Influence of subjective visual vertical misperception on balance recovery after stroke

Abstract

Background: Subjective visual vertical (SVV) perception can be perturbed after stroke, but its effect on balance recovery is not yet known. Aim: To evaluate the influence of SVV perturbations on balance recovery after stroke. Methods: 28 patients (14 with a right hemisphere lesion (RHL) and 14 with a left hemisphere lesion (LHL)) were included, 5 were lost to follow-up. SVV perception was initially tested within 3 months after stroke, then at 6 months, using a luminous line, which the patients adjusted to the vertical position in a dark room. Mean deviation (V) and uncertainty (U), defined as the standard deviation of the SVV, were calculated for eight trials. Balance was initially assessed by the Postural Assessment Scale for Stroke (PASS), and at 6 months by the PASS (PASS6), a force platform (lateral and sagittal stability limits (LSL6 and SSL6)), the Rivermead Mobility Index (RMI6) and gait velocity (v6). Functional outcome was also assessed by the Functional Independence Measure at 6 months (FIM6). Conclusions: Initial misperception of verticality was related to a poor score for balance after stroke. This relationship seems to be independent of motricity and neglect. Rehabilitation programmes should take into account verticality misperceptions, which could be an important factors influencing balance recovery after stroke.

Infarct hemisphere and noninfarcted brain volumes affect locomotor performance following stroke

“…21 This notion is supported by previous research indicating that compared to lesions within the left MCA territory, those within the right MCA territory-and particularly to regions such as the insula and temporoparietal junction-often result in more severe distortion of spatial postural representation, as well as the visual and nonvisual subjective perception of the body's verticality. [22][23][24] Previous work by our group has also suggested that right hemisphere infarcts are more disruptive to the ability to regulate postural sway when standing, but only in the frontal plane. 14,[23][24][25] Future research is therefore warranted to study the effects of MCA infarct on the relationship between residual impairments in the subjective perception of one's posture and gait symmetry in this vulnerable population.…”

“…[22][23][24] Previous work by our group has also suggested that right hemisphere infarcts are more disruptive to the ability to regulate postural sway when standing, but only in the frontal plane. 14,[23][24][25] Future research is therefore warranted to study the effects of MCA infarct on the relationship between residual impairments in the subjective perception of one's posture and gait symmetry in this vulnerable population.…”

The subjective postural vertical in standing: Reliability and normative data for healthy subjects

“…The SVV is the measure investigated most often. It is frequently used in the diagnosis of vestibular disorders, but is poorly correlated with postural impairment (Bonan et al, 2007;Karnath, Ferber, & Dichgans, 2000;Pérennou et al, 2008). The SPV is altered in subjects with deficits of upright body orientation, both in the frontal and sagittal planes-for example, in subjects with pusher behavior or retropulsion after hemispheric lesions (Karnath et al, 2000;Manckoundia, Mourey, Pfitzenmeyer, Van Hoecke, & Pérennou, 2007;Pérennou et al, 2008).…”

A disturbed processing of graviceptive pathways may be involved in the pathophysiology of balance disorders in patients with multiple sclerosis

“…We also found that misperception of verticality in MS patients is correlated to the risk for falling evaluated by DGI scale. Prior studies suggested that the incapacity to detect visual verticality could be related to poor balance recover 27,28 . Despite of these studies have evaluated patients that suffered stroke, the findings highlight that some cortical areas are related to perception of verticality, and these sense is not just related to peripheral lesions.…”