Pusher Syndrome Flashcards
1
Q
big things to know
A
- at risk for falls
- assess during eval
- awareness training
2
Q
definition
A
distortion of perception of postural vertical
- person who pushes actively toward the hemiplegic side, leading to loss of postural balance
- after R and L CVA (more common in R)
3
Q
typical presentation
A
- attempts to transfer weight to affected side (pushing with stronger arm)
- elongated affected side
- head turned away from affected side
- flat affect
- poor breath control, monotone
4
Q
evaluation
A
2 tests:
- clinical scale for contraversive pushing (SCP) - most commonly used
- burke lateropulsion scale (BLS) - better for detecting mild impairment and change over time
5
Q
clinical scale for contraversive pushing (SCP)
A
9 point scale that rates 3 areas:
- symmetry of spontaneous body posture
- use of non paretic extremities to push by abduction and extension thrust
- resistance to passive correction of tilted posture
postures: sitting and standing
6
Q
burke lateropulsion scale (BLS)
A
17 point scale that assesses the degree of action of the patient to keep or change a position 5 testing positions: - supine rolling - sitting - transferring - standing - walking
7
Q
cause of pusher syndrome
A
- largely unknown
- no significant association with visual disruption, side of stroke, neglect, anosognosia
likely due to impairment of perception of body posture in relation to gravity (graviception)
8
Q
what is needed for upright postural control?
A
- vision
- vestibular sense
- somatosensation
9
Q
graviceptive neglect
A
disruption in the processing of somesthetic information in the L side which could be extinction phenomenon
10
Q
impact on rehab potential
A
in early stages of recovery, more severe deficits overall
6mo later nearly complete recovery
L CVA recover faster than R
11
Q
treatment techniques
A
- awareness - safely experience the fall
- self correction - no hands on, use verbal cues, positive reinforcement
- practice weight shifts toward strong side in functional context
