HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Karnath, H.-O. Articles by Broetz, D. Search for Related Content PubMed PubMed Citation Articles by Karnath, H.-O. Articles by Broetz, D.

Understanding and Treating "Pusher Syndrome"

H-O Karnath, MD, PhD, is Associate Professor for Neurology, Department of Cognitive Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Hoppe-Seyler-Str 3, D-72076 Tuebingen, Germany (Karnath{at}uni-tuebingen.de).
D Broetz is Physical Therapist, Department of General Neurology, Hertie Institute for Clinical Brain Research, University of Tuebingen

Address all correspondence to Dr Karnath

"Pusher syndrome" 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. The mechanism underlying this disorder and its related anatomy have only recently been identified. Investigation of patients with severe pushing behavior has shown that perception of body posture in relation to gravity is altered. The patients experience their body as oriented "upright" when the body actually is tilted to the side of the brain lesion (to the ipsilesional side). In contrast, patients with pusher syndrome show no disturbed processing of visual and vestibular inputs determining visual vertical. These new insights have allowed the authors to suggest a new physical therapy approach for patients with pusher syndrome where the visual control of vertical upright orientation, which is undisturbed in these patients, is the central element of intervention.

Key Words: Hemiparesis • Pusher syndrome • Spatial neglect • Spatial orientation • Thalamus

This article has been cited by other articles:

				S. R. Babyar, H. White, N. Shafi, and M. Reding Outcomes With Stroke and Lateropulsion: A Case-Matched Controlled Study Neurorehabil Neural Repair, July 1, 2008; 22(4): 415 - 423. [Abstract] [PDF]

				P. L Scheets, S. A Sahrmann, and B. J Norton Use of Movement System Diagnoses in the Management of Patients With Neuromuscular Conditions: A Multiple-Patient Case Report Physical Therapy, June 1, 2007; 87(6): 654 - 669. [Abstract] [Full Text] [PDF]

				S. R. Babyar, K. H. McCloskey, and M. Reding Surface Electromyography of Lumbar Paraspinal Muscles During Seated Passive Tilting of Patients With Lateropulsion Following Stroke Neurorehabil Neural Repair, March 1, 2007; 21(2): 127 - 136. [Abstract] [PDF]

				M. Baccini, M. Paci, and L. A. Rinaldi The scale for contraversive pushing: a reliability and validity study. Neurorehabil Neural Repair, December 1, 2006; 20(4): 468 - 472. [Abstract] [PDF]

				M. E Finger, A. Cieza, J. Stoll, G. Stucki, and E. O Huber Identification of Intervention Categories for Physical Therapy, Based on the International Classification of Functioning, Disability and Health: A Delphi Exercise Physical Therapy, September 1, 2006; 86(9): 1203 - 1220. [Abstract] [Full Text] [PDF]

				H.-O. Karnath, L. Johannsen, D. Broetz, and W. Kuker Posterior thalamic hemorrhage induces "pusher syndrome" Neurology, March 22, 2005; 64(6): 1014 - 1019. [Abstract] [Full Text] [PDF]

				C. J. Danells, S. E. Black, D. J. Gladstone, and W. E. McIlroy Poststroke "Pushing": Natural History and Relationship to Motor and Functional Recovery Stroke, December 1, 2004; 35(12): 2873 - 2878. [Abstract] [Full Text] [PDF]

				P. Matteo, R. W Bohannon, E. Panturin, H.-O. Karnath, and D. Broetz Pusher syndrome. Physical Therapy, June 1, 2004; 84(6): 580 - 581. [Full Text]