Pusher Syndrome Occupational Therapy Intervention
- 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.
- Rarely observed 6 months post-stroke.
- Rehab often takes 4 weeks longer compared to stroke survivors without pusher syndrome
Occupational Therapy Intervention
- Gait training
- SPC – pushing towards the hemiparetic leg
- Transfers toward the stronger side become difficult due to pushing away from that side.
- Transfers toward the hemiparetic side is easier, but dangerous due to lack of motor control.
- Sitting and standing activities
- 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
- 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)
Gillen, G. (2015). Stroke rehabilitation: a function-based approach. Elsevier Health Sciences.