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Méthodologie d'évaluation et bases neurales du sens de verticalité : étude chez les patients présentant un Accident Vasculaire Cérébral

Abstract : The sense of verticality is a major spatial referential for perception and action in space. It allows determining our body position relatively to the gravity and it contributes to the organization of the postural control in humans. The assessment of the sense of verticality for a better understanding of postural and spatial disorders in stroke patients becomes common practice. However, the lack of standardization and psychometrical studies of the verticality perception assessment limits considerably the clinical integration of these tools and the development of therapeutic clinical trials for the follow-up of postural disorders in neurological diseases. Stroke is also the primary model for studying the sense of verticality. The identification of neural bases underlying the multisensory integration processes of the sense of verticality is based essentially on modern techniques of lesion analysis. However, our knowledge of the neural bases of the construction and updating of the sense of verticality are partial and require further studies. Our research aimed to improve our understanding of the sense of verticality through study of these disorders after stroke, according to a methodological and physiopathological dual approach. We showed that the assessment of the visual vertical perception after stroke requires a specific postural setting (the trunk and the head maintained upright in stroke patients with postural disorders) and should be based on 10 trials to achieve a high inter-trials reliability. Under these conditions, visual vertical orientation has excellent inter- and intrarater reliability, ensuring the reliability of this measure for both clinical practice and research. For the postural perception of the vertical, we proposed a simplified and standardized procedure with the wheel test to assess contralesional postural vertical biases after hemispheric stroke. Finally, by means of a lesional statistical analysis, we identified a cortical and subcortical areas network of the visual and postural vertical perception. The polymodal regions of the sense of verticality are centered on the operculo-insular cortex and the posterolateral thalamus, with a right hemisphere predominance and a partial overlap with the core regions of the vestibular cortex. Our results provide a better understanding of the neural bases of the sense of verticality in humans and constitute guidelines for the clinical use of the verticality perception measures.Keywords: Sense of verticality, stroke, assessment methodology, neural bases, vestibular cortex.
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https://tel.archives-ouvertes.fr/tel-01668410
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Céline Piscicelli. Méthodologie d'évaluation et bases neurales du sens de verticalité : étude chez les patients présentant un Accident Vasculaire Cérébral. Neurosciences. Université Grenoble Alpes, 2015. Français. ⟨NNT : 2015GREAS028⟩. ⟨tel-01668410⟩

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