Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.
Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
PLoS One. 2022 Oct 6;17(10):e0274425. doi: 10.1371/journal.pone.0274425. eCollection 2022.
No previous research has examined cognitive-motor interference (CMI) repeatedly in patients with subacute stroke. This pilot study aimed to report on the changes over time in CMI in patients with stroke who have recently learned to walk with a cane. The assessment started as soon as the participants could walk independently with a quad cane, and was repeated up to six sessions as long as the cane was still used. The dual-tasking paradigm required participants to walk and perform continuous subtractions by 3s. Data were analyzed for 9 participants 33-127 days post-stroke. All 9 participants showed CMI in walking velocity at baseline and 8 of these showed improvement over time (Z = -2.547; p = 0.011). The improvement in CMI was associated with baseline dual-tasking performance (ρ = 0.600; p = 0.044), motor control ability (ρ = -0.695; p = 0.019), walking velocity (ρ = -0.767; p = 0.008), and functional mobility (ρ = 0.817; p = 0.004). All participants showed decrements in both tasks (mutual interference) at baseline, 1 evolved to decrements in walking velocity (cognitive-related motor interference), and 3 finally evolved to decrements in cognitive performance but increments in walking velocity (motor-priority tradeoff). In conclusion, during rehabilitation with cane walking in patients with subacute stroke, the dual-tasking paradigm revealed CMI and its improvements in the majority of participants. Greater improvement in CMI was moderately to strongly associated with worse baseline performance of many variables. The evolution of the CMI pattern over time provides novel information relevant to neurological recovery.
先前的研究并未反复检查亚急性脑卒中患者的认知运动干扰（CMI）。本研究旨在报告新学会使用手杖行走的脑卒中患者的 CMI 随时间的变化。评估在患者可以独立使用四轮手杖行走后立即开始进行，只要还在使用手杖，就会重复进行最多六次。双重任务范式要求参与者在行走的同时进行连续的 3 秒减法。对 9 名患者（发病后 33-127 天）的数据进行了分析。所有 9 名患者在基线时均显示出步行速度的 CMI，其中 8 名患者随着时间的推移显示出改善（Z = -2.547;p = 0.011）。CMI 的改善与基线双重任务表现（ρ=0.600;p=0.044）、运动控制能力（ρ=-0.695;p=0.019）、步行速度（ρ=-0.767;p=0.008）和功能移动性（ρ=0.817;p=0.004）相关。所有患者在基线时均显示出两个任务的表现下降（相互干扰），1 名患者的步行速度下降（与认知相关的运动干扰），3 名患者最终的认知表现下降但步行速度增加（运动优先级权衡）。总之，在亚急性脑卒中患者使用手杖行走的康复过程中，双重任务范式揭示了大多数患者的 CMI 及其改善。CMI 的改善与许多变量的基线表现较差呈中度至强相关。CMI 模式随时间的演变提供了与神经恢复相关的新信息。
