Friday, 26 October 2007
The Pusher Syndrome
I am on my neuro placement at the moment and have been treating a (R) MCA stroke patient (who is 6 days post-stroke) with my partner for the week. He has stage 1 voluntary movement of his (L) UL and LL, very low tone of his (L) LL and UL, no sensation (light touch or proprioception of his (L) UL and LL) and severe (L) sided neglect. We have tried some alignment and balance exercises with him sitting over the edge of the bed and have found that he tends to align himself posteriorly and to the left (as expected). To add to his tendency to bring his CoG posteriorly and to the left he often pushes with his non-hemiplegic hand to the left. As suggested, I have read the article on 'the pusher syndrome' however have found that their suggestions for PT treatment are limited and not so helpful as we havn't been able to take him to the gym yet or gain access to a mirror to help his sense of verticality. I have found that reminding him to place his (R) hand palm up on his lap is often useful to prevent him pushing but besides this I was wondering if anyone had come up with some other nifty treatments for this problem.
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3 comments:
Unfortunately I didn't see any pts with pusher syndrome when I was on neuro prac, however I do remember my supervisor saying that placing something next to them (on their unaffected side, I think), like a chair, may help. But also, ask your supervisor! Because they have a wealth of knowledge and lots of experience and they might have some nifty tricks up their sleeve.
Whilst i never had a pusher patient, i did pick up a few tricks from some of the physios. I found that putting their hand on yours (or leg if they push through their foot) is useful as yu cna help to judge how much they are pushing back. From there you can also apply proprioceptive feedback about the pushing. ie. you can move their hand and say "stop pushing".
But like Liz said, there are so many supervisors out there with great tricks that are often simple but so effective. Practice always improves skills.
Rowan I totally sympathize with you. Being in the same shoes and experiencing a similar case load. What Tanya and I found useful to decrease the pushing from the patient was to step on the patients feet ( shoes and socks off) and provide proprioceptive input at the hip ( unaffected ) and tap the foot at the pushing side and provide commands like 'stop pushing'. A mirror really helps, when a patient sees that they're malaligned, they decrease the pushing, a little.
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