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Meng L, Ge Y, Tsang RCC, Zhang W, Liu X, Li S, Zhao J, Zhang X, Wei Q. rTMS for Poststroke Pusher Syndrome: A Randomized, Patient-Blinded Controlled Clinical Trial. Neurorehabil Neural Repair 2024; 38:670-679. [PMID: 39104197 DOI: 10.1177/15459683241268537] [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] [Indexed: 08/07/2024]
Abstract
BACKGROUND Patients with poststroke pusher syndrome (PS) require longer duration of rehabilitation and more supplemental care after discharge. Effective treatment of PS remains a challenge. The role of repetitive transcranial magnetic stimulation (rTMS) for PS has not been examined. OBJECTIVE Assess the efficacy of rTMS for patients with poststroke PS in reducing pushing behavior, enhancing motor recovery and improving mobility. METHODS A randomized, patient- and assessor-blinded sham-controlled trial with intention-to-treat analysis was conducted. Thirty-four eligible patients with poststroke PS were randomly allocated to receive either rTMS or sham rTMS for 2 weeks. Pushing behavior on the Burke lateropulsion scale and scale for contraversive pushing, motor function on Fugl-Meyer assessment scale-motor domain (FMA-m) and mobility on modified Rivermead mobility index were measured at baseline, 1 and 2 weeks after intervention. Repeated-measures analysis of covariance was used for data analysis. RESULTS There was no significant interaction between intervention and time on Burke lateropulsion scale (F = 2.747, P = .076), scale for contraversive pushing (F = 1.583, P = .214), or change of modified Rivermead mobility index (F = 1.183, P = .297). However, a significant interaction between intervention and time was observed for FMA-m (F = 5.464, P = .019). Post hoc comparisons of FMA-m show better improvement in rTMS group with mean differences of 12.7 (95% CI -7.3 to 32.7) and 15.7 (95% CI -4.6 to 36.0) at post-treatment week 1 and week 2 respectively. CONCLUSIONS rTMS did not demonstrate significant efficacy in improving pushing behavior and mobility in patients with PS. However, rTMS might have potential effect in enhancing motor function for patients with PS. REGISTRATION The study was registered in the Chinese Clinical Trial Registry (registration No. ChiCTR2200058015 at http://www.chictr.org.cn/searchprojen.aspx) on March 26, 2022.
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Affiliation(s)
- Lijiao Meng
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanlei Ge
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Raymond C C Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Wenyue Zhang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingyu Liu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siyi Li
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingyu Zhao
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyue Zhang
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingchuan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Birnbaum M, Brock K, Clark R, Burton E, Hill KD. Six-month outcomes and patterns of recovery for people with lateropulsion following stroke. Disabil Rehabil 2024; 46:2405-2413. [PMID: 37312557 DOI: 10.1080/09638288.2023.2222644] [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: 09/19/2022] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE This study investigated the (1) six-month outcomes of individuals with lateropulsion; (2) the relationship between baseline measures (from in-patient hospitalisation) and six-month functional abilities; and (3) recovery patterns for lateropulsion in stroke survivors. MATERIALS AND METHODS Forty-one individuals with lateropulsion participated in this study. Measures of lateropulsion, postural function, and weight-bearing asymmetry in standing were taken initially and fortnightly over eight weeks. Functional independence and walking abilities were assessed at six months post-stroke. RESULTS Compared to individuals with moderate to severe lateropulsion, those with mild lateropulsion achieved higher levels of functional outcome at six months. However, there were a wide range of scores. Baseline lateropulsion severity explained 26% of the variation in functional outcome. A stronger correlation with functional outcome was observed for lateropulsion (-0.526) than function independence at baseline (0.384). For the task of standing with arm support, patterns of asymmetry were divergent at baseline, favouring either the paretic or non-paretic leg. Over the eight-week period, asymmetry moved towards the non-paretic leg and lateropulsion reduced consistently. CONCLUSIONS Individuals with lateropulsion can recover from lateropulsion and make meaningful functional gains, including some individuals with more severe lateropulsion. Lateropulsion severity is a key indicator of functional outcome post-stroke.IMPLICATIONS FOR REHABILITATIONIndividuals with lateropulsion can make significant gains in terms of mobility and functional abilities by six months post-stroke, learning to compensate for their verticality impairment in standing by loading their non-paretic leg.It is important that stroke survivors with lateropulsion, including those with moderate and severe lateropulsion, are provided with adequate rehabilitation to optimise their longer-term mobility and functional abilities.Routine screening of acute stroke survivors for lateropulsion is recommended, given lateropulsion may negatively impact longer-term functional outcomes in stroke survivors.Therapists should carefully analyse the weight-bearing pattern which an individual with lateropulsion adopts in standing and subsequently tailor treatment to target this.
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Affiliation(s)
- Melissa Birnbaum
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Kim Brock
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ross Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Queensland, Australia
| | - Elissa Burton
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
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Lafitte R, Jeager M, Piscicelli C, Dai S, Lemaire C, Chrispin A, Davoine P, Dupierrix E, Pérennou D. Spatial neglect encompasses impaired verticality representation after right hemisphere stroke. Ann N Y Acad Sci 2023; 1520:140-152. [PMID: 36478572 DOI: 10.1111/nyas.14938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spatial neglect after right hemisphere stroke (RHS) was recently found to encompass lateropulsion, a deficit in body orientation with respect to gravity caused by altered brain processing of graviception. By analogy, we hypothesized that spatial neglect after RHS might encompass an altered representation of verticality. We also assumed a strong relation between body neglect and impaired postural vertical, both referring to the body. To tackle these issues, we performed contingency and correlation analyses between two domains of spatial neglect (body, extra-body) and two modalities of verticality perception (postural, visual) in 77 individuals (median age = 67) with a first-ever subacute RHS (1-3 months). All individuals with a transmodal (postural and visual) tilt in verticality perception (n = 26) had spatial neglect, but the reverse was not found. Correlation and multivariate analyses revealed that spatial neglect (and notably body neglect) was associated more with postural than visual vertical tilts. These findings indicate that after RHS, an impaired verticality representation results from a kind of graviceptive neglect, bearing first on somaesthetic graviception and second on vestibular graviception. They also suggest that the human brain uses not only a mosaic of 2D representations but also 3D maps involving a transmodal representation of verticality.
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Affiliation(s)
- Rémi Lafitte
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Marie Jeager
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Céline Piscicelli
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Shenhao Dai
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Camille Lemaire
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Anne Chrispin
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Patrice Davoine
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Eve Dupierrix
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
| | - Dominic Pérennou
- Department of Neurorehabilitation, Univ. Grenoble Alpes, UMR CNRS 5105 Neuropsychology and Neurocognition, CHU Grenoble Alpes, South Hospital, Grenoble, France
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Seki T, Abe H, Tsujimoto N, Okanuka T. Lower limb muscle strength of the affected side in stroke patients is an accurate predictor of the need for a KAFO. NeuroRehabilitation 2023; 53:355-366. [PMID: 37458050 DOI: 10.3233/nre-230057] [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] [Indexed: 07/18/2023]
Abstract
BACKGROUND Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS We enrolled patients with severe hemiplegia (n = 51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68-0.93). CONCLUSIONS Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke.
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Affiliation(s)
- Takashi Seki
- Department of Rehabilitation Medicine, Kohnan Hospital, Sendai, Japan
| | - Hiroaki Abe
- School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Naohide Tsujimoto
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
| | - Toru Okanuka
- Department of Rehabilitation Medicine, Kohnan Hospital, Sendai, Japan
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Meng L, Tsang RCC, Ge Y, Guo Q, Gao Q. rTMS for poststroke pusher syndrome: study protocol for a randomised, patient-blinded controlled clinical trial. BMJ Open 2022; 12:e064905. [PMID: 35948377 PMCID: PMC9379536 DOI: 10.1136/bmjopen-2022-064905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Poststroke pusher syndrome (PS) prevalence is high. Patients with PS require longer rehabilitation with prolonged length of stay. Effective treatment of PS remains a challenge for rehabilitation professionals. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique that is effective and recommended in the clinical guidelines of stroke rehabilitation. However, the role of rTMS for PS has not been examined. The study is to assess the efficacy of a specific rTMS programme for patients with PS in reducing pushing behaviour, enhancing motor recovery and improving mobility, as well as testing the safety of rTMS for patients with PS. METHODS AND ANALYSIS A randomised, patient and assessor blinded sham-controlled trial with two parallel groups will be conducted. Thirty-four eligible patients with PS will be randomly allocated to receive either rTMS or sham rTMS for 3 weeks. The primary assessment outcome is the pushing behaviour measured by the Burke Lateropulsion Scale and Scale for Contraversive Pushing. The secondary outcomes are the motor functions and mobility measured by the Fugl-Meyer Assessment Scale (motor domain) and Modified Rivermead Mobility Index, and any adverse events. Assessment will be performed at baseline and 1 week, 2 weeks and 3 weeks after intervention. Repeated-measures analysis of variance will be used for data analysis with the level of significance level set at 0.05. ETHICS AND DISSEMINATION The protocol has been approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University on 23 March 2022 (2022-133). The trial findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2200058015).
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Affiliation(s)
- Lijiao Meng
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Raymond C C Tsang
- Physiotherapy Department, MacLehose Medical Rehabilitation Centre, Hong Kong, China
| | - Yanlei Ge
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Qifan Guo
- Department of Rehabilitation Sciences, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Gao
- Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, Sichuan, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Renaissance of "lateropulsion". Ann Phys Rehabil Med 2021; 64:101595. [PMID: 34687959 DOI: 10.1016/j.rehab.2021.101595] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022]
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Martín-Nieto A, Atín-Arratibel MÁ, Bravo-Llatas C, Moreno-Bermejo MI, Martín-Casas P. Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:577-583. [PMID: 34654531 DOI: 10.1016/j.nrleng.2018.03.018] [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: 12/17/2017] [Accepted: 03/12/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.
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Affiliation(s)
- A Martín-Nieto
- Departamento de Fisioterapia, Universidad Católica Santa Teresa de Jesús de Ávila, Ávila, Spain.
| | - M Á Atín-Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
| | - C Bravo-Llatas
- Área de Gobierno de Tecnologías de la Información y de Apoyo Técnico al Usuario-Investigación y Docencia, Universidad Complutense de Madrid, Madrid, Spain
| | - M I Moreno-Bermejo
- Departamento de Fisioterapia, Hospital Universitario de La Princesa, Madrid, Spain
| | - P Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, Spain
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Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Pérennou D. Lateropulsion After Hemispheric Stroke: A Form of Spatial Neglect Involving Graviception. Neurology 2021; 96:e2160-e2171. [PMID: 33722996 DOI: 10.1212/wnl.0000000000011826] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 01/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that lateropulsion is an entity expressing an impaired body orientation with respect to gravity in relation to a biased graviception and spatial neglect. METHODS Data from the DOBRAS cohort (ClinicalTrials.gov: NCT03203109) were collected 30 days after a first hemisphere stroke. Lateral body tilt, pushing, and resistance were assessed with the Scale for Contraversive Pushing. RESULTS Among 220 individuals, 72% were upright and 28% showed lateropulsion (tilters [14%] less severe than pushers [14%]). The 3 signs had very high factor loadings (>0.90) on a same dimension, demonstrating that lateropulsion was effectively an entity comprising body tilt (cardinal sign), pushing, and resistance. The factorial analyses also showed that lateropulsion was inseparable from the visual vertical (VV), a criterion referring to vertical orientation (graviception). Contralesional VV biases were frequent (44%), with a magnitude related to lateropulsion severity: upright -0.6° (-2.9; 2.4), tilters -2.9° (-7; 0.8), and pushers -12.3° (-15.4; -8.5). Ipsilesional VV biases were less frequent and milder (p < 0.001). They did not deal with graviception, 84% being found in upright individuals. Multivariate, factorial, contingency, and prediction analyses congruently showed strong similarities between lateropulsion and spatial neglect, the latter encompassing the former. CONCLUSIONS Lateropulsion (pusher syndrome) is a trinity constituted by body tilt, pushing, and resistance. It is a way to adjust the body orientation in the roll plane to a wrong reference of verticality. Referring to straight above, lateropulsion might correspond to a form of spatial neglect (referring to straight ahead), which would advocate for 3D maps in the human brain involving the internal model of verticality.
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Affiliation(s)
- Shenhao Dai
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France
| | - Céline Piscicelli
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France
| | - Emmanuelle Clarac
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France
| | - Monica Baciu
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France
| | - Marc Hommel
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France
| | - Dominic Pérennou
- From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France.
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Dai S, Piscicelli C, Clarac E, Baciu M, Hommel M, Pérennou D. Balance, Lateropulsion, and Gait Disorders in Subacute Stroke. Neurology 2020; 96:e2147-e2159. [PMID: 33177223 DOI: 10.1212/wnl.0000000000011152] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that impaired body orientation with respect to gravity (lateropulsion) would play a key role in poststroke balance and gait disorders. METHODS Cohort study of 220 individuals consecutively admitted to a neurorehabilitation ward after a first hemisphere stroke (DOBRAS cohort [Determinants of Balance Recovery After Stroke] 2012-2018, ClinicalTrials.gov: NCT03203109), with clinical data systematically collected at 1 month, then at discharge. Primary outcomes were balance and gait disorders, quantified by the Postural Assessment Scale for Stroke and the modified Fugl-Meyer Gait Assessment, to be explained by all deficits on day 30, including lateropulsion assessed with the Scale for Contraversive Pushing. Statistics comprised linear regression analysis, univariate and multivariate analyses, and receiver operating characteristic curves. RESULTS Lateropulsion was frequent, especially after right hemisphere stroke (RHS, D30, 48%; discharge 24%), almost always in right-handers. Among all deficits, impaired body orientation (lateropulsion) had the most detrimental effect on balance and gait. After RHS, balance disorders were proportional to lateropulsion severity, which alone explained almost all balance disorders at initial assessment (90%; 95% confidence interval [CI] [86-94], p < 0.001) and at discharge (92%; 95% CI 89-95, p < 0.001) and also the greatest part of gait disorders at initial assessment (66%; 95% CI 56-77, p < 0.001) and at discharge (68%; 95% CI 57-78, p < 0.001). CONCLUSION Lateropulsion is the primary factor altering poststroke balance and gait at the subacute stage and therefore should be systematically assessed. Poststroke balance and gait rehabilitation should incorporate techniques devoted to misorientation with respect to gravity.
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Affiliation(s)
- Shenhao Dai
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France
| | - Céline Piscicelli
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France
| | - Emmanuelle Clarac
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France
| | - Monica Baciu
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France
| | - Marc Hommel
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France
| | - Dominic Pérennou
- From the Neurorehabilitation Department (S.D., C.P., E.C., M.B., D.P.), Institute of Rehabilitation, Grenoble Alpes University Hospital, Echirolles; and Laboratoire de Psychologie et NeuroCognition, UMR CNRS 5105 (S.D., C.P., M.B., D.P.), and AGEIS EA 7407 (M.H.), University Grenoble Alpes, Grenoble, France.
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Effect of postural training using a whole-body tilt apparatus in subacute stroke patients with lateropulsion: A single-blinded randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101393. [PMID: 32450273 DOI: 10.1016/j.rehab.2020.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/02/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lateropulsion after stroke is defined as a postural bias toward the paretic side and push away from the non-paretic side. New rehabilitation techniques and programs should be designed to attenuate lateropulsion and improve functions of balance and gait. OBJECTIVE This study aimed to determine the effects of whole-body tilting postural training (WTPT) using a Spine Balance 3D on lateropulsion and postural control as compared with general postural training (GPT). Postural training was performed and involved a whole-body tilt apparatus that enables postural training in the tilted position, in multiple directions. METHODS This was a pragmatic, single-blind, randomized controlled trial conducted between June 2018 and May 2019. We randomly allocated 30 patients with subacute stroke and lateropulsion based on the Scale of Contraversive Pushing (SCP score>0) to experimental (n=15) and control (n=15) groups. The experimental group received WTPT with a whole-body tilt apparatus, and the control group GPT. WTPT was performed with the Spine Balance 3D and GPT with postural training commonly applied in the clinic. All participants received treatment for 30min/session, 2 times/day, 5 days/week for 3 weeks. The primary outcome measure was lateropulsion assessed with the Burke Lateropulsion Scale (BLS). Secondary outcome measures were postural control ability, activities of daily living, Postural Assessment Scale for Stroke (PASS) score, Berg Balance Scale (BBS) score, Korea-modified Barthel index (K-MBI), and Fugl-Meyer Motor Assessment-Lower Extremity (FMA-L) score. RESULTS For the primary outcome, after training, BLS scores were decreased more for the experimental than control group (Δ=-5.8 vs. Δ=-4.2, P=0.002). For secondary outcomes, scores were improved more for the experimental than control group: PASS (Δ=13.8 vs. Δ=8.5, P<0.001), BBS (Δ=20.1 vs. Δ=11.1, P=0.001), K-MBI (Δ=27.0 vs. Δ=20.1, P=0.005), and FMA-L (Δ=10.2 vs. Δ=6.3, P=0.002). CONCLUSIONS WTPT is a potentially effective therapeutic intervention for lateropulsion recovery in patients with subacute stroke. It may be useful for improving postural control and activities of daily living.
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Birnbaum M, Brock K, Parkinson S, Burton E, Clark R, Hill KD. Rasch analysis of the Burke Lateropulsion Scale (BLS). Top Stroke Rehabil 2020; 28:268-275. [PMID: 32975165 DOI: 10.1080/10749357.2020.1824724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lateropulsion is a common problem following stroke. Whilst the Burke Lateropulsion Scale (BLS) is recommended in the literature as the outcome measure of choice for measuring lateropulsion, the internal validity of the BLS has not been investigated. OBJECTIVES To evaluate the internal validity of the BLS for use in evaluating the effectiveness of therapies aimed at reducing lateropulsion. METHODS Rasch analysis procedures were undertaken including assessment of overall model fit, item, and person fit, threshold ordering, differential item functioning, internal consistency, targeting, and dimensionality. RESULTS Data from 132 participants were utilized to perform Rasch analysis of the BLS. In this preliminary study, overall model fit and individual item and person fit were found to be good using fit residual statistics and chi-square probability values. The BLS was found to be unidimensional and have good internal consistency (Person Separation Index 0.867). Thresholds for four of the five items were found to be only marginally disordered and were subsequently not modified. Non-uniform differential item functioning was detected for age for the transfers item; however, this item did not display item misfit and was therefore not removed. CONCLUSIONS This study identified good psychometric properties of the BLS using Rasch analysis and supports the use of the BLS as a measure of lateropulsion following stroke. Further use of Rasch analysis on the BLS using a larger sample is recommended to confirm these preliminary findings and allow transformation into an interval-level scale.
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Affiliation(s)
- Melissa Birnbaum
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kim Brock
- Physiotherapy Department, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Stephanie Parkinson
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Elissa Burton
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia
| | - Keith D Hill
- Rehabilitation Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
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Bergmann J, Bardins S, Prawitz C, Keywan A, MacNeilage P, Jahn K. Perception of postural verticality in roll and pitch while sitting and standing in healthy subjects. Neurosci Lett 2020; 730:135055. [DOI: 10.1016/j.neulet.2020.135055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
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Gillespie J, Callender L, Driver S. Usefulness of a standing frame to improve contraversive pushing in a patient post-stroke in inpatient rehabilitation. Proc (Bayl Univ Med Cent) 2019; 32:440-442. [PMID: 31384216 DOI: 10.1080/08998280.2019.1593763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022] Open
Abstract
Despite the negative functional and financial implications of contraversive pushing (CoP) in the post-stroke population, little research has focused on improving this phenomenon more rapidly. A 58-year-old man was admitted to inpatient rehabilitation with a large frontoparietal intracerebral hemorrhage resulting in significant left hemiparesis and CoP. A standing frame protocol was implemented into standard care to improve CoP. The patient was assisted into a standing frame daily, and the Burke Lateropulsion Scale and Functional Independence Measure were tracked. Improvements in both outcome measures were greater than normative data.
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Affiliation(s)
- Jaime Gillespie
- Department of Physical Medicine and Rehabilitation, Baylor Scott & White Institute for RehabilitationDallasTexas
| | - Librada Callender
- Department of Physical Medicine and Rehabilitation, Baylor Scott & White Institute for RehabilitationDallasTexas
| | - Simon Driver
- Department of Physical Medicine and Rehabilitation, Baylor Scott & White Institute for RehabilitationDallasTexas
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Pardo V, Galen S. Treatment interventions for pusher syndrome: A case series. NeuroRehabilitation 2019; 44:131-140. [DOI: 10.3233/nre-182549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Vicky Pardo
- Eugene Applebaum College of Pharmacy and Health Science, Wayne State University, Detroit, MI, USA
| | - Sujay Galen
- Department of Physical Therapy, Georgia State University, GA, USA
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Chow E, Parkinson S, Jenkin J, Anderson A, King A, Maccanti H, Minaee N, Hill K. Reliability and Validity of the Four-Point Pusher Score: An Assessment Tool for Measuring Lateropulsion and Pusher Behaviour in Adults after Stroke. Physiother Can 2019; 71:34-42. [PMID: 30787497 DOI: 10.3138/ptc.2017-69] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The authors determined the reliability and validity of the Four-Point Pusher Score (4PPS) among stroke survivors. Method: Stroke survivors were invited to participate within 48 hours of admission to a stroke rehabilitation unit in a tertiary hospital. Intrarater reliability was determined by examining scores assigned to the same patient by the same physiotherapist. Interrater reliability was determined by examining scores assigned to the same patient by two other physiotherapists. Validity was determined by examining associations with the Burke Lateropulsion Scale (BLS), Scale for Contraversive Pushing (SCP), and functional scales. Results: A total of 85 participants who were a median of 13 (interquartile range 9-21) days post-stroke completed this study. The weighted κ statistic for 4PPS intra- and interrater reliability was 0.97 (p < 0.001). Scores on the 4PPS were very strongly associated with scores on the BLS (r s = 0.95) and the SCP (r s = 0.86). Strong associations were evident between the 4PPS and the Berg Balance Scale (r s = -0.77), Chedoke-McMaster Stroke Assessment postural control scale (r s = -0.76), and FIM Motor sub-scale (r s = -0.64; all ps < 0.001). Conclusion: The 4PPS is a reliable and valid scale to assess lateropulsion and pusher behaviour in stroke survivors in an in-patient rehabilitation setting.
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Affiliation(s)
- Emmanuelle Chow
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Stephanie Parkinson
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Joanna Jenkin
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Alisha Anderson
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Andrea King
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Heidi Maccanti
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Novia Minaee
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Heath Science, Curtin University
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Thalamocortical network: a core structure for integrative multimodal vestibular functions. Curr Opin Neurol 2019; 32:154-164. [DOI: 10.1097/wco.0000000000000638] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Bergmann J, Krewer C, Müller F, Jahn K. A new cutoff score for the Burke Lateropulsion Scale improves validity in the classification of pusher behavior in subactue stroke patients. Gait Posture 2019; 68:514-517. [PMID: 30623845 DOI: 10.1016/j.gaitpost.2018.12.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 12/20/2018] [Accepted: 12/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pusher behavior substantially hampers balance during sitting, standing, and posture transitions in stroke patients. The Burke Lateropulsion Scale (BLS) was recommended to evaluate pusher behavior. However, its cutoff score has not been validated and recent studies found evidence for a need to modify it. As there is no gold standard for the diagnosis of pusher behavior, functions that are typically disturbed in these patients should be used for the validation of the cutoff score. RESEARCH QUESTION To investigate whether pusher behavior correlates with balance performance during sitting, standing and posture transitions, and to validate the BLS cutoff score. METHODS 44 subacute stroke patients with pusher behavior (BLS ≥ 2) were included in this study. The BLS and the Performance-Oriented Mobility Assessment Balance subscale (POMA-B) were assessed several times at intervals of two weeks resulting in a total of 137 data sets. RESULTS Correlation analysis between the BLS score and the POMA-B score revealed a moderate negative correlation (rSp=-0.602, p < 0.001): The lower the BLS score, the higher the balance performance. The maximum Youden Index (J=0.864) was found for a cutoff score ≥2.5. Patients with a BLS score ≥2 scored ≥1 on the POMA-B, while patients with a BLS score ≥3 scored at no item or only at the sitting balance task. SIGNIFICANCE In line with previous findings, the results of this study support using a BLS cutoff score of ≥3 instead of ≥2 to diagnose PB for research purposes and intervention planning. A score ≥3 correlates with severe balance impairments and with an impaired verticality perception in the frontal plane, and it improves the agreement with the Scale for Contraversive Pushing.
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Affiliation(s)
- Jeannine Bergmann
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Carmen Krewer
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany.
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Klaus Jahn
- Schoen Klinik Bad Aibling, Kolbermoorer Strasse 72, 83043 Bad Aibling, Germany; German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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Yun N, Joo MC, Kim SC, Kim MS. Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. Eur J Phys Rehabil Med 2018; 54:827-836. [PMID: 30507899 DOI: 10.23736/s1973-9087.18.05077-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some stroke patients are known to use nonparetic extremities to push toward the paretic side, a movement known as lateropulsion. Lateropulsion impairs postural balance and interferes with rehabilitation. AIM The aim of the present study was to investigate the effect of robot-assisted gait training (RAGT) on recovery from lateropulsion compared with conventional physical therapy (CPT). DESIGN This was a single-blinded, randomized controlled trial. SETTING Participants were recruited from a rehabilitation department of a tertiary hospital. POPULATION Patients diagnosed with lateropulsion after a stroke. METHODS Thirty-six subacute stroke patients with lateropulsion were recruited. RAGT was performed in the experimental group (N.=18), and CPT was performed in the control group (N.=18). The participants received treatment for 3 weeks, 30 minutes per day, 5 days per week. Outcomes were assessed before the intervention (T0), immediately after the intervention (T1), and 4 weeks after the intervention (T2). The Burke Lateropulsion Scale (BLS) was evaluated as a primary outcome to assess the severity of lateropulsion. The secondary outcome measures were the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), and Somatosensory Evoked Potentials (SSEP). RESULTS After intervention, the experimental group showed greater improvement in the BLS score at T1 (experimental group: Δ=-1.9, control group: Δ=-1.1, P=0.032) and T2 (experimental group: Δ=-2.8, control group: Δ=-6.5, P<0.001) than the control group. In addition, the BBS was significantly improved in the experimental group at T1 (experimental group: Δ=+7.1, control group: Δ=+1.9, P<0.001) and T2 (experimental group: Δ=+13.0, control group: Δ=+6.1, P<0.001). There were significant between-group differences in the PASS at T1 (experimental group: Δ=+3.2, control group: Δ=+1.6, P=0.014) and T2 (experimental group: Δ=+8.8, control group: Δ=+4.3, P<0.001). CONCLUSIONS RAGT ameliorated lateropulsion and balance function more effectively than CPT in subacute stroke patients. CLINICAL REHABILITATION IMPACT Early RAGT may be recommended for patients with lateropulsion after stroke.
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Affiliation(s)
- Nari Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Min C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Seung-Chan Kim
- Department of Statistics, Pukyong National University, Busan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Republic of Korea -
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Bergmann J, Krewer C, Jahn K, Müller F. Robot-assisted gait training to reduce pusher behavior: A randomized controlled trial. Neurology 2018; 91:e1319-e1327. [PMID: 30171076 DOI: 10.1212/wnl.0000000000006276] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/02/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the effects of 2 weeks of intensive robot-assisted gait training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT). METHODS In a single-blind, randomized, controlled trial with 2 parallel arms, we compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT (control group). Patients with subacute stroke who had pusher behavior according to the Scale for Contraversive Pushing (SCP) were included. The primary research questions were whether changes in pusher behavior would differ between groups post intervention, and at a follow-up 2 weeks afterward (SCP and Burke Lateropulsion Scale, Class II evidence). Secondary outcomes included the Performance-Oriented Mobility Assessment, the Functional Ambulation Classification, and the Subjective Visual Vertical. RESULTS Thirty-eight patients were randomized. Thereof, 30 patients received the allocated intervention and were included in the analyses. RAGT led to a larger reduction of pusher behavior than nR-PT at post test (SCP: U = 69.00, r = -0.33, p = 0.037; Burke Lateropulsion Scale: U = 47.500, r = -0.50, p = 0.003) and at follow-up (SCP: U = 54.00, r = -0.44, p = 0.008). Pusher behavior had ceased in 6 of 15 participants in the intervention group and 1 of 15 participants in the control group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, no longer exhibited the behavior. CONCLUSIONS Two weeks of RAGT seems to persistently reduce pusher behavior, possibly by recalibrating the disturbed inner reference of verticality. The potential benefits of RAGT on pusher behavior and verticality perception require further investigation. TRIAL REGISTRATION German Clinical Trials Register (registration number: DRKS00003444). CLASSIFICATION OF EVIDENCE This study provides Class II evidence that RAGT is beneficial to reduce pusher behavior in patients with stroke.
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Affiliation(s)
- Jeannine Bergmann
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany.
| | - Carmen Krewer
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
| | - Klaus Jahn
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
| | - Friedemann Müller
- From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany
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Martín-Nieto A, Atín-Arratibel MÁ, Bravo-Llatas C, Moreno-Bermejo MI, Martín-Casas P. Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. Neurologia 2018; 36:S0213-4853(18)30148-8. [PMID: 29891334 DOI: 10.1016/j.nrl.2018.03.019] [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: 12/17/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.
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Affiliation(s)
- A Martín-Nieto
- Departamento de Fisioterapia, Universidad Católica Santa Teresa de Jesús de Ávila, Ávila, España.
| | - M Á Atín-Arratibel
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, España
| | - C Bravo-Llatas
- Área de Gobierno de Tecnologías de la Información y de Apoyo Técnico al Usuario-Investigación y Docencia, Universidad Complutense de Madrid, Madrid, España
| | - M I Moreno-Bermejo
- Departamento de Fisioterapia, Hospital Universitario de La Princesa, Madrid, España
| | - P Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Universidad Complutense de Madrid, Madrid, España
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Jang SH, Lee HD. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report. Medicine (Baltimore) 2018; 97:e10963. [PMID: 29851845 PMCID: PMC6392885 DOI: 10.1097/md.0000000000010963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE A 67-year-old, right-handed male patient underwent craniotomy and drainage for hematoma removal related to an intracerebral hemorrhage (ICH) in the right thalamus and basal ganglia at the neurosurgery department of a university hospital. PATIENT CONCERNS He presented with severe motor weakness of left extremities, impairment of proprioception, and severe pusher syndrome at the start of rehabilitation. DIAGNOSES He was diagnosed as ICH in the right thalamus and basal ganglia. INTERVENTIONS The patient received comprehensive rehabilitative therapy, movement therapy, and somatosensory stimulation. OUTCOMES Four months after onset, left leg motor function (Motricity Index [MI] = 51) did not show significant recovery from that at two months after onset (MI = 41); however, in the same period, Nottingham Sensory Assessment and scale for contraversive pushing significantly improved. At four months, the patient was able to stand independently but required manual contact of one person during independent walking on an even floor. At seven months after onset, he was able to walk independently on an even floor. LESSONS Recovery of a severely injured medial lemniscus with concurrent recovery of impaired proprioception and pusher syndrome.
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Babyar SR, Peterson MG, Reding M. Case–Control Study of Impairments Associated with Recovery from “Pusher Syndrome” after Stroke: Logistic Regression Analyses. J Stroke Cerebrovasc Dis 2017; 26:25-33. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
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Bergmann J, Krewer C, Selge C, Müller F, Jahn K. The Subjective Postural Vertical Determined in Patients with Pusher Behavior During Standing. Top Stroke Rehabil 2016; 23:184-90. [DOI: 10.1080/10749357.2015.1135591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mundim AC, Paz CCDSC, Fachin-Martins E. Could be the predominantly-used hemibody related to the weight bearing distribution modified by the chronic hemiparesis after stroke? Med Hypotheses 2015; 85:645-9. [PMID: 26305448 DOI: 10.1016/j.mehy.2015.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
Since the first Broca publications issued from 1970s, lateralized functions in the human brain have urged the researchers to postulate hypothesis based in the right-left asymmetries and, according to some theories, the lateralization of the voluntary motor control could represent a solution to avoid redundant process optimizing space and time. Supported by this idea, the clinicians and researchers tend to concept that the chronic hemiplegic stroke patients learn to use predominantly the non-affected hemibody after stroke in which is more convenient to execute their daily life activities, modifying their natural preference in some cases. Although could seems reasonable conceptualize the non-affected side as the predominantly-used hemibody for motor tasks after stroke (convenience hypothesis), evidences point to exist also hemiplegic patients that developed a predominantly use of the affected side. To float an idea, in terms of weight bearing distribution during upright position, the researchers have found patients overloading the non-affected hemibody, as expected; but also patients overloading the affected hemibody, not presenting necessarily Pusher's syndrome cases. Given the evidences, we could propose a severity-modulated predominance hypothesis which complements the convenience hypothesis. According to our complementary hypothesis, the severity of the motor disability presented in the hemiparesis condition (light, moderate and heavy severity) could determine a predominant use defined by preference (light to moderate severity) or convenience (moderate to heavy severity). In this hypothesis, we postulate ideas from a rehabilitation perspective to be incorporated in treatment programs.
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Affiliation(s)
- Anderson Castro Mundim
- Post-Graduation Program of Health Sciences and Technologies, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil
| | - Clarissa Cardoso dos Santos Couto Paz
- Post-Graduation Program of Health Sciences and Technologies, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil; Centre of Research in Assistive Technology, School of Physical Therapy, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil
| | - Emerson Fachin-Martins
- Post-Graduation Program of Health Sciences and Technologies, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil; Centre of Research in Assistive Technology, School of Physical Therapy, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil.
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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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Krewer C, Luther M, Müller F, Koenig E. Time Course and Influence of Pusher Behavior on Outcome in a Rehabilitation Setting: A Prospective Cohort Study. Top Stroke Rehabil 2015; 20:331-9. [DOI: 10.1310/tsr2004-331] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yang YR, Chen YH, Chang HC, Chan RC, Wei SH, Wang RY. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil 2014; 29:987-93. [DOI: 10.1177/0269215514564898] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022]
Abstract
Objective: We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Design: Assessor-blinded, pilot randomized controlled study. Participants: A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group ( N = 7, computer-generated interactive visual feedback training) or control group ( N = 5, mirror visual feedback training). Main outcome measures: The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. Results: A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ±1.1 and 1.4 ±1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ±4.3 and 7.2 ±1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ±2.2 and 5.6 ±3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome ( p < 0.01) and balance ( p < 0.05) compared with the mirror visual feedback training program. Conclusions: Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training.
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Affiliation(s)
- Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hua Chen
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Heng-Chih Chang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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The subjective postural vertical in standing: Reliability and normative data for healthy subjects. Atten Percept Psychophys 2014; 77:953-60. [DOI: 10.3758/s13414-014-0815-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Babyar SR, Peterson MGE, Reding M. Time to Recovery From Lateropulsion Dependent on Key Stroke Deficits. Neurorehabil Neural Repair 2014; 29:207-13. [DOI: 10.1177/1545968314541330] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Lateropulsion, a postural control disorder, delays recovery following hemispheric stroke. The number of stroke impairments may lead to differential recovery rates, depending on the intact systems available for recovery from lateropulsion. Objective. To study the impact of key postural control deficits on lateropulsion rate of recovery following stroke. Methods. Through retrospective analysis: 169 patients with hemispheric stroke in an in-patient rehabilitation facility were divided into 3 groups: (1) motor deficits only; (2) motor and hemianopic or visual–spatial deficits or motor and proprioceptive deficits; and (3) motor, proprioceptive, and hemianopic or visual–spatial deficits. Kaplan–Meier survival analysis determined if time to recovery from lateropulsion (achieving a score of 0 or 1 on the Burke Lateropulsion Scale) differed by group. Results. Log rank tests showed that time to recovery from lateropulsion differed based on the number of deficits (group, P = .012). Post hoc analyses by lesion side showed that group differences only occurred in right brain lesion ( P < .05) as compared with left brain lesions ( P = .34). Patients recovered from lateropulsion during in-patient rehabilitation if they had only motor deficits; those with all 3 postural control deficits showed the most protracted recovery. Conclusions. Rate of recovery from lateropulsion after stroke is dependent on the side of lesion, and number of key motor, proprioceptive, and/or hemianopic or visual–spatial deficits. The more postural control systems affected, the slower the recovery. Our data identify patients likely to need protracted rehabilitation targeting key postural control deficits.
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Affiliation(s)
- Suzanne R. Babyar
- Hunter College, New York, NY, USA
- Burke Rehabilitation Hospital, White Plains, NY, USA
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Bergmann J, Krewer C, Rieß K, Müller F, Koenig E, Jahn K. Inconsistent classification of pusher behaviour in stroke patients: a direct comparison of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale. Clin Rehabil 2014; 28:696-703. [DOI: 10.1177/0269215513517726] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 11/30/2013] [Indexed: 11/17/2022]
Abstract
Objective: To compare the classification of two clinical scales for assessing pusher behaviour in a cohort of stroke patients. Design: Observational case-control study. Setting: Inpatient stroke rehabilitation unit. Subjects: A sample of 23 patients with hemiparesis due to a unilateral stroke (1.6 ± 0.7 months post stroke). Methods: Immediately before and after three different interventions, the Scale for Contraversive Pushing and the Burke Lateropulsion Scale were applied in a standardized procedure. Results: The diagnosis of pusher behaviour on the basis of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale differed significantly ( χ2 = 54.260, p < 0.001) resulting in inconsistent classifications in 31 of 138 cases. Changes immediately after the interventions were more often detected by the Burke Lateropulsion Scales than by the Scale for Contraversive Pushing ( χ2 = 19.148, p < 0.001). All cases with inconsistent classifications showed no pusher behaviour on the Scale for Contraversive Pushing, but pusher behaviour on the Burke Lateropulsion Scale. 64.5% (20 of 31) of them scored on the Burke Lateropulsion Scale on the standing and walking items only. Conclusions: The Burke Lateropulsion Scale is an appropriate alternative to the widely used Scale for Contraversive Pushing to follow-up patients with pusher behaviour (PB); it might be more sensitive to detect mild pusher behaviour in standing and walking.
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Affiliation(s)
- Jeannine Bergmann
- Schoen Klinik Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
| | - Carmen Krewer
- Schoen Klinik Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
| | - Katrin Rieß
- Schoen Klinik Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
| | - Eberhard Koenig
- Schoen Klinik Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians University of Munich, Germany
- Department of Neurology, Ludwig-Maximilians University of Munich, Germany
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Pérennou D, Piscicelli C, Barbieri G, Jaeger M, Marquer A, Barra J. Measuring verticality perception after stroke: Why and how? Neurophysiol Clin 2014; 44:25-32. [PMID: 24502902 DOI: 10.1016/j.neucli.2013.10.131] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/12/2013] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Pérennou
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France.
| | - C Piscicelli
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - G Barbieri
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - M Jaeger
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - A Marquer
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - J Barra
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France; Université Paris Descartes, laboratoire de Psychologie et Neuropsychologie Cognitive, FRE 3292, 71, avenue Edouard-Vaillant, 92100 Boulogne Billancourt, France
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Lu RR, Li F, Wu Y, Hu YS, Xu XL, Zou RL, Hu XF. Demonstration of posturographic parameters of squat-stand activity in hemiparetic patients on a new multi-utility balance assessing and training system. J Neuroeng Rehabil 2013; 10:37. [PMID: 23587150 PMCID: PMC3641010 DOI: 10.1186/1743-0003-10-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/10/2013] [Indexed: 11/10/2022] Open
Abstract
Background Quantitative evaluation of position control ability in stroke patients is needed. Here we report a demonstration of position control ability assessment and test-retest reliability during squat-stand activity on a new system in hemiparetic patients and controls. Methods Sixty-two healthy adults and thirty-four hemiparetics were enrolled. All of the participants were required to complete five repeated squat-stand activities under three different conditions: partial weight support, standard weight bearing, and resistance. The healthy adults’ test was repeated twice to assess the reliability, while the hemiparetics were tested one time to assess impairments in their position control ability. The healthy participants completed their second test 1 wk after the first. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability. Results During partial weight support, the ICCs ranged from 0.77 to 0.91, which indicated a good reliability. During standard weight bearing and resistance, the ICCs varied from 0.64 to 0.86 and 0.54 to 0.84, respectively, indicating a fair reliability. Compared with the healthy adults, the stroke patients demonstrated poorer position control ability. Conclusions The posturography of the squat-stand activity is a new and reliable measurement tool for position control. According to the methods proposed here, hemiparetics can be differentiated from healthy adults using the squat-stand activity. This activity will provide a new evaluation tool and therapy with visual feedback for the stroke patients. Trial registration Chinese clinical trial registry, ChiCTR-TRC-10000863
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Krewer C, Rieß K, Bergmann J, Müller F, Jahn K, Koenig E. Immediate effectiveness of single-session therapeutic interventions in pusher behaviour. Gait Posture 2013; 37:246-50. [PMID: 22889929 DOI: 10.1016/j.gaitpost.2012.07.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 06/26/2012] [Accepted: 07/18/2012] [Indexed: 02/02/2023]
Abstract
Some stroke patients with hemiparesis exhibit a so-called pusher behaviour, i.e., they actively push away from the unaffected side and lean towards the hemiparetic side. This impairs their postural balance to such a degree that they are often unable to sit or stand. Pusher behaviour thus substantially hampers the rehabilitation of these patients. So far only a few case studies on treatment strategies have been performed. This study investigated the immediate after-effects of galvanic vestibular stimulation (GVS), machine-supported gait training with the Lokomat, and physiotherapy with visual feedback components (PT-vf). Fifteen pusher and 10 non-pusher patients participated in an observer-blinded cross-over pilot study. Patients were measured on the scale for contraversive pushing (SCP) and on the Burke lateropulsion scale (BLS) immediately before and after a single-session of the specific intervention. Compared to PT-vf, Lokomat therapy had a significant effect on the BLS of pusher patients but no significant effect on the SCP values. GVS had no significant effect on these values on either scale. BLS is more useful than SCP to detect small changes for clinical trials and routine treatment. Forced control of the upright position during locomotion seems to be an effective method for immediately reducing the pushing behaviour of stroke patients, probably because it recalibrates a biased sense of verticality, via the somatic graviception. This finding, however, does not allow prediction of its long-term effects. Furthermore, it would be interesting to evaluate repetitive, multi-session DGO therapy and the amount of therapy needed to effectively reduce the pusher behaviour.
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Menezes LTD, Barbosa PHFDA, Costa AS, Mundim AC, Ramos GC, Paz CCDSC, Martins EF. Baropodometric technology used to analyze types of weight-bearing during hemiparetic upright position. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000300014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.
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36
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Posterior pusher syndrome — case report. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractPusher syndrome is classically described as disorder of body orientation in the coronal plane. It is characterized by a tilt towards the contralesional paretic side and a resistance to external attempts to rectify. It occurs mainly in stroke patients, however, non-stroke causes have been described too. In 2010 the concept of the posterior pusher syndrome had been proposed, defined as disturbance of body orientation in the sagittal plane with imbalance, posterior tilt and an active resistance to forward pulling or pushing. The author describes, on the basis of the literature and own research, symptoms and methods of the treatment of the little-known posterior pusher syndrome.
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37
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Clark E, Hill KD, Punt TD. Responsiveness of 2 Scales to Evaluate Lateropulsion or Pusher Syndrome Recovery After Stroke. Arch Phys Med Rehabil 2012; 93:149-55. [DOI: 10.1016/j.apmr.2011.06.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 06/13/2011] [Accepted: 06/17/2011] [Indexed: 10/14/2022]
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Martins EF, Barbosa PHFDA, Menezes LTD, Sousa PHCD, Costa AS. Comparação entre medidas de descarga, simetria e transferência de peso em indivíduos com e sem hemiparesia. FISIOTERAPIA E PESQUISA 2011. [DOI: 10.1590/s1809-29502011000300005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliação da Simetria e Transferência de Peso (ASTP) foi indicada para se fazer associação entre simetria e atividades funcionais nas hemiparesias, apontando simétricos como mais capacitados. Contudo, tais relações não são claras e divergem com evidências que sugerem assimetrias como estratégias funcionais. Assim, objetivou-se verificar se as medidas subjetivamente determinadas pela ASTP concordam com medidas calculas pela descarga de peso entre os pés. Realizou-se estudo observacional do tipo transversal para amostra de sujeitos com hemiparesia (n=20) pareados por idade e gênero a controles (n=20). Os participantes submeteram-se a procedimentos para obtenção de escore determinado pela ASTP e para cálculo da razão de simetria (RS) na descarga de peso entre os pés obtido por meio de duas balanças digitais. Os resultados obtidos pela ASTP identificaram apenas um sujeito com hemiparesia apresentando simetria, dentre os quatro sujeitos identificados pela RS como simétricos. Ainda, a ASTP não diferenciou assimetrias com sobrecarga para o lado afetado e apresentou correlação significativa somente quando os escores foram analisados com os valores de RS<1(sobrecarga para o lado não afetado). Conclui-se que a ASTP não foi concordante em identificar sujeitos hemiparéticos com descarga de peso compatível com simetria. Ainda, não identificou sobrecargas para o lado afetado que poderia conduzir a análises equivocadas da associação entre simetria e desempenho funcional.
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Martins EF, de Araujo Barbosa PHF, de Menezes LT, de Sousa PHC, Costa AS. Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis? Physiother Theory Pract 2011; 27:566-71. [PMID: 21721993 DOI: 10.3109/09593985.2011.552312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.
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