Combining Physical Therapy With Vestibular Stimulation to Improve Postural Stability in Pusher's Syndrome

Imperial College London

Overview

The study is evaluating the effect of combining Galvanic Vestibular Stimulation (GVS) with standard Physiotherapy treatment in patients admitted to a neurological rehabilitation unit with Pusher syndrome (PS). Patients will be randomised to receive standard Physiotherapy treatment or standard treatment with GVS. Perceived verticality data will also be collected and analysed on age-matched controls. This data will be used to compare these results with the patients with PS. The investigators hypothesis that GVS and standard Physiotherapy treatment will lead to a greater improvement in functional ability and awareness of perceived verticality compared to standard Physiotherapy alone.

Pusher syndrome (PS) can be described as disordered balance and orientation which causes patients to perceive they are in an upright position when in fact they are positioned towards their affected side. These patients use their unaffected limbs to 'push' themselves away from their unaffected side in an attempt to correct their perceived postural alignment. PS is a common disorder and can affect 16% of stroke patients. Patients with PS have shown to take longer to improve in rehabilitation than non-PS patients and tend to stay in hospital for longer. Galvanic Vestibular Stimulation (GVS) involves passing a small electrical current behind the ear to stimulate the vestibular system to in-turn cause the head and body to move.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Conditions

Pusher Syndrome

Interventions

Galvanic Vestibular StimulationDEVICE

Electrical current (under 1.5mA) applied to the mastoid processes to stimulate the balance organs in the inner ear

Standard PhysiotherapyOTHER

45 minutes of standard physiotherapy treating impairments and functional problems

Eligibility

Sex: ALLHealthy volunteers:

Medical Language ↔ Plain English

Pusher Inclusion Criteria: * Identified hemiparetic neglect - identified PS from a stroke or acquired brain injury (using the Scale of Contraversive Pushing and The Burke Lateropulsion Scale) * Consenting to participate in the trial Pusher Exclusion Criteria: * Severe cognitive impairment * Receptive aphasia * Medical co-morbidities * Opthalamic impairment * Vestibular impairment * Peripheral neuropathy * Also any contraindications to GVS including: * Brain metallic implants * Pacemakers * Recent brain surgery * Skull defect * Preceding epileptic seizures * Sensitive skin behind the ears. Healthy volunteers inclusion criteria: * 40 years old minimum age * Consent to taking part in the trial Healthy volunteers exclusion criteria: * Vestibular impairment * History of medical/psychiatric/neurological disorders * Currently taking any psychoactive medication * Drunk more than 3 units of alcohol in the past 24 hours

Locations (1)

Imperial College London

London, United Kingdom

Outcomes

Primary Outcomes

Scale of Contraversive Pushing

This is made up of 3 components: 1.The symmetry of spontaneous body posture (rated with 0, 0.25, 0.75, or 1 point. 1 = severe tilt, 0 = no tilt), 2. The use of non-paretic extremities (0, 0.5, or 1 point. 1 = performed spontaneously at rest), 3. The resistance to passive correction of the tilted posture (0 or 1 point. 1 = resistance occurs). For a diagnosis of Pusher Syndrome all 3 components need to be present.