Standing and supine positions are better than sitting in improving rightward deviation in right-hemispheric stroke patients with unilateral spatial neglect: A randomized trial.

TRIAL DESIGN: How body position affects unilateral spatial neglect (USN) is unclear. This cluster randomized trial aimed to examine the effects of different positions (supine, sitting, and standing) on USN in stroke patients. METHODS: Twenty stroke patients (hemorrhage [n = 11], infarction [n = 9]) who were right-handed, had left hemiplegia due to right hemisphere damage that occurred within the last 2 years, and were in a state of arousal with a Glasgow Coma Scale score of 15 were included in the study. Table-top pen-and-pencil tests for USN (Bells Test, Line Bisection, Scene Copy, and Star Cancellation) were randomly conducted in the supine, sitting, and standing positions. RESULTS: The mean values in each test were significantly smaller in the supine position than were those in the sitting position (P = .015, .047, .015, and <.001), and those in the standing position were significantly smaller than those in the sitting position (P = .007, <.001, =.006, and < .001). The results of the 4 tests in the standing position were similar to those in the supine position. CONCLUSIONS: Body position affects USN in stroke patients and that the standing and supine positions improve USN better than the sitting position. Some possible mechanisms are: muscle contractions in the lower limbs and the trunk could have affected results in the standing position, and reduction in gravitational stimulation in the supine position could have played a role.

Standing position improves arm and hand performance on un-affected side in hemiplegic patients.

BACKGROUND AND PURPOSE: The main objective of this study was to compare the hand and finger performance of stroke patients in standing and sitting positions. METHODS: The study subjects were 11 males and 3 females with history of stroke (age, 68.6 ± 6.3 years, mean ± SD). Inclusion criteria were right-handedness before stroke, right hemiparesis due to left hemisphere lesion induced by stroke, at least 4 months between stroke and study enrollment, and ability to stand for more than 10 minutes. Tests of dexterity (peg board test), attention, unilateral spatial neglect, and cognition were conducted in comfortable sitting and standing positions. Seven subjects started in standing position, and the other seven subjects were tested first in sitting position. Tests in the first position were performed on one day, and repeated one week later but performed in a different position. RESULTS: The mean performance time on the peg board test in standing position was significantly faster than in sitting position (p=0.022). However, the results of the Trail making test-part A, line cancellation test, line bisection and Mini Mental State conducted in standing position were similar to those of sitting position. There were no differences between the first and second trial tests. CONCLUSIONS: Our results showed that standing position improved the functional performance of hand and arm on the un-affected side in stroke patients, but had no effects on consistent attention, unilateral spatial neglect, or cognition.