Effect of Cognitive-Motor Dual-Task Training on Postural Stability and Functional Mobility in Stroke

Strokes are a leading cause of long-term disability worldwide because they frequently result in significant impairments in both cognitive and physical abilities. Traditional rehabilitation methods have primarily focused on single-task training, which targets motor or cognitive processes separately. However, the complex demands of daily tasks, which often require simultaneous cognitive and physical processing, may be too much for these approaches to handle. Cognitive-motor dual-task training (CMDT), which blends cognitive tasks with motor activities, has emerged as a promising rehabilitation method to more accurately mimic real-world scenarios. This approach blends a cognitive task, like problem-solving or attention-demanding activities, with a physical task, like walking or balancing exercises. By enhancing the brain's ability to manage multiple tasks simultaneously, CMDT aims to improve the cognitive and motor outcomes of stroke patients.

It has been demonstrated that dual-tasking increases activity in the prefrontal cortex, a region of the brain related to executive function and attention, which is crucial for managing several tasks at once. By stimulating these brain networks, CMDT may improve neuroplasticity and functional remodelling, which may lead to better postural control and mobility recovery. CMDT is based on two neurophysiological processes: enhanced synaptic plasticity and increased expression of brain-derived neurotrophic factor (BDNF). When cognitive and motor tasks are carried out simultaneously, these mechanisms support synaptogenesis and neuroprotection. Despite the growing body of evidence supporting CMDT, more research is still needed to enhance training techniques, understand the mechanisms behind its effects, and evaluate long-term outcomes. Recent meta-analyses have shown that CMDT therapies result in long-lasting cognitive improvements, including improvements in working memory, cognitive flexibility, and executive function all of which are essential for functional independence. In comparison to single-task training, recent RCTs have shown that CMDT improves quality of life while also improving upper extremity and cognitive performance. Dual-task therapies that include activities of daily living promote motivation and active engagement, leading to significant improvements in functional ability and life satisfaction.

Inclusion criteria

• Age between 40-75 years.
• Clinically diagnosed ischemic or hemorrhagic stroke (≥3 months,post-onset).
• Ability to follow verbal commands (MMSE≥24).
• Medically stable and cleared for physical activity.
• Able to walk independently or with minimal assistance (Functional Ambulation Categories ≥3)
• Berg Balance Scale score between 21-45 (indicating moderate fall risk).

Exclusion criteria

• Severe aphasia or language deficits impacting task comprehension.
• Severe spasticity (modified Ashworth scale ≥2 in lower limbs).
• Visual or vestibular impairments affecting balance.
• Severe musculoskeletal conditions or orthopedic impairments that limit safe participation in balance and gait training. (e.g. recent fractures , severe arthritis).
• Diagnosed Dementia or neurodegenerative disorders
• Participation in any other structured dual-task or cognitive training program within the past 3 months