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Understanding Pusher Syndrome: Causes, Symptoms, and Treatment

man with pusher syndrome practicing balance exercises

After a stroke, survivors may start to lean towards the affected side of their body. This is a condition known as pusher syndrome. Generally, individuals are unaware that they are leaning and feel as if they are sitting or standing upright. As a result, pusher syndrome can significantly affect an individual’s balance and increase the risk of falling. Fortunately, there is a positive recovery outlook for stroke survivors who experience pusher syndrome.

To help you understand what pusher syndrome is, this article will discuss its:

Causes of Pusher Syndrome

Pusher syndrome is most commonly associated with damage to a part of the brain known as the posterolateral thalamus. However, it has also been observed in individuals with injuries in the insula and postcentral gyrus. These three regions of the brain are suggested to play major roles in regulating upright body posture.

To understand why individuals with pusher syndrome lean to the side, it helps to understand how a stroke affects the brain. The brain consists of two hemispheres with the right hemisphere controlling movement on the left side of the body and the left hemisphere controlling movement on the right.

After a stroke, individuals often experience paralysis in the opposite side of the body that the stroke occurred in. For example, a stroke in the left hemisphere may lead to paralysis in the right side of the body. Pusher syndrome can occur following damage to the left or right side of the brain. However, it is more common after a right hemisphere stroke or brain injury.

Depending on the severity of the stroke, survivors may experience various forms of paralysis. For example, a severe stroke may lead to paralysis of one side of the body (hemiplegia). In contrast, a mild stroke may cause weakness on one side of the body (hemiparesis). Pusher syndrome can occur with either form of paralysis following a stroke.

If a person starts to lean towards the affected side of the body, they may have pusher syndrome. The following section will discuss its main signs and symptoms.

Signs and Symptoms of Pusher Syndrome

Generally, individuals with pusher syndrome use their unaffected limbs to tilt their body about 20 degrees towards their weaker side. The problem is, they are unaware that they are tilting because they feel as if they are upright.

Individuals with pusher syndrome experience deficits with the perception of their body’s orientation which may also include impairments to the vestibular system. If they focus on their environment, they can typically orient their body so that it lines up with their surroundings. However, when they are upright, they feel unbalanced.

In other words, individuals with pusher syndrome use their unaffected limbs to actively push away from the unaffected side. In doing so, individuals may push themselves into such unstable positions that they risk falling towards their affected side.

Additionally, individuals with pusher syndrome due to right hemisphere damage often demonstrate left neglect. This is an attention disorder that makes it difficult for individuals to notice or respond to stimuli on their left side. For example, they may only eat from the right side of their plate or frequently bump into objects on their left.

In contrast, individuals with left hemisphere damage are more prone to have aphasia. This is a disorder that affects the ability to produce or understand language. Although left neglect and aphasia both frequently co-occur in individuals with pusher syndrome, neither disorder is the underlying cause of pusher syndrome.

While it can be frustrating or worrisome to have pusher syndrome after stroke, most individuals recover their sense of balance. Up next, we’ll discuss the recovery outlook for pusher syndrome.

Pusher Syndrome Prognosis

stroke survivor overcoming pusher syndrome with rehabilitation therapy

Fortunately, most stroke survivors can recover from pusher syndrome. Generally, any sort of tilting is resolved within 6 months after stroke. This suggests that one’s perception of body orientation can be well compensated by the brain.

Additionally, it demonstrates that just because an individual has pusher syndrome does not mean their recovery from other effects of stroke will be negatively affected.

Recovery after stroke is possible because the brain has neuroplasticity, which is its ability to make adaptive changes and reorganize its neural circuitry. As a result, functions affected by brain damage have the potential to be rewired to unaffected regions and relearned through highly repetitive stimulation. The more you practice an affected function, the better the brain gets at perceiving demand for it and adapts.

However, it’s important to note that patients with pusher syndrome generally take about 3.6 weeks longer than other stroke survivors to reach the same functional outcome level. To optimize recovery outcomes, it’s essential for individuals to participate in rehabilitative therapies as soon as possible and develop their functional independence.

Pusher Syndrome Treatment

Treatment of pusher syndrome generally involves working with rehabilitation specialists such as physical and occupational therapists. These professionals will help evaluate the severity of your balance problems and suggests effective ways to help you feel balanced in an upright position.

Physical therapy focuses on improving balance skills through targeted exercises. Generally, individuals with pusher syndrome are still able to adjust their body positioning so that it aligns with visual cues from surrounding objects. Therefore, a physical therapist may tape a straight, vertical line on a mirror and ask the patient to align their body with the line. These visual cues allow the individual to see that even though they feel upright, they are actually leaning towards the paralyzed side.

Likewise, an occupational therapist will help individuals with pusher syndrome find effective ways to be functional and perform everyday activities in a safe way that acknowledges their increased risk of falling.

Your therapists may try to keep your limbs from pushing towards the paralyzed side by gently repositioning them. For example, facing the unaffected palm up and placing it on their lap will prevent the patient from pushing against it.

Consistently practicing these exercises and activities will help stimulate the brain and promote neuroplasticity. Gradually, individuals should become accustomed to sitting or standing upright and feel more balanced.

Understanding Pusher Syndrome: Key Points

Pusher syndrome most commonly occurs following a stroke in the posterolateral thalamus. When sitting or standing upright, individuals with pusher syndrome may or may not feel unbalanced, depending on the type of stroke they sustained. In some cases, people with PS will lean towards their paralyzed side in an effort to feel balanced again.

Fortunately, most individuals recover from pusher syndrome within 6 months and continue with their stroke rehabilitation journeys. We hope this article helped you understand what pusher syndrome is and how to overcome it.

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