Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France.
Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France.
Neurophysiol Clin. 2014 Jan;44(1):25-32. doi: 10.1016/j.neucli.2013.10.131. Epub 2013 Nov 1.
About 80 papers dealing with verticality after stroke have been published in the last 20years. Here we reviewed the reasons and findings that explain why measuring verticality perception after stroke is interesting. Research on verticality perception after stroke has contributed to improve the knowledge on brain mechanisms, which build up and update a sense of verticality. Preliminary research using modern techniques of brain imaging has shown that the posterior lateral thalamus and the parietal insular cortex are areas of interest for this internal model of verticality. How they interact and are critical remains to be investigated. From a clinical standpoint, it has now been clearly established that biases in verticality perception are frequent after a stroke, causing postural disorders. Measuring the postural vertical with the wheel paradigm has allowed elucidating the mechanisms of lateropulsion, leading or not to a pushing. Schematically, patients with a hemispheric stroke align their erect posture with an erroneous reference of verticality, tilted to the side opposite the lesion. In patients with a brainstem stroke lateropulsion is usually ipsilesional, and results rather from a pathological asymmetry of tone, through vestibulo-spinal mechanisms. These evolutions of concepts and measurement standards of verticality representation should guide the emergence of rehabilitation programs specifically dedicated to the sense of verticality after stroke. Indeed, several pilot studies using appropriate somatosensory stimulation suggest the possibility to recalibrate the internal model of verticality biased by the stroke, and to improve uprightness. Vestibular stimulations seem to be less relevant and efficient.
在过去的 20 年中，已经发表了大约 80 篇关于中风后垂直性的论文。在这里，我们回顾了一些原因和发现，这些原因和发现解释了为什么测量中风后垂直性感知很有趣。中风后垂直性感知的研究有助于提高对大脑机制的认识，这些机制构建和更新了垂直性感知。使用现代大脑成像技术的初步研究表明，外侧丘脑后部和顶内脑岛皮层是该垂直性内部模型的感兴趣区域。它们如何相互作用以及是否关键仍有待研究。从临床角度来看，现在已经清楚地确立了中风后垂直性感知偏差很常见，会导致姿势障碍。使用轮式范式测量姿势垂直性，可以阐明侧向推动的机制，导致或不导致推动。从图上看，半球性中风患者会将其直立姿势与错误的垂直参考对齐，偏向病变对侧。脑干中风患者的侧向推动通常是同侧的，这主要是由于通过前庭-脊髓机制导致的肌张力病理性不对称。这些概念和垂直性表示测量标准的演变应指导专门针对中风后垂直性的康复计划的出现。事实上，几项使用适当体感刺激的初步研究表明，有可能重新校准中风引起的内部垂直性模型，并改善直立性。前庭刺激似乎不太相关和有效。
