不同认知任务对卒中患者双任务步行中步态表现的影响

Effects of different cognitive tasks on gait performance during dual-task walking in patients with stroke

目的探讨认知类型因素对卒中患者双任务范式步态的影响。方法采用横断面研究设计,对卒中患者分别进行单任务步行以及4种不同认知任务(自发叙述、连续倒数计算、词汇生成、听觉stroop)的双任务步行。应用三维步态与运动分析系统记录并分析步态数据,计算不同认知任务的双任务效应值(dual-task effect,DTE),比较不同状态下步态分析时空参数及DTE的差异。结果共纳入35例卒中患者,男性27例(77.1%),年龄(61.0±2.5)岁;缺血性卒中患者25例(71.4%),出血性卒中患者10例(28.6%)。与执行单任务步行相比,患者执行连续倒数计算以及自发叙述双任务步行时步速降低、患侧步长变短且健患侧支撑相比值增高(P均<0.05),执行连续倒数计算双任务步行时变化更为显著(P<0.05)。与执行单任务步行相比,执行连续倒数计算双任务时健患侧摆动相比值显著变低(P<0.05)。执行连续倒数计算以及自发叙述双任务时患者的步速、患侧步长和健患侧支撑相比值DTE显著大于执行词汇生成以及听觉stroop双任务步行时(P均<0.05)。相较于自发叙述双任务,执行连续倒数计算双任务时步速和患侧步长DTE显著更大(P均<0.05)。患者执行连续倒数计算双任务时健患侧摆动相比值DTE显著大于执行其他3种认知任务时(P均<0.05)。结论不同认知任务对卒中患者双任务步行的步态表现有不同影响,双任务干扰程度与特定任务类型有关。

Objective To investigate the effects of cognitive types on dual-task paradigm gait performance in patients with stroke.MethodUsing a cross-sectional study design,patients with stroke were trained with single task walking and dual-task walking with four different cognitive tasks(spontaneous speech[SS],serial counting backward[SCB],word list generation(WLG),and auditory Stroop[AS]).A three-dimensional gait and motion analysis system were used to record and analyze gait data,and calculate dual-task effect(DTE)for different cognitive tasks,and compare the differences in spatiotemporal parameters and DTE of gait analysis under different states.ResultsA total of 35 patients with stroke(aged 61.0±2.5 years)were included,among which 27 were males(77.1%).There were 25 patients with ischemic stroke(71.4%)and 10 patients with hemorrhagic stroke(28.6%).Compared with single task walking,patients had decreased gait speed,shorter step length on the affected side,and a larger support phase ratio of the unaffected to the affected side during SCB dual task and SS dual task(all P<0.05),and the difference was more obvious during SCB dual task(P<0.05).Compared with single task walking,patients had a reduced swing phase ratio of the unaffected to the affected side during SCB dual task(allP<0.05).The DTEs of gait speed,step length of the affected side,and the support phase ratio of the unaffected to the affected side during SCB dual task and SS dual task were significantly greater than those during WLG dual task and AS dual task(P<0.05).The DTEs of gait speed and step length of the affected side during SCB dual task were significantly greater than that during SS dual task(allP<0.05).The DTE of the swing phase ratio of the unaffected to the affected side during SCB dual task was significantly greater than that during other types of cognitive tasks(allP<0.05).ConclusionDifferent cognitive tasks had different effects on gait performance during dual-task walking in patients with stroke,and the degree of dual-task interference was associated with specific task types.