Pusher Syndrome Occupational Therapy Intervention

Main Symptoms

• Body is tilted toward the paretic side when sitting or standing.
• Active pushing with nonaffected extremities, resulting in leaning toward the hemiplegic side (and loss of balance).
• Resistance to any attempts to correct the tilted body.

Prognosis

• Rarely observed 6 months post-stroke.
• Rehab often takes 4 weeks longer compared to stroke survivors without pusher syndrome

Occupational Therapy Intervention

Challenges

• Gait training
  • SPC – pushing towards the hemiparetic leg
• Transfers
  1. Transfers toward the stronger side become difficult due to pushing away from that side.
  2. Transfers toward the hemiparetic side is easier, but dangerous due to lack of motor control.
• Sitting and standing activities

Focus

• Readjusting center of gravity of BoS while standing
• Need for awareness of the loss of balance
• Trial and error; problem-solving
• Perceiving visual alignment (input) as correct compared to the body’s perception

Interventions

• Alignment with the vertical axis through visual feedback (door frames, window frames, tape on a mirror)
• Removing surfaces that may be used to push
• Providing a task for non-involved extremities, e.g. asking the individual to hold a cup of water during transferring
• Parallel bars: discouraged
• Hands-on techniques to facilitate movement: discouraged (individual ends up pushing into therapists’ hands)

Sources:

Gillen, G. (2015). Stroke rehabilitation: a function-based approach. Elsevier Health Sciences.