The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지

Neurophysiological and Clinical Features of the Pusher Syndrome: Review Article

  • Kim, Chung-Sun (Department of Physical Therapy, College of Rehabilitation, Daegu University) ;
  • Nam, Seok-Hyun (Department of Rehabilitation Science, Graduate School, Daegu University)
  • Received : 2010.05.07
  • Accepted : 2010.06.11
  • Published : 2010.06.25
Download PDF
⟨ Previous Next ⟩

Abstract

Patients with the pusher syndrome show severe misperception of their own upright body orientation although visual vestibular processing is almost intact. They recognize their body as oriented upright when it is actually tilted nearly 20 degrees to the affected side. These patients resist any attempts to passively correct their tilted body posture towards an earth vertical upright orientation. They use the non-affected side arm and/or leg to actively push towards the affected side. Pusher syndrome patients have different prognoses and symptoms than general stroke patients without pusher syndrome. Pusher syndrome patients have a poor prognosis, so they need a long duration of treatment. Therefore, accurate diagnosis and proper treatment are important. In this study, we reviewed the symptoms, causes, evaluation, and treatment for pusher syndrome.

Keywords

References

  1. Mittelstaedt H. Somatic versus vestibular gravity reception in man. Ann N Y Acad Sci. 1992;656:124-39. https://doi.org/10.1111/j.1749-6632.1992.tb25204.x
  2. Mergner T, Rosemeier T. Interaction of vestibular, somatosensory and visual signals for postural control and motion perception under terrestrial and microgravity conditions--a conceptual model. Brain Res Brain Res Rev. 1998;28(1-2): 118-35. https://doi.org/10.1016/S0165-0173(98)00032-0
  3. Kavounoudias A, Roll R, Roll JP. Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation. J Physiol. 2001;532(Pt 3):869-78. https://doi.org/10.1111/j.1469-7793.2001.0869e.x
  4. Spinazzola L, Cubelli R, Della Sala S. Impairments of trunk movements following left or right hemisphere lesions: Dissociation between apraxic errors and postural instability. Brain. 2003;126(Pt 12):2656-66. https://doi.org/10.1093/brain/awg266
  5. Karnath HO, Broetz D. Understanding and treating "Pusher syndrome". Phys Ther. 2003;83(12):1119-25.
  6. Karnath HO, Ferber S, Dichgans J. The origin of contraversive pushing: Evidence for a second graviceptive system in humans. Neurology. 2000;55(9):1298-304. https://doi.org/10.1212/WNL.55.9.1298
  7. Pedersen PM, Wandel A, Jorgensen HS et al. Ipsilateral pushing in stroke: Incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The copenhagen stroke study. Arch Phys Med Rehabil. 1996;77(1):25-8. https://doi.org/10.1016/S0003-9993(96)90215-4
  8. Danells CJ, Black SE, Gladstone DJ et al. Poststroke "Pushing": Natural history and relationship to motor and functional recovery. Stroke. 2004;35(12):2873-8. https://doi.org/10.1161/01.STR.0000147724.83468.18
  9. Taylor D, Ashburn A, Ward C. Asymmetrical trunk posture, unilateral neglect and motor performane following stroke. Clin Rehabil. 1994;8:6.
  10. Trombly C. Clinical practice guidelines for post-stroke rehabilitation and occupational therapy practice. Am J Occup Ther. 1995;49(7):711-4. https://doi.org/10.5014/ajot.49.7.711
  11. Brown JA. Recovery of motor function after stroke. Prog Brain Res. 2006;157:223-8. https://doi.org/10.1016/S0079-6123(06)57015-3
  12. Johannsen L, Broetz D, Karnath HO. Leg orientation as a clinical sign for pusher syndrome. BMC Neurol. 2006;6:30. https://doi.org/10.1186/1471-2377-6-30
  13. Karnath HO, Johannsen L, Broetz D et al. Posterior thalamic hemorrhage induces "Pusher syndrome". Neurology. 2005; 64(6):1014-9.
  14. Pontelli TE, Pontes-Neto OM, Colafemina JF et al. Posture control in pusher syndrome: Influence of lateral semicircular canals. Braz J Otorhinolaryngol. 2005;71(4):448-52. https://doi.org/10.1016/S1808-8694(15)31197-6
  15. Paci M, Nannetti L. Physiotherapy for pusher behaviour in a patient with post-stroke hemiplegia. J Rehabil Med. 2004; 36(4):183-5. https://doi.org/10.1080/16501970410029762
  16. Kwon MJ. Daily physical functioning and quality of life for stroke. J Kor Soc Phys Ther. 2007;19(5):87-96.
  17. Kim JS, Jang JS. A reliability study of the scale for contraversive pushing in stroke patients. J Kor Soc Phys Ther. 2009;21(4):31-6.
  18. Baccini M, Paci M, Rinaldi LA. The scale for contraversive pushing: A reliability and validity study. Neurorehabil Neural Repair. 2006;20(4):468-72. https://doi.org/10.1177/1545968306291849
  19. Davies PM. Steps to follow: A guide to the treatment of adulthemiplegia. New York, Springer, 1985.