Approaching Process in Walking through an Aperture for Individuals with Stroke.

Muroi et al. show that individuals with stroke have improved collision avoidance behavior when passing through an aperture while entering from the paretic-side of the body. However, the underlying mechanism remains unknown. We reanalyzed Muroi et al.'s data to reveal how individuals with stroke walk through an aperture by examining changes in walking velocity and behavioral complexity (i.e., sample entropy, an index of (ir)regularity of time series, regarded lower entropy as more regular and less complex) by focusing on the approaching process. The results showed that individuals with stroke reduced their walking velocity and behavioral complexity before passing through the narrow aperture when approaching from the paretic side. We interpreted that the improved obstacle avoidance when penetrating from the paretic side may be due to careful body rotation and adjusting the walking velocity in advance.

Training for walking through an opening improves collision avoidance behavior in subacute patients with stroke: a randomized controlled trial.

PURPOSE: Paretic side collisions frequently occur in stroke patients, especially while walking through narrow spaces. We determined whether training for walking through an opening (T-WTO) while entering from the paretic side would improve collision avoidance behavior and prevent falls after 6 months. MATERIALS AND METHODS: Thirty-eight adults with moderate-to-mild hemiparetic gait after stroke who were hospitalized in a rehabilitation setting were randomly allocated to the T-WTO (n = 20) or regular rehabilitation (R-Control; n = 18) program. Both groups received five sessions of 40 min per week, for three weeks total. T-WTO included walking through openings of various widths while rotating with the paretic side in front, and R-Control involved normal walking without body rotation. Obstacle avoidance ability, 10-m walking test, timed Up and Go test, Berg Balance Scale, Activities-specific Balance Confidence, the perceptual judgment of passability, and fall incidence were assessed. RESULTS: Collision rate and time to passage of the opening in obstacle avoidance task significantly improved in the T-WTO group compared with those in the R-Control group. Contrast, T-WTO did not lead to significant improvements in other outcomes. CONCLUSIONS: T-WTO improved efficiency and safety in managing subacute stroke patients. Such training could improve patient outcomes/safety because of the paretic body side during walking. CLINICAL TRIAL REGISTRATION NO.: R000038375 UMIN000033926.

Individuals with stroke often collide with the paretic side while walking through narrow spaces.Training for walking through a narrow opening from the paretic side improved an individual's ability to avoid obstacles in similar tasks.Moreover, such training could improve patient outcomes/safety because such interventions may temporarily increase attentional focus to the paretic side in specific tasks.

Pathophysiological and motor factors associated with collision avoidance behavior in individuals with stroke.

BACKGROUND: High collision rates and frequency of entering the opening from non-paretic sides are associated with collision in individuals with stroke. OBJECTIVE: To identify factors associated with collision avoidance behavior when individuals with stroke walked through narrow openings. METHODS: Participants with subacute or chronic stroke walked through a narrow opening and had to avoid colliding with obstacles. Multiple regression analyses were conducted with pathophysiology, motor function, and judgment ability as predictor variables; collision rate and frequency of entering the opening from non-paretic sides were outcome variables. RESULTS: Sixty-one eligible individuals with stroke aged 63±12 years were enrolled. Thirty participants collided twice or more and 37 entered the opening from the non-paretic side. Higher collision occurrence was associated with slower Timed Up and Go tests and left-right sway (odds ratios, 1.2 and 5.6; 95% confidence intervals, 1.1-1.3 and 1.3-28.2; p = .008 and.025, respectively). Entering from non-paretic sides was associated with lesions in the thalamus, left-sided hemiplegia, and Brunnstrom stage 3 or lower (odds ratios, 6.6, 8.7, and 6.7; 95% confidence intervals, 1.3-52.5, 2.5-36.5, and 1.2-57.5; and p = .038,.001, and.048, respectively). CONCLUSION: Walking ability is associated with avoiding obstacle collision, while pathophysiological characteristics and degree of paralysis are associated with a preference for which side of the body enters an opening first. Interventions to improve walking ability may improve collision avoidance. Avoidance behavior during intervention varies depending on the lesion position.

Walking through a narrow opening improves collision avoidance behavior in a patient with stroke and unilateral spatial neglect: an ABA single-case design.

We investigated the effect of a 3-week intervention-wherein a patient with unilateral spatial neglect walks through a narrow opening while entering from the contralesional side-to improve walking ability or ADL. A 66-year-old man was diagnosed with right parietal subcortical hemorrhage. We used an ABA single-case design; period B was set as the intervention. The intervention improved the continuous walking distance and balance ability and decreased the number of collisions when walking through the narrow opening; however, it exerted minimal effect on ADL. Thus, the intervention may effectively improve continuous physical or spatial attention behavior, regardless of ADL improvement.

Walking through an aperture while penetrating from the paretic side improves safety managing the paretic side for individuals with stroke who had previous falls.

BACKGROUND: Safety management of the paretic side of the body is critical for individuals with stroke. We previously reported that individuals with stroke who walk through an aperture while penetrating from the paretic side had fewer collisions with the frame of an aperture than did those penetrating from the non-paretic side. We observed spontaneous behavior of collision avoidance in our previous study; this study thus used penetration from the paretic and non-paretic sides as independent variables to confirm the usefulness of penetrating from the paretic side. OBJECTIVE: This study aimed to (1) reconfirm whether walking through a narrow space while penetrating from the paretic side leads to reduced frequency of collision only for individuals with stroke with previous falls by manipulating the direction of penetration as independent variables and to (2) determine whether the behavioral or cognitive characteristics of passing through the aperture are observed in individuals with stroke who had previous falls. METHODS: Individuals with stroke (12 with previous falls, 13 without) were required to walk through a narrow space while penetrating from the paretic and non-paretic sides. The collision rate and kinematic characteristics at the moment of crossing the aperture (body rotation angle, deviation of body's midpoint, and movement speed) were recorded as dependent variables. We also confirmed whether the participants expected collision after passing. RESULTS: Individuals with stroke with previous falls were less likely to have a collision when penetrating from the paretic side. The stroke fall group was likely to experience more collisions because of deleterious changes in body rotation angle and movement speed in narrow apertures. Moreover, individuals with stroke have many unexpected collisions, but the decline in anticipatory ability was not unique to the stroke fall group. CONCLUSIONS: Penetrating a narrow space from the paretic side improved safety management of the paretic side in patients with previous falls despite poor adjustment to narrow apertures. Penetrating a narrow space from the paretic side may make it easier to view and pay attention to the paretic side.