Zusammenfassung
Als Pusher-Symptomatik bezeichnet man das erstaunliche Verhalten
mancher Patienten, nach einer Hirnläsion, sich aktiv mithilfe der nicht
gelähmten Extremitäten zu ihrer gelähmten Seite hin zu
drücken. Dieses Verhalten wurde überwiegend nach Schlaganfällen,
aber auch nach anderen Hirnläsionen beobachtet und beschrieben. In der
Literatur finden sich leider immer noch unterschiedliche Definitionen, obwohl
die Symptomatik charakteristisch und stereotyp auftritt. Mehrere
Untersuchungsverfahren und wenige Behandlungsansätze wurden bislang
beschrieben und untersucht. Dieser Artikel bietet einen Überblick
über den aktuellen Kenntnisstand zu Definition, Untersuchung,
Prävalenz, Ursachen, Analyse der betroffenen Hirnregionen, Behandlung und
Prognose der Pusher-Symptomatik.
Literatur
- 01
Babyar S R, Peterson M G, Bohannon R W et al..
Clinical examination tools for lateropulsion or pusher
syndrome following stroke: a systematic review of the literature.
Clin Rehabil.
2009;
23
639-650
- 02
Baccini M, Paci M, Rinaldi L A.
The scale for contraversive pushing: A reliability and
validity study.
Neurorehabil Neural Repair.
2006;
20
468-472
- 03
Beevor C E.
Remarks on paralysis of the movements of the trunk in
hemiplegia.
Br Med J.
1909;
881-885
- 04
Bisdorff A R, Wolsley C J, Anastasopoulos D et al..
The perception of body verticality (subjective postural
vertical) in peripheral and central vestibular disorders.
Brain.
1996;
119
1523-1534
- 05
Bjerver K, Silfverskiöld B P.
Lateropulsion and imbalance in Wallenberg's
syndrome.
Acta Neurol Scand.
1968;
44
91-100
- 06
Bohannon R W.
Correction of recalcitrant lateropulsion through motor
learning.
Physical Therapy Case Reports.
1998;
1
157-159
- 07
Bohannon R W.
Pusher syndrome.
Phys Ther.
2004;
84
580-581
author reply 582–583
- 08
Broetz D, Karnath H O.
New aspects for the physiotherapy of pushing behaviour.
NeuroRehabilitation.
2005;
20
133-138
- 09
Broetz D, Johannsen L, Karnath H O.
Time course of ”pusher syndrome” under visual
feedback treatment.
Physiother Res Int.
2004;
9
138-143
- 10
Brötz D.
Schlaganfallrehabilitation; zielgerichtete aktive
Physiotherapie.
Zeitschrift für Physiotherapeuten,
Krankengymnasten.
2011;
im Druck
- 11 Brunnstrom S. Movement therapy in hemiplegia. A neurophysiological
approach. Harper & Row; New York; 1970
- 12
Danells C J, Black S E, Gladstone D J et al..
Poststroke "pushing": natural history and relationship to
motor and functional recovery.
Stroke.
2004;
35
2873-2878
- 13
D'Aquila M A, Smith T, Organ D et al..
Validation of a lateropulsion scale for patients recovering
from stroke.
Clin Rehabil.
2004;
18
102-109
- 14 Davies P M. Steps to follow. A guide to the treatment of adult
hemiplegia. Springer; New York; 1985
- 15 Davies P M. Steps to follow. A guide to the treatment of adult
hemiplegia. Springer; New York; 2000
- 16
Dettmann M A, Linder M T, Sepic S B.
Relationships among walking performance, postural stability,
and functional assessments of the hemiplegic patient.
Am J Phys Med.
1987;
66
77-90
- 17
Dieterich M, Brandt T.
Wallenberg's syndrome: lateropulsion, cyclorotation,
and subjective visual vertical in thirty-six patients.
Ann Neurol.
1992;
31
399-408
- 18
Johannsen L, Broetz D, Karnath H O.
Leg orientation as a clinical sign for pusher syndrome.
BMC Neurol.
2006a;
6
30
- 19
Johannsen L, Brötz D, Nägele T et al..
"Pusher syndrome" following cortical lesions that spare the
thalamus.
J Neurol.
2006b;
253
455-463
- 20
Johannsen L, Fruhmann Berger M, Karnath H-O..
Subjective visual vertical (SVV) determined in a
representative sample of 15 patients with pusher syndrome.
Journal of Neurology.
2006c;
253
1367-1369
- 21
Karnath H O, Ferber S, Dichgans J.
The origin of contraversive pushing: Evidence for a second
graviceptive system in humans.
Neurology.
2000a;
55
1298-1304
- 22
Karnath H O, Ferber S, Dichgans J.
The neural representation of postural control in humans.
Proc Natl Acad Sci USA.
2000b;
97
13931-13936
- 23
Karnath H O, Brötz D, Götz A.
Klinik, Ursache und Therapie der Pusher-Symptomatik.
Nervenarzt.
2001;
72
86-92
- 24
Karnath H O, Johannsen L, Broetz D et al..
Prognosis of contraversive pushing.
J Neurol.
2002;
249
1250-1253
- 25
Karnath H O, Brötz D.
Understanding and treating ”pusher
syndrome”.
Physical Therapy.
2003;
83
1119-1125
- 26
Karnath H O, Johannsen L, Brötz D.
Posterior thalamic hemorrhage induces "pusher syndrome".
Neurology.
2005;
64
1014-1019
- 27
Karnath H O.
Pusher syndrome – a frequent but little-known
disturbance of body orientation perception.
Journal of Neurology.
2007a;
254
415-424
- 28
Karnath H O, Brötz D.
Instructions for the Clinical Scale for Contraversive Pushing
(SCP).
Neurorehabil Neural Repair.
2007b;
21
370-371
- 29
Lafosse C, Kerckhofs E, Troch M et al..
Contraversive pushing and inattention of the contralesional
hemispace.
J Clin Exp Neuropsychol.
2005;
27
460-484
- 30
Lagerqvist J, Skargren E.
Pusher syndrome: Reliability, validity and sensitivity to
change of a classification instrument.
Advances in Physiotherapy.
2006;
8
154-160
- 31
Masdeu J C, Gorelick P B.
Thalamic astasia: inability to stand after unilateral
thalamic lesions.
Ann Neurol.
1988;
23
596-603
- 32
Paci M, Baccini M, Rinaldi L M.
Pusher behavior: A critical review of controversial
issues.
Disability and Rehabilitation.
2009;
31
249-258
- 33
Pedersen P M, Wandel A, Jorgensen H S et al..
Ipsilateral pushing in stroke: incidence, relation to
neuropsychological symptoms, and impact on rehabilitation. The Copenhagen
Stroke Study.
Arch Phys Med Rehabil.
1996;
77
25-28
- 34
Pérennou D A, Mazibrada G, Chauvineau V et al..
Lateropulsion, pushing and verticality perception in
hemisphere stroke: a causal relationship?.
Brain.
2008;
131
2401-2413
- 35
Pontelli T E, Pontes-Neto O M, Colafemina J F et al..
Posture control in Pusher syndrome: influence of lateral
semicircular canals.
Rev Bras Otorrinolaringol (Engl Ed).
2005;
71
448-452
- 36
Premoselli S, Cesana L, Cerri C.
Pusher syndrome in stroke: clinical, neuropsychological, and
neurophysiological investigation.
Eur Med Phys.
2001;
37
143-151
- 37
Santos-Pontelli T E, Pontes-Neto O M, Colafemina J F et al..
Contraversive pushing in non-stroke patients.
J Neurol.
2004;
251
1324-1348
- 38
Ticini L F, Klose U, Nägele T et al..
Perfusion imaging in pusher syndrome to investigate the
neural substrates involved in controlling upright body position.
PLoS ONE.
2009;
4
e5737
Doris Brötz
Poststraße 2–4
72072 Tübingen
Email: info@broetz-physiotherapie.de
Prof. Dr. Dr. Hans-Otto Karnath
Zentrum für Neurologie
Sektion Neuropsychologie
Universität Tübingen
Hoppe-Seyler-Str. 3, 72076 Tübingen
Email: karnath@uni-tuebingen.de