• The Journal of Korean Physical Therapy
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• v.15 no.4
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• pp.34-45
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• 2003

A 'pusher syndrome' encompassing postural imbalance and hemi-neglect is believed to aggravate the prognosis of stroke patients. The patients with pusher syndrome show a particular posture that pushing away from the unaffected side of the body. The objective of this study was to investigate associated proprioception, associated neuro-psychological symptoms and characteristics of functional outcome with and without pusher syndrome. The subjects of this study were 58 acute stroke patients who been rehabilitated at two university hospitals in Seoul and Buchun. Data were collected using proprioception test and line bisection test. The ability of ADL was assessed by the Modified Barthel Index, transfer by the Functional Independence Measure, and balance by the Modified Motor Assessment Scale. The results were that significant difference was found in the presence of proprioception, in the incidence of hemineglect and anosognosia, and in the score of ADL, transfer and balance between patients with and without pusher syndrome. Patients without pusher syndrome gained more motor score than patients with pusher syndrome. From improvement of view, patients with pusher syndrome gained the lowest score in ability of transfer. The finding suggest that the patients with pusher syndrome is a poorer functional outcome, be related to proprioception, hemineglect and anosognosia.

• The Journal of Korean Physical Therapy
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• v.22 no.3
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• pp.45-48
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• 2010

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.

• The Journal of Korean Physical Therapy
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• v.11 no.2
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• pp.111-114
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• 1999

Some hemiplegic patients show a particular posture that pushing away from the nonaffected side of the body. A few study has been conducted of any aspect of this syndrome. But despite the lack of a scientific basis, this term is widely used in the physical therapy of hemiplegic patients. The purposes of this study was to investigate whether pusher syndrome has an adverse impact on functional outcome. Included were all acute stroke patients admitted in a months period a hospital in Seoul. The presence of pusher syndrome was assessed by a Bobath trained physical therapist. The ability of transfer was assessed by the Functional Independence Measure(FIM), Activities of daily living by the Modified Barthel Index(MBI), and standing balance by Bohannon's Standing Balance Scale(BSBS) on admission, weekly during the hospital stay, and at discharge. Pusher syndrome was found in $52.4\%$ of the left side and $50.0\%$ of the right aide hemiplegic patients. Significant differences were found in the score of transfer, ADL and standing balance between patients with and without pusher syndrome.

• Journal of Korean Physical Therapy Science
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• v.6 no.3
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• pp.1-7
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• 1999

The objectives of this study was to investigate the incidence and any correction between hemiplegia with pusher syndrome and neuropsychological symptoms such as hemineglect and anosognosia. Pusher syndrome defines that the patient leans toward the hemiplegic side regardless of the position that patient was placed on and resists any attempt for passive correction of posture that would move his weight toward the midline of the body. The subjects of this study were 69 acute hemiplegia who had been rehabilitated at department of rehabilitation medicine, Asan Medical Center from May 1. 1999 through July 31. 1999. The data were analyzed by researchers who were trained for assessment of anosognosia and hemineglect. 12 subjects were excluded for confusion. The method of statistical analysis used for our study was Fisher's exact test. Results of the study disclosed 21 hemiplegia(38.6%) with pusher syndrome. In conclusion, these hemiplegic patients with pusher syndrome did not have any correlation with hemineglect and anosognosia and also had no preference of stroke side.

• Journal of Korean Physical Therapy Science
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• v.14 no.1_4
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• pp.55-60
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• 2007

The purpose of this case report is to investigate whether an attempt to hold the repeated upright posture under blocking the patient's vision affects the deficits to push away from the paralytic side and the relapse time from down to stand up position without push away in patients with hemiplegia with pusher syndrome. Two hemiplegic patients with pusher syndrome were assessed. The task was performed 4 times per day for 6 weeks. The modified barthel index (MBI) was performed to assess activities of daily living (ADL). For assessing balance, the "balanced sitting" and "sit to stand" are analyzed using by modified motor assessment scale (MMAS). The scale for contraversive pushing (SCP) was used for determination of push away from paralyzed side. MBI, MMAS and SCP were assessed before and after trial of the task. In patient 1, total score of the scale is 0 in sitting posture and standing posture within 3 weeks and 4 weeks, respectively, In patient 2, total score of the scale is 0 in sitting posture and standing posture within 4 weeks and 6 weeks, respectively. These results demonstrated that pusher syndrome was completely resolved in at least 6 weeks. Our findings indicate that this physical therapy seems to be relevant for the hemiplegic patients with pusher syndrome.

• Journal of the Korean Academy of Clinical Electrophysiology
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• v.9 no.1
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• pp.41-49
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• 2011

This study purposes to conduct visual feedback and body posture control training on stroke patients with pusher syndrome in order to reduce their pusher syndrome. This study also examines changes resulting from the training and applies the guidelines necessary for documentation of patient/customer management. The participant for this study was one patient with pusher syndrome. The study progressed from a medical examination of the subject followed by evaluation, diagnosis, prognosis, intervention and treatment plan, and finally re-examination in order of precedence. Problems in the participant's functional activities, difficulties in changes from sitting postures into standing postures, and maintaining standing postures were determined as primary restrictions on activities and the improvement of these activities was set up as a goal through discussions with the patient. Interventions were mainly implemented to reduce the pusher syndrome with visual feedback provided using mirrors and exercises focusing on leaning in order to maintain posture while sitting. Changes from supine postures to sitting postures and the degree of changes in maintaining standing postures were compared between before and after the intervention by measuring times in the same environment and the degree of pusher syndrome was measured using the SCP tool. The process of this clinical practice was documented. The SCP score that indicates the degree of changes in the participant's pusher syndrome changed from 3.75 points to 0.8 point indicating a decrease in pushing. Among functional activities, posture changes from sitting postures to standing postures and maintaining standing postures were improved. In addition, since the patient could maintain standing postures, the patient could walk indoors. In this case study, mirrors and body posture control training used as interventions to relieve pusher syndromes can be easily applied in clinics to examine the form of functional recovery. The results indicated that these intervention methods were effective and thus it is thought that the results can be used as basic data to utilize these intervention methods diversely. In addition, the documentation of patient/client management was applied as actual documentation in Korean and based on the results, we could show decision making processes for patients' functional goals and objectively explain problems, prognoses and changes made through the interventions.

• The Journal of Korean Physical Therapy
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• v.21 no.4
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• pp.31-36
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• 2009

Purpose: Pusher syndrome in stroke patients is the tendency to push strongly toward the paretic side with the non-affected limbs. The purpose of this study was to estimated inter-rater and intra-rater reliability of the Scale for Contraversive Pushing (SCP). Methods: Fourteen patients in the acute phase after stroke onset were diagnosed with pusher syndrome. Two physical therapists randomly assessed the same patients on different occasions on the same day. Almost all patients were assessed on more than one day. The inter-rater and intra-rater reliability of the SCP was estimated by calculation of the intraclass correlation coefficient (ICC). Results: The intra-rater reliability of the SCP ranged from 0.87 to 0.97; the inter-rater reliability of the SCP ranged from 0.71 to 0.99 in sitting and standing positions. These results show good reliability for the calculated variables. Conclusion: The results provide support for the use of the SCP in assessing pusher syndrome based on its reliability in stroke patients. It may use the standardized clinical assessments in clinical implication.

• Journal of the Korean Society of Physical Medicine
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• v.12 no.3
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• pp.33-42
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• 2017

PURPOSE: To compare postural vertical training with and without visual feedback for improving functional recovery in post-stroke hemiparesis patients with pusher syndrome. METHODS: This study used a single-subject research with alternating design with multiple baselines. Three patients with hemiparetic post-stroke diagnosed with pusher syndrome were selected from the inpatients at the department of physical therapy of a local rehabilitation hospital. For subjective postural vertical (SPV) training with and without visual feedback, an alternating treatment was used. The subjects were randomly selected using the sequence of the two training methods upon starting the intervention, and then the training was alternated. SPV training was performed twice a day, once in the morning and again in the afternoon. Scale for contraversive pushing (SCP), postural assessment scale for stroke, and Barthel index score were used to determine the intervention-related changes. RESULTS: Compared to the average score at baseline, the average SCP score for the SPV training without visual feedback decreased from 5.3 to 2.8, from 4.6 to 3, and from 3.5 to 2.7 for subjects 1, 2, and 3, respectively. However, the average score for the SPV training with visual feedback decreased from 5.3 to 3.1, from 4.6 to 3.5, and from 3.5 to 3.3 for subjects 1, 2, and 3, respectively. CONCLUSION: Postural vertical training without visual feedback may be more beneficial than postural vertical training with visual feedback for improving pushing behavior and functional activity in stroke patients with pusher syndrome.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.10
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• pp.562-568
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• 2016

This study to investigated the therapeutic effect of robot-assisted rehabilitation (Lokomat) with virtual reality (VR) on Pusher syndrome (PS) after stroke. A total of 10 patients presented with PS after stroke were recruited. The participants were divided into two groups: Lokomat (n=5) and control groups (n=5). Lokomat and conventional physical therapy (CPT) were performed together in the experimental group, and the patients in the control group were treated with CPT only twice a day. One session of intervention was carried out for 30 minutes five times per week for 4 weeks. Scale for contraversive pushing (SCP), Berg balance scale (BBS), falling index (FI), and Timed up and go test (TUG) were measured before and after the intervention. The Lokomat group produced significantly better outcomes in SCP (p=0.046), BBS (p=0.046), FI (p=0.038), and TUG (p=0.038) compared with the control group after 4 weeks of intervention. In addition, there were significant correlations between SCP and BBS (p=0.024), FI (p=0.039), and TUG (p=0.030). In conclusion, Lokomat with VR more effectively aided recovery from PS after stroke, and restoration of PS symptoms was related with improvement of balance and gait function.