Pusher Syndrome

Question 1

O que é o pusher syndrome?

Answer 1

Characterized by leaning and active pushing toward the hemiplegic side with no compensation for the instability and resistance to passive correction toward midline.
Perception of body posture in relation to gravity is altered resulting in actively pushing toward the involved side with the uninvolved side.
Processing is not disturbed by the visual andvestibular systems.

Question 2

O pusher syndrome está normalmente associado a que outras situações clínicas?

Answer 2

Commonly associated with:
– Aphasia when seen with left sided lesions;
– Neglect when seen with right sided lesions.

Question 3

O que caracteriza este síndrome?

Answer 3

• Active pushing makes it distinguishable from thalamic astasia and Wallenberg’s syndrome.
• Patients are able to maintain correct head orientation in presence of severe lean (Distinguishes them from patients with vestibular cortex lesions).
• Area of brain damaged is the left or right posterolateral thalamus.
• Patients feel they are upright when tilted about 18 degrees to the side of the lesion.
• Disturbed neural representation of the truncal graviceptive system.
• Focus of treatment on visual upright using the environment (visual cues and visual and vestibular inputs.

Question 4

O que caracteriza a Thalamic Asthasia e o Wallenberg’s syndrome?

Answer 4

– Thalamic astasia is characterized by falling backwards, truncal instability and the patient reaches to pull themselves up.
– Wallenberg’s syndrome patient falls to weak side.

Question 5

Que ferramenta poderá ajudar a avaliar o pushing syndrome?

Answer 5

Clinical Assessment Scale for Contraversive Pushing (SCP).
• Uses 3 variables to diagnose the occurrence of pushing syndrome, its severity and to show improvement.
• 3 variables measured in sitting and standing: Symmetry of spontaneous body posture; Abduction and extension of the nonparetic extremities; Resistance to passive correction of tilted posture.