Postural disorders and spatial neglect in stroke patients: a strong association.

PURPOSE: In this paper we analyse the arguments for a strong association between spatial neglect and postural disorders and attempt to better understand the mechanisms which underlie that.
METHODS: We first provide a general overview of the available tools for a rational assessment of postural control in a clinical context. We then analyse the arguments in favour of a close relationship, although not necessarily causal, between spatial neglect and: 1) body orientation with respect to gravity (including verticality perception i.e. the visual vertical, the haptic vertical, and the postural vertical); 2) body stabilisation with respect to the base of support; 3) posturographic features of stroke patients; 4) and finally their postural disability in daily life. This second part of the paper is based both on the literature review and on results of our current research.
RESULTS: Neglect patients show a dramatic postural disability, due both to problems in body orientation with respect to gravity and to problems in body stabilisation. It might be that these problems are partly caused by a neglect phenomenon bearing on graviceptive (somaesthetic > vestibular) and visual information serving postural control. This could correspond to a kind of postural neglect involving both the bodily and nonbodily domains of spatial neglect. The existence of distorsion(s) in the body scheme are also probably involved, especially to explain the weight-bearing asymmetry in standing, and probably an impaired multisegmental postural coordination leading to an impaired body stabilisation.
CONCLUSION: The present paper explains why neglect patients show longer/worse recovery of postural-walking autonomy than other stroke patients.