Verticality Perceptions Associate with Postural Control and Functionality in Stroke Patients

Abstract

Deficits of postural control and perceptions of verticality are disabling problems observed in stroke patients that have been recently correlated to each other. However, there is no evidence in the literature confirming this relationship with quantitative posturography analysis. Therefore, the objectives of the present study were to analyze the relationship between Subjective Postural Vertical (SPV) and Haptic Vertical (HV) with posturography and functionality in stroke patients. We included 45 stroke patients. The study protocol was composed by clinical interview, evaluation of SPV and HV in roll and pitch planes and posturography. Posturography was measured in the sitting and standing positions under the conditions: eyes open, stable surface (EOSS); eyes closed, stable surface (ECSS); eyes open, unstable surface (EOUS); and eyes closed, unstable surface (ECUS). The median PV in roll plane was 0.34° (-1.44° to 2.54°) and in pitch plane 0.36° (-2.72° to 2.45°). The median of HV in roll and pitch planes were -0.94° (-5.86° to 3.84°) and 3.56° (-0.68° to 8.36°), respectively. SPV in the roll plane was correlated with all posturagraphy parameters in sitting position in all conditions (r = 0.35 to 0.47; p < 0.006). There were moderate correlations with the verticality perceptions and all the functional scales. Linear regression model showed association between speed and SPV in the roll plane in the condition EOSS (R2 of 0.37; p = 0.005), in the condition ECSS (R2 of 0.13; p = 0.04) and in the condition EOUS (R2 of 0.22; p = 0.03). These results suggest that verticality perception is a relevant component of postural control and should be systematically evaluated, particularly in patients with abnormal postural control.

The influences of age, gender and geometric pattern of visual image on the verticality perception: A subjective visual vertical (SVV) study among Malaysian adults

“…The utricle, one of the otolithic organs of the vestibular system, provides the sense of orientation in relation to gravity. Along with others, this perception of verticality is crucial for maintaining postural orientation and balance when performing related motor activities …”

Test-retest reliability of and age-related changes in the subjective postural vertical on the diagonal plane in healthy subjects

“…The subjective postural vertical (SPV) indicates cognitive awareness of postural orientation and is assessed using motordriven machines (Bisdorff, Wolsley, Anastasopoulos, Bronstein, & Gresty, 1996;Karnath, Ferber, & Dichgans, 2000) or a non-motorized paradigm (Barbieri, Gissot, & Pérennou, 2010;Baggio et al, 2016;Pérennou et al, 2008) that can tilt on the frontal or sagittal plane. In such tests, subjects report experiencing true vertical positioning when their eyes are closed.…”

Avaliação da Simetria Corporal e Controle de Tronco em Hemiparéticos Pós-Acidente Vascular Encefálico: Uma Série de Casos

“…A simetria corporal, o equilíbrio e a estabilidade dinâmica são três elementos fundamentais para o controle postural 4,9,10 . Os indivíduos pós-AVE apresentam diminuição da capacidade do equilíbrio, incluindo assimetria na distribuição da descarga de peso, na estabilidade postural e redução nos seus limites de estabilidade [11][12][13][14][15] . Essa descarga de peso assimétrica é percebida como uma dificuldade em transferir o peso corporal para o hemicorpo comprometido, interferindo na capacidade de manter o controle postural, impedindo a orientação e a estabilidade para realizar movimentos com o tronco e membros 7,11,[14][15][16][17] .…”

“…A fisioterapia em indivíduos hemiparéticos é direcionada para a correção da postura assimétrica, descarga de peso e transferência de peso para o membro inferior afetado, e facilitação de simetria adequada nos movimentos funcionais, utilizando feedback sensorial, tal como as informações visual, auditiva ou somatossensorial 11,18 . Diante disso, analisar a simetria corporal torna-se uma questão importante, decorrente da necessidade de se identificar e compreender os elementos que interferem na aquisição do controle postural e do movimento do hemiparético 2,13,16 . Uma avaliação direcionada fornece parâmetros para que programas de atividades motoras possam ser inseridos com efetividade, apontando as necessidades e os fatores de interferência no desempenho motor 23 .…”

“…A média de idade foi de 71,4 anos (DP=9,4) e a massa corporal foi de 60,6 Kg (DP=7,3). A mediana do tempo de lesão foi de 15 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] meses; o hemicorpo esquerdo foi o afetado para cinco (55,6%) participantes; o hemicorpo dominante foi afetado para seis (66,6%) indivíduos. A ECT total foi de 16 pontos, evidenciando comprometimento no controle do tronco.…”