Lateropulsion (Pusher Syndrome)

Question 1

What is Pusher syndrome?

Answer 1

Patient is pushing away from the non-hemiparetic side

“This occurs due to the patient receive bad info from the brain about verticality”

Question 2

Is it better for the PT to actively or passively correct patient with Pusher Syndrome? Why?

Answer 2

Patient should actively correct. If PT tries to actively orient them to midline, pt will increase the amount of pushing

Question 3

Why do patient Push?

Answer 3

1. Impaired sense of vertical
2. Shift in personal perception of midline
3. impaired sensation on hemiplegic side
4. overcompensation for hemiplegia

Question 4

What is the brain stucture linked to Pusher syndrome?

Answer 4

Posterolateral thalamus

Question 5

Pusher syndrome is also associated with what type of conditions?

Answer 5

severe stroke

Question 6

How early should the PT work on reestablishing midline for PT with Pusher syndrome?

Answer 6

As soon as possible. The faster the reintegration of midline, the better the outcome.

Question 7

What are the clinical presentation of Pusher Syndrome?

Answer 7

1. Impairment in verticality perception
2. Altered sense of midline
3. Fear of movement

Question 8

What other systems should be considered when treating patient witih Pusher Syndrome?

Answer 8

visual: most imp’t. it may be affected with a stroke so screen.

Vestibular: check to see if patient gets dizzy with head movements. Typically it is ok.

Question 9

Initial Outcome of Intervention includes

Answer 9

1. Pt regaining normal sense of midline/verticality
2. Reinitiate use of visual cues to orient themselves
3. Position of head/trunk is key

Question 10

Where should the patient start with treatment intervention?

Answer 10

start at the lowest functional level behavior

e.g. sitting, standing, ambulation

Question 11

How should the environment be when treating a patient with Pusher syndrome?

Answer 11

1. Remove pushing surface
2. Objects you want them to move toward

Question 12

How to design an intervention for Pusher Syndrome?

Answer 12

1. work laterally then anteriorly
2. Make patient feel safe
3. Provide KP, KR, visual and manual feedback
4. Monitor patient’s tendency to push with UE/LE (position limbs to minimize)
5. Transition to functional tasks

remember to consider:

1. use of WC
2. AD
3. maximize sensory input on more affected side with T-band/wrapping, mirror