Understanding Pusher Syndrome
Pusher Syndrome, sometimes called contraversive pushing or lateropulsion, is a neurological condition where individuals actively push themselves away from their unaffected side towards their affected, weaker side. This behavior leads to a loss of postural balance and an increased risk of falls. It is not due to a lack of motor strength or a psychological issue, but rather a disorder of how the brain perceives the body’s orientation in space and its relationship to gravity.
This syndrome often occurs after a stroke or other brain injury, impacting how a person maintains an upright posture. Individuals with Pusher Syndrome perceive themselves as being upright even when they are significantly tilted towards their weaker side. The condition can vary in severity and is seen in both left and right brain damage, though it appears to be more prevalent after right-sided brain injuries.
Identifying the Key Characteristics
Individuals with Pusher Syndrome exhibit distinct behaviors that distinguish them from other balance disorders. A primary characteristic is their active pushing away from their stronger, non-paralyzed side, often using their unaffected arm or leg. This pushing causes them to lean or fall towards their paralyzed side. They will resist any attempt by others to passively correct their tilted posture back to an upright position.
Patients often keep the limbs on their affected side in a flexed position, while extending the limbs on their unaffected side to push themselves. This behavior is observable in various positions, including sitting, standing, and during transfers. Despite being visibly tilted, these individuals genuinely feel that they are in an upright position, which makes self-correction difficult without specific interventions.
Neurological Basis
Pusher Syndrome arises from damage to specific brain regions that play a role in processing spatial orientation and body awareness. Research indicates that the posterolateral thalamus is frequently implicated in this condition. This area of the brain is thought to be involved in the perception of body posture in relation to gravity.
Damage to the posterolateral thalamus can disrupt the brain’s ability to accurately sense the body’s upright position, even when visual and vestibular systems are functioning normally. Other brain areas involved in integrating sensory information and regulating upright posture have also been linked to Pusher Syndrome. Their damage can lead to the misperception of verticality.
Rehabilitation Approaches
Rehabilitation for Pusher Syndrome focuses on retraining the individual’s perception of upright posture and improving balance. Therapists aim to help patients recognize their tilted posture and actively correct it.
Strategies involve providing visual feedback, such as using mirrors or vertical lines on a wall, to help patients align themselves with a true vertical reference. Physical and occupational therapists guide individuals through exercises that encourage active weight-shifting towards their unaffected side and promote correct postural alignment. Tactile cues, such as placing a hand on the patient’s hip, can also be used to facilitate proper weight distribution. The goal is to encourage patients to engage in self-correction and integrate a more accurate sense of verticality into their movements and daily activities.