This study aimed to explore the biomechanical characteristics of patients with stroke and neuromuscular action control mechanisms in single-dual-task walking-conversion training.
Materials and methods
Patients with stroke from four centers were enrolled and randomly divided into the cognitive combined treadmill-walking and exercise combined treadmill-walking groups (n = 30 per group). The gait spatiotemporal parameters, walking function, and fall risk of the two experimental groups were compared before and after 4 and 6 weeks of training. Surface electromyography (sEMG) and functional near-infrared spectroscopy (fNIRS) were performed to analyze neuromuscular action control mechanisms in different task phases.
Results
After 6 weeks of training, the gait spatiotemporal parameters, walking function, integral electromyogram (iEMG) values, and root mean square (RMS) of the affected lower limb muscles of the two experimental groups significantly improved (P < 0.01), while the fall risk was reduced (P < 0.01). fNIRS analysis showed that in both the single- and dual-task phases, HbO signal concentrations in the brain functional regions of the two experimental groups significantly increased after training (P < 0.01). These indicators were not significantly different between the two experimental groups after 6 weeks of training (P > 0.05). In addition, during the dual-task phase, the blood oxygen signal concentrations and functional connectivity in the functional brain regions of the two experimental groups were lower than those of healthy controls.
Conclusion
Cognitive or motor tasks combined with treadmill-walking training can promote the recovery of physical function in patients with stroke.
Clinical trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR; registration number: ChiCTR2200060864).
AnHSKimDJ. Effects of activities of daily living-based dual-task training on upper extremity function, cognitive function, and quality of life in stroke patients. Osong Public Health Res Perspect2021; 12: 304–313.
2.
MaenzaC, et al.Functional deficits in the less-impaired arm of stroke survivors depend on hemisphere of damage and extent of paretic arm impairment. Neurorehabil Neural Repair2020; 34: 39–50.
3.
HobbsBArtemiadisP. A review of robot-assisted lower-limb stroke therapy: unexplored paths and future directions in gait rehabilitation. Front Neurorobot2020; 14: 19.
4.
YangZ-Q, et al.Research progress in the application of motor-cognitive dual-task training in rehabilitation of walking function in stroke patients. J Neurorestoratol2023; 11: 100028.
5.
YangYR, et al.Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil2007; 88: 1236–1240.
6.
TisserandR, et al.Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals. Hum Mov Sci2018; 58: 175–184.
7.
MuciB, et al.What are the factors affecting dual-task gait performance in people after stroke?Physiother Theory Pract2022; 38: 621–628.
8.
HyndmanDAshburnA. Stops walking when talking as a predictor of falls in people with stroke living in the community. J Neurol Neurosurg Psychiatry2004; 75: 994–997.
9.
PangMYC, et al.Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke. Stroke2018; 49: 2990–2998.
10.
KimGYHanMRLeeHG. Effect of dual-task rehabilitative training on cognitive and motor function of stroke patients. J Phys Ther Sci2014; 26: 1–6.
11.
WoollacottMShumway-CookA. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture2002; 16: 1–14.
12.
ChoKHLeeWH. Virtual walking training program using a real-world video recording for patients with chronic stroke: a pilot study. Am J Phys Med Rehabil2013; 92: 371–380, quiz 380-2, 458.
13.
KimJH, et al.Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. Am J Phys Med Rehabil2009; 88: 693–701.
14.
MirelmanABonatoPDeutschJE. Effects of training with a robot-virtual reality system compared with a robot alone on the gait of individuals after stroke. Stroke2009; 40: 169–174.
15.
ZhaoJ, et al.Diagnostic criteria of integrated traditional Chinese and Western medicine for cerebral infarction and cerebral hemorrhage (trial implementation). Chin J Integr Tradit Western Med2006; 26: 948–949.
16.
BullFC, et al.World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med2020; 54: 1451–1462.
17.
ProdingerB, et al.Establishing score equivalence of the functional independence measure motor scale and the barthel Index, utilising the international classification of functioning, disability and health and rasch measurement theory. J Rehabil Med2017; 49: 416–422.
18.
KorsnesMS. Performance on the mini-mental state exam and the Montreal cognitive assessment in a sample of old age psychiatric patients. SAGE Open Med2020; 8: 2050312120957895.
19.
KasovićMŠtefanLZvonařM. Domain-specific and total sedentary behavior associated with gait velocity in older adults: the mediating role of physical fitness. Int J Environ Res Public Health2020; 17.
20.
VillalobosD, et al.A systematic review of normative data for verbal fluency test in different languages. Neuropsychol Rev2022.
21.
ChengDK, et al.Validation of stroke-specific protocols for the 10-meter walk test and 6-min walk test conducted using 15-meter and 30-meter walkways. Top Stroke Rehabil2020; 27: 251–261.
22.
Ortega-BastidasP, et al.Instrumented timed up and go test (iTUG)-more than assessing time to predict falls: a systematic review. Sensors (Basel)2023; 23.
23.
ParkSHLeeYS. The diagnostic accuracy of the berg balance scale in predicting falls. West J Nurs Res2017; 39: 1502–1525.
24.
RahmanMA, et al.A narrative review on clinical applications of fNIRS. J Digit Imaging2020; 33: 1167–1184.
25.
SimićGHofPR. In search of the definitive Brodmann's map of cortical areas in human. J Comp Neurol2015; 523: 5–14.
HatakeyamaMNinomiyaIKanazawaM. Angiogenesis and neuronal remodeling after ischemic stroke. Neural Regen Res2020; 15: 16–19.
28.
WangXQ, et al.Cognitive motor interference for gait and balance in stroke: a systematic review and meta-analysis. Eur J Neurol2015; 22: 555–e37.
29.
ParkJKimTH. The effects of balance and gait function on quality of life of stroke patients. NeuroRehabilitation2019; 44: 37–41.
30.
ZhangM, et al.The effect of balance and gait training on specific balance abilities of survivors with stroke: a systematic review and network meta-analysis. Front Neurol2023; 14: 1234017.
31.
PlummerP, et al.Cognitive-motor interference during functional mobility after stroke: state of the science and implications for future research. Arch Phys Med Rehabil2013; 94: 2565–2574.e6.
32.
TrombettiA, et al.Effect of music-based multitask training on gait, balance, and fall risk in elderly people: a randomized controlled trial. Arch Intern Med2011; 171: 525–533.
33.
Al-YahyaE, et al.Cognitive motor interference while walking: a systematic review and meta-analysis. Neurosci Biobehav Rev2011; 35: 715–728.
34.
Trombini-SouzaF, et al.Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial. PeerJ2023; 11: e15030.
35.
NascimentoMM, et al.The effects of 12-week dual-task physical-cognitive training on gait, balance, lower extremity muscle strength, and cognition in older adult women: a randomized study. Int J Environ Res Public Health2023; 20.
36.
BaekCY, et al.The effect of the degree of dual-task interference on gait, dual-task cost, cognitive ability, balance, and fall efficacy in people with stroke: a cross-sectional study. Medicine (Baltimore)2021; 100: e26275.
37.
TombuMJolicoeurP. All-or-none bottleneck versus capacity sharing accounts of the psychological refractory period phenomenon. Psychol Res2002; 66: 274–286.
38.
PatelPLamarMBhattT. Effect of type of cognitive task and walking speed on cognitive-motor interference during dual-task walking. Neuroscience2014; 260: 140–148.
39.
KavanaghJJ. Lower trunk motion and speed-dependence during walking. J Neuroeng Rehabil2009; 6: 9.
40.
Montero-OdassoMSpeechleyM. Falls in cognitively impaired older adults: implications for risk assessment and prevention. J Am Geriatr Soc2018; 66: 367–375.
41.
StudenskiS, et al.Gait speed and survival in older adults. Jama2011; 305: 50–58.
42.
EspyDD, et al.Independent influence of gait speed and step length on stability and fall risk. Gait Posture2010; 32: 378–382.
43.
HosoiY, et al.Estimation of minimal detectable change in the 10-meter walking test for patients with stroke: a study stratified by gait speed. Front Neurol2023; 14: 1219505.
44.
KangL, et al.Timed up and go test can predict recurrent falls: a longitudinal study of the community-dwelling elderly in China. Clin Interv Aging2017; 12: 2009–2016.
45.
CosenzaL, et al.Rectus femoris characteristics in post stroke spasticity: clinical implications from ultrasonographic evaluation. Toxins (Basel)2020; 12.
46.
CampaniniI, et al.Surface EMG in clinical assessment and neurorehabilitation: barriers limiting its use. Front Neurol2020; 11: 934.
47.
DraicchioFSilvettiARanavoloA. [How surface electromyography (sEMG) can help in biomechanical risk assessment in industrial work]. G Ital Med Lav Ergon2011; 33: 226–229.
48.
GaoC, et al.A study on improvement of hemiplegic stroke Patients’ lower limb muscle activation and coordination by training of limbs linkage. Chinese J Sports Med2020; 39: 363–367.
49.
XieH, et al.Effects of robot-assisted task-oriented upper limb motor training on neuroplasticity in stroke patients with different degrees of motor dysfunction: a neuroimaging motor evaluation index. Front Neurosci2022; 16: 957972.
50.
HaraY. Brain plasticity and rehabilitation in stroke patients. J Nippon Med Sch2015; 82: 4–13.
51.
BajajS, et al.Oscillatory motor network activity during rest and movement: an fNIRS study. Front Syst Neurosci2014; 8: 13.
52.
MiyaiI, et al.Longitudinal optical imaging study for locomotor recovery after stroke. Stroke2003; 34: 2866–2870.
53.
LinPYChenJJLinSI. The cortical control of cycling exercise in stroke patients: an fNIRS study. Hum Brain Mapp2013; 34: 2381–2390.
54.
FujimotoH, et al.Cortical changes underlying balance recovery in patients with hemiplegic stroke. Neuroimage2014; 85 Pt 1: 547–554.
55.
NairDG, et al.Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients. Neuroimage2007; 34: 253–263.
56.
VannasingP, et al.Potential brain language reorganization in a boy with refractory epilepsy; an fNIRS-EEG and fMRI comparison. Epilepsy Behav Case Rep2016; 5: 34–37.
57.
DelormeM, et al.Time course of sensorimotor cortex reorganization during upper extremity task accompanying motor recovery early after stroke: an fNIRS study. Restor Neurol Neurosci2019; 37: 207–218.
58.
TakedaK, et al.Shift of motor activation areas during recovery from hemiparesis after cerebral infarction: a longitudinal study with near-infrared spectroscopy. Neurosci Res2007; 59: 136–144.
59.
KinoshitaS, et al.Association between imbalance of cortical brain activity and successful motor recovery in sub-acute stroke patients with upper limb hemiparesis: a functional near-infrared spectroscopy study. Neuroreport2019; 30: 822–827.
60.
IqbalM, et al.Comparison of dual task specific training and conventional physical therapy in ambulation of hemiplegic stroke patients: a randomized controlled trial. J Pak Med Assoc2020; 70: 7–10.
61.
ChiaramonteR, et al.Proprioceptive and dual-task training: the key of stroke rehabilitation, a systematic review. J Funct Morphol Kinesiol2022; 7.
62.
ZhangX, et al.Effects of dual-task training on gait and balance in stroke patients: a meta-analysis. Clin Rehabil2022; 36: 1186–1198.
63.
HoltzerR, et al.fNIRS study of walking and walking while talking in young and old individuals. J Gerontol A Biol Sci Med Sci2011; 66: 879–887.
64.
AgbanglaNF, et al.Working memory, cognitive load andcardiorespiratory fitness: testing the CRUNCHModel with near-infrared spectroscopy. Brain Sci2019; 9.
