pusher behaviour

[gcoe]

Ciao noemigaudenzi

I find Karnath's work helpful. In this part of the world there has remained some controversy over whether it really is a distinct entity (Carr & Shepherd) however Karnath and associates have greatly improved our understanding about PS as a distinct entity. Have you got his review of 2007:

Karnath, H. O. (2007). Pusher syndrome - A frequent but little-known disturbance of body orientation perception. Journal of Neurology, 254(4), 415-424.

Do you use the The scale for contraversive pushing? While it may not be perfect I think this goes some way to diagnosing PS a distinct entity and is useful for treatment planning:


Baccini, M., Paci, M., Nannetti, L., Biricolti, C., & Rinaldi, L. A. (2008). Scale for contraversive pushing: Cutoff scores for diagnosing "pusher behavior" and construct validity. Physical Therapy, 88(8), 947-955.

Baccini, M., Paci, M., & Rinaldi, L. A. (2006). The scale for contraversive pushing: A reliability and validity study. Neurorehabilitation and Neural Repair, 20(4), 468-472.

There isn't much in clinical trials on effective treatments. Now with a better understanding of the what PS is hopefully we should see some well conducted trials over the next few years. Until then I think it is best to use common sense type approaches. As for what we use, visual cues for orientation (gridlines in front of the patient while practicing sitting & standing etc), conscious strategies of correction combined with positive reinforcement and shaping. These seem to be the most plausible based on Karnaths review. Have you had a look at this paper in Neurologic PT?

'Pusher Syndrome', The | Journal of Neurologic Physical Therapy | Find Articles at BNET

I have never tried Perennou's the TENS treatment. Have you?

the trouble with treatments as these patients generally get better anyway so based on clinical practice it is hard to tell if we are actually being effective or if they would be responding anyway without out the treatment.

One more thing I wanted to ask: Do you speak German. There are two recent papers in that I don't have access and I don't speak German. Have you seen them?

Bohm, C. (2009). Movement therapy - Classic or modern? Why are pushers different? New approaches in the pusher syndrome. [German]. Neurologie und Rehabilitation, 15(1), 43-45.
Urquizo, V. H., & Hundsdorfer, N. (2009). Push or pull? Controversy of the pusher-behaviour. [German]. Neurologie und Rehabilitation, 15(6), 365-372.

I was wondering if you did speak German if you could review them?

[noemigaudenzi]

My English is bad, but I know all you say.
I use SCP of Karnath, I think cut off validated by Baccini-Paci (score >0 in each section) is good only in the early stages post stroke, because I think resistance to passive correction is the first symptom to disappear. Lateropulsion Scale by D'aquila e c. is better, but it is too long to do...
I hope to know Shepherd and Carr experiences, I have Guidelines ....2002: are there their opinions?