# Outdoor Environmental Facilitators and Barriers of Stroke Survivors’ Mobility and Functional Status

> **NIH NIH F31** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2020 · $36,729

## Abstract

PROJECT SUMMARY
Stroke is a leading cause of serious long-term disability within the United States, and it affects an estimated 6.6
million Americans over age 20. Medical advances in treatment of acute stroke and an aging population have
resulted in a greater number of stroke survivors in our population, and many stroke survivors return directly
home. With a greater number of stroke survivors living in their local community, it is critical to determine which
features of the local environment best support stroke survivors' functional status, especially features that
support mobility. Mobility impacts health through various mechanisms, including social engagement,
community involvement, and access to health care resources. Using a mixed methods study design, the
proposed project will determine which features of the outdoor environment are most important for mobility and
functional status in the first 18 months post-stroke. This research project will consist of a secondary data
analysis of existing data by combining three, rich data sources and primary data collection using mobile inertial
measurement units and qualitative methods. Specifically, this research project will address the following aims:
1) Examine the moderating effect of environmental features found on participants' residential blocks on the
relationship between stroke severity and 18-month trajectory of functional status post stroke, 2) Identify
environmental features that moderate the relationship between stroke severity and mobility adaption (i.e.
slower gait speed) in real-time using wearable sensors (i.e. mobile inertial measurement units), and 3) Identify
the most salient environmental features for functional status and mobility as reported by stroke survivors using
qualitative interviews. The mixed methods approach allows the examination of which environmental features
interact with stroke impairment to result in differential functional status (Aim 1), how stroke impairment
interacts with environmental features to affect mobility (Aim 2), and why environmental features affect mobility
and functional status from the perspective of stroke survivors themselves (Aim 3). This research will identify
potential ways to increase stroke survivors' mobility and independence by determining how to maximize the
accessibility of the outdoor built environment. The findings of this research will inform planning and policy
regarding which components of the built environment are most important for survivors' mobility and functional
independence. Ultimately, positive environmental changes can improve stroke survivors' functional
independence and decrease stroke survivors' reliance on caregivers, premature relocation to nursing home
facilities, and development of secondary conditions (e.g. depression, cognitive decline).

## Key facts

- **NIH application ID:** 9922118
- **Project number:** 5F31HD098870-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Erica Twardzik
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $36,729
- **Award type:** 5
- **Project period:** 2019-05-01 → 2021-04-15

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9922118

## Citation

> US National Institutes of Health, RePORTER application 9922118, Outdoor Environmental Facilitators and Barriers of Stroke Survivors’ Mobility and Functional Status (5F31HD098870-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9922118. Licensed CC0.

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