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• W2160172912 abstract "Pusher behavior (PB) is a postural control disorder characterized by actively pushing away from the nonparetic side and resisting passive correction with a tendency to fall toward the paralyzed side.1 These patients have no awareness that their active pushing is counterproductive, which precludes the patients from standing without assistance.Several studies have already demonstrated that PB can occur in patients with lesions in both hemispheres, and PB is distinct from neglect and anosognosia.2-8 The high frequency of the association between PB and neurophysiological deficits might reflect an increased vulnerability of certain regions to stroke-induced injury rather than any direct involvement with the occurrence of PB.9,10Traditionally, PB has only been reported in stroke patients; however, it has also been described under non-stroke conditions.8 Previous imaging studies have suggested the posterolateral thalamus as the brain structure that is typically damaged in pusher patients.4,11 Nevertheless, other cortical and subcortical areas, such as the insular cortex and post-central gyrus, have also been highlighted as structures that are potentially involved in the pathophysiology of PB.2,12-16The mechanisms underlying PB have been attributed to vertical perception dysfunction that leads to postural reactive behavior.3,14, Nevertheless, the true changes in the verticality perception of these patients are still unclear. In this context, Karnath et al. identified five patients with severe PB who experience their body (subjective postural vertical [SPV]) as oriented “upright” when it is actually tilted approximately 18° toward the side of the brain lesion and with no subjective visual vertical (SVV) bias.3 Johansen et al. also found no SVV bias in 15 PB patients.20 In contrast, Perrenou et al. found SPV, SVV, and subjective haptic vertical (SHV) biases toward the side opposite the brain lesion in six pusher patients.21 It is clear that, to state which vertical perception is disturbed in PB patients, the studies' designs require a meticulous methodology, including the analysis of neglect and the influence of haptics on SVV in a large sample of PB patients.Until now, PB has only been reported as a temporary and transitory phenomenon with a maximum recovery time of six months.8, Moreover, it has been suggested that PB does not negatively influence the functional outcomes of rehabilitation.10,22 Nevertheless, those assumptions have primarily emerged from case series of stroke patients admitted to stroke units or followed in rehabilitation centers in developed countries.10, Therefore, the actual impact of the disorder on stroke patients in developing countries may be underestimated. Here, we report three cases of stroke patients that had persistent PB with important disabling consequences on their functional outcomes." @default.
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• W2160172912 date "2011-12-01" @default.
• W2160172912 modified "2023-10-18" @default.
• W2160172912 title "Persistent pusher behavior after a stroke" @default.
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• W2160172912 doi "https://doi.org/10.1590/s1807-59322011001200025" @default.
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