Case Report: Visual Deprivation in Pusher Syndrome Complicated by Hemispatial Neglect After Basal Ganglia Stroke

Abstract

We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.

A Intervenção dos Enfermeiros de Reabilitação na Pessoa com Síndrome de Pusher

“…Foram identificados 9 artigos científicos, publicados entre 2004 e 2021, 3 provenientes da China (13)(14)(15) , 2 da Alemanha (16,17) , 1 dos Estados Unidos (10) , 1 da Coreia do Sul (18) , 1 de Taiwan (19) e 1 de Itália (20) . A maior parte destes artigos recorreu à metodologia estudo de caso (6) (10,13,15,16,18,20) e 2 deles são experimentais (14,19) , abrangendo 72 pessoas com síndrome de pusher. Um dos artigos não aborda o tipo de metodologia implementada (17) .…”

“…Com uma proposta de intervenção diferente, um estudo de 2021 avaliou duas pessoas que sofreram AVC nos gânglios da base à direita, com distúrbios motores graves, ambos com forte inclinação para a esquerda, com diagnóstico de síndrome de pusher e negligência hemiespacial esquerda (15) . Com privação visual através da oclusão do olho esquerdo, reduziu-se a entrada de informações sensoriais visuoespaciais à direita e promoveu-se o equilíbrio da perceção espacial em ambos os lados, reduzindo-se a excitabilidade das áreas cerebrais correspondentes no hemisfério esquerdo e a tendência para prestar atenção ao lado direito.…”

Possibilities of physiotherapeutic treatment in the case of patients with pusher syndrome

“…In another study, two patients with PS after a stroke of the right basal ganglia, in addition to traditional therapy, were additionally covered with a 30minute blindfold of the left eye twice a day while exercising in a standing position. Their condition improved after the first training, and after 4 weeks the patients were able to cover distances of 150200 m under supervision [10].…”

“…Another theory is that PS is a highlevel disruption of processing sensory information from the affected body part. Research is still underway to explain it [1,7,10]. Most of the observed cases of PS are associated with stroke, but it has also been observed (< 1% of patients) in patients after craniocerebral trauma and after treatment of a brain tumour [3,11].…”

“…PS occurs with damage to both the right and left hemispheres, but more often affects the right hemisphere -65% of cases [8]. It usually occurs when the stroke affects the posterior part of the thalamus; it is associated with other areas, such as the posterior part of the insula, internal capsule or germinal gyrus less frequently [3,4,10,11]. Symptoms associated with PS have a significant impact on the daily functioning of the patient and on the effects of therapy, therefore, the earliest possible diagnosis and properly selected targeted treatment has a significant influence on treatment progress.…”