RESUMEN
Abstract Background: Verticality misperception is relatively common among patients after stroke, and it may be evaluated in terms of (a) subjective visual vertical (SVV), (b) subjective haptic vertical (SHV) and (c) subjective postural vertical (SPV). To better understand these assessment methods, we conducted a systematic review of the methodological characteristics of different protocols for evaluating SVV, SHV and SPV among individuals after stroke. Objective: To standardize the methodological characteristics of protocols for evaluating verticality perception after stroke. Methods: We searched the following databases: PUBMED, regional BVS portal (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index and LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Cochrane Library and PEDro. Two review authors independently used the QUADAS method (Quality Assessment of Diagnostic Accuracy Studies) and extracted data. Results: We included 21 studies in the review: most (80.9%) used SVV, eight (38.1%) used SPV and four (19.0%) used SHV. We observed high variability in assessments of verticality perception, due to patient positions, devices used, numbers of repetitions and angle of inclination for starting the tests. Conclusion: This systematic review was one of the first to explore all the methods of assessing verticality perception after stroke, and it provides crucial information on how to perform the tests, in order to guide future researchers/clinicians.
Resumo Antecedentes: A percepção errônea da verticalidade é relativamente comum em pacientes após Acidente Vascular Cerebral (AVC) e pode ser avaliada pelas: (a) vertical visual subjetiva (SVV), (b) vertical háptica subjetiva (SVH) e (c) vertical postural subjetiva (SPV). Para melhor compreender esses métodos de avaliação, realizamos uma revisão sistemática das características metodológicas de diferentes protocolos para avaliações de SVV, SHV e SVP em indivíduos após AVC. Objetivo: Padronizar as características metodológicas de protocolos de avaliação da verticalidade após AVC. Métodos: Foi realizada busca nas bases de dados PUBMED, Portal Regional da BVS (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index, LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Biblioteca Cochrane e PEDro. Dois revisores avaliaram independentemente o QUADAS (Avaliação da Qualidade dos Estudos de Precisão de Diagnóstico) e extraíram os resultados. Resultados: Foram incluídos 21 estudos: a maioria (80,9%) utilizando a SVV, oito (38,1%) a SPV e quatro (19,0%) a SHV. Observou-se grande variabilidade na avaliação da verticalidade, devido às posições dos pacientes, dispositivos utilizados, número de repetições e ângulo de inclinação para iniciar os testes. Conclusão: Esta revisão sistemática é uma das primeiras a explorar todos os métodos de avaliação da verticalidade após o AVC e fornece informações cruciais sobre como realizar os testes para orientar os futuros pesquisadores e clínicos.
Asunto(s)
Humanos , Percepción Visual , Accidente Cerebrovascular , Postura , Percepción EspacialRESUMEN
INTRODUCTION: Stroke patients often exhibit an altered perception of verticality, but there are no studies evaluating verticality perception in the first 72 h after stroke and its relationship with trunk control. Therefore, this study aimed to analyze visual and haptic verticality in the acute phase of stroke. METHODS: This was a cross-sectional study conducted with two groups: (a) 13 individuals with stroke and (b) 12 healthy participants. We assessed verticality via the subjective visual vertical (SVV) and the subjective haptic vertical (SHV); and we measured trunk control with the Trunk Impairment Scale (TIS). We performed t-tests to compare the SVV and SHV between groups. Pearson correlation was performed between verticality tests with National Institutes of Health Stroke Scale (NIHSS) and the TIS. RESULTS: Participants with recent stroke presented higher true and absolute SVV deviation values than did the control group. There was significant negative correlation between absolute (r = -0.57; p = 0.02) and true SVV (r = -0.54; p = 0.01) with TIS scores There was also significant positive correlation between absolute (r = 0.63; p = 0.009) and true SVV (r = 0.61; p = 0.003) with NIHSS. A significant negative correlation between NIHSS and TIS scores also was found (r = -0.80; p = 0.005). CONCLUSION: Individuals with acute stroke presented larger variability in their perceptions of visual verticality than did healthy controls, and verticality perceptions were positively correlated with trunk impairment.
Asunto(s)
Accidente Cerebrovascular , Percepción Visual , Estudios Transversales , Voluntarios Sanos , Humanos , Percepción Espacial , Estados UnidosRESUMEN
Difficulties in the integration of visual, vestibular, and somatosensory information in individuals with Parkinson's disease (PD) may alter perception of verticality. Accordingly, in this cross-sectional study, we analyzed PD patients' (n = 13) subjective visual vertical (SVV) and subjective haptic vertical (SHV) perceptions and compared them to those of healthy controls (n = 14). We compared SVV and SHV findings among participants with PD, healthy controls, and cutoff points of normality based on prior research literature, using the parametric nonpaired t test (at p < .05) and Cohen's d (at d > 0.8) to determine clinical relevance. We analyzed SVV with the bucket test and SHV with the rod rotations task in clockwise and counterclockwise directions. We calculated Pearson correlations to analyze the association between verticality tests and the most clinically affected body side. We calculated both the percentage of A-effect (expression of body tilt underestimation to the midline) and E-effect (expression of body tilt overestimation in the upright position). Individuals with PD showed greater variability in right SHV supination compared to the healthy control participants (p = .002). There was greater clinical relevance in right (as opposed to left) SVV (d = 0.83), right (as opposed to left) SHV pronation (d = 0.91), and left (as opposed to right) SHV pronation (d = 0.88). We observed a higher proportion of E-effect in individuals with PD. A significantly higher proportion of patients with PD, compared to patients in past literature, had right SHV pronation (p = .001), left SHV pronation (p = .023), right SHV supination (p = .001), left SHV supination (p = .046), and left SHV pronation (p = .046). Thus, subjective visual and proprioceptive perception of verticality is altered in patients with PD, compared to individuals without PD.