Pusher's Syndrome Flashcards
Pusher syndrome: define
The patient leans towards the hemiplegic side in any posture and resists any attempt at passive correction of posture that would move his / her weight towards or across the midline of the body toward the non-affected side’
incidence
present in more severe stroke evenly divided R+L side greater deficit in those with - neglect mobility/ motor sensory than non pushers \+/- dysphagia/ incontinence/ aphasia
mechanism
Poorly understood
Altered perception of body’s orientation in relation to midline / gravity
No correlation with right sided stroke (i.e. L Hemi +/- UN)
Impairment in judging vertical - a change in the perception of midline of their body
causes
Damage to sensory pathways
Role of posterolateral thalamus
Disturbed neural representation of truncal graviceptive system
Cortical involvement
Insular, opercular as well as temporal regions are possibly involved in the control of upright body position.
Current research indicates that PS in right-hemispheric lesion patients depends on vestibular otolith input, suggesting a link between the system for postural control and the system responsible for processing vestibular otolith information.
Such close interaction would seem useful for processing in multisensory integration centers at the cortical level. (Baier et al 2011 J Neurol)
implications
Balance control (sitting, standing, walking)
Functional mobility
Recovery of ADL
Safety
clinical findings
Patient leans to hemi side
Resists any attempt to correct posture which moves bodyweight to midline / normal side
Apprehensive re leaning over / WB
Unable to accept weight through unaffected side (if able to WB, may WB on medial border of foot with adduction also)
Demonstrates resistance to passive / active movement toward midline / unaffected side
Over-activity unaffected side UL, LL, trunk
assessment
Diagnosis made by observation
Asymmetrical posture
Lack of midline sitting
Actively pushes to affected side
Verticality & sense of midline
Right / Left awareness
Visuo-spatial neglect
Attention to physical & perceptual deficits to enable appropriate management
management
Restore sense of verticality
Facilitate midline awareness
Balance training
Regain ability to move actively towards that side with visual cueing & feedback
Regain ability to move actively about in sitting & standing
physio
Observation based diagnosis.
No reliable measures.
Patient distressed when attempts made to move to normal side.
Preferable to lead patient to move actively to that side.
Balance retraining.
Visual feedback / actively move midline / normal side.
Positioning.
Sitting - small pillow under affected buttock.
Functional movements.
Mirror therapy.
recovery
- impacts on course of recovery
- impact on baalcne and trunk control
- delayed restoration of functional goals
research findings
Characteristics Prognosis ? Side of stroke Deficits Resolution 3.6 weeks Prolonged hospital stay Often associated with early discharge to nursing home/LTC Understanding Targeted rehabilitation
