Cognitive-Locomotor Dual-Task Interference in Stroke Survivors and the Influence of the Tasks: A Systematic Review

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.

Virtual reality‐based assessment of cognitive‐locomotor interference in healthy young adults

“…Dual-task phenomenon was extensively documented, but only a few studies have used cognitive and locomotor tasks representing daily activities. Indeed, commonly used cognitive tasks are adapted from traditional neuropsychological assessments, such as the Stroop test or serial subtractions [ 23 ]. Existing literature reflects upon the ecological validity of those executive function assessments.…”

“…Those assessments seemed inconsistent with the executive functions solicited when performing daily activities [ 24 ]. Regarding the locomotor task, participants were most frequently asked to walk forward over a short distance, without any mobile obstacles in most dual-task studies [ 12 , 23 ].…”

The effects of a secondary task on gait in axial spondyloarthritis

“…At this point, within the context of a dual-task, the attentional demand associated with gait depends on various factors 8 , 10 , 12 , 15 that could account for the observed results. These factors could be regarded as possible explanations and as study limitation that we acknowledge.…”

“…with effects on cognitive task only ), (3) motor-related (i.e. with effects on locomotor task only ) or (4) absent 12 . In the present study, dual-task interference observed in both patients with axSpA and healthy controls can be placed in the class of ‘motor-related’ as the gait performance was significantly altered during dual-task walking and the performance of secondary manual task while walking remained maximal.…”

“…At this point, it is important to mention that interpreting changes in dual-task walking performance is rather difficult 15 . It is indeed recognised that dual-task interference during walking does depend on a wide variety of factors (e.g., see for reviews 8 , 10 , 12 , 15 ), including among others the gait capabilities of the individuals. In fact, what the above mentioned older adults and patient populations seem to have in common is gait disorders.…”