Is automaticity of walking regained after stroke?

Purpose. The aim of this study was to determine whether people who have completed rehabilitation after stroke have regained a level of automaticity of walking comparable to healthy people of similar age. Method. Twenty stroke subjects, 20 healthy elderly controls and 20 healthy young controls were tested. To quantify the automaticity of walking, subjects were required to walk simultaneously while performing an additional task(s). Subjects walked under four counterbalanced conditions: a single walking task, a dual-cognitive task, a dual-manual task and a triple-task. Walking velocity, cadence, stride length and step length were analysed. Results. Stroke subjects walked slower (p = 0.001), took shorter strides (p = 0.002) and fewer steps/min (p = 0.04) than elderly controls. Velocity declined significantly across conditions from the single to the dual-cognitive to the dual-manual and finally to the triple-task (p < 0.001). Both stroke and elderly groups showed similar deterioration in walking velocity across conditions (p = 0.99), while the deterioration in the young subjects was significantly less than for healthy elderly subjects (p = 0.04) and the stroke subjects (p = 0.02). Conclusion. Community dwelling stroke subjects display the same level of automaticity of walking as elderly controls, but both elderly controls and stroke subjects are less automated than young controls.