Pusher syndrome is a disorder following brain damage where patients actively push away from their non-paretic side, losing postural balance. It is caused by damage to the posterolateral thalamus, altering perception of the body's orientation to gravity. Treatment focuses on helping patients visually explore their surroundings to recognize their tilted posture. Prognosis is generally good, with function often recovering within 6 months.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
NDT, BOBATH TECHNIQUE, BASIC IDEA OF BOBATH, CONCEPT OF BOBATH, NEUROPHYSIOLOGY OF NDT, ICF MODEL, PRINCIPLES OF TREATMENT OF NDT IN STROKE AND CP, AUTOMATIC AND EQUILIBRIUM REACTIONS, KEY POINTS OF CONTROL, FACILITATION, INHIBITION AND HANDLING IN NDT
Hierachical theory- says that higher centers control on lower center; but when higher center damage then this inhibitory control from the higher center is loss which leads to exageration of the movt.
In normal individual, these occur a smooth, rhythmic movt. Because there is a presence of control from higher center on lower center.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Brunnstrom Approach
Brunnstrom's Approach (SIGNE BRUNNSTROM)
Objectives: ➢ Discuss the concepts and principles underlying Brunnstrom’s approach ➢ Brunnstrom recovery stages ➢ Treatment principles & techniques
★ Brunnstrom’s approach was developed by the physical therapist from Sweden in the early 1950’s
★ Brunnstrom used motor control theory and observations of the patients'
★ Procedure: In a “trial & error” fashion ★ Later modified: in light of neurophysiological knowledge
Introduction: Reflex Theory Movement is controlled by stimulus-response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior. Hierarchical Theory Characterized by a top-down structure, in which higher centers are always in charge of lower centers.
● When the CNS is injured, as, in a cerebrovascular accident, an individual goes through an “evolution in reverse”. Movement becomes primitive, reflexive, and automatic.
● Changes in tone and the presence of reflexes are considered a normal process of recovery.
● Movement recovery tends to be stereotypic.
● Patients exhibit only a few stereotypic movement patterns: Basic Limb Synergies.
● Based on observations of recovery following a stroke, this approach makes use of associated reactions, tonic reflexes, and the development of basic limb synergies to facilitate movements.
● The use of such a procedure is temporary.
Basic Limb Synergies:
● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.
● Basic limb synergy (BLS) does not permit the different combinations of muscles.
● BLS is considered primitive, automatic, and reflexive due to loss of inhibitory control from higher centers.
● Mass movement patterns in response to a stimulus or voluntary effort both Gross flexor movement (Flexor Synergy) Gross extensor movement (Extensor Synergy) Combination of the strongest component of the synergies (Mixed Synergy)
● Appear during the early spastic period of recovery
Upper Limb Flexor Synergy: Scapula: Retraction / Elevation Shoulder: Abduction and External rotation Elbow: Flexion Forearm: Supination Wrist and Finger: Flexion Lower Limb Extensor Synergy: Pelvis: posterior tilt Hip: Extension, Adduction & Internal rotation Knee: Extension Ankle: Plantarflexion Toes: Flexion Upper Limb Extensor Synergy: Scapula: Protraction / Depression Shoulder: Adduction and Internal rotation Elbow: Extension Forearm: Pronation Wrist: Extension Finger: Flexion Lower Limb Flexor Synergy: Pelvis: anterior tilt Hip: Flexion, Abduction & External rotation Knee: Flexion Ankle: Dorsiflexion Toes: Extension
Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion
Rubrospinal tract Vestibulospinal tract
Associated Reactions
Primitive Reflexes
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Brunnstrom Approach
Brunnstrom's Approach (SIGNE BRUNNSTROM)
Objectives: ➢ Discuss the concepts and principles underlying Brunnstrom’s approach ➢ Brunnstrom recovery stages ➢ Treatment principles & techniques
★ Brunnstrom’s approach was developed by the physical therapist from Sweden in the early 1950’s
★ Brunnstrom used motor control theory and observations of the patients'
★ Procedure: In a “trial & error” fashion ★ Later modified: in light of neurophysiological knowledge
Introduction: Reflex Theory Movement is controlled by stimulus-response. Reflexes are the basis for movement: reflexes are combined into actions that create behavior. Hierarchical Theory Characterized by a top-down structure, in which higher centers are always in charge of lower centers.
● When the CNS is injured, as, in a cerebrovascular accident, an individual goes through an “evolution in reverse”. Movement becomes primitive, reflexive, and automatic.
● Changes in tone and the presence of reflexes are considered a normal process of recovery.
● Movement recovery tends to be stereotypic.
● Patients exhibit only a few stereotypic movement patterns: Basic Limb Synergies.
● Based on observations of recovery following a stroke, this approach makes use of associated reactions, tonic reflexes, and the development of basic limb synergies to facilitate movements.
● The use of such a procedure is temporary.
Basic Limb Synergies:
● Normal synergistic movements are purposeful movements with maximum precision and minimum waste of energy.
● Basic limb synergy (BLS) does not permit the different combinations of muscles.
● BLS is considered primitive, automatic, and reflexive due to loss of inhibitory control from higher centers.
● Mass movement patterns in response to a stimulus or voluntary effort both Gross flexor movement (Flexor Synergy) Gross extensor movement (Extensor Synergy) Combination of the strongest component of the synergies (Mixed Synergy)
● Appear during the early spastic period of recovery
Upper Limb Flexor Synergy: Scapula: Retraction / Elevation Shoulder: Abduction and External rotation Elbow: Flexion Forearm: Supination Wrist and Finger: Flexion Lower Limb Extensor Synergy: Pelvis: posterior tilt Hip: Extension, Adduction & Internal rotation Knee: Extension Ankle: Plantarflexion Toes: Flexion Upper Limb Extensor Synergy: Scapula: Protraction / Depression Shoulder: Adduction and Internal rotation Elbow: Extension Forearm: Pronation Wrist: Extension Finger: Flexion Lower Limb Flexor Synergy: Pelvis: anterior tilt Hip: Flexion, Abduction & External rotation Knee: Flexion Ankle: Dorsiflexion Toes: Extension
Upper Limb Mixed Synergy: Scapula retraction Shoulder add.+IR Elbow flexion Forearm pronation Wrist & fingers flexion Lower Limb Mixed Synergy: Pelvis post tilt hip add.+IR Knee extension Ankle & toes plantarflexion
Rubrospinal tract Vestibulospinal tract
Associated Reactions
Primitive Reflexes
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
This Presentation Gives a step by step approach on differential diagnosis of adult neurological cases. Gives a clear insight in understanding better the given topic.
Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: C...Ahmed Elaghoury
A case study presented at the 2nd International Brain Stimulation in Barcelona.
Cite as: Gad, M., & Elaghoury, A. (2017). Risk of pulmonary aspiration with the outpatient electroconvulsive therapy: Case report. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 10(2), 419.
http://dx.doi.org/10.1016/j.brs.2017.01.244
A presentation by Sven Erik Gisvold at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Running head STROKE REHABILITATION1Running head STROKE REHAB.docxtoltonkendal
Running head: STROKE REHABILITATION 1
Running head: STROKE REHABILITATION 2
Stroke Rehabilitation
What is a stroke? A stroke, also known as a brain attack, is a condition that affects the brain and nervous system due to a lack of blood supply to the brain. It is the 5th leading cause of death and the main cause of disability in the United States. About 795,000 people in the United States suffer from a stroke each year (CDC, 2017). The three main kinds of strokes are ischemic strokes, which are the most common, hemorrhagic strokes, and transient ischemic attacks (TIA), also known as mini strokes. Strokes have a high risk of reoccurring, especially if remedial measures are not administered. Patients who have suffered from a stroke may have their function impaired in various ways, requiring acute initial care and possibly rehabilitation. A stroke may present itself in many ways such as slurred speech, change in sensation, decreased strength, paralysis, and even headache. Patients who suffer strokes will need the assistance of an entire team of health care professionals ranging from nurses, speech therapists, occupational therapists, physical therapists, neurologists, respiratory therapists, and social workers as well.
A constant concern for stroke patients is effective rehabilitation to improve their strength and regain their ability to preform daily activities of daily living (ADL). In Western medicine, treatment includes pharmacological treatments, surgical procedures, and multi-professional rehabilitation. In Eastern medicine, acupuncture and physiotherapy are used in conjunction with Western medicine to improve functional disability and reduce the risk of further complications. “Acupuncture use as a complementary or alternative therapy has increased worldwide and has become widely applied to stroke rehabilitation over the last decade, which confirms that the efficacy of acupuncture can have a great impact on stroke management” (Jun, Jian, Dhiaedin, Qinhui, Xiao, Yi, & Ma, 2017).
This paper will discuss the application of the topic and how it impacts the MSN program specialty track, supportive evidence regarding acupuncture, supportive evidence on the identification of frequency of its occurrence, a discussion of the stakeholders impacted by the issue, a statement of the PICOT/PICO question based on the evidence, and lastly conclude with a summary and a self-reflection.
Application and Impact on MSN Program Track
Nurses play an integral role in the care of patients who have suffered a stroke. The numbers of advanced practice nurses who have a Masters of Science Degree or Doctorate Degree in nursing has increased over the years and continue to grow in the nursing profession. This author has chosen to pursue the Advanced Registered Nurse Practitioners (ARNP) track. As an ARNP, the role is to not only diagnosis and treat patients, but also to educate patients on new and alternative evidence based treatment modalities focusing on preventi ...
Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
Director of Clinical Education and Clinical Associate Professor
UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Definition:
▪ Is a clinical disorder following left or right brain damage in which patients
actively push away from the nonhemiparetic side, leading to a loss of
postural balance
Karnath H-O, Broetz D. Understanding and treating “pusher syndrome.” Phys Ther. 2003;83:1119–1125.
3. Introduction
▪ 1985 (Patricia Davies), stroke patients use their non paretic extremities to
push toward the paretic side loss lateral postural balance fall toward
the hemiparetic side
▪ Forceful resistance against interventions aiming to correct their tilted
posture
▪ 10,4 % patients
▪ More common in right side stroke
Davies PM. Steps to Follow: A Guide to the Treatment of Adult Hemiplegia. New York, NY: Springer; 1985.
Pedersen PM, Wandel A, Jorgensen HS, et al. Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation—the Copenhagen stroke study. Arch Phys Med Rehabil. 1996;77:25–28.
4. Pusher Syndrome vs Disequilibrum
Push toward the
paretic side
Cling to something
with their
nonparetic hand
Bohannon RW, Smith MB, Larkin PA. Relationship between independent sitting balance and side of hemiparesis. Phys Ther. 1986;66: 944–945.
Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessment of the hemiplegic patient. Am J Phys Med. 1987;66:77–90.
5. Patophysiology
▪ Posterolateral thalamus
▪ Altered perception of the body’s orientation in relation to gravity
Karnath H-O, Broetz D. Understanding and treating “pusher syndrome.” Phys Ther. 2003;83:1119–1125.
6. Diagnosis
▪ 1) spontaneous body posture
▪ 2) increase of pushing force by spreading of the nonparetic extremities from
the body
▪ 3) resistance to passive correction of posture
Karnath H-O, Broetz D. Understanding and treating “pusher syndrome.” Phys Ther. 2003;83:1119–1125.
7. Karnath H-O, Ferber S, Dichgans J. The origin of contraversive pushing: evidence for a second graviceptive system in humans. Neurology. 2000;55:1298–1304.
Karnath H-O, Broetz D, Goetz A. Klinik, Ursache und Therapie der Pusher-Symptomatik. Nervenarzt. 2001;72:86–92.
8. Treatment
▪ Realize the disturbed perception of erect body position.
▪ Visually explore the surroundings and the body’s relation to the
surroundings. (Ensure that the patient sees whether he or she is oriented
upright). We suggest that the physical therapist use visual aids that give
feedback about body orientation and work in a room containing many
vertical structures, such as door frames, windows, pillars, and so on.
▪ Learn the movements necessary to reach a vertical body position.
▪ Maintain the vertical body position while performing other activities.
Karnath H-O, Broetz D. Understanding and treating “pusher syndrome.” Phys Ther. 2003;83:1119–1125.
9. Prognosis
▪ At the time of admission to the hospital following the stroke, patients with
contraversive pushing have a more severely impaired level of
consciousness and ability to walk, paresis of the upper and lower
extremities, and lower initial function in activities of daily living than
patients with hemiparesis but without contraversive pushing
▪ Good prognosis at 6 months
Pedersen PM, Wandel A, Jorgensen HS, et al. Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation—the Copenhagen stroke study. Arch Phys Med Rehabil. 1996;77:25–28.
Karnath H-O, Johannsen L, Broetz D, et al. Prognosis of contraversive pushing. J Neurol. 2002;249:1250–1253.
10. Summary
▪ Push away from the non paretic side lost of postural balance
▪ Posterolateral thalamus
▪ Altered perception of the body’s orientation in relation to gravity
▪ Good prognosis
