Understanding the pusher behavior of some stroke patients with spatial deficits: A pilot study

Pérennou, Dominic; Amblard, B.; Laassel, E.M.; Benaïm, Charles; Hérisson, C.; Pélissier, J.

doi:10.1053/apmr.2002.31198

Cited by 102 publications

(78 citation statements)

References 34 publications

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“…In fact, data distribution was scattered with many patients showing no signs of spatial neglect, especially those with a left stroke, but about 1/5 showing mild to severe spatial neglect. The strong relationship between postural imbalance and spatial neglect found in our study on the standing posture confirms and builds on the findings of several previous studies that focused on the sitting posture 30,32 or even postural control in daily life. 7,9 Spatial neglect may be interpreted as the existence of distortion in the coordinates used to distribute body weight over the 2 limbs while standing.…”

Section: Relationship Between Postural Impairment and Clinical Featuressupporting

confidence: 91%

Contribution of Each Lower Limb to Upright Standing in Stroke Patients

Genthon

Rougier

Gissot

et al. 2008

Stroke

203

122

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Background and Purpose-To analyze the postural behavior of standing stroke patients: (1) To differentiate between postural impairment attributable to the neurological condition (deficits attributable to the cerebral lesion) and postural impairment attributable to new mechanical constraints caused by body weight asymmetry; (2) To assess the involvement of each limb in the postural impairment; (3) To better understand which clinical deficits underlie the postural impairment. Methods-The posturographic characteristics of each limb in 41 stroke patients (first hemispheric stroke: 16 left, 25 right cerebral lesions) required to stand in their preferred posture were compared to those in 40 matched healthy individuals required to stand asymmetrically. Results-Compared to normal individuals in a similar asymmetrical posture, stroke patients were more unstable. The weight bearing asymmetry and the lateral postural instability were mainly related to spatial neglect. The paretic limb was unable to bring into play a normal longitudinal pattern of the center of pressure, which reflects an impaired stabilization control. Overall postural instability occurred when the strong limb was unable to compensate for the postural impairment of the paretic limb. Conclusions-The weight bearing asymmetry of standing stroke patients is not the primary cause of their postural imbalance, which is rather the consequence of impaired control of postural stabilization involving both limbs. Weight bearing asymmetry may not be the principle target of rehabilitation programs aiming at restoring standing balance after stroke. Instead it is suggested that more account should be taken of the compensatory role of the strong limb. (Stroke.

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Section: Relationship Between Postural Impairment and Clinical Featuressupporting

confidence: 91%

Contribution of Each Lower Limb to Upright Standing in Stroke Patients

Genthon

Rougier

Gissot

et al. 2008

Stroke

203

122

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“…32 Lesions to the parietal multisensory cortex can result in deficits in balance and the perception of verticality. [34][35][36][37][38] Therefore, these projections may also play a role in the vestibular control of balance, in addition to their known role in the control of ocular movements. 39 The deficits in balance and verticality perception seen after parietal lesions are often associated with signs of visuo-spatial neglect, [34][35][36] a symptom that was absent in our present cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

1162 The vestibular control of balance after stroke

2005

Journal of the Neurological Sciences

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Objectives: To examine vestibular control of balance in those who recovered the ability to stand after middle cerebral artery (MCA) stroke. Methods: Sixteen patients with MCA stroke were compared with 10 age matched controls. Two additional patients were studied with isolated corticospinal tract lesions, one each at the level of the pons and medulla. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation (GVS) while patients stood with their eyes closed and head facing forwards, equally loading both legs. The GVS response was characterised by measuring the amplitude of the stimulus evoked lateral forces acting through each leg and the lateral displacement of the axial skeleton. Results: Lateral displacement and net lateral force following GVS were significantly larger after stroke. Unlike controls, the lateral forces in the stroke group were asymmetrical, being enhanced on the side of the non-paretic limb and small on the side of the paretic limb. The degree of GVS evoked asymmetry correlated with corticospinal damage assessed using transcranial magnetic stimulation. A similar asymmetrical response was seen in the patient with the pontine lesion but not the patient with the medullary lesion. Conclusions: MCA stroke may disrupt corticobulbar projections to brainstem output pathways involved in vestibular control of balance. These projections are either collaterals of the corticospinal tract or lie close to that tract and terminate in the pons/upper medulla. This hypothesis accounts for the association between corticospinal tract damage and GVS response asymmetry, and the lack of GVS evoked asymmetry with corticospinal lesions below the rostral medulla.

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“…The incidence of PS is estimated to be over 5% of the stroke population and 10% of stroke patients admitted for rehabilitation 3,7) . Some clinicians and researchers have assumed that the symptom might be caused by spatial neglect, perceptual disorder of body orientation, anosognosia, aphasia, ideomotor apraxia, and so forth [8][9][10][11][12] . Recently, it has been suggested that PS is caused by a distortion of two vertical references relative to earth-verticality (e.g, the visual vertical and postural vertical) 8,13) .…”

Section: Introductionmentioning

confidence: 99%

Presence of Ideomotor Apraxia in Stroke Patients with Pusher Syndrome

Kwon¹,

Kwon

Park

et al. 2011

J Phys Ther Sci

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Abstract.[Purpose] Pusher syndrome, which is a disorder of postural balance that occurs in hemiparetic stroke patients, is characterized by a particular tendency to strongly push toward the hemiparetic side. The purpose of this study was to investigate whether stroke patients with pusher syndrome have ideomotor apraxic behavior. [Subjects] Fifteen stroke patients with pusher syndrome and 31 stroke patients without pusher syndrome were recruited.[Methods] All subjects were tested with two tests assessing ideomotor apraxia of movements of the upper and lower limbs. Each test included 12 items of movements, which required the subjects to reproduce movements by imitation after presentation.[Results] Patients with pusher syndrome had significantly lower ideomotor apraxia scores in all of the upper and lower limbs than patients without pusher syndrome. A significant difference was observed between the two groups in the existence of neglect. [Conclusion] We found that patients with pusher syndrome had more severe apraxic disorder in all of the upper and lower limbs than patients without pusher syndrome. Pusher syndrome may be attributable to disabilities in motor planning and execution, which are required to compensate for the partial damage to the postural control system.

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Understanding the pusher behavior of some stroke patients with spatial deficits: A pilot study

Cited by 102 publications

References 34 publications

Contribution of Each Lower Limb to Upright Standing in Stroke Patients

Contribution of Each Lower Limb to Upright Standing in Stroke Patients

1162 The vestibular control of balance after stroke

Presence of Ideomotor Apraxia in Stroke Patients with Pusher Syndrome

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