Abstract
Background: Conventional pusher behavior is pushing on the frontal plane. Clinically, poste- rior pusher behavior is also observed. Posterior pusher behavior is caused by a mispercep- tion of verticality. Verticality has been shown to be associated with vestibular function, and stimulation of the posterior neck muscles has been reported to facilitate vestibular function. This case study reports that the application of transcutaneous electrical nerve stimulation (TENS) to the posterior neck muscle on the paralyzed side of a stroke patient who exhibited posterior pusher behavior.
Case: The patient was a woman in her 67 who exhibited posterior pusher behavior after cere- bral infarction of the left middle cerebral artery. Right-sided hemiplegia was mild, the patient marked backward resistance when attempting posture correction toward the forward direc- tion. The backward disequilibrium scale (BDS) was used to evaluate the patient's posterior pusher behavior. The first BDS was 10 points. The intervention period for TENS (period B) was 2 weeks, and the baseline period (period A) was also 2 weeks, with an alternative design. During this time, a before and after evaluation was performed. In period A, normal physical therapy was used, and in period B, the same physical therapy as in period A was performed while applying TENS to the paralyzed neck. As a result, BDS was unchanged by 10 points af- ter the A1 period and changed to 3 points after the B1 period. After the A2 period, the BDS score worsened to 5 points, and after the B2 period, it improved to 3 points.
Discussion: TENS in the posterior neck muscles can stimulate the insular cortex. It has also been reported that stimulation of the insular cortex can improve vestibular function. There- fore, we thought that TENS to the posterior neck in this case stimulated the insular cortex and might reduce the posterior pusher behavior.
https://ror.org/00ws30h19 
