Pusher Syndrome

Question 1

What are the other names for Pusher Syndrome?

Answer 1

• Contraversive pushing
• Ipsilateral pushing
• Lateropulsion

Question 2

What is Pusher Syndrome?

Answer 2

• Patient thinks they are tilted toward side of lesion so they push to the opposite side (toward hemiporatic side)
• Resistance to passive correction
• Patient often unaware of pushing behavior (when you push against them, they push back)

Question 3

How is Pusher Syndrome presentation different from typical patients post stroke?

Answer 3

Pusher: Leans TOWARD bad side.

Question 4

How is Pusher Syndrome presentation similar to typical patients post stroke?

Answer 4

• Often have sensory impairments
• Can have spatial orientation impairments

Question 5

What is damaged to cause Pusher Syndrome?

Answer 5

• Unknown
• Could be: lesion in the posterolateral thalamus
  
  • Involved in perception of vertical upright posture
• NO IMPAIRMENT of visual world

Question 6

How many degrees are these patients usually off?

Answer 6

18 degrees toward ipsilesional side (toward hemiperotic side)

Question 7

How do you treat patients with Pusher Syndrome?

Answer 7

1. Help them realize they are pushing
2. Help them orient to upright things around the,
3. Learn movements necessary to reah vertical position
4. Maintain vertical body position while performing other activities

Question 8

How can you help patients realize posture? What cues do you give?

Answer 8

• Using a mirror to see what they look like - right to vertical
• Can have them right to different objects.
• Video them
• Ask him “are you sitting up right? Can you sit up for me?”
• Cue them to sit up

Question 9

How can you help patients visually explore/right to things around them?

Answer 9

• Vertical tape on the wall, have them realign himself to it (ex: tape, our arms, door frame, corner of a room, other people, IV poles
• Cue
• Use mirror
• Directly point it out

Question 10

How can you help patients correct posture?

Answer 10

• Sitting
  
  • Wall on opposite side (Target lean)
  • While sitting, bring arm to other side and lean on elbow (ex: left side effected, lean on right elbow)
  • After good balance, working on weight shifting
  • If he shifts to left, shift to right then back to mid line (ex: go to the red tape, go back to the blue tape)
  • Targets out of base of support
• In Standing
  
  • Patient will push harder than you, may knock you over
  • Raise mat to do progressive standing
• How to make sit <-> stand easier
  
  • Could put uninvolved leg on a slight step stool (so they are uneven) - work on mini squats. This helps them not work so hard.

Question 11

How do you teach the family to transfer a patient with Pusher Syndrome?

Answer 11

Scoot pivot to impaired side

(easier for those untrained)

Question 12

How do you work on transfers in PT with a patient with Pusher Syndrome?

Answer 12

• Transferring toward sound side
• Can transfer to the end of the mat and have the scoot toward the pillows, leaning to the side that we want him to (sound side)

Question 13

How can you help patients improve function in posture?

Answer 13

• Good start: brushing teeth in front on mirror
  
  • Is unilateral
  • Sitting in BOS
  • Done with dominant arm, no pushing
• Lean to side to put on shoes
• Leaning to side to put on jacket

Question 14

How do you work on gait trainging with a patient with Pusher Syndrome?

Answer 14

Hold their hands while they walk (no device) → tend to push less