Brain-motor behavior coupling during walking while negotiating obstacle: A systematic review

Obstacle negotiation is a complex walking task requiring sensory integration, motor planning, and executive control. Understanding its neural mechanisms may improve insight into mobility impairments. This systematic review investigated cortical activity and gait performance during obstacle negotiation across different populations using a brain-motor behavior framework. PubMed and Web of Science were searched up to April 2025 following PRISMA guidelines. Studies including adults performing obstacle negotiation with concurrent functional near-infrared spectroscopy (fNIRS) and gait assessments were eligible. Findings were interpreted as neural compensation, neural inefficiency, or capacity limitation. Thirteen studies (n=649) involving individuals with Parkinson's disease (PD), stroke, older adults, and young adults were included. Most studies assessed prefrontal cortex (PFC) activity. Increased PFC activation with impaired gait performance was common in PD, stroke, and older adults, supporting the neural inefficiency model. In contrast, increased PFC activation with preserved gait performance in healthy young and older adults suggested neural compensation. A few studies showed unchanged cortical activation despite gait deterioration, indicating neural capacity limitation under demanding conditions. Task characteristics, such as unanticipated obstacles and dual-task conditions, were associated with further increases in PFC activation. Cortical control of obstacle negotiation is influenced by task demands, neural reserve, and methodological factors. Executive cortical resources appear critical for adaptive walking across populations, whereas neurological populations and older adults more frequently exhibit neural inefficiency or capacity limitation when gait performance deteriorates. Future studies should investigate additional cortical regions to further elucidate the neural mechanisms underlying adaptive walking.