The ‘Pusher Syndrome’

Abstract

Pusher syndrome in patients post-stroke is characterized by leaning and active pushing toward the hemiplegic side with no compensation for the instability, and resistance to passive correction toward midline. Patients with pusher syndrome post-stroke have been found to require longer than average to reach independence in activities of daily living and ambulation. This behavior is found to be present primarily in patients with right hemispheric lesions centered in the area of the posterolateral thalamus. Patients with this disorder misperceive body orientation in space, believing that the upright position is approximately 18°t ilted toward the ipsilesional side. This could be the result of 'graviceptive neglect' of signals originating in the contralesional trunk and pelvis. The ability to use visual information for the correction of body posture continues to exist in this population, allowing for the use of visual cues and cognitive strategies as potential rehabilitation tools.

Usefulness of a standing frame to improve contraversive pushing in a patient post-stroke in inpatient rehabilitation

“…The premise of use of the SF in this manner is based on previous studies encouraging upright posture and verticality as an emphasis of treatment. 12,13 In 2004, Roller identified a preserved ability in patients with CoP to align the body to vertical using visual cues from the environment, and this can be utilized to improve orientation to midline. 12 In addition, a previous case series reported positive results from a Lokomat 14 (which, like the SF, passively places the patient in midline).…”

“…12,13 In 2004, Roller identified a preserved ability in patients with CoP to align the body to vertical using visual cues from the environment, and this can be utilized to improve orientation to midline. 12 In addition, a previous case series reported positive results from a Lokomat 14 (which, like the SF, passively places the patient in midline). Additionally, Wong et al found a positive effect of supported standing on stance symmetry in the hemiplegic population.…”

Therapeutic approaches for pusher syndrome after a stroke: a literature review

“…transfers, which hamper the rehabilitation process. 4 Additionally, these patients also require a much longer time to regain functional independence. 1,8 Pedersen et al 8 reported that patients with pusher syndrome need almost 3.6 weeks longer to reach the same levels of outcome than those without the syndrome.…”

“…[1][2][3] In an attempt to compensate this postural imbalance, these patients usually shift their body weight across the midline, away from the paretic side, and onto their nonparetic side. 4 However, in 1985, Davies reported the behavior of a group of stroke patients who used their non-paretic extremities to push actively towards the paretic side and resist any effort at passive correction of their tilted posture. 5 If left unsupported, these patients can continue to push themselves laterally until they experience a loss of postural balance, where they would fall on their paretic side.…”

Abnormal bias in subjective vertical perception in a post-stroke astasia patient

“…This symptom can be observed in post-stroke patients who have experienced thalamic hemorrhage or ischemia1,2,3 ) , and it is frequently accompanied by falling toward the contralesional side without exhibiting pushing behavior, which is a tendency to actively push away from the ipsilesional side4 ) . It has been reported that symptoms of astasia tend to spontaneously disappear several days after stroke onset1,2,3 ) .…”