Physical therapy for a pontine stroke patient with body tilt toward the contralesional side with motor paralysis as well as tactile, pressure and proprioceptive disturbances

Abstract

Stroke patients exhibit various postural abnormalities, such as pusher behavior and lateropulsion. Commonly, patients with pusher behavior show a marked body tilt to the contralesional side with hemiparesis and sensory disturbances, such as tactile, pressure, thermal, pain and proprioceptive disturbances. On the other hand, many cases of lateropulsion exhibit a marked body tilt to the ipsilesional side with limb ataxia, vertigo, pain and thermal hypoalgesia, without hemiparesis or the above-mentioned disturbances. A 60s man had a pontine hemorrhage. He exhibited a marked body tilt toward the contralesional side with hemiparesis and several sensory disturbances. We determined the postural abnormality to be lateropulsion according to brain imaging findings and the results of previous reports. We performed physical therapy to facilitate the patient’s awareness of residual sensory input based on our determination. As a result, improvement in the patient’s body tilt was observed. The findings in the current case may contribute to the decision-making process of physiotherapists in the clinical setting.