Progress in research on pusher syndrome_West China Medical Journal

Authors：

LIU Siwei , GUAN Min , ZHANG Jing , YANG Mei ,  GAO Qiang

Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

GAO Qiang, Email: gaoqiang_hxkf@163.com

Keywords：

Stroke; Pusher syndrome; Vestibular; Balance; Posture control

DOI：

10.7507/1002-0179.201909007

Video：

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Abstract Full text Figures/Tables Video References Cited by

Pusher syndrome (PS) is a postural control disorder that occurs after stroke, which is mainly manifested as a balance dysfunction that is difficult to correct, leading to a significant decline in activity safety of stroke patients and hindering the process of rehabilitation treatment. Proper interventions are needed as soon as possible. Based on the research results of PS both domestic and foreign, this paper firstly summarizes the foundations of the mechanism of PS occurrence, and elaborates the existing disputes. Secondly, this paper systematically introduces the current mainstream assessment and treatment methods of PS, summarizes the problems in relevant clinical practice, and on this basis, gives some suggestions on the possible research directions in the future. The purpose is to provide reference for clinical application and future research directions.

Citation： LIU Siwei, GUAN Min, ZHANG Jing, YANG Mei, GAO Qiang. Progress in research on pusher syndrome. West China Medical Journal, 2019, 34(11): 1315-1320. doi: 10.7507/1002-0179.201909007 Copy

1.	Lee JH, Kim SB, Lee KW, et al. Somatosensory findings of pusher syndrome in stroke patients. Ann Rehabil Med, 2013, 37(1): 88-95.
2.	Bergmann J, Krewer C, Müller F, et al. A new cutoff score for the Burke Lateropulsion scale improves validity in the classification of pusher behavior in subactue stroke patients. Gait Posture, 2019, 68: 514-517.
3.	Gandolfi M, Geroin C, Ferrari F, et al. Rehabilitation procedures in the management of postural orientation deficits in patients with poststroke pusher behavior: a pilot study. Minerva Med, 2016, 107(6): 353-362.
4.	Lee K, Pee YH, Jang IT, et al. Pusher syndrome improved by secondary newly developed stroke. Neurology Asia, 2018, 23(1): 89-91.
5.	Tomaszewska E, Cichosz M, Kochański B. The current look of repulsion on pusher syndrome. Review of the literature and our own experience. J Educ Health Sport, 2015, 5(2): 196-207.
6.	Bergmann J, Krewer C, Selge C, et al. The subjective postural vertical determined in patients with pusher behavior during standing. Top Stroke Rehabil, 2016, 23(3): 184-190.
7.	Baier B, Janzen J, Müller-Forell W, et al. Pusher syndrome: its cortical correlate. J Neurol, 2012, 259(2): 277-283.
8.	Bergmann J, Krewer C, Jahn K, et al. Robot-assisted gait training to reduce pusher behavior: a randomized controlled trial. Neurology, 2018, 91(14): e1319-e1327.
9.	Romick-Sheldon D, Kimalat A. Novel treatment approach to contraversive pushing after acute stroke: a case report. Physiother Can, 2017, 69(4): 313-317.
10.	Pérennou DA, Mazibrada G, Chauvineau V, et al. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship?. Brain, 2008, 131(Pt 9): 2401-2413.
11.	Mansfield A, Fraser L, Rajachandrakumar R, et al. Is perception of vertical impaired in individuals with chronic stroke with a history of " pushing”?. Neurosci Lett, 2015, 590: 172-177.
12.	辻本直秀, 阿部浩明, 大鹿糠徹, 他. 脳卒中後のPusher syndromeの重症度およびその改善経過とsubject visual verticalityの偏倚との関連. 理学療法学, 2017, 44(5): 340-347.
13.	Ashish G, Augustine AM, Tyagi AK, et al. Subjective visual vertical and horizontal in vestibular migraine. J Int Adv Otol, 2017, 13(2): 254-258.
14.	Dieterich M, Brandt T. Perception of verticality and vestibular disorders of balance and falls. Front Neurol, 2019, 10: 172.
15.	Eguchi S, Hirose G, Miaki M. Vestibular symptoms in acute hemispheric strokes. J Neurol, 2019, 266(8): 1852-1858.
16.	Chen XW, Lin CH, Zheng H, et al. A Chinese patient with pusher syndrome and unilateral spatial neglect syndrome. Can J Neurol Sci, 2014, 41(4): 493-497.
17.	Dieterich M, Brandt T. Global orientation in space and the lateralization of brain functions. Curr Opin Neurol, 2018, 31(1): 96-104.
18.	Brandt T, Dieterich M. Does the vestibular system determine the lateralization of brain functions?. J Neurol, 2015, 262(1): 214-215.
19.	Saeys W, Herssens N, Verwulgen S, et al. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies. PLoS One, 2018, 13(6): e0199098.
20.	Jang SH, Lee HD. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report. Medicine (Baltimore), 2018, 97(22): e10963.
21.	Dai S, Clarac E, Odin A, et al. Lateropulsion syndrome or pusher syndrome?. Ann Phys Rehabil Med, 2018, 61: e64.
22.	Dai S, Piscicelli C, Clarac E, et al. Syndrome pusher ou plutôt syndrome lateropulsion?. Neurophysiol Clin, 2018, 48(6): 326.
23.	洪文军, 陶静. 脑卒中后单侧忽略的研究进展. 中国康复, 2016, 31(4): 305-308.
24.	Takase M, Shirai M, Matsushita H, et al. The severity of unilateral spatial neglect was positively correlated with that of pusher syndrome. Ann Phys Rehabil Med, 2018, 61: e35.
25.	Vaes N, Lafosse C, Hemelsoet D, et al. Contraversive neglect? A modulation of visuospatial neglect in association with contraversive pushing. Neuropsychology, 2015, 29(6): 988-997.
26.	Karnath HO, Brötz D. Instructions for the clinical scale for contraversive pushing (SCP). Neurorehabil Neural Repair, 2007, 21(4): 370-371.
27.	Koter R, Regan S, Clark C, et al. Clinical outcome measures for lateropulsion poststroke: an updated systematic review. J Neurol Phys Ther, 2017, 41(3): 145-155.
28.	Clark E, Hill KD, Punt TD. Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke. Arch Phys Med Rehabil, 2012, 93(1): 149-155.
29.	Krewer C, Rieß K, Bergmann J, et al. Immediate effectiveness of single-session therapeutic interventions in Pusher behaviour. Gait Posture, 2013, 37(2): 246-250.
30.	Bergmann J, Krewer C, Rieß K, et al. Inconsistent classification of pusher behaviour in stroke patients: a direct comparison of the scale for contraversive pushing and the burke lateropulsion scale. Clin Rehabil, 2014, 28(7): 696-703.
31.	Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res, 2010, 19(4): 539-549.
32.	Lagerqvist J, Skargren E. Pusher syndrome: reliability, validity and sensitivity to change of a classification instrument. Adv Physiother, 2006, 8(4): 154-160.
33.	Yang MX, Jiang Y. Study of the burke lateropulsion scale to evaluate pusher syndrome rehabilitation. Physiotherapy, 2015, 101: e683.
34.	Chow B, Parkinsen S, Hill K, et al. Is the four point pusher scale a reliable and valid assessment tool for measuring lateropulsion and/or pushing behaviour in adults following stroke?. Cerebrovasc Dis, 2016, 41(Suppl 1): 50.
35.	Chow E, Parkinson S, Jenkin J, et al. Reliability and validity of the Four-Point Pusher Score: an assessment tool for measuring lateropulsion and pusher behaviour in adults after stroke. Physiother Can, 2019, 71(1): 34-42.
36.	邵印麟, 欧阳迎, 周立晨, 等. 姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能和步行功能改善的影响. 河北医药, 2018, 40(3): 389-392, 396.
37.	Davies PM. 循序渐进: 偏瘫患者的全面康复治疗. 刘钦刚, 译. 北京: 华夏出版社, 2007: 352-362.
38.	张乃国, 周伟宏, 王海波. 视觉反馈联合躯干强化训练对脑卒中 Pusher 综合征的疗效观察. 中国康复, 2018, 33(4): 286-288.
39.	王海波, 李建军, 倪波业. 单跪立位躯干强化训练对脑卒中 Pusher 综合征患者平衡功能的影响. 中国康复理论与实践, 2016, 22(9): 1049-1051.
40.	赵富强, 平兴团, 杨飞, 等. 重心重塑训练对 Pusher 综合征的疗效观察. 医学信息, 2018, 31(20): 94-95, 98.
41.	Piotr P, Dorota RS, Małgorzata P, et al. Treatment of pusher syndrome in a patient after extensive cerebral infarction caused by cerebral embolism - case report. J Educ Health Sport, 2017, 7(8): 583-592.
42.	Pardo V, Galen S. Treatment interventions for pusher syndrome: a case series. NeuroRehabilitation, 2019, 44(1): 131-140.
43.	王文丽, 张春军, 张瑜, 等. 脑卒中后倾斜综合征动平衡特征探讨. 昆明医科大学学报, 2015, 36(9): 129-132.
44.	Haruyama K, Kawakami M, Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients. Neurorehabil Neural Repair, 2017, 31(3): 240-249.
45.	Yang YR, Chen YH, Chang HC, et al. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil, 2015, 29(10): 987-993.
46.	Hwang KK, Song SY, Doo YT, et al. Physical therapy clinical practice and documentation for Pusher syndrome in stroke patients: case report. J Korean Acad Clin Electrophysiol, 2011, 9(1): 41-49.
47.	陈国平, 亢连茹, 王艳, 等. 视觉反馈结合任务导向性训练治疗 Pusher 综合征的临床观察. 中国康复医学杂志, 2016, 31(4): 467-468.
48.	段好阳, 闫兆红, 刘福迁, 等. 动态平衡训练仪中的视觉反馈任务导向性训练对脑卒中后倾斜综合征的影响. 中华物理医学与康复杂志, 2017, 39(9): 674-676.
49.	曾杜纯, 叶祥明, 田亮, 等. 基于交互式视觉反馈的姿势控制训练对脑梗死 Pusher 综合征患者平衡功能的影响. 中国康复医学杂志, 2018, 33(7): 828-832.
50.	Kim MS. Effect of robot assisted rehabilitation based on visual feedback in post stroke pusher syndrome. J Korea Acad Ind CoopSoc, 2016, 17(10): 562-568.
51.	王丹丹, 林坚, 刘晓林, 等. 视觉反馈结合核心稳定训练对脑卒中 Pusher 综合征患者的影响. 中国康复医学杂志, 2016, 31(4): 426-429.
52.	苏久龙, 潘翠环, 邵会凯, 等. 策略性靶向训练技术治疗脑卒中倾斜综合征的疗效观察. 中华物理医学与康复杂志, 2017, 39(7): 510-512.
53.	詹海兰, 汤清平, 周权, 等. 针刺结合意向性运动疗法治疗脑卒中 Pusher 综合征的临床研究. 湖南中医药大学学报, 2018, 38(7): 791-794.
54.	毕研贞, 王桂芬, 郑志雄, 等. 脑卒中后倾斜综合征综合康复治疗的疗效观察. 中华物理医学与康复杂志, 2013, 35(11): 909-910.
55.	Yumiko K, Sachiko T, Mitsuhiro N, et al. Characteristics of sitting balance during reaching in stroke patients with pusher syndrome//16th International Congress of the World Federation of Occupational Therapists in collaboration with the 48th Japanese Occupational Therapy Congress and Expo. Japan: JPOT, 2014: 1596-1597.
56.	Zhang L, Zhang Q, Su Y, et al. A new treatment of pusher syndrome based on central integration concept. Ann Phys Rehabil Med, 2018, 61: e37.
57.	方来漫. 注意力训练在脑卒中后 Pusher 综合征中的应用效果. 按摩与康复医学, 2015, 6(21): 76-78.

1. Lee JH, Kim SB, Lee KW, et al. Somatosensory findings of pusher syndrome in stroke patients. Ann Rehabil Med, 2013, 37(1): 88-95.
2. Bergmann J, Krewer C, Müller F, et al. A new cutoff score for the Burke Lateropulsion scale improves validity in the classification of pusher behavior in subactue stroke patients. Gait Posture, 2019, 68: 514-517.
3. Gandolfi M, Geroin C, Ferrari F, et al. Rehabilitation procedures in the management of postural orientation deficits in patients with poststroke pusher behavior: a pilot study. Minerva Med, 2016, 107(6): 353-362.
4. Lee K, Pee YH, Jang IT, et al. Pusher syndrome improved by secondary newly developed stroke. Neurology Asia, 2018, 23(1): 89-91.
5. Tomaszewska E, Cichosz M, Kochański B. The current look of repulsion on pusher syndrome. Review of the literature and our own experience. J Educ Health Sport, 2015, 5(2): 196-207.
6. Bergmann J, Krewer C, Selge C, et al. The subjective postural vertical determined in patients with pusher behavior during standing. Top Stroke Rehabil, 2016, 23(3): 184-190.
7. Baier B, Janzen J, Müller-Forell W, et al. Pusher syndrome: its cortical correlate. J Neurol, 2012, 259(2): 277-283.
8. Bergmann J, Krewer C, Jahn K, et al. Robot-assisted gait training to reduce pusher behavior: a randomized controlled trial. Neurology, 2018, 91(14): e1319-e1327.
9. Romick-Sheldon D, Kimalat A. Novel treatment approach to contraversive pushing after acute stroke: a case report. Physiother Can, 2017, 69(4): 313-317.
10. Pérennou DA, Mazibrada G, Chauvineau V, et al. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship?. Brain, 2008, 131(Pt 9): 2401-2413.
11. Mansfield A, Fraser L, Rajachandrakumar R, et al. Is perception of vertical impaired in individuals with chronic stroke with a history of " pushing”?. Neurosci Lett, 2015, 590: 172-177.
12. 辻本直秀, 阿部浩明, 大鹿糠徹, 他. 脳卒中後のPusher syndromeの重症度およびその改善経過とsubject visual verticalityの偏倚との関連. 理学療法学, 2017, 44(5): 340-347.
13. Ashish G, Augustine AM, Tyagi AK, et al. Subjective visual vertical and horizontal in vestibular migraine. J Int Adv Otol, 2017, 13(2): 254-258.
14. Dieterich M, Brandt T. Perception of verticality and vestibular disorders of balance and falls. Front Neurol, 2019, 10: 172.
15. Eguchi S, Hirose G, Miaki M. Vestibular symptoms in acute hemispheric strokes. J Neurol, 2019, 266(8): 1852-1858.
16. Chen XW, Lin CH, Zheng H, et al. A Chinese patient with pusher syndrome and unilateral spatial neglect syndrome. Can J Neurol Sci, 2014, 41(4): 493-497.
17. Dieterich M, Brandt T. Global orientation in space and the lateralization of brain functions. Curr Opin Neurol, 2018, 31(1): 96-104.
18. Brandt T, Dieterich M. Does the vestibular system determine the lateralization of brain functions?. J Neurol, 2015, 262(1): 214-215.
19. Saeys W, Herssens N, Verwulgen S, et al. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies. PLoS One, 2018, 13(6): e0199098.
20. Jang SH, Lee HD. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report. Medicine (Baltimore), 2018, 97(22): e10963.
21. Dai S, Clarac E, Odin A, et al. Lateropulsion syndrome or pusher syndrome?. Ann Phys Rehabil Med, 2018, 61: e64.
22. Dai S, Piscicelli C, Clarac E, et al. Syndrome pusher ou plutôt syndrome lateropulsion?. Neurophysiol Clin, 2018, 48(6): 326.
23. 洪文军, 陶静. 脑卒中后单侧忽略的研究进展. 中国康复, 2016, 31(4): 305-308.
24. Takase M, Shirai M, Matsushita H, et al. The severity of unilateral spatial neglect was positively correlated with that of pusher syndrome. Ann Phys Rehabil Med, 2018, 61: e35.
25. Vaes N, Lafosse C, Hemelsoet D, et al. Contraversive neglect? A modulation of visuospatial neglect in association with contraversive pushing. Neuropsychology, 2015, 29(6): 988-997.
26. Karnath HO, Brötz D. Instructions for the clinical scale for contraversive pushing (SCP). Neurorehabil Neural Repair, 2007, 21(4): 370-371.
27. Koter R, Regan S, Clark C, et al. Clinical outcome measures for lateropulsion poststroke: an updated systematic review. J Neurol Phys Ther, 2017, 41(3): 145-155.
28. Clark E, Hill KD, Punt TD. Responsiveness of 2 scales to evaluate lateropulsion or pusher syndrome recovery after stroke. Arch Phys Med Rehabil, 2012, 93(1): 149-155.
29. Krewer C, Rieß K, Bergmann J, et al. Immediate effectiveness of single-session therapeutic interventions in Pusher behaviour. Gait Posture, 2013, 37(2): 246-250.
30. Bergmann J, Krewer C, Rieß K, et al. Inconsistent classification of pusher behaviour in stroke patients: a direct comparison of the scale for contraversive pushing and the burke lateropulsion scale. Clin Rehabil, 2014, 28(7): 696-703.
31. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res, 2010, 19(4): 539-549.
32. Lagerqvist J, Skargren E. Pusher syndrome: reliability, validity and sensitivity to change of a classification instrument. Adv Physiother, 2006, 8(4): 154-160.
33. Yang MX, Jiang Y. Study of the burke lateropulsion scale to evaluate pusher syndrome rehabilitation. Physiotherapy, 2015, 101: e683.
34. Chow B, Parkinsen S, Hill K, et al. Is the four point pusher scale a reliable and valid assessment tool for measuring lateropulsion and/or pushing behaviour in adults following stroke?. Cerebrovasc Dis, 2016, 41(Suppl 1): 50.
35. Chow E, Parkinson S, Jenkin J, et al. Reliability and validity of the Four-Point Pusher Score: an assessment tool for measuring lateropulsion and pusher behaviour in adults after stroke. Physiother Can, 2019, 71(1): 34-42.
36. 邵印麟, 欧阳迎, 周立晨, 等. 姿势控制训练对脑卒中偏瘫患者足底压力、平衡功能和步行功能改善的影响. 河北医药, 2018, 40(3): 389-392, 396.
37. Davies PM. 循序渐进: 偏瘫患者的全面康复治疗. 刘钦刚, 译. 北京: 华夏出版社, 2007: 352-362.
38. 张乃国, 周伟宏, 王海波. 视觉反馈联合躯干强化训练对脑卒中 Pusher 综合征的疗效观察. 中国康复, 2018, 33(4): 286-288.
39. 王海波, 李建军, 倪波业. 单跪立位躯干强化训练对脑卒中 Pusher 综合征患者平衡功能的影响. 中国康复理论与实践, 2016, 22(9): 1049-1051.
40. 赵富强, 平兴团, 杨飞, 等. 重心重塑训练对 Pusher 综合征的疗效观察. 医学信息, 2018, 31(20): 94-95, 98.
41. Piotr P, Dorota RS, Małgorzata P, et al. Treatment of pusher syndrome in a patient after extensive cerebral infarction caused by cerebral embolism - case report. J Educ Health Sport, 2017, 7(8): 583-592.
42. Pardo V, Galen S. Treatment interventions for pusher syndrome: a case series. NeuroRehabilitation, 2019, 44(1): 131-140.
43. 王文丽, 张春军, 张瑜, 等. 脑卒中后倾斜综合征动平衡特征探讨. 昆明医科大学学报, 2015, 36(9): 129-132.
44. Haruyama K, Kawakami M, Otsuka T. Effect of core stability training on trunk function, standing balance, and mobility in stroke patients. Neurorehabil Neural Repair, 2017, 31(3): 240-249.
45. Yang YR, Chen YH, Chang HC, et al. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil, 2015, 29(10): 987-993.
46. Hwang KK, Song SY, Doo YT, et al. Physical therapy clinical practice and documentation for Pusher syndrome in stroke patients: case report. J Korean Acad Clin Electrophysiol, 2011, 9(1): 41-49.
47. 陈国平, 亢连茹, 王艳, 等. 视觉反馈结合任务导向性训练治疗 Pusher 综合征的临床观察. 中国康复医学杂志, 2016, 31(4): 467-468.
48. 段好阳, 闫兆红, 刘福迁, 等. 动态平衡训练仪中的视觉反馈任务导向性训练对脑卒中后倾斜综合征的影响. 中华物理医学与康复杂志, 2017, 39(9): 674-676.
49. 曾杜纯, 叶祥明, 田亮, 等. 基于交互式视觉反馈的姿势控制训练对脑梗死 Pusher 综合征患者平衡功能的影响. 中国康复医学杂志, 2018, 33(7): 828-832.
50. Kim MS. Effect of robot assisted rehabilitation based on visual feedback in post stroke pusher syndrome. J Korea Acad Ind CoopSoc, 2016, 17(10): 562-568.
51. 王丹丹, 林坚, 刘晓林, 等. 视觉反馈结合核心稳定训练对脑卒中 Pusher 综合征患者的影响. 中国康复医学杂志, 2016, 31(4): 426-429.
52. 苏久龙, 潘翠环, 邵会凯, 等. 策略性靶向训练技术治疗脑卒中倾斜综合征的疗效观察. 中华物理医学与康复杂志, 2017, 39(7): 510-512.
53. 詹海兰, 汤清平, 周权, 等. 针刺结合意向性运动疗法治疗脑卒中 Pusher 综合征的临床研究. 湖南中医药大学学报, 2018, 38(7): 791-794.
54. 毕研贞, 王桂芬, 郑志雄, 等. 脑卒中后倾斜综合征综合康复治疗的疗效观察. 中华物理医学与康复杂志, 2013, 35(11): 909-910.
55. Yumiko K, Sachiko T, Mitsuhiro N, et al. Characteristics of sitting balance during reaching in stroke patients with pusher syndrome//16th International Congress of the World Federation of Occupational Therapists in collaboration with the 48th Japanese Occupational Therapy Congress and Expo. Japan: JPOT, 2014: 1596-1597.
56. Zhang L, Zhang Q, Su Y, et al. A new treatment of pusher syndrome based on central integration concept. Ann Phys Rehabil Med, 2018, 61: e37.
57. 方来漫. 注意力训练在脑卒中后 Pusher 综合征中的应用效果. 按摩与康复医学, 2015, 6(21): 76-78.

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