Affiliations: Service de Rééducation Neurologique,
CHU, INSERM ERM207 Motricité et plasticité, Centre de
Médecine Physique & Réadaptation, 23 rue Gaffarel, BP 77908
F, 21079 Dijon cedex, France. Tel.: +33 380 293 371; Fax: +33 380 293 643;
E-mail: dominic.perennou@chu-dijon.fr
Abstract: 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.
