Pusher Syndrome Flashcards
what three characteristics of pushing must ALL be present to qualify someone as a “pusher”
Spontaneous body posture
ABD and extension of non-paretic extremities
Resistance to passive correction
should be assess in both sitting and standing
which direction do pushers push towards
involved/hemiparetic side
true or false: pushers FALL to the hemiparetic side?
false! they actively push themselves over
are the following sites common or uncommon lesion sites for pushers syndrome?
L and R posterolateral thalamus
Ventral posterior and lateral nucleus
common
the uncommon are
- insular cortex
- post central gyrus
- ACA territory
do pushers have a normal perception of visual vertical?
yes! They can drop a plumb line just fine
true or false: pts who push do not align their body w/ visual vertical OR perceived postural vertical
true!
with eyes closed, when do pushers feel they are “upright”
tilted 18 degrees towards the side with the lesion (non-involved side)
they attempt to correct posture towards upright
spontaneous body posture is defined as what?
longitudinal body axis tilted toward the paretic side
how would you document someone with spontaneous posture?
severe, moderate or mild tilt
falling?
if falling “falling to the side contralateral to lesion”
Hand Elbow Leg hip knee
are all doing what on the non-involved side?
hand: ABD Elbow: extended Leg: ABD Hip: extended Knee: extended
how do you document ABD and extension of limbs?
spontaneous (more severe) or only in response to movement
Active resistance to movement towards which side
the NON-hemiparetic side
true or false: often this population has a longer stay in acute rehab
true!
they are also less likely to be discharged home from rehab
true or false: 6 months post stroke, evidence of pusher syndrome is rarely present?
true!
true or false: pusher syndrome negatively impacts long term outcome of rehab
false! They are likely to make the same recovery as someone who does not push
Compare and contrast L and R hemisphere damage when it comes to the following things
Time to recovery
LE weakness
Functional recovery
Time to recovery: L hemisphere damage faster
LE weakness: R hemisphere damage weaker
Functional recovery: L hemisphere damage better
REMEMBER YOURE TALKING ABOUT HEMISPHERE SIDE HERE SO THE AFFECTED BODY SIDE IS THE OPPOSITE
Overall would you expect someone with R or L hemiparesis to recover more optimally?
R hemiparesis because that is L hemisphere damage which has more optimal recovery
true or false: the more impairments you have on top of pusher syndrome and motor impairment the worse the prognosis?
true!
true or false: pts with pusher syndrome are more resource intensive?
true:
early identification is key!
need to be able to measure change!
what are the three things you want to make sure you’re doing documentation wise when you have a pusher?
identify: presence of syndrome
quantify: severity of presentation
evaluate: effectiveness of interventions
Scale for contraversive pushing (SCP) is comprised of what three sections?
spontaneous body posture
extension/ABD of nonaffected extremities
resistance to passive correction
Burke Lateropulsion Scale (BLS) measures what?
if resistance is present during correction of posture, how much and when the resistance began.
what does BLS assess mobility wise
rolling, sitting, standing, transfers, walking
what is the preferred measuring tool for pushing?
BLS! has good sensitivity and responsive to measuring progress
what is the cut off score for BLS
> or = to 3