Compromised cognition, but not stepping-down performance, when dual-tasking in stroke survivors

Descending stairs is an indicator of independence among stroke survivors, but is demanding in terms of both neuromuscular control and cognitive functioning. Previous studies found a compromised performance when stepping down with a concurrent cognitive task among healthy older adults, but whether stroke survivors react similarly is not known. This cross-sectional study thus investigated how stroke survivors responded to a dual-task that involved stepping down and compared their performance with that of control subjects. Thirty-four healthy individuals and 26 stroke survivors reacted to an auditory Stroop test while stepping off a 19-cm high platform. The auditory Stroop test was evaluated with a composite score (dividing accuracy by averaged reaction time). Stepping down performances were quantified with subjects’ sway amplitudes in anteroposterior and mediolateral directions after landing and sway velocities of their center of pressure. Stroke survivors demonstrated significantly lower composite scores when dual-tasking (76.4 ± 31.2) than when single-tasking (90.0 ± 25.6), while no significant change in stepping down performance was observed. Stroke survivors also swayed significantly more and with a higher velocity than controls when dual-tasking. The results suggested that stroke survivors adopted a posture-first strategy to deal with this dual-tasking challenge. This study raised the awareness on dual-tasking ability among stroke survivors.