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Hum Mov Sci. 2018 Apr;58:175-184. doi: 10.1016/j.humov.2018.01.012. Epub 2018 Mar 12.

Cognitive-motor dual-task interference modulates mediolateral dynamic stability during gait in post-stroke individuals.

Author information

1
Univ. Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMR_T9406, LBMC, 69622 Lyon, France; School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada.
2
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
3
Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.
4
Division of Neurorehabilitation, Geneva University Hospitals and University of Geneva, Switzerland.
5
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland; Univ. Grenoble Alpes, HP2 Laboratory, 38000 Grenoble, France; INSERM, U1042, 38000 Grenoble, France; Pole Thorax et Vaisseaux, Grenoble Alpes University Hospital, Grenoble, France. Electronic address: sbaillieul@chu-grenoble.fr.

Abstract

Gait asymmetry and dynamic balance impairments observed in post-stroke individuals increase their risk of fall. Moreover, walking while performing a cognitive task (i.e. dual-task) disturbs the control of balance in post-stroke individuals. Here we investigated the mediolateral dynamic stability in twenty-two community-dwelling participants (12 post-strokes and 10 healthy controls) while walking in single-task (normal gait) and four different dual-tasks (cognitive-motor interference). Positions of the extrapolated center of mass and mediolateral widths of both margin of stability and base of support were extracted from 35 marker trajectories. Post-stroke participants presented larger margin of stability and base of support than controls during single-task (both p < 0.01), with a larger margin of stability on the non-paretic side than on the paretic side at ipsilateral foot-strike (p < 0.05). No significant effect of the dual-task was found between groups. In post-stroke participants, dual-task induced slight modification of the mediolateral stability strategy, as the margin of stability was not different between the two limbs at foot-strike, and significantly reduced the performance in every cognitive task. Post-stroke participants increased their dynamic stability in the frontal plane in single-task by extending their base of support and mainly relying on their non-paretic limb. Under cognitive-motor interference (dual-task), post-stroke participants prioritized dynamic stability over cognitive performance to ensure a safe locomotion. Thus, rehabilitation programs should consider both dynamic balance and dual-task training, even at a chronic delay following stroke, to reduce the risk of fall in post-stroke individuals.

KEYWORDS:

Dual-task; Dynamic stability; Gait; Hemiparesis; Stroke

PMID:
29448162
DOI:
10.1016/j.humov.2018.01.012
[Indexed for MEDLINE]

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