Avaliação da percepção vertical subjetiva em pacientes com acidente vascular cerebral: uma revisão sistemática

Ferreira, Luana Ribeiro; Ferreira, Flávio José Pereira De Almeida; Campos, Fernanda Aparecida; Luvizutto, Gustavo José; Souza, Luciane Aparecida Pascucci Sande De

doi:10.1590/0004-282X-ANP-2020-0584

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Arquivos de Neuro-Psiquiatria

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Sumário

View and Review • Arq. Neuro-Psiquiatr. 79 (11) • Nov 2021 • https://doi.org/10.1590/0004-282X-ANP-2020-0584 copiar

Avaliação da percepção vertical subjetiva em pacientes com acidente vascular cerebral: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Antecedentes:

A percepção errônea da verticalidade é relativamente comum em pacientes após Acidente Vascular Cerebral (AVC) e pode ser avaliada pelas: (a) vertical visual subjetiva (SVV), (b) vertical háptica subjetiva (SVH) e (c) vertical postural subjetiva (SPV). Para melhor compreender esses métodos de avaliação, realizamos uma revisão sistemática das características metodológicas de diferentes protocolos para avaliações de SVV, SHV e SVP em indivíduos após AVC.

Objetivo:

Padronizar as características metodológicas de protocolos de avaliação da verticalidade após AVC.

Métodos:

Foi realizada busca nas bases de dados PUBMED, Portal Regional da BVS (MEDLINE, LILACS, IBECS, CUBMED, Psychology Index, LIS), CINAHL, SCOPUS, Web of Science, Science Direct, Biblioteca Cochrane e PEDro. Dois revisores avaliaram independentemente o QUADAS (Avaliação da Qualidade dos Estudos de Precisão de Diagnóstico) e extraíram os resultados.

Resultados:

Foram incluídos 21 estudos: a maioria (80,9%) utilizando a SVV, oito (38,1%) a SPV e quatro (19,0%) a SHV. Observou-se grande variabilidade na avaliação da verticalidade, devido às posições dos pacientes, dispositivos utilizados, número de repetições e ângulo de inclinação para iniciar os testes.

Conclusão:

Esta revisão sistemática é uma das primeiras a explorar todos os métodos de avaliação da verticalidade após o AVC e fornece informações cruciais sobre como realizar os testes para orientar os futuros pesquisadores e clínicos.

Palavras-chave:
Acidente Vascular Cerebral; Avaliação da Pesquisa em Saúde; Verticalidade; Subjetiva Vertical Visual; Subjetiva Vertical Háptica; Subjetiva Vertical Postural

Study	Participants	Age (years) (Mean ± SD)	Gender (M/F)	Aim	Verticality
Kerkhoff (1999)2020. Kerkhoff G. Multimodal spatial orientation deficits in left-sided visual neglect. Neuropsychologia. 1999 Nov;37(12):1387-405. https://doi.org/10.1016/S0028-3932(99)00031-7 https://doi.org/10.1016/S0028-3932(99)00...	Stroke with and without USN* and healthy individuals.	Stroke: 53 ± 4.92; Healthy: 51 ± 10.06	35/21	To test visual and haptic orientation among individuals with and without left USN and healthy subjects.	SVV and SHV
Karnath et al. (2000)1919. Karnath HO, Ferber S, Dichgans J. The origin of contraversive pushing: evidence for a second graviceptive system in humans. Neurology. 2000 Nov 14;55(9):1298-304. https://doi.org/10.1212/WNL.55.9.1298 https://doi.org/10.1212/WNL.55.9.1298...	Stroke with Pusher** and USN	73.6 ± 4.5 53.4 ± 13.57	2/3 3/2	To analyze the mechanism of pushing.	SPV and SVV
Saj et al. (2005)2424. Saj A, Honoré J, Coello Y, Rousseaux M. The visual vertical in the pusher syndrome: influence of hemispace and body position. J Neurol. 2005 Aug;252(8):885-91. https://doi.org/10.1007/s00415-005-0716-0 https://doi.org/10.1007/s00415-005-0716-...	Stroke with and without USN	Stroke: 60	5/3	To evaluate SVV among individuals with and without USN and to relate of the trunk position	SVV
Bonan et al. (2006)11. Bonan IV, Guettard E, Leman MC, Colle FM, Yelnik AP. Subjective visual vertical perception relates to balance in acute stroke. Arch Phys Med Rehabil. 2006 May 1;87(5):P642-6. https://doi.org/10.1016/j.apmr.2006.01.019 https://doi.org/10.1016/j.apmr.2006.01.0...	Right and Left stroke	Stroke: 59	16/14	To determine SVV misperception and balance after stroke	SVV
Bonan et al. (2006)1616. Bonan IV, Leman MC, Legargasson JF, Guichard JP, Yelnik AP. Evolution of subjective visual vertical perturbation after stroke. Neurorehabil Neural Repair. 2006 Dec 1;20(4):484-91. https://doi.org/10.1177/1545968306289295 https://doi.org/10.1177/1545968306289295...	Right and Left stroke	RS: 55 ± 18 LS: 52 ± 17	7/6 10/07	To determine SVV misperception after stroke	SVV
Johannsen et al. (2006)1818. Johannsen L, Berger MF, Karnath H-O. Subjective visual vertical (SVV) determined in a representative sample of 15 patients with pusher syndrome. J Neurol. 2006 Oct;253(10):1367-9. https://doi.org/10.1007/s00415-006-0216-x https://doi.org/10.1007/s00415-006-0216-...	Stroke and healthy individuals	Stroke: 70 Healthy: 66.5	12/3	To investigate SVV and the longitudinal axis of the body after hemispheric stroke.	SVV
Bonan et al. (2007)1515. Bonan IV, Hubeaux K, Gellez-Leman MC, Guichard JP, Vicaut E, Yelnik AP. Influence of subjective visual vertical misperception on balance recovery after stroke. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):49-55. https://doi.org/10.1136/jnnp.2006.087791 https://doi.org/10.1136/jnnp.2006.087791...	Right and Left Stroke	57.71 ± 16.49	14/14	To assess SVV misperception regarding balance recovery after stroke	SVV
Barra et al. (2008)1414. Barra J, Benaim C, Chauvineau V, Ohlmann T, Gresty M, Pérennou D. Are rotations in perceived visual vertical and body axis after stroke caused by the same mechanism? Stroke. 2008 Nov;39(11):3099-101. https://doi.org/10.1161/STROKEAHA.108.515247 https://doi.org/10.1161/STROKEAHA.108.51...	Right and Left Stroke	58.88 ± 6.3	11/4	To investigate SVV and the longitudinal axis of the body after hemispheric stroke.	SVV
Perennou et al. (2008)22. Pérennou D, Piscicelli C, Barbieri G, Jaeger M, Marquer A, Barra J. Measuring verticality perception after stroke: why and how? Neurophysiol Clin. 2014 Jan;44(1):25-32. https://doi.org/10.1016/j.neucli.2013.10.131 https://doi.org/10.1016/j.neucli.2013.10...	Stroke and healthy individuals	Stroke: 55.4 ± 13.1 Healthy: 48.8 ± 10.8	57/29 22/11	To evaluate relationships between verticality perceptions after stroke	SVV and SPV, SHV
Paci et al. (2011)2121. Paci M, Matulli G, Megna N, Baccini M, Baldassi S. The subjective visual vertical in patients with pusher behaviour: a pilot study with a psychophysical approach. Neuropsychol Rehabil. 2011 Aug 8;21(4):539-51. https://doi.org/10.1080/09602011.2011.583777 https://doi.org/10.1080/09602011.2011.58...	Stroke with Pusher** and healthy individuals	Stroke: 76.5 ± 10.1 Healthy: 77.4 ± 4.1	5/3 5/5	To evaluate SVV among individuals with Pusher**	SVV
Utz et al. (2011)2525. Utz KS, Keller I, Artinger F, Stumpf O, Funk J, Kerkhoff G. Multimodal and multispatial deficits of verticality perception in hemispatial neglect. Neuroscience. 2011 Aug 11;188:68-79. https://doi.org/10.1016/j.neuroscience.2011.04.068 https://doi.org/10.1016/j.neuroscience.2...	Stroke with and without USN* and healthy individuals	Stroke: 70.6 ± 8.3 Healthy: 69.68 ± 9.9	9/7 14/4	To investigate both SVV and SHV in the frontal and sagittal plane among patients with USN after stroke	SVV and SHV
Funk et al. (2011)1717. Funk J, Finke K, Müller HJ, Utz KS, Kerkhoff G. Visual context modulates the subjective vertical in neglect: evidence for an increased rod-and-frame-effect. Neuroscience. 2011 Jan 26;173:124-34. https://doi.org/10.1016/j.neuroscience.2010.10.067 https://doi.org/10.1016/j.neuroscience.2...	Stroke with and without USN* and healthy individuals	51.1 ± 6.2; 55.6 ± 6; 47.2 ± 12.7	6/6 9/3 7/5	To investigate SVV among individuals with and without USN after stroke	SVV
Saeys et al. (2012)1010. Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Van de Heyning P. Influence of sensory loss on the perception of verticality in stroke patients. Disabil Rehabil. 2012 Apr 16;34(23):1965-70. https://doi.org/10.3109/09638288.2012.671883 https://doi.org/10.3109/09638288.2012.67...	Stroke	62.77 ± 13.56	16/16	To investigate the relationship between somatosensory loss and verticality perception after stroke	SVV and SPV
Bergmann et al. (2016)3030. Bergmann J, Krewer C, Selge C, Müller F, Jahn K. The subjective postural vertical determined in patients with pusher behavior during standing. Top Stroke Rehabil. 2016 Jun;23(3):184-90. https://doi.org/10.1080/10749357.2015.1135591 https://doi.org/10.1080/10749357.2015.11...	Stroke with Pusher**	71.1 ± 8.93	11/7	To investigate SPV among individuals with Pusher**	SPV
Baggio et al. (2016)99. Baggio JAO, Mazin SSC, Alessio-Alves FF, Barros CGC, Carneiro AAO, Leite JP, et al. Verticality perceptions associate with postural control and functionality in stroke patients. PLoS One. 2016 Mar 8;11(3):e0150754. https://doi.org/10.1371/journal.pone.0150754 https://doi.org/10.1371/journal.pone.015...	Stroke	64.4 ± 12.4	27/18	To analyze the relationships of SPV and SHV with postural control among individuals after stroke	SPV and SHV
Reinhart et al. (2016)2323. Reinhart S, Schaadt AK, Keller I, Hildebrandt H, Kerkhoff G, Utz K. Rotational coherent dot movement normalizes spatial disorientation of the subjective visual vertical in patients with rightsided stroke. Neuropsychologia. 2016 Nov;92:174-80. https://doi.org/10.1016/j.neuropsychologia.2016.04.027 https://doi.org/10.1016/j.neuropsycholog...	Right stroke and healthy individuals	55.5 ± 9.3	12/8	To investigate whether rotational coherent dot movement (RCDM) modulates spatial orientation deficits of the SVV in the roll plane in right hemispheric stroke	SVV
Jamal et al. (2018)2626. Jamal K, Leplaideur S, Rousseau C, Chochina L, Moulinet-Raillon A, Bonan I. Disturbances of spatial reference frame and postural asymmetry after a chronic stroke. Exp Brain Res. 2018 Aug;236(8):2377-85. https://doi.org/10.1007/s00221-018-5308-1 https://doi.org/10.1007/s00221-018-5308-...	Stroke	60.3 ± 10.0	24/6	To examine both egocentric and allocentric space representation and weight-bearing asymmetry among chronic stroke patients.	SVV
Saeys et al. (2018)2727. Saeys W, Herssens N, Verwulgen S, Truijen S. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies. PLoS One. 2018 Jun 29;13(6):e0199098. https://doi.org/10.1371/journal.pone.0199098 https://doi.org/10.1371/journal.pone.019...	Stroke	62.4 ± 13.3	22/15	To explore verticality perception and sensory reweighting strategies among stroke subjects	SVV and SPV
Mori et al. (2020)2828. Mori K, Nakamura K, Hashimoto S, Wakida M, Hase K. Novel characterization of subjective visual vertical in patients with unilateral spatial neglect. Neurosci Res. 2021 Feb;163:18-25. https://doi.org/10.1016/j.neures.2020.02.005 https://doi.org/10.1016/j.neures.2020.02...	Stroke with and without USN* and healthy individuals	67.1 ± 8.0	11/32	To investigate the cause of the increase in the orientation and variability of SVV among USN patients	SVV
Fukata et al. (2020)2929. Fukata K, Amimoto K, Fujino Y, Inoue M, Inoue M, Takahashi Y, et al. Influence of unilateral spatial neglect on vertical perception in post-stroke pusher behavior. Neurosci Lett. 2020 Jan 10;715:134667. https://doi.org/10.1016/j.neulet.2019.134667 https://doi.org/10.1016/j.neulet.2019.13...	Stroke with and without USN and/or Pusher* and healthy individuals	66.54 ± 2.3	30/28	To compare direction and variability in SPV and SVV among patients with PB with and without USN.	SVV and SPV
Fukata et al. (2020)3131. Fukata K, Amimoto K, Fujino Y, Inoue M, Inoue M, Takahashi Y, et al. Starting position effects in the measurement of the postural vertical for pusher behavior. Exp Brain Res. 2020 Oct;238(10):2199-2206. https://doi.org/10.1007/s00221-020-05882-z https://doi.org/10.1007/s00221-020-05882...	Stroke with and without Pusher*	66.5 ± 11.0	30/23	To clarify the differences in SPV with regard to the measurement starting position between patients with and without PB.	SPV

Author/Year/Reference	1	2	5	9	12	13	Score
Kerkhoff (1999)2020. Kerkhoff G. Multimodal spatial orientation deficits in left-sided visual neglect. Neuropsychologia. 1999 Nov;37(12):1387-405. https://doi.org/10.1016/S0028-3932(99)00031-7 https://doi.org/10.1016/S0028-3932(99)00...	N	NC	P	NC	NC	N	1/6
Karnath, Ferber & Dichgans, (2000)1919. Karnath HO, Ferber S, Dichgans J. The origin of contraversive pushing: evidence for a second graviceptive system in humans. Neurology. 2000 Nov 14;55(9):1298-304. https://doi.org/10.1212/WNL.55.9.1298 https://doi.org/10.1212/WNL.55.9.1298...	N	NC	P	P	NC	N	2/6
Saj, Honoré, Coello & Rousseaux (2005)2424. Saj A, Honoré J, Coello Y, Rousseaux M. The visual vertical in the pusher syndrome: influence of hemispace and body position. J Neurol. 2005 Aug;252(8):885-91. https://doi.org/10.1007/s00415-005-0716-0 https://doi.org/10.1007/s00415-005-0716-...	N	N	N	P	NC	N	1/6
Bonan, Guettard, Leman, Colle & Yelnik (2006)11. Bonan IV, Guettard E, Leman MC, Colle FM, Yelnik AP. Subjective visual vertical perception relates to balance in acute stroke. Arch Phys Med Rehabil. 2006 May 1;87(5):P642-6. https://doi.org/10.1016/j.apmr.2006.01.019 https://doi.org/10.1016/j.apmr.2006.01.0...	N	P	P	P	NC	P	4/6
Bonan, Leman, Legargasson, Guichard & Yelnik (2006)1616. Bonan IV, Leman MC, Legargasson JF, Guichard JP, Yelnik AP. Evolution of subjective visual vertical perturbation after stroke. Neurorehabil Neural Repair. 2006 Dec 1;20(4):484-91. https://doi.org/10.1177/1545968306289295 https://doi.org/10.1177/1545968306289295...	N	P	P	P	P	P	5/6
Johannsen, Fruhmann Berger & Karnath (2006)1818. Johannsen L, Berger MF, Karnath H-O. Subjective visual vertical (SVV) determined in a representative sample of 15 patients with pusher syndrome. J Neurol. 2006 Oct;253(10):1367-9. https://doi.org/10.1007/s00415-006-0216-x https://doi.org/10.1007/s00415-006-0216-...	N	N	P	NC	NC	N	1/6
Bonan et al. (2007)1515. Bonan IV, Hubeaux K, Gellez-Leman MC, Guichard JP, Vicaut E, Yelnik AP. Influence of subjective visual vertical misperception on balance recovery after stroke. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):49-55. https://doi.org/10.1136/jnnp.2006.087791 https://doi.org/10.1136/jnnp.2006.087791...	N	P	P	P	P	P	5/6
Barra et al. (2008)1414. Barra J, Benaim C, Chauvineau V, Ohlmann T, Gresty M, Pérennou D. Are rotations in perceived visual vertical and body axis after stroke caused by the same mechanism? Stroke. 2008 Nov;39(11):3099-101. https://doi.org/10.1161/STROKEAHA.108.515247 https://doi.org/10.1161/STROKEAHA.108.51...	N	NC	P	P	P	N	3/6
Perennou et al. (2008)22. Pérennou D, Piscicelli C, Barbieri G, Jaeger M, Marquer A, Barra J. Measuring verticality perception after stroke: why and how? Neurophysiol Clin. 2014 Jan;44(1):25-32. https://doi.org/10.1016/j.neucli.2013.10.131 https://doi.org/10.1016/j.neucli.2013.10...	N	P	NC	P	P	P	4/6
Paci et al. (2011)2121. Paci M, Matulli G, Megna N, Baccini M, Baldassi S. The subjective visual vertical in patients with pusher behaviour: a pilot study with a psychophysical approach. Neuropsychol Rehabil. 2011 Aug 8;21(4):539-51. https://doi.org/10.1080/09602011.2011.583777 https://doi.org/10.1080/09602011.2011.58...	N	P	P	P	P	P	5/6
Utz et al. (2011)2525. Utz KS, Keller I, Artinger F, Stumpf O, Funk J, Kerkhoff G. Multimodal and multispatial deficits of verticality perception in hemispatial neglect. Neuroscience. 2011 Aug 11;188:68-79. https://doi.org/10.1016/j.neuroscience.2011.04.068 https://doi.org/10.1016/j.neuroscience.2...	N	NC	P	NC	NC	N	1/6
Funk et al. (2011)1717. Funk J, Finke K, Müller HJ, Utz KS, Kerkhoff G. Visual context modulates the subjective vertical in neglect: evidence for an increased rod-and-frame-effect. Neuroscience. 2011 Jan 26;173:124-34. https://doi.org/10.1016/j.neuroscience.2010.10.067 https://doi.org/10.1016/j.neuroscience.2...	N	NC	P	P	P	N	3/6
Saeys et al. (2012)1010. Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Van de Heyning P. Influence of sensory loss on the perception of verticality in stroke patients. Disabil Rehabil. 2012 Apr 16;34(23):1965-70. https://doi.org/10.3109/09638288.2012.671883 https://doi.org/10.3109/09638288.2012.67...	N	NC	P	P	P	N	3/6
Bergmann et al. (2016)3030. Bergmann J, Krewer C, Selge C, Müller F, Jahn K. The subjective postural vertical determined in patients with pusher behavior during standing. Top Stroke Rehabil. 2016 Jun;23(3):184-90. https://doi.org/10.1080/10749357.2015.1135591 https://doi.org/10.1080/10749357.2015.11...	N	NC	P	P	P	N	3/6
Baggio et al. (2016)99. Baggio JAO, Mazin SSC, Alessio-Alves FF, Barros CGC, Carneiro AAO, Leite JP, et al. Verticality perceptions associate with postural control and functionality in stroke patients. PLoS One. 2016 Mar 8;11(3):e0150754. https://doi.org/10.1371/journal.pone.0150754 https://doi.org/10.1371/journal.pone.015...	N	NC	P	P	P	P	4/6
Reinhart et al. (2016)2323. Reinhart S, Schaadt AK, Keller I, Hildebrandt H, Kerkhoff G, Utz K. Rotational coherent dot movement normalizes spatial disorientation of the subjective visual vertical in patients with rightsided stroke. Neuropsychologia. 2016 Nov;92:174-80. https://doi.org/10.1016/j.neuropsychologia.2016.04.027 https://doi.org/10.1016/j.neuropsycholog...	N	NC	P	P	P	N	3/6
Jamal et al. (2018)2626. Jamal K, Leplaideur S, Rousseau C, Chochina L, Moulinet-Raillon A, Bonan I. Disturbances of spatial reference frame and postural asymmetry after a chronic stroke. Exp Brain Res. 2018 Aug;236(8):2377-85. https://doi.org/10.1007/s00221-018-5308-1 https://doi.org/10.1007/s00221-018-5308-...	NC	P	P	P	NC	N	3/6
Saeys et al. (2018)2727. Saeys W, Herssens N, Verwulgen S, Truijen S. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies. PLoS One. 2018 Jun 29;13(6):e0199098. https://doi.org/10.1371/journal.pone.0199098 https://doi.org/10.1371/journal.pone.019...	NC	P	P	P	NC	N	3/6
Mori et al. (2020)2828. Mori K, Nakamura K, Hashimoto S, Wakida M, Hase K. Novel characterization of subjective visual vertical in patients with unilateral spatial neglect. Neurosci Res. 2021 Feb;163:18-25. https://doi.org/10.1016/j.neures.2020.02.005 https://doi.org/10.1016/j.neures.2020.02...	NC	P	P	P	NC	N	3/6
Fukata et al. (2020)2929. Fukata K, Amimoto K, Fujino Y, Inoue M, Inoue M, Takahashi Y, et al. Influence of unilateral spatial neglect on vertical perception in post-stroke pusher behavior. Neurosci Lett. 2020 Jan 10;715:134667. https://doi.org/10.1016/j.neulet.2019.134667 https://doi.org/10.1016/j.neulet.2019.13...	N	P	P	P	NC	N	3/6
Fukata et al. (2020)3131. Fukata K, Amimoto K, Fujino Y, Inoue M, Inoue M, Takahashi Y, et al. Starting position effects in the measurement of the postural vertical for pusher behavior. Exp Brain Res. 2020 Oct;238(10):2199-2206. https://doi.org/10.1007/s00221-020-05882-z https://doi.org/10.1007/s00221-020-05882...	N	P	P	P	NC	N	3/6
Score	0/21	10/21	19/21	18/21	10/21	6/21

	SVV	SHV	SPV
Device	Computerized, vertical luminous stimulus and virtual reality helmet	Manually rotated bar	Manual, hydraulic or motorized chair
Patient’s position	Seated or upright standing position	Seated	Seated
Distance (patient to device)	0.5 to 2.5 m	0.4 to 0.5 m	-
Device measurement	7.5 to 30 cm (rod)	15 to 40 cm (rod)	-
Velocity (^o/s)	-	-	1.5
Lighting	Dark room	Blindfolded	Blindfolded
Overall support	Head, chin and trunk fixed*	Head, trunk and limbs fixed*	Head, trunk and limbs fixed*
Number of repetitions (range)	10 (6-10)	10 (6-10)	10 (6-10)
Directions	Clockwise and counterclockwise	Vertical, horizontal and oblique	Sagittal and frontal planes
Initial degree (range)	35 (15-88)	17.5 (15-45)	20 (15-45)
Data analysis	Average and median	Average	Average

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[1] Correspondence:
Gustavo José Luvizutto; Email: gluvizutto@gmail.com