Functioning and Disability
Toshiya Nezu, MS
Physical Therapist
Juntendo University
Kasukabe City, Saitama, Japan
Yuji Fujino, PhD
Associate Professor
Juntendo University
Bunkyo-ku, Tokyo, Japan
Koshiro Haruyama, PhD
Associate Professor
Juntendo University
Bunkyo-ku, Tokyo, Japan
Tadamitsu Matsuda, PhD
professor
Department of Physical Therapy, Faculty of Health and Medical Sciences, Juntendo University
Bunkyo-ku, Tokyo, Japan
A 70-year-old left-handed woman developed lateropulsion (LP) after a stroke in the right-hemisphere. Despite right-hemisphere injury, she had aphasia, consistent with atypical language lateralization in left-handed individuals. Western Aphasia Battery was 51; yes/no responses were reliable. From the early acute phase, she showed trunk pushing toward the paretic side and resistance to correction in sitting and standing consistent with LP. We prospectively examined whether the direction of fear of falling during controlled trunk tilt differed by posture and changed over time.
Case Description:
On day 5, the Scale for Contraversive Pushing (SCP; posture/push/resistance) was 1/1/1 in sitting and standing (total 6). During therapist-guided tilt, fear was strongest toward the non-paretic side in both postures. On day 30, SCP improved to 1/0.5/0 in sitting but remained 1/1/1 in standing. Concurrently, fear in sitting shifted to the paretic side, whereas in standing it persisted only during non-paretic tilt. Thus, sitting improvement of LP coincided with reversal of fear direction; standing showed no change.
Discussions:
Previous studies describe LP patients perceiving non-paretic tilt as particularly threatening. Here, reduction of SCP push/resistance in sitting paralleled a shift of fear toward the paretic side, while standing showed neither behavioral nor fear-direction change. This posture-dependent dissociation suggests that mitigating LP may recalibrate perceived safe versus unsafe directions in sitting. Differences in base of support, center of mass, and trunk/lower-limb control likely shape threat appraisal. Posture-specific probing of fear direction paired with SCP may expose clinically relevant change.
Conclusions:
This case shows posture-dependent dissociation between LP behavior and perceived threat direction. In sitting, better SCP coincided with a shift in fear from non-paretic to paretic; in standing, LP severity and non-paretic-tilt fear persisted. Assessment should pair behavioral scales (e.g., SCP) with posture-specific fear probing. Rehabilitation should reduce pushing and recalibrate directional risk within distinct mechanics of sitting and standing.
