New assessment approach could personalize dual-task walking rehabilitation after stroke

Multitasking while walking—be it mentally drafting a grocery list or replying to a text message on a phone—is simply second nature to many. For stroke survivors with weakened mobility and cognitive abilities, however, this common practice of dual-task walking can present a formidable challenge.

A research team at The Hong Kong Polytechnic University (PolyU) that pioneered early studies on dual-task walking and fall risk in post-stroke individuals has conducted a follow-up study that reveals the interaction of cognitive task type and complexity can influence the degree and pattern of dual-task interference (DTI), resulting in declines in physical and mental performance.

The paper, titled “Effects of Cognitive Task Type and Complexity on Dual-Task Interference During Level-Ground Walking and Obstacle Negotiation in Individuals with Stroke,” has been published in Neurorehabilitation and Neural Repair.

The findings offer valuable clinical implications for the design of dual-task assessment and training for stroke rehabilitation.

Led by Marco Pang, Shun Hing Education and Charity Fund Professor in Rehabilitation Sciences, chair professor of neurorehabilitation and head of the Department of Rehabilitation Sciences at PolyU, together with Charlotte Tsang, assistant professor in the department, the research team assessed the dual-tasking ability of individuals with chronic stroke.

During the study, participants were assessed under two mobility conditions: walking on flat ground and navigating obstacles. They simultaneously performed various cognitive tasks, ranging from auditory discrimination to shopping list recall and serial subtraction.

The research team adopted a standardized metric known as the dual-task effect (DTE) to measure patients’ performance in mobility (walking distance) and cognitive function (accuracy in performing tasks). The findings revealed that patients were often affected by DTI when walking and simultaneously carrying out cognitive exercises.

The interference led to a decline in performance in the cognitive task, the walking task or both, ultimately increasing fall risk and hindering a return to normal life.

The study also demonstrated that dual-task walking performance is highly task-dependent. Cognitive tasks that involve internally driven responses, such as performing serial subtractions, made greater demands on working memory, mental tracking and internal processing, thereby inducing greater DTI.

The greatest mobility interference was observed during these internally driven tasks, resulting in clinically significant reductions in walking distance. Furthermore, the combined interactive effects of task type and complexity affected dual-task performance more significantly than either factor alone.

Pang elaborated, “The results of our study underscore the importance of individualized assessments to better understand the dual-task challenges faced by post-stroke patients. Dual-task exercise training has been shown to reduce DTI and decrease fall risk during walking.

“Clinically, it is essential to develop a comprehensive DTE profile to evaluate post-stroke patient mobility. Standardized assessments involving cognitive tasks across various domains and complexities are key to guiding effective functional training for individuals with chronic stroke.”

Tsang added, “As strokes affect different brain regions responsible for various cognitive and physical functions, a one-size-fits-all approach that targets only a single cognitive domain and difficulty level is inadequate for identifying crucial functional deficits in stroke survivors. The precise identification of specific functional deficits, followed by personalized training, is vital for achieving effective rehabilitation outcomes.”

The study sheds light on the need to move beyond traditional, standalone functional training and incorporate realistic dual-task scenarios that patients would encounter in daily life to improve rehabilitation efficacy.

Who’s behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

Full profile →

Advertisements

Alexander Pol

PhD nano-engineering from Delft University. Published researcher and journal reviewer. Brings scientific insight to content standards.

Full profile →

See also  Outlining the future of theranostics in neurooncology