Prefrontal Cortex Activation While Walking Under Dual-Task Conditions in Stroke

Abstract

Background Walking while performing another task (eg, talking) is challenging for many stroke survivors, yet its neural basis are not fully understood. Objective To investigate prefrontal cortex activation and its relationship to gait measures while walking under single-task (ST) and dual-task (DT) conditions (ie, walking while simultaneously performing a cognitive task) in stroke survivors. Methods We acquired near-infrared spectroscopy (NIRS) data from the prefrontal cortex during treadmill walking in ST and DT conditions in chronic stroke survivors and healthy controls. We also acquired functional magnetic resonance imaging (fMRI) and NIRS during simulated walking under these conditions. Results NIRS revealed increased oxygenated hemoglobin concentration in DT-walking compared with ST-walking for both groups. For simulated walking, NIRS showed a significant effect of group and group × task, being greater on both occasions, in stroke survivors. A greater increase in brain activation observed from ST to DT walking/ simulated walking was related to a greater change in motor performance in stroke survivors. fMRI revealed increased activity during DT relative to ST conditions in stroke patients in areas including the inferior temporal gyri, superior frontal gyri and cingulate gyri bilaterally, and the right precentral gyrus. The DT-related increase in fMRI activity correlated with DT-related change in behavior in stroke participants in the bilateral inferior temporal gyrus, left cingulate gyrus, and left frontal pole. Conclusion Our results provide novel evidence that enhanced brain activity changes relate to dual task motor decrements.

Neuroimaging of Human Balance Control: A Systematic Review

“…Using a verbal fluency task, Clark et al (2014b) found an increase in prefrontal cortex activation compared to single-task walking. In a walking while counting dual-task condition, Al-Yahya et al (2016) found increased activation of the prefrontal cortex compared to single task walking in older adults with chronic stroke. Lu et al (2015) found increased activation of the left prefrontal cortex, supplementary motor area, and premotor cortex during walking while subtracting conditions and that increased premotor cortex and supplementary motor area activation were correlated with declines in gait performance.…”

“…Some studies found an increase in activation in dual-task conditions (Holtzer et al, 2011; Doi et al, 2013; Clark et al, 2014b; Al-Yahya et al, 2016), while others found a decrease (Shimada et al, 2013; Beurskens et al, 2014; Lin and Lin, 2016). In addition, although aging negatively affects balance control, Takeuchi et al (2016) did not find a difference in prefrontal cortex activation between young and older adults while playing a game and walking.…”

“…By concurrently using multiple imaging modalities within the same study, we could develop a deeper understanding of the temporal and spatial dynamics of brain activity in the balance control domain. Within this review, one study analyzed dynamic balance control through fNIRS and fMRI (Al-Yahya et al, 2016). In this study, real gait was paired with fNIRS methods while isolated ankle movements were paired with fMRI.…”

Review of functional near-infrared spectroscopy in neurorehabilitation

“…The prefrontal activation increased more in dual-task condition than normal gait in nondemented elderly subjects and larger prefrontal activation correlated with larger stride length and better cognitive performance. 32 Al-Yahya et al 33 have also reported that the prefrontal activity was more prominent in dual-task walking compared with single-task walking in both healthy subjects and patients with stroke. These findings suggested that the PFC is involved in the allocation of attentional resources during dual-task walking situations.…”

Verification of Preventive Effect of Dual-Task and N-Back Task- Incorporated Music Therapy against Dementia

“…It had also been reported that dual-task can activate the brain more significantly, compared to single-task (a single task such as exercise only or learning only), and the activation of prefrontal cortex had been verified [7,8].…”