Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Avenue, Boston, MA, 02129, United States.
Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL, United States.
Gait Posture. 2020 Jun;79:3-9. doi: 10.1016/j.gaitpost.2020.03.013. Epub 2020 Apr 9.
The impact of high distraction, real-world environments on dual-task interference and flexibility of attentional prioritization during dual-task walking in people with stroke is unknown.
How does a real-world environment affect dual-task performance and flexible task prioritization during dual-task walking in adults with and without stroke?
Adults with stroke (n = 29) as well as age-, gender-, and education-matched adults without stroke (n = 23) participated. Single and dual-task walking were examined in two different environments (lab hallway, hospital lobby). Two different dual-task combinations were assessed (Stroop-gait, speech-gait). Each dual-task was performed first without explicit instruction about task prioritization (no-priority) and then with gait-priority instruction and Stroop/speech-priority instruction in randomized order.
People with stroke had significantly slower dual-task gait speed (Stroop only) in the lobby than the lab, but the effect was not clinically meaningful. Stroop reaction time for all participants was also slower in the lobby than the lab. All participants slowed their walking speed while generating spontaneous speech, but this effect was not influenced by environment. The dual-task attention allocation strategy was generally inflexible to instructed prioritization in adults with and without stroke in both environments, however, the volitional attention allocation strategy differed for the two dual-task conditions such that speech was prioritized in the speech-gait dual-task and gait appeared to be prioritized in the Stroop-gait dual-task.
Although dual-tasking slows walking speed and verbal responses to auditory stimuli in people with stroke, the effects are not considerably impacted by a more complex, distracting environment. Adults with and without stroke may have difficulty overriding the preferred attention allocation strategy during dual-task walking, especially for habitual dual-tasks such as walking while speaking. It may also be that the cognitive control strategy governing task prioritization is influenced by degree of cognitive engagement.
在患有中风的个体进行双任务行走时，高度分散的现实世界环境对注意力分配的双重任务干扰和灵活性的影响尚不清楚。
现实世界的环境如何影响患有和不患有中风的成年人在进行双任务行走时的双重任务表现和灵活的任务优先级？
参与者包括 29 名患有中风的成年人和 23 名年龄、性别和教育程度相匹配的无中风成年人。在两个不同的环境（实验室走廊、医院大厅）中检查了单任务和双任务行走。评估了两种不同的双重任务组合（Stroop 步态、言语步态）。每个双重任务首先在没有明确任务优先级指令的情况下进行（无优先级），然后按照随机顺序进行步态优先级指令和 Stroop/言语优先级指令。
患有中风的个体在大厅中的双任务步态速度（仅 Stroop）明显较慢，但影响无临床意义。所有参与者在大厅中的 Stroop 反应时间也较慢。所有参与者在自发言语生成时都会减慢行走速度，但环境对此无影响。在两个环境中，患有和不患有中风的成年人的双重任务注意力分配策略通常对指令优先级的调整不够灵活，但是，两种双重任务条件的自愿注意力分配策略有所不同，即言语在言语步态双重任务中优先，而步态在 Stroop 步态双重任务中似乎优先。
尽管双重任务会降低中风患者的行走速度和对听觉刺激的言语反应，但复杂、分散注意力的环境不会对这些影响产生明显影响。患有和不患有中风的成年人在进行双任务行走时可能难以克服首选的注意力分配策略，特别是对于习惯性的双重任务，例如边行走边说话。可能是控制任务优先级的认知控制策略受到认知参与程度的影响。
