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.

背景。中风后患者在日常生活中使用麻痹手臂的频率低于预期，即使在临床测试中运动恢复得分很高。现实世界的环境通常是不可预测的，需要能够同时处理多项任务并就快速准确的手臂运动调整做出决策。客观的。确定恢复良好的中风患者的认知运动缺陷是否以及在多大程度上影响在不断变化的认知和环境条件下快速适应伸展运动的能力。方法。13 名轻度中风患者和 11 名健康对照者在站立时在虚拟环境中执行了避障任务。在单任务和双任务条件下，受试者尽可能快地用偏瘫手臂伸手去拿一个虚拟果汁瓶。在单任务条件下，滑动玻璃门部分阻碍了瘫痪手臂的到达路径。当受试者在手不与门碰撞的情况下触摸瓶子时，即为一次成功的试验。在双重任务条件下，受试者在执行听觉-语言工作记忆任务时重复相同的任务。结果。中风患者在单项任务中避开移动门的成功率显着低于对照组（中风：51.8 ± 21.2%，对照组：70.6 ± 12.7%；P= .018）和双任务条件（中风：40.0 ± 27.6%，对照：65.3 ± 20.0%；P = .015）。在两种情况下成功试验的中风受试者的终点速度较低。两组的认知需求增加加剧了避障缺陷。报告使用偏瘫手臂更有信心的个人成功率更高。结论。临床上恢复良好的中风患者在执行复杂的伸手任务时可能存在持续性缺陷。