Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke / 中国康复理论与实践

ObjectiveTo investigate the effect of transcranial direct current stimulation (tDCS) combined with constraint-induced weight training (CIWT) on Pusher syndrome after stroke. MethodsA total of 60 stroke inpatients with Pusher syndrome in the First Affiliated Hospital of Soochow University from January to December, 2021 were randomly divided into tDCS group, CIWT group and combination group, with 20 cases in each group. The three groups accepted routine rehabilitation training, the tDCS group received anode tDCS, the CIWT group received CIWT of the affected lower limb, and the combination group received CIWT of the affected lower limb and tDCS, for eight weeks. They were assessed with Berg Balance Scale (BBS), Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Burke Lateropulsion Scale (BLS) and Holden Walking Functional Ambulation Category (FAC) before and after treatment. ResultsAfter treatment, the scores of BBS, FMA-LE, BLS and FAC improved (|t| > 1.452, P < 0.05) in all the groups, and improved the most in the combination group (|F| > 1.827, P < 0.05). ConclusiontDCS combined with CIWT of the affected lower extremity can effectively improve the function of stroke patients with Pusher syndrome.

Features and Rehabilitation of Pusher Syndrome after Parietal Lobe Hemorrhage: A Case Report / 中国康复理论与实践

Objective:To explore the features and rehabilitation of Pusher syndrome (PS). Methods:A female patient was reported and the literatures were reviewed. Results:The patient presented moderate ipsilateral, deep sensory disturbance, left spatial neglect and disuse. White matter degeneration was found. After four-week rehabilitation, the score of Scale for Contraversive Pushing decreased from 2.5 to 0.75, and her hand function recovered to assistant hand. Conclusion:The degeneration of white matter develops rapidly in PS patient, while the recovery of motor function is relatively slow, and need longer and comprehensive rehabilitation, especially the exercise therapy and somatosensory stimulation.

Pusher syndrome improved by secondary newly developed stroke

@#Pusher syndrome is a neurological disorder where the patient actively pushes away from the non-hemiparetic side following brain damage. We experienced a case in whom intractable pusher syndrome associated with thalamic hemorrhage improved following a newly developed pontine infarction. A 63-year-old man showed severe pusher syndrome after an initial thalamic hemorrhage. After approximately 2 years, a pontine infarction developed and improved the persistent pusher syndrome. We postulate that it resulted from involvement of the medial lemniscus with interruption of the distorted upward proprioceptive signal of body orientation.

Effects of Single Kneeling Trunk Intensive Training on Balance in Patients with Pusher Syndrome after Stroke / 中国康复理论与实践

Objective To observe the effect of single kneeling position trunk intensive training on the balance of patients with stroke Pusher syndrome. Methods From January, 2014 to February, 2016, forty patients with stroke Pusher syndrome were randomly divided into observation group and control group equally. They all accepted routine rehabilitation, while the observation group added a trunk intensive training with one knee kneeled. They were assessed with Berg Balance Scale (BBS), Fugl-Meyer Assessment (FMA) of lower limb and Sheikh's Scale of Trunk Control before and after training. Results The scores of BBS, lower limb FMA and trunk control improved in both groups after eight weeks of treatment (t>1.756, P1.827, P<0.05). Conclusion Single kneeling trunk intensive training can effectively improve the balance in stroke patients with Pusher syndrome.

Somatosensory Findings of Pusher Syndrome in Stroke Patients

OBJECTIVE: To investigate the somatosensory findings of pusher syndrome in stroke patients. METHODS: Twelve pusher patients and twelve non-pusher patients were enrolled in this study. Inclusion criteria were unilateral stroke, sufficient cognitive abilities to understand and follow instructions, and no visual problem. Patients were evaluated for pusher syndrome using a standardized scale for contraversive pushing. Somatosensory finding was assessed by the Cumulative Somatosensory Impairment Index (CSII) and somatosensory evoked potentials (SEPs) at 1 and 14 weeks after the stroke onset. Data of SEPs with median and tibial nerve stimulation were classified into the normal, abnormal, and no response group. RESULTS: In the baseline characteristics (sex, lesion character, and side) of both groups, significant differences were not found. The score of CSII decreased in both groups at 14 weeks (p<0.05), but there were no significant differences in the CSII scores between the two groups at 1 and 14 weeks. There were no significant differences in SEPs between the two groups at 1 and 14 weeks after the stroke onset. CONCLUSION: It appears that somatosensory input plays a relatively minor role in pusher syndrome. Further study will be required to reveal the mechanism of pusher syndrome.

Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

OBJECTIVE: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). METHOD: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). RESULTS: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8+/-1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6+/-3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. CONCLUSION: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.

Clinical study of pusher syndrome in stroke patients / 中华物理医学与康复杂志

Objective To investigate the incidence of the pusher syndrome in stroke patients, and the relationship between the syndrome and the neuropsychological symptoms and location of brain lesion, and to investigate the mechanism and the physiotherapy intervention of pusher syndrome. Methods Thirty nine patients(25 male, 14 female, 62.5?9.4 years old) with pusher syndrome were examined, 91 patients(57 male,34 female, 58.4?11.6 years old) without ipsilateral pushing served as control. The lesion areas, neuropsychological syndrome and the Barthel Index(BI) were recorded, and the physiotherapy were administered in the patients. Results The incidence of pusher syndrome was 30% in the patients studied, corresponding to 17% of the total number of stroke patients in the study period. The percentage of pusher syndrome occurrence was higher in the patients with right side lesion than those with left side lesion ( P