Article

Some stroke patients with hemiparesis exhibit a so-called pusher behaviour, i.e.,
they actively push away from the unaffected side and lean towards the hemiparetic
side. This impairs their postural balance to such a degree that they are often
unable to sit or stand.
Pusher behaviour thus substantially hampers the
rehabilitation of these patients. So far only a few case studies on treatment
strategies have been performed. This study investigated the immediate
after-effects of galvanic vestibular stimulation (GVS), machine-supported gait
training with the Lokomat, and physiotherapy with visual feedback components
(PT-vf). Fifteen pusher and 10 non-pusher patients participated in an
observer-blinded cross-over pilot study. Patients were measured on the scale for
contraversive pushing (SCP) and on the Burke lateropulsion scale (BLS)
immediately before and after a single-session of the specific intervention.
Compared to PT-vf, Lokomat therapy had a significant effect on the BLS of pusher
patients but no significant effect on the SCP values. GVS had no significant
effect on these values on either scale. BLS is more useful than SCP to detect
small changes for clinical trials and routine treatment. Forced control of the
upright position during locomotion seems to be an effective method for
immediately reducing the pushing behaviour of stroke patients, probably because
it recalibrates a biased sense of verticality, via the somatic graviception. This
finding, however, does not allow prediction of its long-term effects.
Furthermore, it would be interesting to evaluate repetitive, multi-session DGO
therapy and the amount of therapy needed to effectively reduce the pusher behaviour.
CI - Copyright (c) 2012 Elsevier B.V. All rights reserved.

Langue : ANGLAIS