Abstract
Background: Walking in the community can be challenging for stroke survivors. The fact that community walking often requires performing another task while walking further adds to this challenge and can lead to a deterioration of performance in one or both tasks.Objective: To review the existing literature about cognitive-locomotor dual-task interference (DTI) magnitude and pattern while walking in patients with stroke and to explore the influence of tasks' nature on DTI. Moreover, this review investigated the differences in DTI between stroke survivors and age-matched healthy adults.Methods: The literature search was conducted in 4 databases (MEDLINE, CINAHL, EMBASE and PEDro). Two authors independently identified relevant studies based on predetermined selection criteria. Among these criteria, studies had to include both locomotor and cognitive DTI. Methodological quality of the studies was independently assessed by two raters using a standardized checklist. Studies were categorized according to the nature of the locomotor and the cognitive tasks.Results: A total of twenty studies, with good to high methodological quality, were selected. Task combinations, outcome measures and participants characteristics varied widely from one study to another. Despite heterogeneous results across studies, mutual DTI (decrements in both locomotor and cognitive performance) was the most frequently observed pattern in participants with stroke. Interestingly, this DTI pattern was systematically obtained when participants had to avoid obstacles while walking. DTI seemed also to be influenced by the nature of the cognitive task. Compared to age-matched healthy participants, stroke survivors had greater DTI. Mutual interferences were also more frequently observed in stroke survivors than in age-matched healthy adults.Conclusions: DTI magnitude and pattern in persons with stroke varied considerably across studies. Multiple factors, including nature of the tasks, may influence dual-task abilities when assessing individuals with stroke. Consequently, dual-task assessments should be performed in similar contexts of individuals' daily lives to ensure ecological validity.
Highlights
Stroke survivors, as well as age-matched healthy older adults, reduced their walking speed and answered with less accuracy while performing serial[7] subtractions than serial-3 subtractions. These results suggest that the nature of the cognitive tasks involved in dual-tasking has an impact on the magnitude of locomotor and cognitive dual-task interference (DTI)
In Chan et al (26), no DTI difference was observed between stroke survivors and agematched healthy adults, despite the presence of a baseline cognitive difference across groups. These findings suggest that different baseline cognitive function did not necessarily result in different cognitive DTI between stroke survivors and healthy controls
This systematic review demonstrated that persons who sustained a stroke are likely to present decrements in one or both performances while walking and performing a cognitive task, simultaneously
Summary
The ability to get out and about community is considered essential or very important by more than 70% of stroke survivors (1). People have frequently to walk while performing another task such as discussing with someone, texting or recalling a shopping list This ability to perform two tasks simultaneously can be assessed using a dual-task paradigm. Different theories suggest that DTI may be the result of limited attentional resources, but the latter may reflect a broad variety of underlying mechanisms or processes One of these frameworks, referred to as Central Capacity Sharing (13), proposes that both tasks share available processing resources. Tasks might be performed in parallel, with decrement in performances when resources are overloaded Another theoretical framework, the Bottleneck Theory, rather proposes that processing involved in each task may need simultaneous access to processor that can only act with one input at the time (14). The fact that community walking often requires performing another task while walking further adds to this challenge and can lead to a deterioration of performance in one or both tasks
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