Effects of different cognitive tasks in dual-task training on task performance and brain activation in convalescent period stroke patients_West China Medical Journal

Authors：

XIE Erkang , LI Congqin , WANG Yuyuan , HUA Yan , ZHAO Juan , HU Zhaoxu , CONG Yangyang ,  BAI Yulong

Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P. R. China;

Corresponding?author：

BAI Yulong, Email: dr_baiyl@fudan.edu.cn

Keywords：

Stroke; convalescent period; pelvic weight support rehabilitation robot; verbal fluency-stepping training; serial subtraction-stepping training; functional near-infrared spectroscopy

DOI：

10.7507/1002-0179.202410040

Video：

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Objective To observe the effects of selecting different cognitive tasks during dual-task stepping training assisted by a pelvic weight support rehabilitation robot on cerebral cortex activation and task performance in convalescent period stroke patients. Methods Convalescent period stroke patients treated at Huashan Hospital, Fudan University between June 2023 and July 2024 were selected. Patients were recruited and conducted a self-controlled study. Patients were subjected to a self controlled study and received AB regimen training. The plan A underwent dual-task verbal fluency-stepping training assisted by the pelvic weight support rehabilitation robot, while the plan B performed dual-task serial subtraction-stepping training assisted by the pelvic weight support rehabilitation robot. During the intervention process, near-infrared equipment was used to collect relative oxyhemoglobin (HbO₂) concentrations in six brain areas including prefrontal cortex (PFC), supplementary motor area (SMA), and primary motor cortex (PMC). The correct response rate and average number of steps were collected. Results A total of 20 patients were included. Among them, there were 16 males and 4 females. The average number of steps in Plan A were higher than those in Plan B (P<0.05). The correct response rate and the relative increase in HbO₂ concentration of PFC, PMC, and SMA in both hemispheres of Plan A was higher than that in Plan B, but there was no statistically significant difference between the groups (P>0.05). Conclusions Compared with the dual-task serial subtraction-stepping training assisted by the pelvic weight support rehabilitation robot, the dual-task verbal fluency-stepping training assisted by the pelvic weight support rehabilitation robot can significantly increase the mean number of steps in the dual tasks.

Citation： XIE Erkang, LI Congqin, WANG Yuyuan, HUA Yan, ZHAO Juan, HU Zhaoxu, CONG Yangyang, BAI Yulong. Effects of different cognitive tasks in dual-task training on task performance and brain activation in convalescent period stroke patients. West China Medical Journal, 2025, 40(6): 896-900. doi: 10.7507/1002-0179.202410040 Copy

1.	Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 2021, 97(Suppl 20): S6-S16.
2.	Young MJ, Regenhardt RW, Leslie-Mazwi TM, et al. Disabling stroke in persons already with a disability: ethical dimensions and directives. Neurology, 2020, 94(7): 306-310.
3.	Wang Q, Dai W, Xu S, et al. Brain activation of the PFC during dual-task walking in stroke patients: a systematic review and Meta-analysis of functional near-infrared spectroscopy studies. Front Neurosci, 2023, 17: 1111274.
4.	Park MO, Lee SH. Effects of cognitive-motor dual-task training combined with auditory motor synchronization training on cognitive functioning in individuals with chronic stroke: a pilot randomized controlled trial. Medicine (Baltimore), 2018, 97(22): e10910.
5.	解二康, 從洋洋, 王瑜元, 等. 基于下肢康復機器人的雙任務訓練對腦卒中患者下肢運動及步行能力的影響. 中華物理醫學與康復雜志, 2024, 46(2): 112-117.
6.	Hermand E, Compagnat M, Dupuy O, et al. Functional status is associated with prefrontal cortex activation in gait in subacute stroke patients: a functional near-infrared spectroscopy study. Front Neurol, 2020, 11: 559227.
7.	Gramigna V, Pellegrino G, Cerasa A et al. Near-infrared spectroscopy in gait disorders: is it time to begin?. Neurorehabil Neural Repair, 2017, 31(5): 402-412.
8.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
9.	中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦出血診治指南(2019). 中華神經科雜志, 2019, 52(12): 994-1005.
10.	Nosaka S, Imada K, Saita K, et al. Prefrontal activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia. Front Neurosci, 2023(17): 1169744.
11.	Doi T, Makizako H, Shimada H, et al. Brain activation during dual-task walking and executive function among older adults with mild cognitive impairment: a fNIRS study. Aging Clin Exp Res, 2013, 25(5): 539-544.
12.	Mori T, Takeuchi N, Izumi SI. Prefrontal cortex activation during a dual task in patients with stroke. Gait Posture, 2018, 59: 193-198.
13.	Mirelman A, Maidan I, Bernad-Elazari H, et al. Effects of aging on prefrontal brain activation during challenging walking conditions. Brain Cogn, 2017, 115: 41-46.
14.	Pang MYC, Yang L, Ouyang H, et al. Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke. Stroke, 2018, 49(12): 2990-2998.
15.	Zou F, Lin YF, Chen SG, et al. The impact of electroacupuncture at Hegu, Shousanli, and Quchi based on the theory “treating flaccid paralysis by yangming alone” on stroke patients’ EEG: A Pilot Study. Evid Based Complement Alternat Med, 2020: 8839491.
16.	解二康, 李叢琴, 王瑜元, 等. 基于骨盆減重康復機器人輔助下的雙任務踏步訓練對腦卒中恢復期患者大腦皮層激活影響初探. 中國康復, 2025, 40(5): 296-300.
17.	Bishnoi A, Holtzer R, Hernandez ME. Brain activation changes while walking in adults with and without neurological disease: systematic review and Meta-analysis of functional near-infrared spectroscopy studies. Brain Sci, 2021, 11(3): 291.
18.	Tsang CS, Wang S, Miller T, et al. Degree and pattern of dual-task interference during walking vary with component tasks in people after stroke: a systematic review. J Physiother, 2021, 68(1): 26-36.
19.	Collett J, Fleming MK, Meester D, et al. Dual-task walking and automaticity after Stroke: insights from a secondary analysis and imaging sub-study of a randomised controlled trial. Clin Rehabil, 2021, 35(11): 1599-1610.
20.	解二康, 李策, 陸蓉蓉, 等. 骨盆減重康復機器人訓練對腦卒中后偏癱患者下肢功能的影響. 中國康復, 2020, 35(8): 404-408.
21.	Ren Y, Cui G, Feng K, et al. A scoping review of utilization of the verbal fluency task in Chinese and Japanese clinical settings with near-infrared spectroscopy. Front Psychiatry, 2024(15): 1282546.
22.	Pumpho A, Chaikeeree N, Saengsirisuwan V, et al. Selection of the better dual-timed up and go cognitive task to be used in patients with stroke characterized by subtraction operation difficulties. Front Neurol, 2020(11): 262.
23.	Beauchet O, Dubost V, Gonthier R, et al. Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task matters. Gerontology, 2005, 51(1): 48-52.
24.	Yang Y, Zhong N, Friston K, et al. The functional architectures of addition and subtraction: network discovery using fMRI and DCM. Hum Brain Mapp, 2017, 38(6): 3210-3225.
25.	Ruthruff E, Pashler HE, Klaassen A. Processing bottlenecks in dual-task performance: structural limitation or strategic postponement?. Psychonomic Bull Rev, 2001, 8(1): 73-80.
26.	Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov disord, 2008, 23(3): 329-342.
27.	Lee IW, Kim YN, Lee DK. Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. J Phys Ther Sci, 2015, 27(7): 2175-2177.
28.	Pelicioni PHS, Tijsma M, Lord SR, et al. Prefrontal cortical activation measured by fNIRS during walking: effects of age, disease and secondary task. Peer J, 2019, 7: e6833.

1. Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 2021, 97(Suppl 20): S6-S16.
2. Young MJ, Regenhardt RW, Leslie-Mazwi TM, et al. Disabling stroke in persons already with a disability: ethical dimensions and directives. Neurology, 2020, 94(7): 306-310.
3. Wang Q, Dai W, Xu S, et al. Brain activation of the PFC during dual-task walking in stroke patients: a systematic review and Meta-analysis of functional near-infrared spectroscopy studies. Front Neurosci, 2023, 17: 1111274.
4. Park MO, Lee SH. Effects of cognitive-motor dual-task training combined with auditory motor synchronization training on cognitive functioning in individuals with chronic stroke: a pilot randomized controlled trial. Medicine (Baltimore), 2018, 97(22): e10910.
5. 解二康, 從洋洋, 王瑜元, 等. 基于下肢康復機器人的雙任務訓練對腦卒中患者下肢運動及步行能力的影響. 中華物理醫學與康復雜志, 2024, 46(2): 112-117.
6. Hermand E, Compagnat M, Dupuy O, et al. Functional status is associated with prefrontal cortex activation in gait in subacute stroke patients: a functional near-infrared spectroscopy study. Front Neurol, 2020, 11: 559227.
7. Gramigna V, Pellegrino G, Cerasa A et al. Near-infrared spectroscopy in gait disorders: is it time to begin?. Neurorehabil Neural Repair, 2017, 31(5): 402-412.
8. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南 2018. 中華神經科雜志, 2018, 51(9): 666-682.
9. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國腦出血診治指南(2019). 中華神經科雜志, 2019, 52(12): 994-1005.
10. Nosaka S, Imada K, Saita K, et al. Prefrontal activation during dual-task seated stepping and walking performed by subacute stroke patients with hemiplegia. Front Neurosci, 2023(17): 1169744.
11. Doi T, Makizako H, Shimada H, et al. Brain activation during dual-task walking and executive function among older adults with mild cognitive impairment: a fNIRS study. Aging Clin Exp Res, 2013, 25(5): 539-544.
12. Mori T, Takeuchi N, Izumi SI. Prefrontal cortex activation during a dual task in patients with stroke. Gait Posture, 2018, 59: 193-198.
13. Mirelman A, Maidan I, Bernad-Elazari H, et al. Effects of aging on prefrontal brain activation during challenging walking conditions. Brain Cogn, 2017, 115: 41-46.
14. Pang MYC, Yang L, Ouyang H, et al. Dual-task exercise reduces cognitive-motor interference in walking and falls after stroke. Stroke, 2018, 49(12): 2990-2998.
15. Zou F, Lin YF, Chen SG, et al. The impact of electroacupuncture at Hegu, Shousanli, and Quchi based on the theory “treating flaccid paralysis by yangming alone” on stroke patients’ EEG: A Pilot Study. Evid Based Complement Alternat Med, 2020: 8839491.
16. 解二康, 李叢琴, 王瑜元, 等. 基于骨盆減重康復機器人輔助下的雙任務踏步訓練對腦卒中恢復期患者大腦皮層激活影響初探. 中國康復, 2025, 40(5): 296-300.
17. Bishnoi A, Holtzer R, Hernandez ME. Brain activation changes while walking in adults with and without neurological disease: systematic review and Meta-analysis of functional near-infrared spectroscopy studies. Brain Sci, 2021, 11(3): 291.
18. Tsang CS, Wang S, Miller T, et al. Degree and pattern of dual-task interference during walking vary with component tasks in people after stroke: a systematic review. J Physiother, 2021, 68(1): 26-36.
19. Collett J, Fleming MK, Meester D, et al. Dual-task walking and automaticity after Stroke: insights from a secondary analysis and imaging sub-study of a randomised controlled trial. Clin Rehabil, 2021, 35(11): 1599-1610.
20. 解二康, 李策, 陸蓉蓉, 等. 骨盆減重康復機器人訓練對腦卒中后偏癱患者下肢功能的影響. 中國康復, 2020, 35(8): 404-408.
21. Ren Y, Cui G, Feng K, et al. A scoping review of utilization of the verbal fluency task in Chinese and Japanese clinical settings with near-infrared spectroscopy. Front Psychiatry, 2024(15): 1282546.
22. Pumpho A, Chaikeeree N, Saengsirisuwan V, et al. Selection of the better dual-timed up and go cognitive task to be used in patients with stroke characterized by subtraction operation difficulties. Front Neurol, 2020(11): 262.
23. Beauchet O, Dubost V, Gonthier R, et al. Dual-task-related gait changes in transitionally frail older adults: the type of the walking-associated cognitive task matters. Gerontology, 2005, 51(1): 48-52.
24. Yang Y, Zhong N, Friston K, et al. The functional architectures of addition and subtraction: network discovery using fMRI and DCM. Hum Brain Mapp, 2017, 38(6): 3210-3225.
25. Ruthruff E, Pashler HE, Klaassen A. Processing bottlenecks in dual-task performance: structural limitation or strategic postponement?. Psychonomic Bull Rev, 2001, 8(1): 73-80.
26. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov disord, 2008, 23(3): 329-342.
27. Lee IW, Kim YN, Lee DK. Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients. J Phys Ther Sci, 2015, 27(7): 2175-2177.
28. Pelicioni PHS, Tijsma M, Lord SR, et al. Prefrontal cortical activation measured by fNIRS during walking: effects of age, disease and secondary task. Peer J, 2019, 7: e6833.

West China Medical Journal

Effects of different cognitive tasks in dual-task training on task performance and brain activation in convalescent period stroke patients

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