Pushers syndrome

A clinical disorder where patients actively A lesion in the vestibular cortex does often lead

push away from the non -

www.panetic side , to a tilt of the perceived visual vertical , but

leading to a ton of postural balance . not to contravenesine pushing .

" "
falling sensation
←
Patient's that their Mechanisms heading to pusher syndrome
penciene
Kamath 120001 examined the ability of patients
body posture in relation to
gravity
is altered
'
to determine upright position in
.

They experience upright a sealing

'

orientation when the body is device

allowing timing of the
patient .

patients with Ps experienced their body

→
tilted to the ipsileisonaln.de
④ ⑧ as
upright at 18 degree tilt towards the

Hallett ~
101 .
of stroke survivors ,
and occurs side of the lesion .

with equal frequency in with left →

They had disturbed orientation perception
patients no

and right brain damage : 471 . vs 53% of the visual world .

ie
they could align

respectively . themselves with visual clues .

Pusher's show a normal

perception of usual Under normal beside conditions ,
patient's with Ps

but do not align their body visual vertical ,

vertical ,
they exhibit a severe tilt of perciened with the

body posture in relation to gravity . perceived postural vertical or immediate posture .

Instead moving their body in opposite direction .

Pathophysiology
Although controversial
pushing within patients By pwning longitudinal body axis towards

with right -
side lesions were highly associated the control himat side ,
may be
trying to

with compensate for the mismatch between visual vertical

spatial neglect , neglect nutty
-

was

tilted orientation at the

cake of the
pushing behaviour .
and the
body verticality .

Patients with left side brain damage this is supported by the observation that
-
snowed patients
with PS diminish their behaviour, with
no symptoms of neglect , but rather had
aphasia , pushing
their eyes closed
°

Right -

side brain damage

-

neglect
.

°
left -
side brain damage -

aphasia
Balan U

Whilst there are not

causally related to
pushing , Pushing behaviour may be a
secondary response
the relevant brain structures amounted with these to the patient 's unexpected experience that

functions lie in Uwe anatomical proximity .

they use lateral balance , as the center of
man is shifted too far to the ipsi lesionat side .

Damage to the patients are unable to me the visual input to

posterolaleral thalamus untrue upright body posture .

is involved in our No
purring occurs when patients sit immobilised

by lateral stabilisation
control of upright
.

posture .

Non pantie Extremities

-

Traditionally , the posterdaterat thalamus Patient's with PS me their non

-

pantie extremities to

Unni derned of
'

bring about the lateral tilt

'
structure the
was as the relay body axis .

for the vestibular

pathway
-

brainstem : cortex .
 ①
Ipsi lesionat hand abducted
-

Patients can be successfully retrained to

② Ipsi lesionat elbow extended -

me their structured
surroundings to
identify
③ Ipsi lesionat leg abducted -

that they're not in an erect

position .

④ Ipsilesional kneel hip extended -

the experience of not falling after attaining the

Resistance to panine correction unreeled position ,

combined with
seeing themselves

Any attempt by the examiner to move the tilted upright increases confidence , and lowers the

body axis to an upright position by shifting the extent 1 presence of the reaction to abduct 1 extend .

weight towards me nmparetic side , elicits active

resistance from the patient .

fsi
1
Only need
Diagnosis →
3 variables important for
diagnosis :

I
spontaneous body posture position
-

2-
Increase at of
pushing force by me non panelic
-

extremities away from the body

} -
resistance to panine correction
Mirrors

can be analysed wing : clinical scale for .

cognitively intact

contravenes ive pushing LSCPI .

.

learn from it

on feet 1 waiting when pushing

'

3 intensities
.

i
-
external , extrinsic cue ,
consider intrinsic wheat
1
severe contravenesive hit with
falling the side
-

to

contralateral to the brain lesion

'

Homionopia I neglect may impact ability

2 severe contravenesive hit without
falling using visuals to re orientate this then
-

remove
.
-
. . .

3- mild contravenes ive hit without

falling pushing returns

Prognosis """

Patients with PS have a more severely impaired smaller Bos , worse

pushing ]
level of consciousness and ability to wave ,
paresis may push tying down it serene

of UL ILL and initial lower function in ADLS .

push with head I push backwards ( Atp )
'

abnormal movement '

busy I unstable
It is well compensated by brain nmpoinehc
→
the .
arm

6 ↳
months after a stroke ,
pamovoqn.cat pushing feels different to the 1 but rigid e active

behaviour is rarely still evident .

impaired T Bos for

Patients More
retraining
=
take on average 3.6 weeks
longer man

patient's without push comes back as

you to Bos
pusher syndrome to reach the .

same functional level →

treat intact side first !
weight transfer
pioneering
-

Treatment stability sitting standing

}
-

'
Patients SHOULD NOT be treated in a horizontal -
active midline perm

position . but in an earth vertical position .

Never push back on patient who has PS parietal

/
.

0 MCA common stroke site ps

¥T ¥
-

Thalamic