A Systematic Review of Cortical Excitability during Dual-Task in Post-Stroke Patients

Objective: Stroke is a leading cause of disability worldwide, often resulting in significant cognitive and motor impairments. Dual tasks (DTs), which involve performing cognitive and motor tasks simultaneously, can influence brain activation patterns and functional recovery in patients with stroke. This systematic review aimed to determine the effects of DTs on cortical activation in patients with stroke. Design: Systematic review. Methods: Following the PRISMA guidelines, the MEDLINE, CINAHL, Embase, and Web of Science databases were searched for studies assessing cortical activation via functional near-infrared spectroscopy (fNIRS) during DT performance in patients with stroke. Studies were selected based on predefined eligibility criteria focusing on changes in hemodynamic responses and their correlation with task performance. Results: Eight studies met the inclusion criteria. The findings indicatedthat DT leads to increased activation in the prefrontal cortex (PFC), premotor cortex (PMC), and posterior parietal cortex (PPC), suggesting an integrated cortical response for managing concurrent cognitive and motor demands. However, increased brain activation did not consistently translate to improved functional outcomes, highlighting the complex relationship between brain activation and successful rehabilitation. Conclusions: DT interventions may enhance cortical activation and neuroplasticity in post-stroke patients; however, the relationship between increased brain activity and functional recovery remains complex and requires further investigation. Tailored DT programs consideringindividual neurophysiological and functional capacities are recommended to optimize rehabilitation outcomes.