Treatment interventions for pusher syndrome: A case series

Pusher syndrome (PS) is a clinical disorder that causes decreased postural balance and active pushing away from the non-hemiparetic side in patients with right or left brain damage. Therapists are challenged by needing to manage both the hemiparetic and the pushing/non-hemiparetic sides. There is a minimal amount of evidence about effective treatment interventions for PS.

To describe treatment interventions that reduce pushing behavior and improve functional outcomes in patients with PS.

Five individuals (aged 42-76, admitted 5-16 days post-stroke) with PS participated in this case series. The participants received 90 minutes of physical therapy (5 days/week) with an average length of stay of 27 days. Treatment focused on regaining their sense of midline (balance and transfers), mobility retraining, and neuro re-education activities. Outcome measures examined pushing behavior, transfer ability, and sitting balance.

All five participants demonstrated improvements in pushing behavior, balance and transfer status.

These outcomes provide preliminary evidence of decreased pushing behavior, and improved balance and transfers following a program of interventions designed to improve the functional outcomes of patients with PS. Larger studies are needed to confirm these findings, and whether these interventions are effective for patients with less severe pushing behavior.