Week 3 Pusher Syndrome

Question 1

in what patients do we see pusher syndrome

Answer 1

in those with right or left hemisphere lesions

Question 2

TF: there is evidence that co- occurrence of spatial neglect, anosognosia, aphasia and apraxia occur with pusher syndrome

Answer 2

false, there is no evidence

Question 3

TF: neglect and aphasia are the underlying cause of pusher syndrome

Answer 3

false

Question 4

neglect is highly associated with pushing after ___ hemisphere damage

Answer 4

right

Question 5

aphasia is highly associated with pushing after ____ hemisphere damage

Answer 5

left

Question 6

pusher syndrome is significantly higher in those with _(right or left)___ CVA

Answer 6

right

Question 7

in pusher syndrome, the patient will push onto the affected or unaffected side

Answer 7

affected

Question 8

pusher syndrome is associated with damage to the

Answer 8

posteriolateral thalamus

Question 9

what does the posteriolateral thalamus do

Answer 9

involved in control of upright body posture.

Question 10

lesions of the thalamic nuclei are found to be affected in those with

Answer 10

CP

Question 11

what role does the posteriolateral thalamus play in vision

Answer 11

provides information about movement and cues for judging upright posture

Question 12

what role does the posteriolateral thalamus play in vestibular

Answer 12

informs the person about head position relative to gravity and about head movements

Question 13

what role does the posteriolateral thalamus play in somatosensation

Answer 13

provides information about weight bearing and relative position of the body parts.

Question 14

are visual and vestibular processing disturbed in pusher syndrome

Answer 14

no, you may have a lesion of the vestibular cortex and have a tilt perceived as vertical, but this does not cause controversies pushing.

Question 15

Pusher syndrome is a problem integrating

Answer 15

visual and vestibular information

Question 16

TF: people with controversies pushing feel their COM is too far to one side, the uninvolved side, so they push themselves onto the involved side

Answer 16

true

Question 17

what is graviception

Answer 17

perception of the body position equilibrium and direction of gravitational forces.

Question 18

pusher syndrome is a ___ of subjective postural vertical

Answer 18

distortion

Question 19

how does alignment to vertical change in people with pushers syndrome

Answer 19

eyes closed, they may think they are vertical when they are leaning. eyes open, they can use visual cues to be upright

Question 20

what is the conflict with pusher syndrome

Answer 20

there is a mismatch between the visual and postural vertical.

Question 21

what is the prognosis of pusher syndrome

Answer 21

evident up to 6 months, slows the progress. will take about 3.6 weeks longer to get the same functional outcomes,

Question 22

TF: pushing can be well compensated by the brain

Answer 22

true

Question 23

TF: pusher syndrome is significantly worse in people with Right CVA

Answer 23

true

Question 24

what does pusher syndrome mean for LOS

Answer 24

its longer, the length of stay

Question 25

what scales can we use for pusher syndrome, and what are they all about

Answer 25

SCP: scale for contraversive pushing
Modified SCP: 4 test conditions.
Burke Lateropulsion scale (BLS)

Question 26

what are the four conditions of the modified SCP scale

Answer 26

1. static sitting at bedside, feet on the floor
2. static standing with full erect posture
3. transferring from bed to chair or WC with squat pivot
4. transferring from bed to chair with stand pivot

Question 27

what does the BLS look at

Answer 27

postural alignment and degree of resistance when moving the patient passively in supine, sitting, standing, transfer and walking. a lower score is worse.

Question 28

what is the recommended measure for pushing

Answer 28

BLS, because there are several functional tasks, and it was written in English and it is reliable and responsive

Question 29

in what positions should we treat

Answer 29

earth vertical positions (sitting standing or walking)

Question 30

TF: we want to allow pushing to occur

Answer 30

true, we want them to know what it feels like to fall

Question 31

what do we want to make patients aware of

Answer 31

the vertical position, and if they are tilted, can they tell they are not upright?

Question 32

how can we teach them to use their environment

Answer 32

explore the surroundings, and look at things like poles and doors to help orient them.

Question 33

which is more effective? computer or mirror feedback

Answer 33

computer, interactive and addresses upright positions and body shifting to limits of stability

Question 34

overall what 6 things should we include in treatment for pusher

Answer 34

awareness of dysfunction 
earth vertical positions 
link visual input with reality 
involve visual stimuli 
relearning movements to maintain vertical
functional tasks

Question 35

what is a great way to block an unwanted movement

Answer 35

give them a glass of water to hold in their hand, or a task, so they cannot push

Question 36

is pusher syndrome recoverable

Answer 36

yes, but at a much slower rate