2011 issue 4

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Volume 20, issue 4

Clinical notes

Rehabilitation of patients with the pusher syndrome

Emilia Mikołajewska1
1. Klinika Rehabilitacji, 10. Wojskowy Szpital Kliniczny, Poliklinika SP ZOZ, Bydgoszcz
Postępy Psychiatrii i Neurologii 2011; 20(4): 291–296
Keywords: neurology, neurorehabilitation, pusher syndrome

Abstract

Objective. The aim of the article is to present the diagnostics and rehabilitation of patients with the pusher syndrome on the grounds of the author's experience.
Review. The pusher syndrome is known in neurology and neurorehabilitation as a disorder of body orientation in the coronal plane. The main cause of the pusher syndrome is brain damage due either to stroke or to other factors. The major features of the syndrome include: (1) leaning toward the contralesional hemiparetic side, and (2) resistance to external attempts at posture correction toward midline. No detailed reports on treatment of the disorder are available in the literature. The rehabilitation approach outlined in the paper was found to be effective and useful in clinical practice. After a relatively short-term rehabilitation following the presented regimen patients with the pusher syndrome regained their ability to adopt the correct upright position. It seems particularly important since in the classical model of rehabilitation of patients with CNS damage the pusher syndrome is not recognized, so it is neither diagnosed nor appropriately treated.
Conclusions. Misdiagnosis of the pusher syndrome may lead to misinterpretation of the patient's behavior, so inappropriate therapy may be provided, making the process of rehabilitation longer and less effective. Further clinical research into the pusher syndrome is needed.

Address for correspondence:
Dr Emilia Mikołajewska
Klinika Rehabilitacji, 10. Wojskowy Szpital Kliniczny z Polikliniką SP ZOZ
ul. Powstańców Warszawy 5, 85-681 Bydgoszcz
tel. 52 378-71-35
e-mail: e.mikołajewska@wp.pl