| Objective: Stroke is a neurological disease caused by neuronal hypoxia,functional injury,or necrosis caused by rupture or blockage of the cerebral vascular region,which has become one of the main causes of adult disability.It is reported that only 60% to 80% of stroke patients can walk independently after rehabilitation,most patients have an abnormal gait,and a very small number of patients can resume functional community activities.Functional activities in the community require the ability to maintain steady walking while completing the second task.Understanding the interaction between the second task and human walking may be a key factor in designing future studies and rehabilitation interventions to improve functional activities in patients with stroke in the community.Therefore,this study investigated the kinematic parameters,lower limb neuromuscular control levels and walking stability characteristics of community stroke patients during cognitive dual-task walking and motor dual-task walking under different loads,in order to gain a more comprehensive understanding of the dual-task interference effects related to dynamic postural control during dual-task walking in community stroke patients and to provide a theoretical basis for clinical and community rehabilitation of community stroke patients.Methods: Kinematic parameters and electromyographic tests were collected simultaneously using the Simi Motion 3D movement analysis system and the FREEEMG300 wireless surface EMG test system from 20 community stroke patients in chronic recovery during single-task walking as well as cognitive dual-task walking and motor dual-task walking with different loads,and the kinematic data were used to indirectly calculate walking stability-related indicators.A one-way repeated measures ANOVA was used to compare the differences in gait spatio-temporal parameters,lower limb joint angles,mean EMG values and dynamic stability margin values between single-task walking and different dual-task walking,and a two-way repeated measures ANOVA was used to analyse the effects of dual-task type(cognitive and motor tasks),dual-task load(simple and difficult loads)and the interaction between them on gait kinematic parameters,EMG test indices and walking stability in community stroke patients,p<0.05 being the level of significance.Results:(1)Gait temporal and spatial parameters: Compared with single-task walking,the walking speed,stride length,stride length of the affected side,and the proportion of healthy side swing were all decreased in the intervention of high-low load cognitive tasks(p<0.05),and the proportion of healthy side stride width and support of healthy side and affected side was increased in the intervention of difficult cognitive tasks(p<0.05),and the proportion of healthy step length and affected side swing was decreased in the intervention of difficult cognitive tasks(p<0.05).The results of the two-factor repeated measures statistical analysis showed that the stride width of the affected side in simple cognitive dual-task walking was smaller than that in difficult cognitive dual-task walking(p<0.05),and the ratio of healthy side support phase in cognitive dual-task walking was larger than that in sports dual-task walking(p<0.05).(2)Lower limb joint Angle: Compared with single-task walking,the flexion Angle of the hip joint on the affected side increased(p<0.05)and the plantar flexion Angle of the ankle joint on the healthy side decreased(p<0.05)during the intervention of difficult exercise task,and the flexion Angle of the knee joint on the affected side was less than that of single-task walking during the intervention of simple exercise task(p<0.05).In simple cognitive tasks,the flexion Angle of a healthy knee joint decreased when the affected side touched the ground(p<0.05).In difficult cognitive tasks,the flexion Angle of the healthy hip joint decreased(p<0.05)and the plantar flexion Angle of the healthy ankle joint decreased(p<0.05).In simple exercise tasks,the flexion Angle of the healthy hip joint decreased(p<0.05)at the time when the healthy side was off the ground.The flexion Angle of the healthy hip joint decreased(p<0.05)and increased(p<0.05)during the intervention of simple motor tasks;the flexion Angle of the healthy hip joint decreased(p<0.05)during the intervention of difficult motor tasks;and the flexion Angle of the affected knee joint increased(p<0.05)during the intervention of difficult cognitive tasks.The results of the two-factor repeated measures statistical analysis showed that the Angle value of the healthy hip joint at the touchdown moment of the healthy side in cognitive dual-task walking was greater than that of the exercise dual-task walking(p<0.05),and the Angle value of the affected hip joint and ankle joint was smaller than that of the exercise dual-task walking(p<0.05).The Angle values of healthy and affected knee joints at the moment when the affected side touched the ground in simple double-task walking were lower than those in difficult double-task walking(p<0.05).The Angle value of the affected hip joint at the lifting moment of the healthy side was less than that of the sports walking moment(p<0.05)in cognitive dual-task walking,and the Angle value of the affected knee joint at the lifting moment of the healthy side was less than that of the difficult dual-task walking moment in simple dual-task walking(p<0.05).The Angle value of the healthy hip joint at the moment of the affected side lifting in cognitive dual-task walking was greater than that of the sports dual-task walking(p<0.05),and the Angle value of the healthy knee joint at the moment of the affected side lifting in simple cognitive dual-task walking was smaller than that of the difficult cognitive dual-task walking(p<0.05).The Angle value of the affected knee at the moment of the affected side lifting from the ground in simple double-task walking was smaller than that in difficult double-task walking(p<0.05).(3)Average EMG value: Compared with single-task walking,the standardized AEMG values of the healthy biceps femoris and the affected biceps femoris decreased in the intervention of simple cognitive tasks(p<0.05),the standardized AEMG values of the anterior tibial muscle of the affected side and the gastrocnemius muscle of the affected side decreased(p<0.05),and the standardized AEMG values of the healthy biceps femoris in the intervention of difficult cognitive tasks decreased(p<0.05).The standardized AEMG value of the gastrocnemius muscle of the affected side decreased in the intervention of simple exercise tasks(p<0.05),and the standardized AEMG value of the anterior tibial muscle of the affected side increased in the intervention of difficult exercise tasks(p<0.05).The results of the two-factor repeated measures statistical analysis showed that the standardized AEMG value of the gastrocnemius muscle on the affected side was less than that of difficult two-task walking in simple two-task walking(p<0.05).(4)Dynamic stability margin value: compared with single-task walking,the dynamic stability margin(MoS)value of healthy side feet increased during difficult cognitive task intervention in community stroke patients(p<0.05).Conclusions:(1)Community stroke patients mainly cope with cognitive task interference by reducing step speed,reducing stride length and length,reducing swing proportion,increasing step width and support proportion,and changing gait patterns,to maintain body stability.In the face of movement task interference,it only involves the adjustment of the changes in the Angle of the hip,knee,and ankle joint,but does not cause a change in the overall gait pattern.(2)After the intervention of cognitive tasks,community stroke patients will transfer cognitive resources to cognitive tasks,compete for cognitive resources of gait control,and reduce the level of neuromuscular control of walking.The intervention of motor tasks can optimize the lower limb motor ability of community patients with stroke,and form a unique ankle joint function optimization effect of exercise dual-task walking in community patients with stroke.(3)Compared with single-task walking,the intervention of high-load cognitive tasks can improve the walking stability of community stroke patients,and intervention of high-load exercise tasks has no significant impact on walking stability.(4)There were main effects of different types and loads of dual tasks on gait characteristics and levels of neuromuscular control of the lower limb in community stroke patients.The degree of interference with gait characteristics and levels of neuromuscular control around the ankle were stronger for the difficult load dual task intervention than for the simple load dual task,the degree of interference with gait characteristics was stronger for the cognitive dual task intervention than for the motor dual task,and there were no interaction or main effects of dual task load and dual task type on walking stability in community stroke patients. |
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