Effects of Attentional Loadings on Gait Performance Before Turning in Stroke Survivors

BackgroundAttentional loadings have significant impacts on turning performance in individuals with stroke. Improper gait modification before turning may contribute to falls after stroke. Therefore, examination of the changes in temporal-spatial gait parameters before turning may reveal important deficits in gait control when stroke survivors are challenged by dual-tasking.ObjectiveTo compare the effects of 3 attentional loading conditions on spatial-temporal gait parameters before turning between stroke survivors and healthy control subjects.DesignCase-control study design.SettingUniversity motion analysis laboratory.ParticipantsTen chronic stroke survivors (mean age = 49 ± 9 years) and 10 healthy control subjects (mean age = 53 ± 5 years) were included.MethodsSpatial-temporal gait parameters were obtained by the use of a motion-capture system while participants performed the Timed-Up and Go (TUG) test under 3 attentional loading conditions: single, dual-motor, and dual-cognitive task conditions. A repeated-measure analysis of variance was used to analyze the data.Main outcome measuresWe measured gait speed, stride length, and stride time during the straight walking phase (one gait cycle before turn) of the TUG test.ResultsWe found that attentional loadings had a differential effect on gait speed measured for both groups (P = .001). The dual-motor and dual-cognitive task conditions led to a slower gait speed compared with the single-task condition in stroke survivors (both P = .02). However, in the TUG scores of healthy control subjects, only the dual-cognitive condition led to a significantly reduced gait speed compared with the single task condition (P = .001) and dual motor condition (P = .01).ConclusionThe results demonstrated that attentional loadings resulted in a greater deterioration of gait performance before turning in stroke survivors compared with healthy control subjects. Particularly, temporal gait parameter was more vulnerable to dual-task interference than the spatial gait parameter.