Treatment approaches for pusher behaviour: a scoping review

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Psychology

Background:

• Pusher behavior is a distinct postural disorder observed in some individuals with hemiplegia.
• The underlying mechanisms of pusher behavior are not fully understood, leading to diverse treatment strategies.

Purpose of the Study:

• To conduct a scoping review of existing literature on treatment approaches for pusher behavior.
• To identify, analyze, and categorize interventions aimed at addressing pusher behavior.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Scopus, Web of Science, CINAHL, PEDro) up to December 2020.
• Two independent reviewers screened studies, extracting data on treatment interventions.
• Interventions were categorized based on proposed underlying mechanisms, and the Template for Intervention Description and Replication (TIDieR) checklist was used to assess reporting quality.

Main Results:

• Thirty-one papers detailing 45 interventions for pusher behavior were included.
• The majority of studies were case reports (n=16), with fewer randomized controlled trials (n=5).
• Treatment approaches were classified into five categories: visual feedback, somatosensory cues, visual-somatosensory integration, brain stimulation, and non-specific treatments. The median TIDieR score was 7.

Conclusions:

• Pusher behavior remains a poorly understood condition with limited high-quality evidence for its treatment.
• Five main categories of interventions exist, but the evidence base is predominantly from case reports.
• Future research should prioritize well-designed controlled trials and improve the detailed reporting of interventions to facilitate replication and advancement of treatment strategies.