Effect of sensory-motor training on gait quality and executive functioning of chronic stroke survivors

Abstract

Traditionally gait was believed to be an automated task; however current research shows that walking involves higher cognitive functions i.e. executive function (EF). Optimal EF allows allocation of appropriate attentional resources to performing motor tasks correctly and effectively and is severely affected in stroke survivors. Limited research has been done on the effectiveness of sensory-motor training (SMT) on cognitive functioning in stroke. It is hypothesized that SMT may improve this motor-cognitive interaction during gait, as well as EF. This study endeavoured to determine if an eight-week SMT programme would influence executive functioning and dual task gait quality in chronic stroke survivors. This pre-post study design consisted of ten chronic stroke survivors (67 ± 14 years; ≥ 6 months since stroke) with no severe cognitive impairment (24 ± 2 score on Montreal Cognitive Assessment) who participated in the eight-week SMT programme, three times a week (45–60 minutes per session) under therapist-supervision. A two-minute walk test assessed single (ST) and dual task (DT) spatial-temporal gait variables; while EF was assessed with an adapted Stroop, Trail Making (Part A and B) and Verbal Digit Span Forward and Backward tests. Stroke-related self-efficacy was determined by completing the Stroke Self-efficacy Questionnaire. No significant changes were found in EF or ST gait variables. DT stride velocity ( P = 0.05, d = 0.39, 95% CI: −11.07 to −0.73), paretic stride velocity ( P = 0.04, d = 0.40, 95% CI: −11.34 to −1.18), cadence ( P = 0.03, d = 0.78, 95% CI: −19.04 to −2.50), stride time ( P = 0.02, d = 0.82, 95% CI: 0.00 to 0.40) and peak medio-lateral trunk acceleration ( P = 0.02, d = 0.45, 95% CI: −5.93 to −1.16) showed improvement. Stroke-related self-efficacy ( P < 0.001; d = 2.66, 95% CI: 1.26 to 4.57) also improved. Preliminary findings suggest that SMT have some benefits for improving cognitive-motor interaction during walking, while also improving factors that specifically influence performance in stroke survivors. Furthermore, studies should investigate the use of DT as an ecological assessment tool for stroke survivor's EF.