than in comparison with younger and healthy older adults. ROC analyses confirmed that only the tasks with higher cognitive load could differentiate older adults with pMCI from controls (area under the curve >0.7, p < 0.05). The TWT is a reliable DT mobility measure in people with pMCI. However, the condition with high cognitive load is more sensitive than the condition with low cognitive load in identifying pMCI. The TWT-3 thus could serve as a screening tool for early detection of individuals with pMCI. Future studies need to determine the neural correlates for cognitive-motor interference in older adults with pMCI.
The Relationship Between Dual-Task Performance and Functional Independence in Stroke Patients
Türk fen ve sağlık dergisi, 2022
Dual-task performance have a role in independent motor functions such as gait and balance. Although walking and balance parameters are important in functional independence, the level of independence is a complex condition affected by many factors. The aim of this cross-sectional study is to investigate the relationship between dual-task performance and functional independence levels in stroke patients. Material and Methods: 26 hemiplegic patients were included in this research in a tertiary healthcare institution. The participants' independence levels were evaluated by the functional independence mesasure(FIM). Single task performance, motor dual-task performance, and cognitive dual-task performance were evaluated by calculating walking time in a 10-meter walking test. The relationship between dual-task interference and functional independence level was examined by Spearman correlation analysis. Results: The motor dual-task interference was found as 0.7 (0.0-0.26) and the cognitive dual-task interference was found as 0.19 (0.05-0.38). There was a negative, moderate, and statistically significant correlation between the FIM score and the motor dual-task interference (r =-0.48, p = 0.01). However, no significant correlation was detected between FIM score and cognitive dual-task interference (p = 0.16). Conclusion: The level of functional independence in stroke patients is associated with motor dual-task interference. Rehabilitation programs that improve dual-task performance can increase the functional independence levels of stroke patients.
Cognitive-motor dual-task interference: A systematic review of neural correlates
Neuroscience & Biobehavioral Reviews, 2017
Cognitive-motor interference refers to dual-tasking (DT) interference (DTi) occurring when the simultaneous performance of a cognitive and a motor task leads to a percentage change in one or both tasks. Several theories exist to explain DTi in humans: the capacity-sharing, the bottleneck and the cross-talk theories. Numerous studies investigating whether a specific brain locus is associated with cognitivemotor DTi have been conducted, but not systematically reviewed. We aimed to review the evidences on brain activity associated with the cognitive-motor DT, in order to better understand the neurological basis of the CMi. Results were reported according to the technique used to assess brain activity. Twenty-three articles met the inclusion criteria. Out of them, nine studies used functional magnetic resonance imaging to show an additive, under-additive, over-additive, or a mixed activation pattern of the brain. Seven studies used near-infrared spectroscopy, and seven neurophysiological instruments. Yet a specific DT locus in the brain cannot be concluded from the overall current literature. Future studies are warranted to overcome the shortcomings identified.