Level IV.

Stroke patients often exhibit difficulties performing a cognitive task while walking, defined as a dual task (DT). Their prefrontal cortex (PFC) activity is higher in DT than in single task (ST). The effects of an increasing load on PFC activity during DT in subacute stroke patients remains unexplored. Our objective was to assess the effects of N-back tasks (low/high load) on cerebral activity, gait parameters, and cognitive performances. Eleven subacute stroke patients (days post-stroke 45.8 ± 31.6) participated in this pilot study (71.4 ± 10 years, BMI 26.7 ± 4.8 kg.m −2 , Barthel index 81.8 ± 11.0). Patients completed a ST walk , and 4 conditions with 1-back (low load) and 2-back (high load): ST low , ST high , DT low , and DT high . Overground walking was performed at a comfortable pace and -N-back conditions were carried out verbally. Both gait (speed, stride variability) and cognitive (rate of correct answers) performances were recorded. Changes in PFC oxyhemoglobin (ΔO 2 Hb) and deoxyhemoglobin (ΔHHb) were measured by functional near infrared spectroscopy (fNIRS). Results showed an increase of ΔO 2 Hb while walking, which was not augmented by cognitive loads in DT. Walking speed was reduced by low and high cognitive loads in DT compared to ST walk ( P < 0.05), but was not different between DT low and DT high . Cognitive performances were negatively impacted by both walking ( P < 0.05) and cognitive load (between “low” and “high,” P < 0.001). These data highlight a “ceiling” effect in ΔO 2 Hb levels while walking, leaving no available resources for simultaneous cognitive tasks, during the early recovery period following stroke. In these patients, cognitive, but not motor, performances declined with a higher cognitive load.

Background: Health professionals need valid devices to assess a stroke individual’s ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor’s position in stroke individuals. Methods: Post-stroke patients able to walk without human assistance were equipped with several wearable devices: pedometers, Actigraph, and Sensewear Armband placed according to the manufacturers' recommendations. Participants walked for 6 min at a comfortable speed wearing all sensors at the same time. We analyzed the validity of sensor-estimated distances according to their position using Bland–Altman analysis, root-mean-square error, and coefficient of correlation. Results: In total, 35 individuals were included (mean age = 65 ± 15 years). The best estimations were given by the Actigraph worn on the unaffected ankle (mean bias (MB) = 22.6 ± 32.4 m; p = 0.37) and by the pedometer worn on the unaffected hip (MB = 20.5 ± 24.6 m; p = 0.46). The other sensors and positions provided large estimation errors over 95 m (p < 0.05). Conclusion: This study led to a recommendation of a pedometer worn on the unaffected hip or an Actigraph worn on the unaffected ankle to get a valid estimation of the distance walked by stroke individuals.