Pusher Syndrome in stroke patients. The current state of knowledge on assessment and physiotherapy
Journal Title: Rehabilitacja Medyczna - Year 2013, Vol 17, Issue 4
Abstract
Introduction: Pusher Syndrome is a result of damage to the central nervous system manifesting itself as a postural disturbance, whereby the patient in every position pushes himself away in the direction of the paresis and actively resists any attempts towards passive correction of posture. Such behaviour results in the body being position being established according to its own distorted sense of verticality.Aim: The review of literature dedicated to the symptoms, research and physiotherapy conducted within pusher syndrome.Methods: A review of studies published within the following electronic databases: Scopus, Embase, Pubmed/Medline, PeDro, Cochrane, ProQuest for the period from 01.01.2002 to 13.09.2013. Results: Results of research and publications on the subject of Pusher Syndrome appear only occasionally. The subjects of such research are: examination methods, searching for neurophysiological explanations of the Pusher Syndrome and its concurrence with other neurological disorders. Physiotherapy with clear practical implications is rarely the subject of research. The state of knowledge on the matter of the effectiveness of physiotherapy in Pusher Syndrome is based chiefly on narrative reviews as well as on case study reports. Their analysis points to an approach to be adopted as regards the rehabilitation of this group of patients which is based on the principle of motor learning with the use of visual cues as well as proceedings blocking the possibility to push away with limbs that are indirectly involved (limbs on the opposite side to the paresis are referred to as directly involved) in all positions the patient assumes.Conclusions: There is limited literature available regarding physiotherapy methods used in PS. Existing knowledge is primarily based on observational studies and case reports which provide low evidence (grade III) for clinical practice. The analysis of 9 publications with high risk of bias showed that physiotherapists apply: positioning, principles of motor learning, using visual cues, galvanic vestibular stimulation, robot assisted gait therapy and methods of preventing the possibility for a pushing away with indirectly involved limbs. Most of the included studies promote the same scheme of treatment approach for patients with PS, described in four main points (A-D) in section Physiotherapy treatment of the article.
Authors and Affiliations
Agnieszka Śliwka, Rafał Piliński
Keywords
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