From the Neurorehabilitation Department, Institute of Rehabilitation (S.D., C.P., E.C., M.B., D.P.), Grenoble Alpes University Hospital; and Lab Psychology and NeuroCognition (S.D., C.P., M.B., D.P.) and AGEIS EA 7407 (M.H.), Université Grenoble Alpes, Grenoble, France.
Neurology. 2021 Apr 27;96(17):e2160-e2171. doi: 10.1212/WNL.0000000000011826. Epub 2021 Mar 15.
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.
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.
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 ( < 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.
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.
检验以下假设，即侧冲是一种实体，它表现出与重力有关的身体方向障碍，与偏向的重觉和空间忽略有关。
从 DOBRAS 队列（ClinicalTrials.gov：NCT03203109）中收集首次半球卒中后 30 天的数据。使用对抗性推挤量表评估身体侧倾、推动和阻力。
在 220 名个体中，72%为直立，28%表现出侧冲（倾斜者[14%]比推动者[14%]轻）。这 3 个迹象在同一维度上具有非常高的因子负荷（>0.90），表明侧冲实际上是一个包含身体倾斜（主要迹象）、推动和阻力的实体。因子分析还表明，侧冲与视觉垂直（VV）不可分割，VV 是一个指垂直方向（重觉）的标准。对侧 VV 偏倚很常见（44%），其大小与侧冲严重程度有关：直立-0.6°（-2.9；2.4），倾斜者-2.9°（-7；0.8），推动者-12.3°（-15.4；-8.5）。同侧 VV 偏倚不太常见且较轻（<0.001）。它们与重觉无关，84%发生在直立个体中。多变量、因子、 contingency 和预测分析一致表明，侧冲和空间忽略之间存在很强的相似性，后者包含前者。
侧冲（推动者综合征）是由身体倾斜、推动和阻力组成的三位一体。它是一种在滚动平面上调整身体方向的方法，以适应错误的垂直参考。参照正上方，侧冲可能对应于空间忽略的一种形式（参照正前方），这将倡导在人类大脑中使用涉及垂直内部模型的 3D 地图。
