Functional near-infrared spectroscopy revealed distinct prefrontal cortex activation patterns in 34 older stroke patients performing walking-based cognitive challenges, with hemodynamic responses potentially serving as biomarkers for rehabilitation outcomes. The dual-task paradigm—combining ambulatory movement with Stroop interference tests—exposed differential cortical recruitment strategies that correlate with motor and cognitive recovery trajectories. This neuroimaging approach addresses a critical gap in stroke rehabilitation, where traditional assessments often fail to capture the complex interplay between motor control and executive function during real-world activities. The findings suggest that patients with preserved prefrontal oxygenation during cognitively demanding locomotion may demonstrate superior neuroplasticity and functional recovery potential. This represents a significant advance over static cognitive or motor assessments, as dual-task performance more accurately reflects the demands of independent living. The methodology could transform rehabilitation planning by identifying patients who would benefit most from intensive cognitive-motor training protocols versus those requiring compensatory strategies. However, the relatively small cohort and single-center design warrant validation across diverse stroke populations and recovery phases before clinical implementation.