Cognitive load and visual field restriction affect safety and efficiency of individuals with stroke walking through narrow openings.

Safety management of the paretic side is critical for stroke individuals. We previously demonstrated that stroke individuals who walk through an opening while entering from the paretic side have a reduced incidence of collisions with the opening frame. We investigated whether lower visual field restriction and cognitive load affect collision avoidance performance when individuals with stroke enter narrow openings from the paretic side. Seventeen stroke participants repeatedly walked through the opening under three task conditions: one control and two constraints (downward visual field restriction and calculation). Each participant performed the task by entering an opening with a width equal to their shoulder width, from either the paretic or non-paretic side. Collision events were analyzed using logistic regression models, including Generalized Linear Mixed Models (GLMMs) to account for repeated measures within participants. For task performance time, both ordinary least squares regression and linear mixed-effects models were employed to examine the effects of condition and entry direction, while controlling for individual variability. No differences were observed in the collision rate or task performance time across conditions regardless of the direction of entry into the opening. The GLMM analysis did not reveal any significant predictors of collisions, although a trend toward an association with the relative perceptual boundary was observed. In contrast, performance time was prolonged by visual restriction, calculation task, paretic side entry, and reduced balance. The present study suggests that overestimation of one’s own ability to walk through narrow openings may be related to decreased safety, whereas visual restriction, cognitive load, use of the paretic side, and reduced balance ability are associated with decreased efficiency.