Dear Antonella,
There are some resources for treatment of pusher's syndrome.
Pat Davies discusses issues of midline orientation in her
books, available from Springer-Verlag. Anne Shumway-Cooke
discusses some ideas for improving weight shifting and
midline orientation in her book, Motor Control: Theory and
Applications.
In my experience, pusher syndrome seems to be a result of
interference in the pathways involving postural control,
which include the cortex (esp. right parietal lobe),
cerebellum, brain stem (vestibular and cerebellar related
centers), and nerve tracts (spinocerebellar,
vestibulospinal, rubrospinal, and reticulospinal). I have
treated many patients with midline orientation problems and
can tell you, it is readily resolvable. Many patients
spontaneously recover midline during the course of rehab.
Some are more difficult to help but there are some tricks
you can try.
One technique is to use mirrors and other cues (video-tape,
etc.) to show the patient how far off midline they are. You
can even place some tape vertically on the mirror and the
patient's shirt and have him try to match them up. For
walking, sometimes I'll shorten up a cane on their
noninvolved side to encourage them to overcompensate for
lean. For higher level patients you can either weight down
their hemiplegic side (the side they lean towards) and have
them lean away from the weights while they walk. Or, I have
actually pulled patients towards the hemi side, telling them
to "fight the resistance" while they walk.
I have rarely seen these problems persist beyond a month or
two post injury with diligent therapy. I hope this helps!
Sincerely,
Geoff Mosley, PT
Missouri Rehabilitation Center
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