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の重癥度およびその改善経過とsubject visual verticalityの偏倚との関連. 理學療法學, 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 plut?t syndrome lateropulsion?. Neurophysiol Clin, 2018, 48(6): 326.
23.	洪文軍, 陶靜. 腦卒中后單側忽略的研究進展. 中國康復, 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, Br?tz 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, Rie? 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, Rie? 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, 歐陽迎, 周立晨, 等. 姿勢控制訓練對腦卒中偏癱患者足底壓力、平衡功能和步行功能改善的影響. 河北醫藥, 2018, 40(3): 389-392, 396.
37.	Davies PM. 循序漸進: 偏癱患者的全面康復治療. 劉欽剛, 譯. 北京: 華夏出版社, 2007: 352-362.
38.	張乃國, 周偉宏, 王海波. 視覺反饋聯合軀干強化訓練對腦卒中 Pusher 綜合征的療效觀察. 中國康復, 2018, 33(4): 286-288.
39.	王海波, 李建軍, 倪波業. 單跪立位軀干強化訓練對腦卒中 Pusher 綜合征患者平衡功能的影響. 中國康復理論與實踐, 2016, 22(9): 1049-1051.
40.	趙富強, 平興團, 楊飛, 等. 重心重塑訓練對 Pusher 綜合征的療效觀察. 醫學信息, 2018, 31(20): 94-95, 98.
41.	Piotr P, Dorota RS, Ma?gorzata 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.	王文麗, 張春軍, 張瑜, 等. 腦卒中后傾斜綜合征動平衡特征探討. 昆明醫科大學學報, 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.	陳國平, 亢連茹, 王艷, 等. 視覺反饋結合任務導向性訓練治療 Pusher 綜合征的臨床觀察. 中國康復醫學雜志, 2016, 31(4): 467-468.
48.	段好陽, 閆兆紅, 劉福遷, 等. 動態平衡訓練儀中的視覺反饋任務導向性訓練對腦卒中后傾斜綜合征的影響. 中華物理醫學與康復雜志, 2017, 39(9): 674-676.
49.	曾杜純, 葉祥明, 田亮, 等. 基于交互式視覺反饋的姿勢控制訓練對腦梗死 Pusher 綜合征患者平衡功能的影響. 中國康復醫學雜志, 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, 林堅, 劉曉林, 等. 視覺反饋結合核心穩定訓練對腦卒中 Pusher 綜合征患者的影響. 中國康復醫學雜志, 2016, 31(4): 426-429.
52.	蘇久龍, 潘翠環, 邵會凱, 等. 策略性靶向訓練技術治療腦卒中傾斜綜合征的療效觀察. 中華物理醫學與康復雜志, 2017, 39(7): 510-512.
53.	詹海蘭, 湯清平, 周權, 等. 針刺結合意向性運動療法治療腦卒中 Pusher 綜合征的臨床研究. 湖南中醫藥大學學報, 2018, 38(7): 791-794.
54.	畢研貞, 王桂芬, 鄭志雄, 等. 腦卒中后傾斜綜合征綜合康復治療的療效觀察. 中華物理醫學與康復雜志, 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.	方來漫. 注意力訓練在腦卒中后 Pusher 綜合征中的應用效果. 按摩與康復醫學, 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の重癥度およびその改善経過とsubject visual verticalityの偏倚との関連. 理學療法學, 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 plut?t syndrome lateropulsion?. Neurophysiol Clin, 2018, 48(6): 326.
23. 洪文軍, 陶靜. 腦卒中后單側忽略的研究進展. 中國康復, 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, Br?tz 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, Rie? 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, Rie? 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, 歐陽迎, 周立晨, 等. 姿勢控制訓練對腦卒中偏癱患者足底壓力、平衡功能和步行功能改善的影響. 河北醫藥, 2018, 40(3): 389-392, 396.
37. Davies PM. 循序漸進: 偏癱患者的全面康復治療. 劉欽剛, 譯. 北京: 華夏出版社, 2007: 352-362.
38. 張乃國, 周偉宏, 王海波. 視覺反饋聯合軀干強化訓練對腦卒中 Pusher 綜合征的療效觀察. 中國康復, 2018, 33(4): 286-288.
39. 王海波, 李建軍, 倪波業. 單跪立位軀干強化訓練對腦卒中 Pusher 綜合征患者平衡功能的影響. 中國康復理論與實踐, 2016, 22(9): 1049-1051.
40. 趙富強, 平興團, 楊飛, 等. 重心重塑訓練對 Pusher 綜合征的療效觀察. 醫學信息, 2018, 31(20): 94-95, 98.
41. Piotr P, Dorota RS, Ma?gorzata 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. 王文麗, 張春軍, 張瑜, 等. 腦卒中后傾斜綜合征動平衡特征探討. 昆明醫科大學學報, 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. 陳國平, 亢連茹, 王艷, 等. 視覺反饋結合任務導向性訓練治療 Pusher 綜合征的臨床觀察. 中國康復醫學雜志, 2016, 31(4): 467-468.
48. 段好陽, 閆兆紅, 劉福遷, 等. 動態平衡訓練儀中的視覺反饋任務導向性訓練對腦卒中后傾斜綜合征的影響. 中華物理醫學與康復雜志, 2017, 39(9): 674-676.
49. 曾杜純, 葉祥明, 田亮, 等. 基于交互式視覺反饋的姿勢控制訓練對腦梗死 Pusher 綜合征患者平衡功能的影響. 中國康復醫學雜志, 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, 林堅, 劉曉林, 等. 視覺反饋結合核心穩定訓練對腦卒中 Pusher 綜合征患者的影響. 中國康復醫學雜志, 2016, 31(4): 426-429.
52. 蘇久龍, 潘翠環, 邵會凱, 等. 策略性靶向訓練技術治療腦卒中傾斜綜合征的療效觀察. 中華物理醫學與康復雜志, 2017, 39(7): 510-512.
53. 詹海蘭, 湯清平, 周權, 等. 針刺結合意向性運動療法治療腦卒中 Pusher 綜合征的臨床研究. 湖南中醫藥大學學報, 2018, 38(7): 791-794.
54. 畢研貞, 王桂芬, 鄭志雄, 等. 腦卒中后傾斜綜合征綜合康復治療的療效觀察. 中華物理醫學與康復雜志, 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. 方來漫. 注意力訓練在腦卒中后 Pusher 綜合征中的應用效果. 按摩與康復醫學, 2015, 6(21): 76-78.

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