Abstract

Postural disturbances in stroke patients may present as pusher syndrome. The aim of the study was to describe the treatment process and outcomes of physiotherapy of a post-ischaemic stroke patient with co-existing pusher syndrome. We describe a 78-year-old patient (S.L.) with left hemiplegia and pusher syndrome. Magnetic Resonance Imaging (MRI) revealed an ischaemic focus with a small haemorrhage in the posterior thalamus and posterior limb of the internal capsule. The patient underwent physiotherapy based on Proprioceptive Neuromuscular Facilitation (PNF). The pusher syndrome, which was diagnosed in the late stage of hospitalisation, was measured with the Scale for Contraversive Pushing (SCP), in which the patient scored 3.75 pts. Intensive rehabilitation started in the early post-stroke phase helped the patient achieve independence in changing position and sitting without assistance or support. The pushing behaviour did not improve in spite of appropriate therapy and verbal instructions. After 33 days of hospitalisation and physiotherapy at a Neurology Department, the patient was transferred to a Neurorehabilitation Unit for further rehabilitation. The pusher syndrome slowed down the recovery and reduced possibilities for applying rehabilitation in high positions (sitting and standing) in the early stage of post-stroke physiotherapy.

Key words:

physiotherapy, Stroke, pusher syndrome, PNF