Management of Pusher Syndrome Can Be Challenging
Management of patients who present with pusher syndrome following a stroke can be challenging. There is a greater likelihood of recovery when we understand the mechanism causing the pushing, and develop interventions that correlate to the impairments specific to this sub-group of patients.

This course will introduce participants to the latest theories regarding the causes of pusher syndrome. A framework will be developed to assist the clinician in classifying the "pusher" patient into a functional recovery category which will assist with appropriate goal-setting, thus maximizing treatment and guiding progression. The intervention strategies presented will meet the needs of the patient along the recovery spectrum including severe, lower-level "pushers" through higher-level, ambulatory patients with persistent pushing and midline deficits.

Course Content

A. Common Impairments of Patients Who Push Following a Stroke
  1. Testing measures to identify patients who push
  2. Common presentations of patients meeting criteria for pusher syndrome
  3. Impairments
    a. Trunk asymmetry
    b. Active pushing/abduction uninvolved UE and LE
    c. Midline deficit
B. Causes of Pushing Behavior
  1. Cerebral localization of ”pusher” behavior
  2. Visual vs. Postural Vertical
  3. Postural Control Dysfunction
C. Treatment Interventions
  1. Role of impairment identification in treatment planning
  2. 3 levels of severity of “pushing” behavior
  3. Prioritizing treatment interventions for each level of severity
  4. Case study
    a. 45-year-old Special Forces soldier
    b. Right middle cerebral infarct