Gait Analysis With Cognitive-Motor Dual Tasks to Distinguish Fallers From Nonfallers Among Rehabilitating Stroke Patients

Abstract

This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Abstract Objectives: To evaluate fall risk in stroke patients based on single-and dual-task gait analyses, and to investigate the difference between 2 cognitive tasks in the dual-task paradigm. Design: Prospective cohort study. Setting: Rehabilitation hospitals. Participants: Subacute stroke patients (NZ32), able to walk without physical/manual help with or without walking aids, while performing a verbal task. Interventions: Not applicable. Main Outcome Measures: Functional gait measures were Functional Ambulation Categories (FAC) and use of a walking aid. Gait measures were evaluated by an electronic walkway system under single-and dual-task (DT) conditions. For the single-task, subjects were instructed to walk at their usual speed. One of the DTs was a verbal fluency dual task, whereby subjects had to walk while simultaneously enumerating as many different animals as possible. For the other DT (counting dual task), participants had to walk while performing serial subtractions. After inclusion, participants kept a 6-month falls diary. Results: Eighteen (56.3%) of the 32 included patients fell. Ten (31.3%) were single fallers (SFs), and 8 (25%) were multiple fallers (MFs). Fallers (Fs) more frequently used a walking aid and more frequently needed an observatory person for walking safely (FAC score of 3) than nonfallers (NFs). Two gait decrement parameters in counting dual task could distinguish potential Fs from NFs: decrement in stride length percentage (PZ.043) and nonparetic step length percentage (PZ.047). Regarding the division in 3 groups (NFs, SFs, and MFs), only MFs had a significantly higher percentage of decrement for paretic step length (PZ.023) than SFs. Conclusions: Examining the decrement of spatial gait characteristics (stride length and paretic and nonparetic step length) during a DT addressing working memory can identify fall-prone subacute stroke patients.

Task Matters: Influence of Different Cognitive Tasks on Cognitive-Motor Interference During Dual-Task Walking in Chronic Stroke Survivors

“…This suggests that during (eg, counting backwards while walking) can better differentiate fallers from nonfallers compared with a verbal fl uency task in people with stroke. 37 Based on the higher cognitive-motor interference observed with the working memory task in this study and previous investigations, use of such a dual-tasking test is recommended for detecting defi cits in gait and balance functions that could impact safe and independent community mobility in chronic stroke survivors. Furthermore, timely evaluation of functional mobility under challenging circumstances might also aid in early detection of cognitive decline post stroke.…”

Imaging gait analysis: An fMRI dual task study

“…However, gait alterations such as decreased walking speed and increased gait variability are associated with deficits in attentional processes (Baetens et al, 2012;Bridenbaugh & Kressig, 2011;Hausdorff, Balash, & Giladi, 2003). These gait alterations become especially prominent during a dual task condition when performing a concurrent cognitive task.…”

Gait Change Is Associated with Cognitive Outcome after an Acute Ischemic Stroke

“…Although most of the stroke survivors experience some degrees of recovery in walking within the first months following symptom onset, gait disturbances can persist and worsen functional outcome (Baetens et al, 2013). The burden of cognitive and gait impairment has often been studied separately while the cognitive effort required to detect environmental changes and to compensate postural perturbations when walking suggests that these two domains should be evaluated together (Montero-Odasso et al, 2012).…”