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Aziz JR, Good SR, Horne SC, Eskes GA. A scoping review and critique of the Input-Output subtyping dimension of spatial neglect. Cortex 2024; 176:11-36. [PMID: 38729033 DOI: 10.1016/j.cortex.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/28/2024] [Accepted: 04/22/2024] [Indexed: 05/12/2024]
Abstract
Spatial neglect is a common and debilitating disorder after stroke whereby individuals have difficulty reporting, orienting, and/or responding to the contralesional side of space. Given the heterogeneity of neglect symptom presentation, various neglect subtypes have been proposed to better characterize the disorder. This review focuses on the distinction between Input neglect (i.e., difficulty perceiving and/or attending to contralesional stimuli) and Output neglect (i.e., difficulty planning and/or executing movements toward contralesional stimuli). Conceptualizations of Input and Output neglect have varied considerably. We provide a novel summary of the terminology, measurement approaches, and neural correlates of these subtypes. A protocol detailing our systematic scoping review strategy is registered on the Open Science Framework (https://osf.io/bvtxf/). For feasibility and greater comparability across studies, we limited our inclusion criteria to tasks focused on visual stimuli and upper-limb movements. A total of 110 articles were included in the review. Subtyping tasks were categorized based on whether they mainly manipulated aspects of the input (i.e., congruence of visual input with motor output, presence of visual input) or the output (i.e., modality, goal, or direction of output) to produce an Input-Output subtype dissociation. We used our review results to identify four main critiques of this literature: 1) lack of consistency/clarity in conceptual models; 2) methodological issues of dissociating Input and Output subtypes; 3) a need for updated neural theories; and 4) barriers to clinical application. We discuss the lessons learned from this subtyping dimension that can be applied to future research on neglect subtype assessment and treatment.
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Affiliation(s)
- Jasmine R Aziz
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada.
| | - Samantha R Good
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada
| | - Samantha C Horne
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Gail A Eskes
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Department of Psychiatry, Dalhousie University, Halifax, Canada
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2
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Piscitelli D, Baniña MC, Lam TK, Chen JL, Levin MF. Psychometric Properties of a New Measure of Upper Limb Performance in Post-Stroke Individuals: Trunk-Based Index of Performance. Neurorehabil Neural Repair 2023; 37:66-75. [PMID: 36575955 PMCID: PMC9896540 DOI: 10.1177/15459683221143462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several measures of upper limb (UL) motor tasks have been developed to characterize recovery. However, UL performance and movement quality measures in isolation may not provide a true profile of functional recovery. OBJECTIVE To investigate the measurement properties of a new trunk-based Index of Performance (IPt) of the UL combining endpoint performance (accuracy and speed) and movement quality (trunk displacement) in stroke. METHODS Participants with stroke (n = 25, mean time since stroke: 18.7 ± 17.2 months) performed a reaching task over 3 evaluation sessions. The IPt was computed based on Fitts' Law that incorporated endpoint accuracy and speed corrected by the amount of trunk displacement. Test-retest reliability was analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. Standard error of measurement (SEM) and Minimal Detectable Change (MDC) were determined. Validity was investigated through the relationship between IPt, Fugl-Meyer Assessment (FMA-UE), and Action Research Arm Test (ARAT), as well as the ability of IPt to distinguish between levels of UL motor impairment severity. RESULTS Test-retest reliability was excellent (ICC = .908, 95% CI: 0.807-0.96). Bland-Altman did not show systematic differences. SEM and MDC95 were 14% and 39%, respectively. Construct validity was satisfactory. The IPt showed low-to-moderate relationships with FMA-UE (R2 ranged from .236 to .428) and ARAT (R2 ranged from .277 to .306). IPt scores distinguished between different levels of UL severity. CONCLUSIONS The IPt showed evidence of good reliability, and initial validity. The IPt may be a promising tool for research and clinical settings. Further research is warranted to investigate its validity with additional comparator instruments.
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Affiliation(s)
- Daniele Piscitelli
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Department of Kinesiology, University
of Connecticut, Storrs, CT, USA
| | - Melanie C. Baniña
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada
| | - Timothy K. Lam
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada
| | - Joyce L. Chen
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada,Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada
| | - Mindy F. Levin
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Mindy F. Levin, School of Physical and
Occupational Therapy, McGill University, 3654 Promenade Sir William Osler,
Montreal, QC H3G 1Y5, Canada.
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Barton JJ, Rubino C, Albonico A, Jackson M, Davies-Thompson J. Right hemi-alexia. Cortex 2022; 157:288-303. [PMID: 36370599 DOI: 10.1016/j.cortex.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 09/02/2022] [Accepted: 09/26/2022] [Indexed: 12/15/2022]
Abstract
While pure alexia was long considered a disconnection syndrome, it may also be a selective visual word agnosia due to damage to the visual word form area. Disconnection is still the likely explanation of hemi-alexias, though, particularly when splenial lesions damage inter-hemispheric projections and cause left hemi-alexia. An intra-hemispheric disconnection causing right hemi-alexia is theoretically possible but seems very rare, with only a single report that has been challenged on the grounds of inadequate perimetry. We describe the case of PH, who had a severe reading deficit in her right hemifield. Detailed perimetry showed only a small relative hemi-scotoma along the horizontal meridian, while word reading was impaired over a much larger expanse of her right hemifield, in which object recognition was spared. Reading, lexical decisions, and perceptual discrimination of words were impaired in the right hemifield, and this extended to letters and numbers, with a trend to an effect on the perception of an unfamiliar script, namely Korean. On magnetic resonance imaging she had a large left lateral occipital meningioma with vasogenic edema of occipital white matter tracts. Functional magnetic resonance imaging showed that the visual word form area was located just anterior to the mass. Her perceptual abnormalities resolved after resection of the tumor. We conclude that right hemi-alexia exists and is most likely due to intra-hemispheric disconnection of occipital input to the visual word form area.
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Affiliation(s)
- Jason Js Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Science, University of British Columbia, Vancouver, Canada; Departments of Ophthalmology and Visual Science, University of British Columbia, Vancouver, Canada.
| | - Cristina Rubino
- Graduate Program in Rehabilitative Sciences, University of British Columbia, Vancouver, Canada.
| | - Andrea Albonico
- Departments of Medicine (Neurology), Ophthalmology and Visual Science, University of British Columbia, Vancouver, Canada; Departments of Ophthalmology and Visual Science, University of British Columbia, Vancouver, Canada.
| | - MaryLou Jackson
- Departments of Ophthalmology and Visual Science, University of British Columbia, Vancouver, Canada.
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Schuch CP, Lam TK, Levin MF, Cramer SC, Swartz RH, Thiel A, Chen JL. A comparison of lesion-overlap approaches to quantify corticospinal tract involvement in chronic stroke. J Neurosci Methods 2022; 376:109612. [PMID: 35487314 DOI: 10.1016/j.jneumeth.2022.109612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Clarissa Pedrini Schuch
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, M5S 2W6, Canada
| | - Timothy K Lam
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, H3G 1Y5, Canada; Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, QC, H7V 1R2, Canada
| | - Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles; and California Rehabilitation Institute; Los Angeles, CA, 90095-1769, United States of America
| | - Richard H Swartz
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada; Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, M4N 3M5, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Joyce L Chen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, M5S 2W6, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, M4N 3M5, Canada.
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5
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Ni Cathain D, Browne E, Skehan K, Boyle K. MELAS syndrome: an acute stroke-like episode complicated by renal tubular acidosis. BMJ Case Rep 2021; 14:e245898. [PMID: 34728512 PMCID: PMC8565551 DOI: 10.1136/bcr-2021-245898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/03/2022] Open
Abstract
MELAS, a mitochondrially inherited multisystem disorder, can present with acute stroke-like episodes. The literature thus far supports the use of L-arginine therapy in acute MELAS flares to alleviate and shorten the duration of symptoms. This is the case of a patient who presented with ataxia and worsening confusion on a background of genetically confirmed MELAS syndrome. In this instance, intravenous L-arginine therapy, along with corticosteroids, was administered in keeping with best practice. However, in a metabolically vulnerable patient, L-arginine therapy resulted in a further deterioration in his clinical status and the development of a non-anion gap metabolic acidosis.
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Whitehouse CE, Green J, Giles SM, Rahman R, Coolican J, Eskes GA. Development of the Halifax Visual Scanning Test: A New Measure of Visual-Spatial Neglect for Personal, Peripersonal, and Extrapersonal Space. J Int Neuropsychol Soc 2019; 25:1-11. [PMID: 30990154 DOI: 10.1017/s135561771900002x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Visual-spatial neglect is a common attentional disorder after right-hemisphere stroke and is associated with poor rehabilitation outcomes. The presence of neglect symptoms has been reported to vary across personal, peripersonal, and extrapersonal space. Currently, no measure is available to assess neglect severity equally across these spatial regions and may be missing subsets of symptoms or patients with neglect entirely. We sought to provide initial construct validity for a novel assessment tool that measures neglect symptoms equally for these spatial regions: the Halifax Visual Scanning Test (HVST). METHODS In Study I, the HVST was compared to conventional measures of neglect and functional outcome scores (wheelchair navigation) in 15 stroke inpatients and 14 healthy controls. In Study II, 19 additional controls were combined with the control data from Study I to establish cutoffs for impairment. Patterns of neglect in the stroke group were examined. RESULTS In Study I, performance on all HVST subtests were correlated with the majority of conventional subtests and wheelchair navigation outcomes. In Study II, neglect-related deficits in visual scanning showed dissociations across spatial regions. Four inpatients exhibited symptoms of neglect on the HVST that were not detected on conventional measures, one of which showed symptoms in personal and extrapersonal space exclusively. CONCLUSIONS The HVST appears a useful measure of neglect symptoms in different spatial regions that may not be detected with conventional measures and that correlates with functional wheelchair performance. Preliminary control data are presented and further research to add to this normative database appears warranted.
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Affiliation(s)
| | - Janet Green
- 1Department of Psychology and Neuroscience,Dalhousie University,Nova Scotia
| | - Sarah M Giles
- 2Department of Family Medicine,University of Ottawa,Ottawa,Canada
| | - Rosanna Rahman
- 3Capital and Coast District Health Board,Wellington Regional Hospital,New Zealand
| | | | - Gail A Eskes
- 1Department of Psychology and Neuroscience,Dalhousie University,Nova Scotia
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Fraser LE, Mansfield A, Harris LR, Merino DM, Knorr S, Campos JL. The Weighting of Cues to Upright Following Stroke With and Without a History of Pushing. Can J Neurol Sci 2018; 45:405-414. [PMID: 29925437 PMCID: PMC6088547 DOI: 10.1017/cjn.2017.297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Perceived upright depends on three main factors: vision, graviception, and the internal representation of the long axis of the body. We assessed the relative contributions of these factors in individuals with sub-acute and chronic stroke and controls using a novel tool; the Oriented Character Recognition Test (OCHART). We also considered whether individuals who displayed active pushing or had a history of pushing behaviours had different weightings than those with no signs of pushing. METHOD Three participants experienced a stroke 6 months prior: eight with a history of pushing. In total, 12 participants served as healthy aged-matched controls. Visual and graviceptive cues were dissociated by orienting the visual background left, right, or upright relative to the body, or by orienting the body left, right, or upright relative to gravity. A three-vector model was used to quantify the weightings of vision, graviception, and the body to the perceptual upright. RESULTS The control group showed weightings of 13% vision, 25% graviception, and 62% body. Some individuals with stroke showed a similar pattern; others, particularly those with recent stroke, showed different patterns, for example, being unaffected by one of the three factors. The participant with active pushing behaviour displayed an ipsilesional perceptual bias (>30°) and was not affected by visual cues to upright. CONCLUSION The results of OCHART may be used to quantify the weightings of multisensory inputs in individuals post-stroke and may help characterize perceptual sources of pushing behaviours.
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Affiliation(s)
- Lindsey E. Fraser
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
| | - Avril Mansfield
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | | | - Daniel M. Merino
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Svetlana Knorr
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer L. Campos
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
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8
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Hanna KL, Hepworth LR, Rowe F. Screening methods for post-stroke visual impairment: a systematic review. Disabil Rehabil 2016; 39:2531-2543. [PMID: 27669628 DOI: 10.1080/09638288.2016.1231846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To provide a systematic overview of the various tools available to screen for post-stroke visual impairment. METHODS A review of the literature was conducted including randomised controlled trials, controlled trials, cohort studies, observational studies, systematic reviews and retrospective medical note reviews. All languages were included and translation was obtained. Participants included adults ≥18 years old diagnosed with a visual impairment as a direct cause of a stroke. We searched a broad range of scholarly online resources and hand-searched articles registers of published, unpublished and on-going trials. Search terms included a variety of MESH terms and alternatives in relation to stroke and visual conditions. Study selection was performed by two authors independently. The quality of the evidence and risk of bias were assessed using the STROBE, GRACE and PRISMA statements. RESULTS A total of 25 articles (n = 2924) were included in this review. Articles appraised reported on tools screening solely for visual impairments or for general post-stroke disabilities inclusive of vision. The majority of identified tools screen for visual perception including visual neglect (VN), with few screening for visual acuity (VA), visual field (VF) loss or ocular motility (OM) defects. Six articles reported on nine screening tools which combined visual screening assessment alongside screening for general stroke disabilities. Of these, three included screening for VA; three screened for VF loss; three screened for OM defects and all screened for VN. Two tools screened for all visual impairments. A further 19 articles were found which reported on individual vision screening tests in stroke populations; two for VF loss; 11 for VN and six for other visual perceptual defects. Most tools cannot accurately account for those with aphasia or communicative deficits, which are common problems following a stroke. CONCLUSION There is currently no standardised visual screening tool which can accurately assess all potential post-stroke visual impairments. The current tools screen for only a number of potential stroke-related impairments, which means many visual defects may be missed. The sensitivity of those which screen for all impairments is significantly lowered when patients are unable to report their visual symptoms. Future research is required to develop a tool capable of assessing stroke patients which encompasses all potential visual deficits and can also be easily performed by both the patients and administered by health care professionals in order to ensure all stroke survivors with visual impairment are accurately identified and managed. Implications for Rehabilitation Over 65% of stroke survivors will suffer from a visual impairment, whereas 45% of stroke units do not assess vision. Visual impairment significantly reduces the quality of life, such as being unable to return to work, driving and depression. This review outlines the available screening methods to accurately identify stroke survivors with visual impairments. Identifying visual impairment after stroke can aid general rehabilitation and thus, improve the quality of life for these patients.
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Affiliation(s)
- Kerry Louise Hanna
- a Department of Health Services Research , University of Liverpool , Liverpool , UK
| | | | - Fiona Rowe
- a Department of Health Services Research , University of Liverpool , Liverpool , UK
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Wall KJ, Isaacs ML, Copland DA, Cumming TB. Assessing Cognition after Stroke. Who Misses Out? A Systematic Review. Int J Stroke 2015; 10:665-71. [DOI: 10.1111/ijs.12506] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
Background Cognitive impairments post-stroke are common. Assessment of cognition typically involves pen-and-paper tasks, which are often reliant on linguistic and motor function, creating barriers for many stroke survivors. The characteristics of stroke survivors excluded from cognitive assessments have never been investigated. Aims ( 1 ) To determine if the stroke samples included in studies evaluating clinimetric properties of cognitive assessments represent the stroke population, ( 2 ) to identify the different modes of cognitive assessments, and ( 3 ) to ascertain whether the different modes of cognitive assessments influence the stroke samples used in the studies. Summary of review We systematically reviewed studies that evaluated at least one clinimetric property of a cognitive assessment in adult stroke survivors from January 2000 to October 2013. Eligibility criteria, reasons for drop-outs and missing data were extracted. A theming process was employed to synthesize the data. From the initial yield of 3731 articles, 109 were included. Six broad categories describing reasons for exclusion were identified. Cognitive impairments were the most common (68%), then communication issues (62%), endurance problems (42%), sensory loss (39%), psychiatric illness (38%) and motor limitations (27%). The most prevalent assessment mode was pen-and-paper (73%), then virtual reality (11%), computer (6%), observational functional performance (5%), informant (3%) and telephone (3%). Regardless of mode, issues with cognition and communication were the most frequently used exclusion criteria. Conclusions Our findings indicate that cognitive assessments are not tested in representative stroke samples. Research is needed to identify valid and reliable cognitive assessments that are feasible in a wider range of stroke survivors.
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Affiliation(s)
- Kylie J. Wall
- The University of Queensland, Clinical Centre for Research, Royal Women's & Children's Hospital Campus, Herston, Qld, Australia
| | - Megan L. Isaacs
- The University of Queensland, Clinical Centre for Research, Royal Women's & Children's Hospital Campus, Herston, Qld, Australia
| | - David A. Copland
- The University of Queensland, Clinical Centre for Research, Royal Women's & Children's Hospital Campus, Herston, Qld, Australia
| | - Toby B. Cumming
- Stroke, The Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Melbourne, Vic, Australia
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Mansfield A, Fraser L, Rajachandrakumar R, Danells CJ, Knorr S, Campos J. Is perception of vertical impaired in individuals with chronic stroke with a history of ‘pushing’? Neurosci Lett 2015; 590:172-7. [DOI: 10.1016/j.neulet.2015.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/16/2015] [Accepted: 02/05/2015] [Indexed: 11/25/2022]
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Mansfield A, Danells CJ, Zettel JL, Black SE, McIlroy WE. Determinants and consequences for standing balance of spontaneous weight-bearing on the paretic side among individuals with chronic stroke. Gait Posture 2013; 38:428-32. [PMID: 23357758 DOI: 10.1016/j.gaitpost.2013.01.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 11/09/2012] [Accepted: 01/04/2013] [Indexed: 02/02/2023]
Abstract
Hemiparetic stroke patients commonly bear more weight on the non-paretic side which seems intuitively linked to unilateral control deficits. However, there is evidence that some post-stroke favour weighting the paretic side, which may be problematic given altered capacity of the paretic limb to contribute to the control of upright posture. This study explores the prevalence and clinical determinants of stance asymmetry, and the relationship between stance asymmetry and postural control among chronic stroke patients. Subjects (n=147; >6 months post-stroke) stood on two force plates in eyes-open and eyes-closed conditions; 59 were symmetric, 18 had paretic asymmetry (PA), and 70 had non-paretic asymmetry (NPA). Root mean square (RMS) of antero-posterior and medio-lateral centre-of-pressure under each limb and both limbs combined were compared. RMS of total medio-lateral centre-of-pressure was greater for both asymmetric groups compared with the symmetric group. PA subjects relied less on the loaded limb for control than NPA subjects and relied more on visual information for postural control than those who were symmetric. There were no differences in the characteristics of individuals between the PA and NPA groups. The loading of the paretic limb was not related to impaired postural control during stationary standing which was attributable, in part, to individuals relying on control from the non-paretic limb, in spite of lower vertical load, and a greater dependence on visual contributions. There was no evidence that greater loading on the paretic limb was related to persisting dyscontrol but may rather reflect a learned strategy.
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Affiliation(s)
- Avril Mansfield
- Heart and Stroke Foundation Centre for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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