Dual-Task Walking in Challenging Environments in People with Stroke: Cognitive-Motor Interference and Task Prioritization

Cognitive-motor interference may contribute to the risk of falling in people with stroke, as may be the associated phenomenon of inappropriate task prioritization. Examining dual-task walking could provide valuable insights as to how to best evaluate and treat walking in people with stroke. This study aimed to examine the effect of different walking environments on cognitive-motor interference and task prioritization in dual-task walking in people with stroke. Using a repeated-measures design, cognitive-motor interference and task prioritization were assessed in 30 stroke survivors, while walking in a plain environment and in two challenging environments that were enriched with either stationary physical context or suddenly appearing projector-augmented context. All three walking environment conditions were performed with and without a concurrent serial-3 subtraction task. We found stronger cognitive-motor interference for the two challenging environments than for the plain walking environment. Cognitive-motor interference did not differ between challenging walking environments, but task prioritization did: motor performance was prioritized more in the environment with physical context than in the environment with projector-augmented context and vice versa for cognitive-task performance. In conclusion, walking environment strongly influenced cognitive-motor interference and task prioritization during dual-task walking in people with stroke.