Brain Activity Changes After Structured Cognitive-motor Exercise for People With Stroke

Study Overview
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Brief Summary
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To assess the effects of a dual-task exercise program on cognitive-motor interference during dual-task walking and the associated changes in brain activity.

Detailed Description
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Stroke is one of the leading causes of chronic disability in Hong Kong and other parts of the world. Mobility dysfunctions are among the most common impairments observed after stroke. Restoration of mobility is also a top priority in rehabilitation goal-setting by stroke patients. In daily life, functional ambulation in the community requires the ability to maintain walking balance while simultaneously engaging in other attention-demanding tasks (i.e., dual-tasking), such as walking when holding a conversation, or crossing the street while attending to traffic signals. There is increasing evidence that performing a cognitive task in conjunction with a mobility task would cause more severe degradation of one or both tasks among stroke patients when compared with age-matched able-bodied individuals. This phenomenon, termed cognitive-motor interference, should warrant detailed study, since it has an important impact on community-living among people with stroke.

Official Title
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Using Functional Near-infrared Spectroscopy to Study the Changes in Brain Activity During Dual-task Walking and the Effects of Structured Cognitive-motor Exercise in Individuals With Stroke

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Dual-task training
* Behavioral: Single-task training
* Behavioral: Control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of stroke confirmed by brain scan reports Community-living Stroke onset ≥ 6 months Aged 50 years or older Modified Rankin scale 1-3 Capable of following verbal instructions Montreal Cognitive Assessment score ≥ 22 Ability to walk for 1 min independently with or without a walking aid Not receiving formal rehabilitation elsewhere Exclusion Criteria: Other neurological disorders Pain or other comorbidities that seriously affect the ability to walk Contraindications to exercise (e.g., angina).

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: After stratification according to gender and walking speed, the participants will be randomly allocated to one of three groups: (1) dual-task training, (2) single-task training, and (3) control intervention, using a 1:1:1 allocation ratio.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dual-task training<br>Mobility tasks performed in conjunction with cognitive tasks | Behavioral: Dual-task training<br>* This group will receive 30 min of dual-task exercise training and 30 min of stretching exercises in each session. The dual-task component involves walking activities performed in conjunction with cognitive activities. For the stretching exercise component, no cognitive load will be added.<br>|
| Active Comparator: Single-task training<br>Separate cognitive and mobility exercises | Behavioral: Single-task training<br>* This group will undergo 30 min of single-task mobility training and another 30 min of single-task cognitive activities. The cognitive and mobility exercises will be the same as those in the dual-task group, but they will be performed separately. No extra cognitive load will be imposed during the mobility exercises. No additional motor demand will be imposed during the cognitive exercises, as the participants will be sitting.<br>|
| Active Comparator: Control group<br>Upper limb strengthening and flexibility exercises | Behavioral: Control group<br>* This group will undergo 30 min of stretching exercises (same as the dual-task group) and another 30 min of upper limb strengthening exercises performed primarily in the sitting or lying position. No cognitive load will be added.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dual-task gait speed | Gait speed under dual-task condition will be recorded | Through study completion, an average of 1 year | 
| Dual-task cognitive performance | Number of correct responses will be measured during dual-task walking | Through study completion, an average of 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dual-task gait performance 1 | Gait cadence will be measured during dual-task walking | Through study completion, an average of 1 year | 
| Dual-task gait performance 2 | Stride length will be measured during dual-task walking | Through study completion, an average of 1 year | 
| Dual-task gait performance 3 | Trunk stability will be measured during dual-task walking | Through study completion, an average of 1 year | 
| Oxyhemoglobin concentration changes of the brain | Oxyhemoglobin concentration changes will be measured using functional near infra-red spectroscopy during dual-task walking | Through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dual-task training, Cognitive-motor interference