25 Questions
What is the primary location of pathology associated with contraversive pushing?
Left or Right Posteriolateral thalamus
What is the primary underlying cause of pusher syndrome?
Distortion of subjective postural vertical
What is the prognosis for individuals with contraversive pushing?
The disorder is rarely still evident at 6 months
Which of the following systems is NOT associated with contraversive pushing?
Auditory system
What is the result of a mismatch between visual and postural vertical in contraversive pushing?
A distortion of subjective postural vertical
What is the primary goal of pushing behavior in contraversive pushing?
To compensate for a mismatch between visual and postural vertical
What is the average time it takes for patients with pusher syndrome to reach the same functional outcome as those without pusher syndrome?
3.6 weeks
What percentage of patients with pusher syndrome resolve at 3 months?
83%
What is the main goal of rehabilitation for patients with pusher syndrome?
To shorten rehabilitation time
What is the primary advantage of using the Burke Lateropulsion Scale (BLS)?
It is more reliable and responsive than other scales
What is the recommended approach to treating patients with pusher syndrome?
Treating in earth vertical positions and allowing pushing to occur
What is the primary function of the Clinical Scale for Contraversive Pushing (SCP) and the Modified SCP (M-SCP)?
To identify contraversive lateropulsion across several functional tasks
What is the primary goal of treatment for Pusher Syndrome?
To correct the patient's perception of their body position
What is the purpose of using a Nintendo Wii balance board in the treatment of Pusher Syndrome?
To address maintaining vertical body posture and rhythmic body shifting
What is the key to managing transfers in Pusher Syndrome patients?
Forward weight shift
What is the role of visual feedback in the treatment of Pusher Syndrome?
To link visual input to reality and facilitate motor learning
What is the purpose of using vertical structures in the treatment of Pusher Syndrome?
To help the patient see that they are or are not oriented upright
What type of visual feedback is more effective than mirror visual feedback training in the treatment of Pusher Syndrome?
Computer-generated interactive visual feedback
What is the effect of contraversive pushing on patient recovery?
It slows down recovery, but is still recoverable
What is the name of the syndrome characterized by contraversive pushing?
Pusher Syndrome
What is the impact of contraversive pushing on rehabilitation?
It negatively impacts rehabilitation
What is the term for the system that is thought to be responsible for contraversive pushing?
Second graviceptive system
What is the relationship between contraversive pushing and inattention of the contralesional hemispace?
They are closely linked
What is the focus of the study by Dannels et al. (2004)?
The natural history of contraversive pushing
What is the name of the study tool mentioned in the 2008 article by Baccini M et al.?
Scale for Contraversive Pushing
Study Notes
Contraversive Pushing (Pusher Syndrome)
- Observed in individuals with right or left hemisphere lesions, with no evidence of co-occurrence with spatial neglect, anosognosia, aphasia, or apraxia.
- Pusher syndrome incidence is significantly higher in those with right hemisphere CVA (cerebrovascular accident).
Anatomy and Pathology
- The posterolateral thalamus is fundamentally involved in the control of upright body posture and is associated with pusher syndrome.
- Lesions of thalamic nuclei are found to be affected in individuals with contraversive pushing.
- The posterolateral thalamus is involved in processing visual, vestibular, and somatosensory information.
Clinical Presentation
- Individuals with pusher syndrome exhibit a mismatch between their visual and postural vertical, leading to a distortion of their subjective postural vertical.
- They display a pushing behavior, which is an effort to compensate for this mismatch.
Prognosis
- Pusher syndrome does not affect functional outcomes, but it can slow down the rehabilitation process.
- Individuals with pusher syndrome require 3.6 weeks longer to reach the same functional outcome as those without pusher syndrome.
- At 3 months, 83% of patients with pusher syndrome have resolved, but motor recovery and function are significantly lower compared to non-pushers.
Assessment Scales
- Clinical Scale for Contraversive Pushing (SCP) and Modified SCP (M-SCP) are used to assess pusher syndrome.
- Burke Lateropulsion Scale (BLS) is another scale used to evaluate postural alignment and degree of resistance when moving the patient passively.
Treatment Strategies
- Treatment should focus on addressing the disturbed perception of erect body position.
- Exercises should be conducted in earth-vertical positions, and visual input should be linked to reality.
- Involve visual stimuli in motor learning, and relearn movements to achieve and maintain a vertical body position.
- Integrate treatment into functional tasks, and use activities such as vertical structures, active reaching, and forward weight shift to manage transfers.
Assess your knowledge of contraversive pushing, a disorder commonly seen in patients with right or left hemisphere lesions. Identify the clinical presentation, location of pathology, and treatment strategies for recovery. Test your understanding of this neuromuscular condition.
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