Vertical Perception and Stroke Rehabilitation

Abstract

Introduction
Vertical perception is the ability to relate to gravity defined upright. It is known that people with stroke can present with vertical perception deficits. It is rarely identified, little understood and has no known effective interventions. It is related to longer length of time in rehabilitation and worse functional outcomes.
Method
A series of research studies were undertaken to investigate vertical perception deficits following stroke. Firstly, a systematic review of vertical perception deficits relationship with postural and perceptual impairments following stroke. Secondly, a survey and interviews with rehabilitation professionals to gauge their understanding and management of vertical perception deficits. Finally, a feasibility study to identify vertical perception deficits in an acute stroke setting.
Results
The outcome of these studies has found that vertical perception deficits have a relationship with neglect and lateropulsion, but these relationships are not understood or consistent. There is an inconsistency in the terminology used in relation to these deficits. Rehabilitation therapists encounter vertical perception deficits regularly, but have no evidence-based assessments or interventions to address them. Rehabilitation therapists discussed that these deficits are complex and require experience to address. They also agreed that the terminology used in this field was inconsistent and those people with stroke with vertical perception deficits have a worse functional outcome. It is feasible to identify vertical perception deficits in the acute stroke setting using a suite of three outcome measures, but this is not quantifiable. The use of these outcome measures was acceptable to both people with stroke and clinicians.
Conclusion
The combined results of these studies have deepened our understanding of vertical perception deficits following stroke. Further research recommendations include: Standardisation of the terminology used in relation to vertical perception and quantification of the deficits through development of standardised assessment tools. It is important to understand the impact of these deficits in community dwelling people with stroke and to study the natural history of these deficits following stroke. Finally, the use of environmental cues as a potential intervention to address these deficits needs to be researched.

Date of Award	27 Apr 2026
Original language	English
Awarding Institution	University of Winchester
Supervisor	James Faulkner (Supervisor), Hazel J Brown (Supervisor), Louise Johnson (Supervisor) & Katherine Cook (Supervisor)