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

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

This Randomized Controlled Trial is conducted to investigate the effects of Cognitive-Motor Dual-Task Training on Postural Stability and Functional Mobility in Stroke Survivors.

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke
• Intervention / Treatment: Other: Cognitive-motor dual-task training (CMDT) Group; Other: Conventional Balance Training

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Estimated): 28
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Abrish H Abbasi, PhD* Rehab; Phone Number: 03155311799; Email: abrish.habib@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab Province
    • Chak One Hundred Fifty-seven, Punjab Province, Pakistan
      • Family Diagnostic Center
      • Contact: Abrish H Abbasi, PhD* Rehab; Phone Number: 03155311799; Email: abrish.habib@riphah.edu.pk
      • Contact: Arshad Nawaz Malik, PhD Rehab; Email: arshad.nawaz@riphah.edu.pk
      • Sub-Investigator: Abrish H Abbasi, PhD* Rehab
      • Principal Investigator: Muattar Hina, MS-NMPT*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cognitive-motor dual-task training (CMDT) Group; Cognitive-motor dual-task training (CMDT) conducted three times weekly for 45-60 minutes with 10 repetitions each task over 6 weeks progressively challenges stroke survivors with static and dynamic tasks in weeks 1-2, anticipatory tasks in weeks 3-4, and reactive tasks in weeks 5-6, integrating cognitive challenges such as verbal fluency, Stroop tests, and auditory reactions with motor activities like walking and balance exercises	Other: Cognitive-motor dual-task training (CMDT) Group; Cognitive-motor dual-task training (CMDT) conducted three times weekly for 45-60 minutes with 10 repetitions each task over 6 weeks progressively challenges stroke survivors with static and dynamic tasks in weeks 1-2, anticipatory tasks in weeks 3-4, and reactive tasks in weeks 5-6, integrating cognitive challenges such as verbal fluency, Stroop tests, and auditory reactions with motor activities like walking and balance exercises
Active Comparator: Conventional Balance Training; Static and dynamic balance exercises without cognitive load, e.g., standing and shifting weight, conducted three times weekly for 45-60 minutes with 10 repetitions each task over 6 weeks progressively challenges stroke survivors with static and dynamic tasks in weeks 1-2, anticipatory tasks in weeks 3-4, and reactive tasks in weeks 5-6.	Other: Conventional Balance Training; Static and dynamic balance exercises without cognitive load, e.g., standing and shifting weight, conducted three times weekly for 45-60 minutes with 10 repetitions each task over 6 weeks progressively challenges stroke survivors with static and dynamic tasks in weeks 1-2, anticipatory tasks in weeks 3-4, and reactive tasks in weeks 5-6.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Berg Balance Scale(BBS)	A clinical tool used to assess static and dynamic balance through 14 functional tasks. Tasks include sitting, standing, reaching, turning, and single-leg stance. It evaluates a person's ability to maintain balance during common daily activities and helps determine the risk of falls, especially in stroke patients and older adults. Scoring: Each item is scored from 0 to 4 (maximum score: 56); Low fall risk: 41-56; Moderate fall risk: 21-40; High fall risk: 0-20	6 weeks
Timed-Up and Go Test	A simple test used to assess mobility, balance, walking ability, and fall risk. The participant is timed while standing up from a chair, walking 3 meters, turning around, walking back, and sitting down. Scoring: Time recorded in seconds; <10 sec: Normal mobility; 10-20 sec: Good mobility, mostly independent; >20 sec: Limited mobility, may require assistance	6 weeks
Postural Assessment Scale (PASS)	A stroke-specific tool used to assess postural control in lying, sitting, and standing positions. It includes 12 items that evaluate the ability to maintain or change postures. Scoring: Each item scored 0-3 (Total score: 36) Higher scores indicate better postural control.	6 weeks
Dual Task Cost (DTC)	Quantifies the impact of performing a cognitive task on motor performance (e.g., gait or balance). Calculated as: DTC(%)= Single-task performance-Dual-task performance×100 Higher DTC values indicate greater dual-task interference and poorer ability to manage simultaneous cognitive and motor demands.	6 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Muattar Hina, MS-NMPT*, Riphah International Unversity

Study record dates

Study Major Dates

• Study Start (Estimated): May 20, 2026
• Primary Completion (Estimated): October 20, 2026
• Study Completion (Estimated): November 20, 2026

Study Registration Dates

• First Submitted: June 1, 2026
• First Submitted That Met QC Criteria: June 1, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Functional mobility; Stroke rehabilitation; Postural control; Tasks- Oriented training; Cognitive-motor dual task
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke; Population Characteristics; Demography; Population Groups
• Other Study ID Numbers: 02269/ Muattar Hina

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No