Attentional prioritization in dual-task walking: Effects of stroke, environment, and instructed focus.

Participants had to be able to walk continuously for at least 1 minute, report fewer than 2 falls in the last 12 months, score at least 20/30 on cognitive screening, and avoid severe aphasia, so the results may not apply to people with more severe stroke, aphasia, or fall risk. The study measured gait speed and task scores, not stability, double-limb support, variability, or safety; the authors note these other gait aspects are needed. The real-world Stroop gait difference in adults with stroke was 0.03 m/s, below the reported minimal clinically important difference of 0.06 m/s and standard error of 0.04 m/s, so it may not matter clinically. Participants were not asked whether they could shift attention as instructed, and attention to distractions was not measured. The headset may have muted lobby noise, reducing environmental distraction. Some participants used assistive devices; they walked slower than those who did not, although dual-task gait cost did not differ between these stroke subgroups. The study was not a training or cueing trial, so it cannot show what will change gait in therapy.

The authors declared no conflicts of interest. The paper is listed as supported by NIH extramural research.

Do not conclude that telling patients to focus on walking will protect gait speed during dual-task walking. The study found no effect of priority instruction on the gait speed cost during the Stroop task and no priority effect on speech gait cost, while walking and talking still slowed gait speed.