Pusher syndrome – the role of the Bobath Concept

Abstract

The Pusher syndrome is described as frequent, but not very well recognized disorder of body posture characterized by a deflection in the opposite direction to the damaged hemisphere, and the active resistance of the patient's external action to restore its true vertical position. The Pusher syndrome occurs more frequently in patients with a history of cerebral vascular event, and was first described by Patricia M. Davies (senior IBITA instructor) in 1985. Bobath Concept Therapy should include not only special exercises, but also the use visual objects as points of reference. The primary objective of rehabilitation is the development of proper mechanism of the righting reflex. The essence of this action is to remove the obstacles blocking the implementation of normal postural and motor patterns, and the provision of correct sensorimotor experiences. This is a long-term process requiring patience and individual therapy tailored to individual patients, depending on motor and cognitive deficits.

Possibilities of physiotherapeutic treatment in the case of patients with pusher syndrome

“…The syndrome can be suspected if therapy has been conducted for a long time, the patient has normal muscle strength, is properly motivated and has no coordination disorders, muscle contractures, and yet the expected effects are not observed. In this case, the patient should be evaluated for PS and pusher syndrome is diagnosed [20].…”

“…The primary goal is to reteach the patient the correct orientation of the body in space and the mechanism of the postural reflex. Physiotherapy for patients with PS should include visual exploration of the environment and observation where the body is in relation to the environment; learning the movements necessary to assume the vertical position; maintaining this position while performing other activities and preventing pushing [1,6,11,17,20,26,27]. Initially, therapy is aimed at maximum stimulation and loading of the indirectly affected side, so it is the opposite principle to that used in patients with paresis, especially in the case of hemineglect.…”

“…In the initial stages of therapy, a lot of elements of hypercorrection are used in the form of excessive transfer of the body weight to the nonaffected side and the use of loads on the side from which the patient pushes and the appropriate positioning of the patient's body to limit pushing (Fig. 2a-e) [2,6,7,11,15,17,20,26,27].…”

“…Therefore, it is advisable to position the patient on the apparently healthy side, and in the lying position, to cover the hyperactive side to minimize the pushing symptoms (Fig. 4a, b) [6,11,19,20,26,27].…”

“…The patient shows no fear of falling and puts up active resistance during correction attempts and shows apprehension or reluctance during correction attempts (Fig. 5) [6,11,19,20,26,27,32].…”