Physiotherapy for pusher behaviour

Paci, Matteo; Rinaldi, L.

doi:10.3233/nre-2005-20410

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…Consequently, treatment based on visual cues alone may not be fully effective. 8 Multimodal rehabilitation approaches show some promise. 10 Evidence for the effect of different approaches to rehabilitation on lateropulsion is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…Broetz and Karnath 7 subsequently published recommendations for the rehabilitation of people with lateropulsion, including treating people in an ‘earth-vertical’ position and leveraging visual feedback of vertical position. However, Paci and Rinaldi 8 noted that some people with lateropulsion are unable to use visual input to align with their surroundings. More recent findings 9 have shown lateropulsion to be associated with neglect and impaired perception of visual vertical, which suggests difficulty exploring the spatial environment.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, treatment based on visual cues alone may not be fully effective. 8 Multimodal rehabilitation approaches show some promise. 10 …”

Section: Introductionmentioning

confidence: 99%

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Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

et al. 2023

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Objective People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel. Design This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations. Participants Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion. Main Measures The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding ‘unsure’ responses. Results Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which ‘some agreement’ (50%–74% agreement) was achieved and those for which recommendations remain to be clarified were recorded. Conclusions These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel

et al. 2023

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The subjective visual vertical in patients with pusher behaviour: A pilot study with a psychophysical approach

Paci

Matulli²,

Megna

et al. 2011

Neuropsychological Rehabilitation

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Pusher behaviour (PB) reflects some misrepresentation of verticality. However, its neural mechanisms are still unclear. The aim of this pilot study is to assess the perception of the subjective visual vertical in patients with PB using an orientation discrimination task relying on a psychophysical forced-choice procedure. A sample of eight patients with post-stroke hemiplegia, three of whom with (PB+ group) and five without (PB- group) a clear PB, and 10 matched healthy subjects, was selected. All participants were assessed with an orientation discrimination task based on the objective Two-Alternatives Forced Choice (2AFC) procedure, in which observers are forced to report whether an oriented stimulus that was tilted off-vertical by a varying amount (but never vertical) was tilted clockwise or counterclockwise from vertical. Participants' ability in detecting the visual vertical was estimated by calculation of bias and threshold, which represent deviations of the subjective vertical from the physical vertical and the sensitivity to orientation offsets away from vertical, respectively. While there were no significant differences between groups in terms of bias, statistical analysis showed a significantly higher threshold in the PB+ group compared to both PB- and control groups. Results suggest that vertical misrepresentation might be due to the presence, in patients with PB, of a lower signal-to-noise ratio in coding systems. Implications for clinical practice are discussed.

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