Relationship between improvements in pusher behavior and the progression of subjective postural vertical: A single case study

Abstract

Background: This case study investigated the temporal relationship between improvements in pusher behavior (PB) and the progression of subjective postural vertical (SPV) in a participant with stroke.

Methods: We assessed a participant with severe PB following thalamic hemorrhage, conducting weekly assessments from one-month post-onset until PB resolution. Outcome measures included the Scale for Contraversive Pushing (SCP), Burke Lateropulsion Scale (BLS), lower extremity motor function of Fugl-Meyer Assessment (FMA-LE), lower extremity somatosensory function, and SPV. Cross-correlation analyses were performed to explore these variables' relationships and temporal sequences.

Results: PB resolved approximately five months post-onset. Significant positive correlations were observed between improvements in SCP and BLS. In contrast, significant negative correlations were found between SCP and FMA-LE and between BLS and FMA-LE. These changes occurred synchronously. However, neither SCP nor BLS improvements showed significant correlations with SPV changes. Somatosensory deficits persisted despite the resolution of PB.

Conclusion: This case demonstrated that PB improvement occurred independently of SPV changes, suggesting that the mechanisms of PB recovery may be more complex than previously hypothesized.