Relationships between motor function and gait-related dual-task interference after stroke: A pilot study

doi:10.1016/j.gaitpost.2011.08.015

Gait & Posture

Volume 35, Issue 1, January 2012, Pages 170-172

https://doi.org/10.1016/j.gaitpost.2011.08.015 Get rights and content

Abstract

The purpose of this pilot study was to examine the relationships between motor performance measures and dual-task interference in gait among community-dwelling adults with stroke. Dual-task costs on gait were correlated with Fugl-Meyer lower extremity score and usual gait speed in 13 community-dwelling adults with stroke. Individuals with greater lower extremity motor impairment and slower gait speed experienced greater cognitive-motor interference in gait. Paretic single limb stance was particularly susceptible to dual-task interference. Gait speed was only vulnerable to dual-task interference in the most complex dual-task. Thus, global characteristics of gait were vulnerable in the most difficult cognitive tasks, but even easy tasks impaired discrete components of dynamic balance.

Highlights

► Slow walking speed is associated with greater dual-task costs on gait after stroke. ► Motor impairment severity is associated with increased dual-task interference. ► Paretic single limb stance is particularly vulnerable to dual-task interference.

Introduction

Cognitive-motor interference is the phenomenon in which simultaneous performance of cognitive and motor tasks result in deterioration in performance of one or both tasks. After stroke, cognitive-motor interference produces substantial disruption to many aspects of gait [1], [2], [3], [4], [5]. In particular, dual-task interference results in slower gait speeds [1], [2], [4], reduced cadence [3], [4], shorter stride length [2], [4], increased stride duration [4], and longer double limb support phases [1], [5]. Research is lacking on predicting which patients are at greatest risk for potentially harmful cognitive-motor interference and which impairments contribute to cognitive-motor interference. Given that different aspects of gait are differentially sensitive to dual-task interference in older adults [6], and that dual-task effects on gait are exaggerated in older adults who walk slowly [7], studying the relationships between measures of gait performance and dual-task interference after stroke is warranted to help identify potential predictors of gait-related cognitive-motor interference. The purpose of this pilot study was to examine relationships between motor abilities and gait-related cognitive-motor interference in community-dwelling individuals after stroke.

Section snippets

Methods

Thirteen community-dwelling adults (11 men) post-stroke who could walk independently participated. Exclusion criteria were pre-existing neurological disorders, orthopedic conditions affecting gait, uncorrected vision or hearing impairments, severe aphasia or dysarthria, and inability to follow a three-step command. A comprehensive test battery showed that global cognitive function was intact, although many participants performed 1–1.5 SD below norms for their age on tests of executive function

Results

Dual-task costs are shown in Table 2. For performance during the memory task, significant relationships were found between measures of motor ability and dual-task cost on paretic SLS duration only. Participants with slower gait speed and greater lower extremity motor impairment (lower Fugl-Meyer scores) had greater dual-task costs on paretic SLS duration (Table 3).

Examining performance during the visuospatial dual-task, significant relationships were found between usual walking speed and

Discussion

This pilot study begins to identify the characteristics of individuals most susceptible to cognitive-motor interference, and to document the effects of distractor task difficulty on performance. The finding that slow gait speed was associated with increased dual-task costs on gait speed during speech is consistent with recent research demonstrating that slow walking older adults experience exaggerated dual-task effects on gait speed, stride duration variability, and gait symmetry during a

Conflicts of interest statement

There are no conflicts of interest.

Acknowledgements

We would like to thank Andrea Behrman, PhD, and Michael Marsiske, PhD, for their input on the earlier stages of this project. Preparation of this manuscript was partially supported by grant 1R21AG033284 from the National Institute of Aging to Lori J. Altmann.

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Interference between balance, gait and cognitive task performance among people with stroke living in the community
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There are more references available in the full text version of this article.

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Cognitive-motor interference (CMI) is evident when simultaneous performance of a cognitive task and a motor task results in deterioration in performance in one or both of the tasks, relative to performance of each task separately. The purpose of this review is to present a framework for categorizing patterns of CMI and to examine the specific patterns of CMI evident in published studies comparing single-task and dual-task performance of cognitive and motor tasks during gait and balance activities after stroke. We also examine the literature for associations between patterns of CMI and a history of falls, as well as evidence for the effects of rehabilitation on CMI after stroke. Overall, this review suggests that during gait activities with an added cognitive task, people with stroke are likely to demonstrate significant decrements in motor performance only (cognitive-related motor interference), or decrements in both motor and cognitive performance (mutual interference). In contrast, patterns of CMI were variable among studies examining balance activities. Comparing people poststroke with and without a history of falls, patterns and magnitude of CMI were similar for fallers and nonfallers. Longitudinal studies suggest that conventional rehabilitation has minimal effects on CMI during gait or balance activities. However, early-phase pilot studies suggest that dual-task interventions may reduce CMI during gait performance in community-dwelling stroke survivors. It is our hope that this innovative and critical examination of the existing literature will highlight the limitations in current experimental designs and inform improvements in the design and reporting of dual-task studies in stroke.
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Short communicationRelationships between motor function and gait-related dual-task interference after stroke: A pilot study

Abstract

Highlights

Introduction

Section snippets

Methods

Results

Discussion

Conflicts of interest statement

Acknowledgements

Gait Posture

Gait Posture

Dual-task effects of talking while walking on velocity and balance following a stroke

Age Ageing

Interference between balance, gait and cognitive task performance among people with stroke living in the community

Disabil Rehabil

Short communication
Relationships between motor function and gait-related dual-task interference after stroke: A pilot study