Real World Assessment of Dual-Task Performance After Stroke

描述(申请人提供)：中风幸存者的社区行走是一项非常复杂的技能，不仅需要适应日益复杂的环境 (相对于诊所)，但也适用于双重任务的情况，如边走边交谈。事实上，在社区中行走的能力是社区融合和参与的关键决定因素。环境对中风后单任务和双任务步态的影响知之甚少，尽管众所周知，居住在社区的个人患有中风 中风患者在双任务步行过程中会受到严重的认知-运动干扰，而且由于行动能力的限制，社区参与也会受到限制。这项拟议研究的目标是确定实验室中单任务和双任务行走与真实世界环境中单任务和双任务行走之间的差异(目标1)，确定中风后双任务行走中注意的灵活优先顺序的能力相对于匹配的健康成年人是否受到损害，以及这种能力是否受到环境设置的影响(目标2)，并确定社区居住的中风幸存者和匹配的健康成年人中双任务干扰效应的最小临床重要效应大小(目标3)。这项拟议的研究是一项跨学科合作，涉及物理治疗、生物医学等领域的经验丰富的研究人员。 工程学和心理语言学。采用重复测量设计，在实验室和真实环境(医院大厅)中，在单一和三种不同的可变优先级双任务条件(无优先、步态优先、认知优先)以及两种不同的双任务组合(边说话边走，边执行执行功能任务时行走)下，对30名中风成人和30名匹配的健康成年人的步态和认知表现进行评估。我们将使用基于锚点和基于分布的方法来估计与步态相关的双重任务效应的最小临床重要差异(MCID)值。该项目将帮助我们实现我们的长期目标，即开发干预措施，以提高社区居住的中风幸存者的运动适应性和安全性。拟议的研究还将使我们能够确定现实世界中最容易受到临床上显著行动障碍影响的个人，并获得必要的数据，以充分支持随后针对最有需要的人进行的R01干预研究。这项创新的研究关注中风幸存者在真实环境中行走的能力，将产生目前文献中无法获得的关键数据。

DESCRIPTION (provided by applicant): Community ambulation for stroke survivors is a highly complex skill, requiring the ability to adapt not only to increased environmental complexity (relative to the clinic), but also to dual-tasking situations, such as walking while conversing. Indeed, the ability to walk in the community is a key determinant of community integration and participation. Very little is known about the impact of the environment on single-task and dual-task gait after stroke, even though it is well established that community-dwelling individuals with stroke experience profound cognitive-motor interference during dual-task walking and restricted community participation due to mobility limitations. The goals of the proposed research are to identify the differences between single and dual-task walking in the laboratory and single and dual-task walking in a real-world context (Aim 1), to determine whether the ability to flexibly prioritize attention during dual-task walking after stroke is impaired relative to matched healthy adults, and whether this ability is impacted by environmental setting (Aim 2), and to determine minimal clinically important effect sizes for dual-task interference effects in community-dwelling stroke survivors and matched healthy adults (Aim 3). The proposed research is an interdisciplinary collaboration involving experienced investigators in physical therapy, biomedical engineering, and psycholinguistics. Using a repeated measures design, gait and cognitive performance of 30 adults with stroke and 30 matched healthy adults will be assessed in single and three different variable-priority dual-task conditions (no-priority, gait-priority, cognitive-priority) in the laboratory and a real-world context (hospital lobby), and in two different dual-tak combinations (walking while talking, walking while performing an executive function task). We will use anchor-based and distribution-based approaches to estimate minimal clinically important difference (MCID) values of gait- related dual-task effects. This project will help us achieve our long-term goal to develop interventions to improve the locomotor adaptability and safety of community-dwelling stroke survivors. The proposed research will also enable us to identify the individuals most susceptible to clinically significant mobility disability in the realworld and acquire the data needed to adequately power a subsequent R01 intervention study targeting those most in need. This innovative study, concerned with stroke survivors' ability to walk in real-world environments, will yield crucial data currently unavailable in the literature.