Effects of performing a lateral-reaching exercise while seated on a tilted surface for severe post-stroke pusher behavior: A case series

ABSTRACT

Background: For patients with severe post-stroke pusher behavior (PB), acquiring a vertical posture involves correcting paretic-sided body tilt to the non-paretic side. Active lateral sitting training may facilitate improvement in postural orientation for patients with PB. However, its effect on patients with severe PB remains unclear.

Objective: To determine the effect of performing a lateral-reaching exercise in patients with severe PB seated on a tilted surface

Methods: Three patients with severe PB due to right hemispheric stroke participated in our study. Using a single-case design, the intervention’s effect was verified using the applied behavior analysis method. Conventional physical therapy was performed for 1 h at baseline and at follow-up. During the intervention, lateral sitting training on a tilted surface was performed 40 times per session (total, 2 sessions). PB was assessed using the Scale for Contraversive Pushing and the Burke Lateropulsion Scale, and patient-reported fear of falling. The Function in Sitting Test (FIST) and the Trunk Control Test (TCT) were administered.

Results: PB improved in all patients post-intervention and persisted at follow-up. Fear of falling during the passive sitting task while moving toward the non-paretic side disappeared post-intervention and at follow-up. FIST and TCT scores improved in 2 patients.

Conclusion: The lateral sitting exercise reduced severe PB in all patients; however, sitting balance and trunk performance did not improve in 1 patient. Future studies to examine the adaptability of this task and long-term effects are needed.

KEYWORDS:

• Exercise
• lateral sitting training
• postural balance
• pusher behavior
• stroke rehabilitation
• trunk

Acknowledgments

We thank the rehabilitation staff at the Saitama Medical University International Medical Center for their help during the study.

Availability of data

The datasets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Disclosure of interest

The authors report no conflicts of interest

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by the Japan Society for the Promotion of Science (KAKENHI), under Grant Number 20K19386.