Pusher syndrome andUnilateral Neglect

Question 1

What is Pusher Syndrome?

Answer 1

A motor behavior characterized by active pushing with the stronger extremities towards the hemiparetic side, resulting in a tendency to fall towards the hemiparetic side.

Question 2

What is Unilateral Neglect?

Answer 2

A failure to report, respond, or orient to stimuli in contralesional space after brain injury, not explained by primary sensory or motor deficit.

Question 3

.

Answer 3

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Question 4

What percentage of stroke patients experience Pusher Syndrome?

Answer 4

10% of stroke patients.

Question 5

What is the typical lesion location associated with Pusher Syndrome?

Answer 5

• Posterolateral thalamus
• More common with right-sided CVA lesions

Question 6

What are the characteristics of Pusher Syndrome?

Answer 6

Patients push towards the hemiplegic side, have difficulty with transfers, independent sitting, standing, and walking, and resist correction of their tilted posture.

Question 7

How does Pusher Syndrome affect transfers and mobility?

Answer 7

Patients have difficulty transferring to the less affected side and with independent sitting, standing, and walking.

Question 8

What is the altered perception in Pusher Syndrome?

Answer 8

Patients have an altered perception of their body’s orientation in relation to gravity, perceiving their body as vertical when it is actually tilted about 20 degrees toward the hemiparetic side.

Question 9

What is the significance of subjective visual vertical in Pusher Syndrome?

Answer 9

Subjective visual vertical remains intact, implying that visual and vestibular inputs are intact.

Question 10

What are the key aspects to note during the examination of Pusher Syndrome?

Answer 10

Extent of pushing behavior, use of pusher-specific tools like the Clinical Assessment Scale for Contraversive Pushing (SCP).

Question 11

Describe the Clinical Assessment Scale for Contraversive Pushing (SCP).

Answer 11

It assesses spontaneous body posture, pushing force by the less involved extremities, and resistance to passive correction of posture in sitting and standing positions.

Question 12

What are the criteria assessed by SCP?

Answer 12

Spontaneous body posture tilting towards the more paretic side, increased pushing force by less involved extremities, and resistance to passive correction of posture.

Question 13

What are the main goals in treating Pusher Syndrome?

Answer 13

To enable the patient to realize the disturbed perception of their body position and to practice movements to reach a vertical body position.

Question 14

What strategies are used to help patients realize their disturbed perception?

Answer 14

Visual exploration of surroundings, use of reference points like the therapist’s arm or vertical structures, and practicing movements to reach a vertical position.

Question 15

How can visual exploration help in the treatment of Pusher Syndrome?

Answer 15

It helps patients see whether they are oriented upright and use visual reference points to correct their posture.

Question 16

Describe the use of mirrors and reference points in treating Pusher Syndrome.

Answer 16

Mirrors with vertical tapes and reference points like door frames or windows can help patients align themselves correctly.

Question 17

What functional activities can be practiced to maintain a vertical body position?

Answer 17

Functional activities such as reaching for objects on the nonparetic side, maintaining correct posture during tasks, and using a shorter cane or lower parallel bars.

Question 18

What are the common terms for Unilateral Neglect?

Answer 18

• hemi-inattention
• hemi-neglect
• visual inattention

Question 19

What is the typical lesion location associated with Unilateral Neglect?

Answer 19

Inferior posterior regions of the right parietal lobe.

Question 20

Describe the different types of neglect in terms of personal, peripersonal, and extrapersonal space.

Answer 20

• personal space pertains to the body
• peripersonal space is within arm’s distance
• extrapersonal space is beyond arm’s distance

Question 21

What percentage of stroke survivors experience neglect?

Answer 21

30% of stroke survivors, with 50% of right hemispheric lesions leading to left neglect.

Question 22

Describe the Behavioral Inattention Test (BIT).

Answer 22

A commonly used test for neglect that includes 9 behavioral subtests like picture scanning, telephone dialing, menu reading, and more.

Question 23

What are the subtests included in the BIT?

Answer 23

Picture scanning, telephone dialing, menu reading, article reading, telling and setting time, coin sorting, address and sentence copying, map navigation, card sorting.

Question 24

What are the traditional treatment approaches for Unilateral Neglect?

Answer 24

Cueing, cueing, cueing; general cognitive training does not help and must be specific to neglect.

Question 25

What are the new concepts in treating Unilateral Neglect?

Answer 25

• prism glasses
• eye patching
• virtual reality/computer training

Question 26

Describe the use of prism glasses in treating Unilateral Neglect.

Answer 26

Prism glasses skew the visual field 10 to 20 degrees to the non-neglected side, forcing the brain to reconcile the discrepancy between visual and kinesthetic information.

Question 27

How does eye patching work for Unilateral Neglect?

Answer 27

Eye patching obstructs the right hemifield of both eyes, selectively activating the right hemisphere and rebalancing the hemispheres.

Question 28

What is the role of virtual reality/computer simulation in treating Unilateral Neglect?

Answer 28

It creates a mismatch between what is seen on screen and actual movement, helping the brain adjust and improve neglect.

Question 29

Describe the use of TENS in treating Unilateral Neglect.

Answer 29

Transcutaneous electrical nerve stimulation (TENS) on the hemiplegic side over posterior cervical musculature can temporarily correct neglect by stimulating the sensory cortex.

Question 30

What are compensatory approaches for managing everyday activities with Unilateral Neglect?

Answer 30

Placing essential items on the less affected side, using visual cues like red ribbons when reading, and using mirrors during dressing or ambulating to draw attention to the neglected side.