Presence of Ideomotor Apraxia in Stroke Patients with Pusher Syndrome

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.

Download Full-text

Posterior pusher syndrome — case report

Open Medicine ◽

10.2478/s11536-011-0145-7 ◽

2012 ◽

Vol 7 (3) ◽

pp. 354-357

Author(s):

Emilia Mikołajewska

Keyword(s):

Case Report ◽

Sagittal Plane ◽

Body Orientation ◽

Coronal Plane ◽

Stroke Patients ◽

Active Resistance ◽

Paretic Side ◽

Pusher Syndrome ◽

Posterior Tilt

AbstractPusher syndrome is classically described as disorder of body orientation in the coronal plane. It is characterized by a tilt towards the contralesional paretic side and a resistance to external attempts to rectify. It occurs mainly in stroke patients, however, non-stroke causes have been described too. In 2010 the concept of the posterior pusher syndrome had been proposed, defined as disturbance of body orientation in the sagittal plane with imbalance, posterior tilt and an active resistance to forward pulling or pushing. The author describes, on the basis of the literature and own research, symptoms and methods of the treatment of the little-known posterior pusher syndrome.

Download Full-text

The ‘pusher’ syndrome in elderly stroke patients

British Journal of Therapy and Rehabilitation ◽

10.12968/bjtr.2000.7.1.13908 ◽

2000 ◽

Vol 7 (1) ◽

pp. 11-16 ◽

Cited By ~ 5

Author(s):

Maggie J Bailey ◽

Linda Leivseth

Keyword(s):

Stroke Patients ◽

Pusher Syndrome

Download Full-text

Somatosensory Findings of Pusher Syndrome in Stroke Patients

Annals of Rehabilitation Medicine ◽

10.5535/arm.2013.37.1.88 ◽

2013 ◽

Vol 37 (1) ◽

pp. 88 ◽

Cited By ~ 3

Author(s):

Jong Hwa Lee ◽

Sang Beom Kim ◽

Kyeong Woo Lee ◽

Ji Yeong Lee

Keyword(s):

Stroke Patients ◽

Pusher Syndrome

Download Full-text

Dysfunction of the Human Mirror Neuron System in Ideomotor Apraxia: Evidence from Mu Suppression

Journal of Cognitive Neuroscience ◽

10.1162/jocn_a_00936 ◽

2016 ◽

Vol 28 (6) ◽

pp. 775-791 ◽

Cited By ~ 6

Author(s):

Silvi Frenkel-Toledo ◽

Dario G. Liebermann ◽

Shlomo Bentin ◽

Nachum Soroker

Keyword(s):

Right Hemisphere ◽

Mirror Neuron System ◽

Inferior Frontal Gyrus ◽

Mirror Neuron ◽

Stroke Patients ◽

Neuron System ◽

Mu Suppression ◽

Ideomotor Apraxia ◽

Manual Movements ◽

The Right

Stroke patients with ideomotor apraxia (IMA) have difficulties controlling voluntary motor actions, as clearly seen when asked to imitate simple gestures performed by the examiner. Despite extensive research, the neurophysiological mechanisms underlying failure to imitate gestures in IMA remain controversial. The aim of the current study was to explore the relationship between imitation failure in IMA and mirror neuron system (MNS) functioning. Mirror neurons were found to play a crucial role in movement imitation and in imitation-based motor learning. Their recruitment during movement observation and execution is signaled in EEG recordings by suppression of the lower (8–10 Hz) mu range. We examined the modulation of EEG in this range in stroke patients with left (n = 21) and right (n = 15) hemisphere damage during observation of video clips showing different manual movements. IMA severity was assessed by the DeRenzi standardized diagnostic test. Results showed that failure to imitate observed manual movements correlated with diminished mu suppression in patients with damage to the right inferior parietal lobule and in patients with damage to the right inferior frontal gyrus pars opercularis—areas where major components of the human MNS are assumed to reside. Voxel-based lesion symptom mapping revealed a significant impact on imitation capacity for the left inferior and superior parietal lobules and the left post central gyrus. Both left and right hemisphere damages were associated with imitation failure typical of IMA, yet a clear demonstration of relationship to the MNS was obtained only in the right hemisphere damage group. Suppression of the 8–10 Hz range was stronger in central compared with occipital sites, pointing to a dominant implication of mu rather than alpha rhythms. However, the suppression correlated with De Renzi's apraxia test scores not only in central but also in occipital sites, suggesting a multifactorial mechanism for IMA, with a possible impact for deranged visual attention (alpha suppression) beyond the effect of MNS damage (mu suppression).

Download Full-text