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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.
Glossary
- AUC=
- area under the receiver operating characteristic curve;
- BAG=
- behavior against gravity;
- CI=
- confidence interval;
- DOBRAS=
- Determinants of Balance Recovery After Stroke;
- FIM=
- Functional Independence Measure;
- OR=
- odds ratio;
- PV=
- postural vertical;
- ROC=
- receiver operating characteristic;
- SCP=
- Scale for Contraversive Pushing;
- VV=
- visual vertical
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received February 25, 2020.
- Accepted in final form January 28, 2021.
- © 2021 American Academy of Neurology
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