Changes in cognitive-motor interference during rehabilitation of cane walking in patients with subacute stroke: A pilot study

Abstract

No previous research has examined cognitive-motor interference (CMI) repeatedly in patients with subacute stroke. This pilot study aimed to report on the changes over time in CMI in patients with stroke who have recently learned to walk with a cane. The assessment started as soon as the participants could walk independently with a quad cane, and was repeated up to six sessions as long as the cane was still used. The dual-tasking paradigm required participants to walk and perform continuous subtractions by 3s. Data were analyzed for 9 participants 33–127 days post-stroke. All 9 participants showed CMI in walking velocity at baseline and 8 of these showed improvement over time (Z = -2.547; p = 0.011). The improvement in CMI was associated with baseline dual-tasking performance (ρ = 0.600; p = 0.044), motor control ability (ρ = -0.695; p = 0.019), walking velocity (ρ = -0.767; p = 0.008), and functional mobility (ρ = 0.817; p = 0.004). All participants showed decrements in both tasks (mutual interference) at baseline, 1 evolved to decrements in walking velocity (cognitive-related motor interference), and 3 finally evolved to decrements in cognitive performance but increments in walking velocity (motor-priority tradeoff). In conclusion, during rehabilitation with cane walking in patients with subacute stroke, the dual-tasking paradigm revealed CMI and its improvements in the majority of participants. Greater improvement in CMI was moderately to strongly associated with worse baseline performance of many variables. The evolution of the CMI pattern over time provides novel information relevant to neurological recovery.