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

Abstract

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

Implications for Rehabilitation

• 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.

Keywords:

• gait
• obstacle avoidance
• randomized controlled trial
• stroke
• walking

Acknowledgment

The authors would like to thank all the people who participated in the trial.

Disclosure statement

None declared.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the Japan Society for the Promotion of Science (KAKENHI Grant Number 19K19845). The funders played no role in the design, conduct, or reporting of this study.