Department of Orthopedic Surgery, Duke University, Durham, NC, USA.
Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA -
Eur J Phys Rehabil Med. 2021 Jun;57(3):327-336. doi: 10.23736/S1973-9087.20.06273-5. Epub 2020 Sep 16.
Many ambulatory stroke survivors are discharged to community settings where they will confront highly attention-demanding mobility situations. Very little is known about cognitive-motor interference during walking in acutely rehabilitating stroke survivors.
To examine the magnitude and patterns of cognitive-motor dual-task interference at hospital discharge post stroke and explore the characteristics associated with distinct interference patterns.
Observational study.
Acute care and inpatient rehabilitation centers.
Forty-seven adults with hospital admission for stroke who were being discharged to home. Mean age was 59.5 years (SD=11.7) and median days post stroke was 14 (IQR=7-21).
Gait and cognitive (category naming task) performance were assessed under single- and dual-task conditions at hospital discharge. Dependent variables were gait speed, stride duration, stride duration variability, stride length, cadence, and correct response rate. Single and dual-task values were compared to assess the effects of dual-tasking on gait and category naming. Relative dual-task effects on gait speed and cognitive performance were plotted to identify patterns of dual-task interference. Exploratory analysis compared clinical characteristics between subgroups defined by pattern of interference.
There were significant dual-task declines in gait speed, with corresponding dual-task effects on stride length, cadence, and stride duration, but no dual-task effects on stride duration variability or correct response rate. Dual-task effects on the category naming task were not significant due to large between-subject variability. Three predominant patterns of cognitive-motor interference were evident: mutual interference (37% of participants), gait interference (30% of participants), and cognitive-priority trade-off (22% of participants) - these patterns reflect the consistently observed negative dual-task effect on gait speed with positive, negative, or null effects on category naming. Participants who demonstrated cognitive-priority trade-off pattern of interference had significantly worse single-task category-naming performance, while those with mutual interference had greater overall stroke severity.
Cognitive-motor dual-task interference on gait speed is highly prevalent in ambulatory stroke survivors with mild cognitive-linguistic impairments at hospital discharge. Variability in cognitive-task performance under dual-task conditions has implications for the reliability of dual-task assessment after stroke.
Assessment of dual-task walking is feasible as a predischarge evaluation of attention-demanding mobility function after stroke.
许多门诊中风幸存者出院后进入社区环境，他们将面临高度需要注意力的移动情况。在急性康复中风幸存者中，对行走时的认知运动干扰知之甚少。
探讨中风后住院期间认知运动双重任务干扰的程度和模式，并探讨与不同干扰模式相关的特征。
观察性研究。
急性护理和住院康复中心。
47 名因中风住院并出院回家的成年人。平均年龄为 59.5 岁（SD=11.7），中风后中位数为 14 天（IQR=7-21）。
在出院时评估单任务和双重任务条件下的步态和认知（类别命名任务）表现。因变量为步行速度、步幅时长、步幅时长变异性、步幅长度、步频和正确反应率。比较单任务和双任务值以评估双任务对步态和类别命名的影响。绘制步态速度和认知表现的相对双重任务效应图，以确定双重任务干扰模式。探索性分析比较了根据干扰模式定义的亚组之间的临床特征。
步态速度有明显的双重任务下降，相应的双重任务对步长、步频和步幅时长有影响，但对步幅时长变异性或正确反应率没有影响。由于个体间变异性较大，双重任务对类别命名任务的影响不显著。有三种主要的认知运动干扰模式：相互干扰（37%的参与者）、步态干扰（30%的参与者）和认知优先权衡（22%的参与者）——这些模式反映了步态速度上一致观察到的负面双重任务效应，对类别命名有积极、消极或无影响。表现出认知优先权衡干扰模式的参与者的单一任务类别命名表现明显更差，而相互干扰的参与者则有更严重的整体中风严重程度。
在出院时轻度认知语言障碍的门诊中风幸存者中，认知运动双重任务对步态速度的干扰非常普遍。双重任务条件下认知任务表现的变异性对中风后双重任务评估的可靠性有影响。
双重任务行走评估作为中风后对注意力要求高的移动功能的出院前评估是可行的。
