Prone positioning reduces severe pushing behavior: three case studies.
Yuji Fujino, Kazu Amimoto, Satoshi Sugimoto and 4 others
PMID 27799722WHAT IT FOUND
Three stroke patients with severe pushing behavior had lower scores after 10-minute prone relaxation added to visual feedback, sit-to-stand and knee-ankle-foot orthotic gait training; scores remained lower at follow-up.
Prone relaxation cannot be separated from these other treatments.
Key findings
01Pushing behavior scores fell after prone relaxation was added to visual feedback training, sit-to-stand training and gait training with a knee-ankle-foot orthosis, and remained lower at follow-up.
02Trunk control scores rose after prone relaxation and conventional therapy were given together, and remained higher at follow-up in all patients.
03After intervention, all patients accurately noticed their excessive use of the non-paretic limbs, but their subjective vertical body images remained inclined.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only three patients were studied, so the findings cannot show that the treatment works for other patients. The study used a single case ABA design with no separate control group or comparison treatment. Prone relaxation was given together with conventional visual feedback training, sit-to-stand training and gait training with a knee-ankle-foot orthosis, so the contribution of any single component cannot be separated. The follow-up was brief, described as 2-day sessions conducted over 6 consecutive days. The paper does not report blinding of patients or assessors, although the assessor was not involved in treatment. The study did not assess changes in muscle tone. All patients had acute stroke, severe pushing behavior, hemiparesis and unilateral spatial neglect, so the results may not apply to less severe or non-acute patients.
The easy way to misread this
Do not conclude that prone positioning alone reduced severe pushing behavior. Three acute stroke patients also received visual feedback training, sit-to-stand training and gait training with a knee-ankle-foot orthosis, and the study did not separate the effects of those treatments. It also cannot show that the treatment works for other patients.