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The ‘Pusher Syndrome’

Roller, Margaret L. DPT, MS

Journal of Neurologic Physical Therapy: March 2004 - Volume 28 - Issue 1 - p 29
doi: 10.1097/01.NPT.0000284775.32802.c0
Special Interest Papers

Pusher syndrome in patients post-stroke is characterized by leaning and active pushing toward the hemiplegic side with no compensation for the instability, and resistance to passive correction toward midline. Patients with pusher syndrome post-stroke have been found to require longer than average to reach independence in activities of daily living and ambulation. This behavior is found to be present primarily in patients with right hemispheric lesions centered in the area of the posterolateral thalamus. Patients with this disorder misperceive body orientation in space, believing that the upright position is approximately 18° tilted toward the ipsilesional side. This could be the result of ‘graviceptive neglect’ of signals originating in the contralesional trunk and pelvis. The ability to use visual information for the correction of body posture continues to exist in this population, allowing for the use of visual cues and cognitive strategies as potential rehabilitation tools.

Assistant Professor in the Department of Physical Therapy, California State University, Northridge, Northridge, CA (, and Physical Therapist, UCLA Medical Center Department of Rehabilitation Services, Los Angeles, CA

© 2004 Neurology Section, APTA