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

Article type: Research Article

Authors: Muroi, Daisuke^{a; b; *} | Ohtera, Shosuke^{c; d} | Saito, Yutaro^e | Koyake, Aki^e | Higuchi, Takahiro^b

Affiliations: [a] Department of Rehabilitation Sciences, Division of Physical Therapy, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan | [b] Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan | [c] Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan | [d] Department of Health Economics, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan | [e] Department of Rehabilitation, Kameda Medical Center, Chiba, Japan

Correspondence: [*] Address for correspondence: Daisuke Muroi, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, 645-1 Nitona-cho, Chiba Chuo-ku, Chiba, 260-0801, Japan. E-mail: mutyon88@hotmail.com.

Abstract: 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.

Keywords: Multiple regression analysis, obstacle avoidance, pathophysiological, stroke, walking

DOI: 10.3233/NRE-220174

Journal: NeuroRehabilitation, vol. 52, no. 2, pp. 155-163, 2023