The effects of different types of dual-task gait training on lower-limb coordination during dual-task gait in patients with stroke: a single-blind randomized controlled trial

Declined lower-limb coordination is one of the main factors to the increased risk of falls in patients with stroke. Dual-task gait training has been shown to be effective in improving lower-limb coordination during single-task walking. However, its efficacy in enhancing coordination during dual-task gait remains unclear. Therefore, this study aims to investigate the effects of cognitive dual-task gait training (CDTG) and motor dual-task gait training (MDTG) on lower-limb coordination during dual-task gait in patients with subacute stroke. Thirty-five patients with subacute stroke were randomly assigned to the MDTG group (n = 17) or CDTG group (n = 18), and received a 4-week intervention. An infrared high-speed motion capture system was used to collect trajectory data of surface markers during dual-task gait tests. Lower-limb coordination was assessed using the mean continuous relative phase (MCRP) and its variability (MCRPV) between joints. A mixed-design ANOVA was used to analyze training effects. After training, during cognitive dual-task gait, both groups showed increased MCRP between the unaffected hip and knee during the affected-side stance period (P = 0.002). In the MDTG group, bilateral hip MCRP increased (P = 0.026), while in the CDTG group, bilateral ankle MCRP increased (P = 0.031). During motor dual-task gait, the CDTG group showed increased MCRP between the affected hip and knee in the stance period (P = 0.017) and decreased MCRPV between the unaffected hip and knee in the swing period (P = 0.035). Four weeks of MDTG can promote out-of-phase coordination between the unaffected hip and knee joints, as well as the bilateral hip joints, during cognitive dual-task gait in patients with subacute stroke. CDTG improves out-of-phase coordination between the unaffected hip and knee joints, and the bilateral ankle joints, during cognitive dual-task gait. It also facilitates out-of-phase coordination of the affected hip and knee joints and enhances the coordination stability of the unaffected side during motor dual-task gait. These findings support task-specific dual-task gait training as a targeted approach to improve coordination and reduce fall risk in subacute stroke rehabilitation. The trial was registered on 03/11/2023 at ChiCTR, under the registration number ChiCTR2300077304.