Keywords
Neurological Rehabilitation
Stroke
Mobility Limitation
How to Cite
Citações
Dimensions
Abstract
Introduction: Pusher syndrome is a little-known, but relatively frequent, postural disorder. It occurs when patients sitting or in an orthostatic position use the non-paretic limbs to push (push) towards the paretic side, which results in an inclined posture, resisting with the non-paretic side any attempt at postural correction. This is a challenge for Rehabilitation Nurses. The objective of this study is to identify the strategies to be used in Rehabilitation Nursing care for people with pusher syndrome after stroke.
Methodology: Integrative literature review, with narrative synthesis of 9 articles resulting from research in Medline and Web of Science.
Results: There is unanimity in terms of strategies to train people with pusher syndrome. These involve guiding the person towards their midline, using visual feedback strategies. Balance training, cross-facilitation and weight alternation exercises, lifting/sitting training with weight transfer to the unaffected side and transfer training with verbal guidance and the help of professionals, on both sides, are fundamental. The mirror is a frequent resource in the analyzed studies.
Conclusion: There is little evidence on the strategies to be used in the person with pusher syndrome. The use of assessment instruments, in addition to allowing the characterization of postural disturbance, will be decisive in the planning of care. The placement of a checkered mirror in the wards and/or bathrooms of the units/services is a fundamental resource.
References
Sociedade Portuguesa de Medicina Interna. O AVC é a principal causa de morte e incapacidade em Portugal [Internet]. 2021.
Lee JH, Kim SB, Lee KW, Lee JY. Somatosensory Findings of Pusher Syndrome in Stroke Patients. Ann Rehabil Med. 2013 Feb;37(1):88. Available from: https://doi.org/10.5535/arm.2013.37.1.88
Karnath H-O. Pusher Syndrome – a frequent but little-known disturbance of body orientation perception. J Neurol. 2007 Apr 25;254(4):415–24. Available from: https://doi.org/10.1007/s00415-006-0341-6
Davies PM, Bobath B, Bobath B. Steps to follow: a guide to the treatment of adult hemiplegia. Springer; 1985.
Cardoen S, Santens P. Posterior pusher syndrome: A report of two cases. Clin Neurol Neurosurg. 2010 May;112(4):347–9. Available from: https://doi.org/10.1016/j.clineuro.2009.12.007
Fukata K, Amimoto K, Inoue M, Shida K, Kurosawa S, Inoue M, et al. Effects of performing a lateral-reaching exercise while seated on a tilted surface for severe post-stroke pusher behavior: A case series. Top Stroke Rehabil. 2021 Nov 17;28(8):606–13. Available from: https://doi.org/10.1080/10749357.2020.1861718
Karnath H-O, Broetz D. Understanding and Treating “Pusher Syndrome.” Phys Ther. 2003 Dec 1;83(12):1119–25. Available from: https://doi.org/10.1093/ptj/83.12.1119
Abe H, Kondo T, Oouchida Y, Suzukamo Y, Fujiwara S, Izumi S-I. Prevalence and Length of Recovery of Pusher Syndrome Based on Cerebral Hemispheric Lesion Side in Patients With Acute Stroke. Stroke. 2012 Jun;43(6):1654–6. Available from: https://doi.org/10.1161/STROKEAHA.111.638379
Karnath H-O, Ferber S, Dichgans J. The origin of contraversive pushing: Evidence for a second graviceptive system in humans. Neurology. 2000 Nov 14;55(9):1298–304. Available from: https://doi.org/10.1212/WNL.55.9.1298
Pardo V, Galen S. Treatment interventions for pusher syndrome: A case series. NeuroRehabilitation. 2019 Feb 20;44(1):131–40. Available from: https://doi.org/10.3233/NRE-182549
Mota de Sousa LM, Furtado Firmino C, Alves Marques-Vieira CM, Silva Pedro Severino S, Castelão Figueira Carlos Pestana H. Revisões da literatura científica: tipos, métodos e aplicações em enfermagem. Rev Port Enferm Reabil. 2018 Jun 23;1(1):45–55. Available from: https://doi.org/10.33194/rper.2018.v1.n1.07.4391
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021;372. Available from: https://doi.org/10.1136/bmj.n71
Chen X-W, Lin C-H, Zheng H, Lin Z-L. A Chinese Patient with Pusher Syndrome and Unilateral Spatial Neglect Syndrome. Can J Neurol Sci / J Can des Sci Neurol. 2014 Jul 20;41(4):493–7. Available from: https://doi.org/10.1017/S0317167100018540
Zhang L, Zhang Q, Su Y, Zheng X, Zhang L, Chen S. A new treatment of Pusher syndrome based on central integration concept. Ann Phys Rehabil Med. 2018 Jul 2;61:e37. Available from: https://doi.org/10.1016/j.rehab.2018.05.082
Zhang Q, Zhang L, He W, Zheng X, Zhao Z, Li Y, et al. Case Report: Visual Deprivation in Pusher Syndrome Complicated by Hemispatial Neglect After Basal Ganglia Stroke. Front Neurol. 2021 Sep 22;12:706611. Available from: https://doi.org/10.3389/fneur.2021.706611
Broetz D, Johannsen L, Karnath H-O. Time course of ‘pusher syndrome’ under visual feedback treatment. Physiother Res Int. 2004 Aug;9(3):138–43. Available from: https://doi.org/10.1002/pri.314
Karnath H-O, Johannsen L, Broetz D, Ferber S, Dichgans J. Prognosis of contraversive pushing. J Neurol. 2002 Sep 1;249(9):1250–3. Available from: https://doi.org/10.1007/s00415-002-0824-z
Jang SH, Lee H Do. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient. Medicine (Baltimore). 2018 Jun;97(22):e10963. Available from: https://doi.org/10.1097/MD.0000000000010963
Yang Y-R, Chen Y-H, Chang H-C, Chan R-C, Wei S-H, Wang R-Y. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil. 2015 Oct 28;29(10):987–93. Available from: https://doi.org/10.1177/0269215514564898
Paci M, Nannetti L. Physiotherapy for pusher behaviour in a patient withpost?stroke hemiplegia. J Rehabil Med. 2004 Jul 1;36(4):183–5. Available from: https://doi.org/10.1080/16501970410029762
Chow E, Parkinson S, Jenkin J, Anderson A, King A, Maccanti H, et al. Reliability and Validity of the Four-Point Pusher Score: An Assessment Tool for Measuring Lateropulsion and Pusher Behaviour in Adults after Stroke. Physiother Canada. 2019 Feb 12;71(1):34–42. Available from: https://doi.org/10.3138/ptc.2017-69
Paci M, Baccini M, Rinaldi LA. Pusher behaviour: A critical review of controversial issues. Disabil Rehabil. 2009 Jan 7;31(4):249–58. Available from: https://doi.org/10.1080/09638280801928002
Koter R, Regan S, Clark C, Huang V, Mosley M, Wyant E, et al. Clinical Outcome Measures for Lateropulsion Poststroke: An Updated Systematic Review. J Neurol Phys Ther. 2017 Jul;41(3):145–55. Available from: https://doi.org/10.1097/NPT.0000000000000194
Lagerqvist J, Skargren E. Pusher syndrome: Reliability, validity and sensitivity to change of a classification instrument. Adv Physiother. 2006 Jan 11;8(4):154–60. Available from: https://doi.org/10.1080/14038190600806596
Pedersen PM, Wandel A, Jørgensen HS, Nakayama H, O. Raaschou H, S. Olsen T. Ipsilateral pushing in stroke: Incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen stroke study. Arch Phys Med Rehabil. 1996 Jan;77(1):25–8. Available from: https://doi.org/10.1016/S0003-9993(96)90215-4
Santos-Pontelli TEG, Pontes-Neto OM, Colafêmina JF, Araújo DB de, Santos AC, Leite JP. Pushing behavior and hemiparesis: which is critical for functional recovery in pusher patients?? Case report. Arq Neuropsiquiatr. 2007 Jun;65(2b):536–9. Available from: https://doi.org/10.1590/S0004-282X2007000300035
Perennou DA, Mazibrada G, Chauvineau V, Greenwood R, Rothwell J, Gresty MA, et al. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain. 2008 Aug 21;131(9):2401–13. Available from: https://doi.org/10.1093/brain/awn170
Ordem dos Enfermeiros. Regulamento das Competências Específicas do Enfermeiro Especialista em Enfermagem de Reabilitação. 2010;30508–25.
Santos-Pontelli TEG, Pontes-Neto OM, Colafêmina JF, de Araujo DB, Santos AC, Leite JP. Contraversive pushing in non-stroke patients. J Neurol. 2004 Nov;251(11):1324–8. Available from: https://doi.org/10.1007/s00415-004-0532-y
D’Aquila MA, Smith T, Organ D, Lichtman S, Reding M. Validation of a lateropulsion scale for patients recovering from stroke. Clin Rehabil. 2004 Feb 1;18(1):102–9. Available from: https://doi.org/10.1191/0269215504cr709oa
Paci M, Matulli G, Megna N, Baccini M, Baldassi S. The subjective visual vertical in patients with pusher behaviour: A pilot study with a psychophysical approach. Neuropsychol Rehabil. 2011 Aug;21(4):539–51. Available from: https://doi.org/10.1080/09602011.2011.583777
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2021 Portuguese Rehabilitation Nursing Journal
Downloads
| Abstract Views | 1098 |
|---|
| PDF (Português (Portugal)) | 641 |
|---|