Purpose/Hypothesis: After a stroke (CVA), lesion location may affect the capacity to allocate attention to the acquisition and processing of information necessary to guide motor performance for standing and walking. The purpose of this study was to examine the difference in the capacity to allocate attention to multiple task performance based on hemispheric lesion location in patients who have had a stroke. Number of Subjects: Thirty-two adults, admitted for acute inpatient rehabilitation, were assigned to one of two groups based on lesion location – left CVA (n=14, mean age = 62.9±13.6 yrs), right CVA (n=18, mean age = 62.7±12.8 yrs). At the time of testing, all achieved modified independence for ambulation, had a single, unilateral, first-time lesion and were within 48 hours of discharged from the hospital. Two non-disabled control groups consisting of older (n=18, mean age = 68.3±10.3 yrs) and young (n=18, mean age = 25.9±2.6 yrs) adults also participated. Materials/Methods: A dual-task voice reaction time (VRT) paradigm was used to measure the attentional requirements of completing the two primary functional tasks, standing and walking, by examining changes in performance on a secondary task, the time required to verbally respond to an auditory stimulus by saying the letter “B”. In addition, single and dual-task cadence and gait velocity and overall balance performance was examined. Results: A four (group) × two (task) repeated measures ANOVA revealed significantly slower standing and walking VRT for both CVA groups (p<;.001) when compared to the control groups. Standing and walking VRT did not differ significantly (p=.087) between the post-stroke groups. However, one between task difference appeared for the right CVA group, walking VRT was significantly slower (p<;.001) than standing VRT. There was no statistically significant between group and between task differences in VRT for the control groups. When compared to the control groups, the post-CVA groups walked significantly slower. A comparison of single and dual-task walking performance revealed no statistically significant changes in either cadence or velocity for any of the groups. Conclusions: Among patients who have had a relatively good rehabilitation outcome, the pattern of statistically significant differences in VRT indicates the need for a greater allocation of attentional resources to functional task performance after a stroke. The limitation in the capacity to attend to multiple tasks may be due to one or more lesion specific consequences, such as residual motor defcits, impairments in balance and/or altered capacity for stimulus acquisition and processing. Clinical Relevance: The inability to attend to multiple stimuli is an identifed risk factor for falls in older adults. The participants in this study, while achieving a high level of functional performance for walking, had at least one risk factor, difficulty allocating attention, which places them at increased risk for falling. The literature indicates individuals post-stroke frequently fall soon after being discharged from the hospital.
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