| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Cognitive and General Neurology, University of Tübingen, Germany.
Address correspondence and reprint requests to Dr. H.-O. Karnath, Department of Cognitive Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; e-mail: Karnath{at}uni-tuebingen.de
BACKGROUND: Stroke patients may exhibit the peculiar behavior of actively pushing away from the nonhemiparetic side, leading to lateral postural imbalance and a tendency to fall toward the paralyzed side. This phenomenon has been called the "pusher syndrome."
OBJECTIVE: The current study analyzes the mechanism leading to contraversive pushing.
METHODS: The subjective postural vertical (SPV) and subjective visual vertical (SVV) were determined in five consecutively admitted patients with severe contraversive pushing and in controls. Whereas adjustment of the SPV reflects the perceived upright orientation of the body, the SVV provides a sensitive and direction-specific measurement of peripheral and central vestibular dysfunction.
RESULTS: The deficit leading to contraversive pushing is an altered perception of the body’s orientation in relation to gravity. Pusher patients experience their body as oriented "upright" when it is tilted 18° to the nonhemiparetic, ipsilesional side. In contrast, perception of the SVV was undisturbed.
CONCLUSIONS: A separate pathway seems to be present in humans for sensing the orientation of gravity apart from the one for orientation perception of the visual world. This second graviceptive system decisively contributes to humans’ control of upright body posture. Contraversive pushing occurring after stroke lesions may represent the behavioral correlate of a disturbed neural representation of this system.
This article has been cited by other articles:
|
|
 |
|
  D. A. Perennou, G. Mazibrada, V. Chauvineau, R. Greenwood, J. Rothwell, M. A. Gresty, and A. M. Bronstein Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain, September 1, 2008; 131(9): 2401 - 2413. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Baccini, M. Paci, L. Nannetti, C. Biricolti, and L. A Rinaldi Scale for Contraversive Pushing: Cutoff Scores for Diagnosing "Pusher Behavior" and Construct Validity Physical Therapy, August 1, 2008; 88(8): 947 - 955. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Baier, S. Bense, and M. Dieterich Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus? Brain, June 1, 2008; 131(6): 1445 - 1454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-O. Karnath, D. Brotz, M. Baccini, M. Paci, and L. A. Rinaldi Instructions for the Clinical Scale for Contraversive Pushing (SCP) Neurorehabil Neural Repair, July 1, 2007; 21(4): 370 - 371. [PDF]
|
|
|
|
|
|
S. R. Babyar, K. H. McCloskey, and M. Reding Surface Electromyography of Lumbar Paraspinal Muscles During Seated Passive Tilting of Patients With Lateropulsion Following Stroke Neurorehabil Neural Repair, March 1, 2007; 21(2): 127 - 136. [Abstract] [PDF]
|
|
|
|
 |
|
 J Barra, V Chauvineau, T Ohlmann, M Gresty, and D Perennou Perception of longitudinal body axis in patients with stroke: a pilot study J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 43 - 48. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I V Bonan, K Hubeaux, M C Gellez-Leman, J P Guichard, E Vicaut, and A P Yelnik Influence of subjective visual vertical misperception on balance recovery after stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 49 - 55. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. V. Bonan, M. C. Leman, J. F. Legargasson, J. P. Guichard, and A. P. Yelnik Evolution of subjective visual vertical perturbation after stroke. Neurorehabil Neural Repair, December 1, 2006; 20(4): 484 - 491. [Abstract] [PDF]
|
|
|
|
 |
|
 J. C. Masdeu, P. B. Gorelick, H.-O. Karnath, L. Johannsen, D. Broetz, and W. Kuker Posterior thalamic hemorrhage induces "pusher syndrome" Neurology, November 22, 2005; 65(10): 1682 - 1682. [Full Text] [PDF]
|
|
|
|
|
|
R. Nandhagopal, B. Vengamma, S. G. Krishnamoorthy, D. Rajasekhar, and G. Subramanyam Thalamic disequilibrium syndrome after thrombolytic therapy for acute myocardial infarction Neurology, August 9, 2005; 65(3): 494 - 494. [Full Text] [PDF]
|
|
|
|
|
|
H.-O. Karnath, L. Johannsen, D. Broetz, and W. Kuker Posterior thalamic hemorrhage induces "pusher syndrome" Neurology, March 22, 2005; 64(6): 1014 - 1019. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Danells, S. E. Black, D. J. Gladstone, and W. E. McIlroy Poststroke "Pushing": Natural History and Relationship to Motor and Functional Recovery Stroke, December 1, 2004; 35(12): 2873 - 2878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Matteo, R. W Bohannon, E. Panturin, H.-O. Karnath, and D. Broetz Pusher syndrome. Physical Therapy, June 1, 2004; 84(6): 580 - 581. [Full Text]
|
|
|
|
 |
|
 R. G. Kaptein and J. A. M. Van Gisbergen Interpretation of a Discontinuity in the Sense of Verticality at Large Body Tilt J Neurophysiol, May 1, 2004; 91(5): 2205 - 2214. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A D'Aquila, T. Smith, D. Organ, S. Lichtman, and M. Reding Validation of a lateropulsion scale for patients recovering from stroke Clinical Rehabilitation, January 1, 2004; 18(1): 102 - 109. [Abstract] [PDF]
|
|
|
|
|
|
H.-O. Karnath and D. Broetz Understanding and Treating "Pusher Syndrome" Physical Therapy, December 1, 2003; 83(12): 1119 - 1125. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Sharpe What's up, doc? Altered perception of the haptic, postural, and visual vertical Neurology, November 11, 2003; 61(9): 1172 - 1173. [Full Text] [PDF]
|
|
|
|
|
|
A. M. Bronstein, D. A. Perennou, M. Guerraz, D. Playford, and P. Rudge Dissociation of visual and haptic vertical in two patients with vestibular nuclear lesions Neurology, November 11, 2003; 61(9): 1260 - 1262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. P. Yelnik, F. O. Lebreton, I. V. Bonan, F. M.C. Colle, F. A. Meurin, J. P. Guichard, and E. Vicaut Perception of Verticality After Recent Cerebral Hemispheric Stroke Stroke, September 1, 2002; 33(9): 2247 - 2253. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
