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

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.