Effects of dual-task gait training on attention allocation after stroke: A case report

Abstract

Purpose: Individuals with stroke have a diminished ability to walk and perform cognitive tasks simultaneously. This may be due to an inability to shift attention between the two tasks. We examined the effect of dual-task gait training (DTGT) on the ability to switch attention during dual-task walking in a patient after stroke. Methods: A 64 year old female, 10 months post-stroke, completed twelve 30-minute sessions of DTGT over 4 weeks. DTGT involved simultaneous practice of gait tasks with cognitive tasks. We assessed gait and cognitive performance under single and four different dual-task conditions (no priority, gait priority, cognitive priority, and equal priority). To assess the ability to shift attention between tasks, we calculated the attention allocation index for gait speed (AAIg) and reaction time (AAIr). An AAI of 0 indicates no shift of attention; a value of 1 indicates a complete shift of attention. We also assessed lower extremity motor impairment, usual gait speed, functional balance, perceived recovery, and executive function before and after the intervention. Results: AAIr improved after the intervention (-0.07 to 0.12), but the change in AAIg was minimal (0.00 to 0.01). There was a clinically important increase in gait speed, as well as improvements in lower extremity motor impairment, executive function, and perceived recovery. Conclusions: This case study suggests that the ability to shift attention during dual-task walking is impaired after stroke. DTGT may improve the flexibility of attention allocation to secondary cognitive tasks, as well facilitate recovery of motor function and gait after stroke.