Obstacle crossing in subjects with stroke

Objective: To study the ability of subjects with stroke to successfully ste p over an obstacle during ambulation. Setting: A geriatric rehabilitation unit in a tertiary referral hospital. Subjects: Twenty-four inpatients with stroke (median time poststroke 27 day s, interquartile range 21 to 44.5 days) able to walk 10m unassisted without walking aids; also, 22 healthy subjects. Method: Subjects were required to step over obstacles of various heights an d widths, ranging from 1cm to 8cm. A fail was scored if the obstacle was co ntacted by either lower limb or if assistance or upper limb support was req uired. The choice of leading limb and the presence of visual deficits and n eglect were also recorded in the stroke subjects. Subjects were tested on t wo occasions. Results: Significantly more fails were recorded for stroke subjects, with 1 3 subjects failing at least once. No preference was shown for leading eithe r with the affected or with the unaffected leg. Stroke subjects showed inco nsistent performance over the two testing sessions. Conclusion: The ability to negotiate obstacles was compromised and inconsis tent in stroke subjects undergoing inpatient rehabilitation. This suggests that gait safety in this population remains threatened. (C) 1999 by the Ame rican Congress of Rehabilitation Medicine and the American Academy of Physi cal Medicine and Rehabilitation.