Abnormal bias in subjective vertical perception in a post-stroke astasia patient.
Keisuke Tani, Akiyoshi Matsugi, Shintaro Uehara and 1 others
PMID 27821973WHAT IT FOUND
In one man who could not stand after stroke, wall-based body-tilt training was added to ongoing gait and rehabilitation.
Better vertical perception and longer standing followed. He stood 34 seconds with eyes open without a cane. One case is not proof.
Key findings
01Before the baseline period, the patient’s subjective postural vertical was tilted 2.7 ± 0.3 degrees toward the right and −3.0 ± 0.4 degrees toward the left, and he stood 5 seconds with eyes open and a cane but 0 seconds without a cane or with eyes closed.
02After the intervention, the left-side subjective postural vertical tilt was −0.8 ± 0.4 degrees, and standing duration increased under all conditions; with eyes open and no cane it was 34 seconds.
03Bed and toilet transfer scores improved from 4 to 5 after the intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a single case report, so it cannot show that the training works for other patients. There was no control group or comparison treatment; changes happened during a before-after sequence. The patient received standard physical therapy, occupational therapy, gait training, a knee-ankle-foot orthosis, and cane or parallel bars at the same time, so the contribution of body-tilt training alone cannot be separated. The authors note that astasia often disappears within days, while this patient had symptoms for more than 50 days. He may be a unique case. The authors also state that spontaneous recovery could have contributed to the improvements. The tilt-table subjective postural vertical method was checked for reliability in eight healthy people, not in patients with astasia.
The easy way to misread this
Do not conclude that body-tilt training caused the improvement. One patient received standard physical therapy, occupational therapy, gait training, a knee-ankle-foot orthosis, and cane or parallel bars at the same time, and the authors state that spontaneous recovery could have contributed.