Dual-task walking and automaticity after Stroke: Insights from a secondary analysis and imaging sub-study of a randomised controlled trial.
Johnny Collett, Melanie K Fleming, Daan Meester and 9 others
PMID 34053250WHAT IT FOUND
Stroke survivors with faster baseline walking improved their dual-task walking after training.
Those with slower walking did not. This suggests increasing walking speed should be the priority before attempting complex dual-task rehabilitation.
Key findings
01Participants with good baseline walking capacity improved their dual-task two-minute walk distance after training, while those with limited capacity did not.
02Both groups improved their single-task walking distance, but neither group significantly increased their daily step count or perception of community participation.
03Limited walkers showed greater brain activation in motor and frontal areas during a dual-task planning test compared to good walkers, suggesting a higher demand for conscious control.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a secondary analysis, so the study was not specifically powered to test the hypothesis regarding baseline walking capacity. The cut-off for 'good' walking capacity (0.8 m/s) was an assumption based on community ambulation, not a defined threshold for automaticity. fNIRS data had high missing rates (31%) due to signal quality issues. The fMRI sub-study had a very small sample size (16 participants), limiting the reliability of the brain imaging findings. The cognitive task used in the clinical walking test differed from the tasks used during brain imaging.
Declared interests
The authors declared no potential conflicts of interest. The study was funded by the Stroke Association.
The easy way to misread this
Do not assume that dual-task training is inherently superior or necessary for all stroke patients. This study suggests that without sufficient baseline walking speed, patients may not benefit from dual-task challenges, and simple walking training may be more appropriate initially.