Department of Rehabilitation, Kameda Medical Center, Chiba, Japan; Department of Health Promotion Science, Tokyo Metropolitan University, Tokyo, Japan; Division of Physical Therapy, Department of Rehabilitation Sciences, Faculty of Health Care Sciences, Chiba Prefectural University of Health Sciences, Chiba, Japan.
Department of Rehabilitation, Kameda Medical Center, Chiba, Japan.
Hum Mov Sci. 2022 Feb;81:102906. doi: 10.1016/j.humov.2021.102906. Epub 2021 Nov 24.
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.
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.
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.
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.
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.
对脑卒中患者而言，对患侧身体的安全管理至关重要。我们之前报告过，与从非患侧穿入相比，从患侧穿入时穿过狭窄空间的脑卒中患者与框架的碰撞次数更少。在我们之前的研究中观察到了避免碰撞的自发性行为；因此，本研究使用从患侧和非患侧穿入作为自变量来确认从患侧穿入的有用性。
本研究旨在（1）通过操纵穿入的方向作为自变量，重新确认仅对于曾经跌倒过的脑卒中患者，从患侧穿入狭窄空间是否会因减少碰撞频率，以及（2）确定在曾经跌倒过的脑卒中患者中是否观察到通过开口的行为或认知特征。
要求脑卒中患者（12 例有跌倒史，13 例无跌倒史）从患侧和非患侧穿入狭窄空间。将碰撞率和穿过开口时的运动学特征（身体旋转角度、身体中点的偏差和运动速度）作为因变量进行记录。我们还确认了参与者在穿过开口后是否预期会发生碰撞。
有跌倒史的脑卒中患者从患侧穿入时更不容易发生碰撞。脑卒中跌倒组更有可能发生碰撞，这是由于在狭窄开口处身体旋转角度和运动速度的有害变化。此外，脑卒中患者有许多意外碰撞，但预期能力下降并非跌倒组所特有。
尽管对狭窄开口的调整较差，但从患侧穿入狭窄空间改善了对曾经跌倒过的患者的患侧安全管理。从患侧穿入狭窄空间可能更容易观察和关注患侧。
