Effects of Two Different Multicomponent Cognitive-Motor Training Protocols on EEG Spectral Activity, Cognitive-Motor Interference, and Gait Performance in Individuals with Chronic Stroke: A Randomized Controlled Trial.

Background and Objectives: This trial examined whether two task-complexity gait training protocols differentially affect EEG spectral activity, cognitive-motor interference, and gait performance in chronic stroke. Materials and Methods: Forty-four participants were randomly allocated to Progressive Task-Complexity Gait Training (PTCGT; n = 22) or Constant Task-Complexity Gait Training (CTCGT; n = 22). Both groups trained for 4 weeks using the same auditory-feedback walker. PTCGT progressed from obstacle avoidance to rhythmic auditory cueing plus obstacle avoidance, followed by a verbal fluency dual-task. CTCGT maintained rhythmic auditory cueing plus obstacle avoidance. Outcomes included EEG theta, SMR, mid-beta, Concentration Index, SEF-50, DTC%, and GAITRite gait parameters. Results: Significant group-by-time interactions were observed for EEG and gait measures. DTC showed a significant interaction in repeated-measures ANOVA (p = 0.041), but not in mixed-effects sensitivity analysis (p = 0.088). PTCGT showed greater pre-post changes in EEG and gait outcomes, whereas the DTC difference was less robust. Conclusions: PTCGT was associated with greater changes in EEG spectral characteristics and gait performance than CTCGT. However, these differences cannot be attributed specifically to the progressive task-complexity protocol because PTCGT also involved additional cognitive-task exposure and greater task complexity. In addition, because cognitive-task performance was not quantitatively assessed, improvements in dual-task ability or cognitive-motor integration cannot be established.