||発症早期の脳血管障害患者における主観的垂直認知の特性分析 : Pusher現象の有無による差異について
Characteristics of Verticality Perception in Patients with Pusher Behavior in Early Stroke
【目的】発症早期の脳血管障害患者における Pusher現象の有無による主観的垂直認知の差異について検討した.【方法】対象は初発の脳血管障害患者31名とし,Pusher現象のある群 (Pusher群)とPusher現象のない群に分類した. さらにPusher現象のない群については左脳損傷群 (LBD群)と右脳損傷群 (RBD群)に分け,各群における主観的視覚垂直 (SVV), 開眼時主観的身体垂直 (SPV-E0), 閉眼時主観的身体垂直 (SPV) の傾斜方向性と動揺性を比較した.【結果】垂直認知の傾斜方向性は, 全ての垂直パラメータにおいて主効果はなかった. 一方Pusher群はLBD群とRBDよりもSVV, SPV-E0, SPVの動揺性が有意に大きかった(P<0.05).【結論】本研究の結果から, 発症早期の脳血管障害患者では, Pusher現象を合併することで各垂直パラメータの垂直判断が不安定となることが示された.
【Introduction】The distortion of subjective vertical perception have been reported in patients with Pusher Behavior (PB). However, it is unclear as to characteristics of verticality for PB. The purpose of present study was to clarify the difference of subjective vertical perception in patients with or without PB.【Methods】Thirty-one patients with acute stroke participated in this study. The diagnosis of PB was assessed using Scale for Contraversive Pushing (SCP). According to SCP, 11 patients were PB (P+) and 20 Patients were non-PB. In addition, the patients without PB were classified into Right Brain Damage (RBD) and Left Brain Damage (LBD). The control group was composed of 15 elderly healthy subjects. We measured Subjective Postural Vertical (SPV) by an originally designed Vlertical Board (VB). The subjects seated on the VB and tilted to the right or left sides in frontal plane, with eyes closed (SPV) or with eyes open (SPV-EO). The VB was rolled toward opposite position until the subjects feel upright position. Subjective Visual Vertical (SVV) was eliminated using computer program, experimenter rotate the luminous rod until the subjects feel vertical. The mean value of orientation was defined as the directional error. The standard deviation was calculated as inconsistency. The data defined as the negative value was a paretic side (leftward in elderly subjects). The differences of vertical parameter between groups were compered using one-way ANOVA. 【Results】In the ANOVA on directional error, the effects of group were no significant for all subjective vertical perception. However, inconsistency of SVV, SPV-E0 and SPV was significantly higher in P+group than all the other groups. 【Conclusion】This study indicates that PB makes unstable representation of visual and postural verticality. We suggest that PB may be induced by the multiple instabilities of subjective vertical perception.
首都大学東京, 2016-03-25, 修士（理学療法学）