Obstacle Avoidance and Dual-Tasking During Reaching While Standing in Patients With Mild Chronic Stroke

Abstract

Background. Poststroke individuals use their paretic arms less often than expected in daily life situations, even when motor recovery is scored highly in clinical tests. Real-world environments are often unpredictable and require the ability to multitask and make decisions about rapid and accurate arm movement adjustments. Objective. To identify whether and to what extent cognitive–motor deficits in well-recovered individuals with stroke affect the ability to rapidly adapt reaching movements in changing cognitive and environmental conditions. Methods. Thirteen individuals with mild stroke and 11 healthy controls performed an obstacle avoidance task in a virtual environment while standing. Subjects reached for a virtual juice bottle with their hemiparetic arm as quickly as possible under single- and dual-task conditions. In the single-task condition, a sliding glass door partially obstructed the reaching path of the paretic arm. A successful trial was counted when the subject touched the bottle without the hand colliding with the door. In the dual-task condition, subjects repeated the same task while performing an auditory–verbal working memory task. Results. Individuals with stroke had significantly lower success rates than controls in avoiding the moving door in single-task (stroke: 51.8 ± 21.2%, control: 70.6 ± 12.7%; P = .018) and dual-task conditions (stroke: 40.0 ± 27.6%, control: 65.3 ± 20.0%; P = .015). Endpoint speed was lower in stroke subjects for successful trials in both conditions. Obstacle avoidance deficits were exacerbated by increased cognitive demands in both groups. Individuals reporting greater confidence using their hemiparetic arm had higher success rates. Conclusion. Clinically well-recovered individuals with stroke may have persistent deficits performing a complex reaching task.

Perceived Facilitators and Barriers for Actual Arm Use during Everyday Activities in Community Dwelling Individuals with Chronic Stroke

“…One explanation for this could be that real-world hand tasks such as carrying a cup of water to the table or pouring laundry detergent into the washer increase the motor and attentional demands of the task. The literature on dual tasks demonstrates that increased motor and cognitive demands decrease UE performance time and motor control in individuals with stroke compared to healthy populations [ 46 , 47 ], so it is not surprising that tasks completed at home with increased hazards and decreased safety would be a deterrent to use the affected side.…”

Intra-limb Coordination and Control in Individuals with Stroke: Conceptual and Methodological Considerations

“…1). Nine of the studies were descriptive and 11 were interventions [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”

“…In the current review, 14 articles examined issues in movement control. Six studies examined issues of both coordination and control [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35].…”

“…The issues in movement control were examined https://doi.org/10.46889/JCMR.2023.4107 https://athenaeumpub.com/journal-of-clinical-medical-research/ in spatial and temporal domains, in both joint and effector space. In joint space, measures of spatial control included maximum joint angles of the shoulder elbow and wrist forearm, as well as range of motion of the shoulder, elbow wrist and forearm [19,20,24,26,[32][33][34]37]. The nature of temporal control was inferred from angular velocity of the elbow, shoulder, wrist and forearm as well as execution time [34,37].…”

“…In effector space, spatial measures consisted of an index of curvature trajectory length reaching trajectories spectral arch length, constant final position error, path length ratio normalized total displacement of the hand and variability of endpoint position [19,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. In the temporal domain, the measures included movement duration of the hand peak velocity of the hand number of velocity peaks mean endpoint velocity time to peak velocity end effector velocity profiles, normalized jerk, percentage of movement time in which peak velocity occurred and reaction time of the hand [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38].…”