Cognitive and motor multi-task balance training improves dual-task walking performance in ambulatory patients after stroke: a randomized controlled trial

Purpose: With stroke, declines in gait performance while performing another task have been observed. This study investigated the effects of Cognitive-Motor Multi-Task balance training on walking, cognition, and balance under single- and dual-task conditions in ambulatory patients after stroke. Material and methods: Fifty-seven individuals with stroke were randomized to Cognitive-Motor Multi-Task, Cognitive Dual-Task, or Motor Dual-Task training groups. Each group underwent three 60-minute training sessions per week for four weeks. The primary outcomes were gait speed (measured by the 10-meter walk test) and cognitive score (calculated as accuracy divided by reaction time), assessed under both single- and dual-task conditions. Secondary outcome measures included dual-task Timed Up and Go test (TUG), Functional Gait Assessment (FGA), and Activities-specific Balance Confidence scale (ABC). Outcomes were assessed before and after the intervention and at 1-month follow-up. Results: Both Cognitive-Motor Multi-Task and Cognitive Dual-Task groups demonstrated the greatest improvements in gait speeds under single- and dual-task conditions post-treatment and at follow-up. Furthermore, only the Cognitive-Motor Multi-Task group demonstrated significant improvements in dual-task TUG, FGA, and ABC at post-treatment and follow-up. Conclusion: Balance training combined with Cognitive-Motor Multi-Task enhances immediate and retained effects on cognitive and motor dual-task walking in ambulatory patients after stroke.