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Rehabilitation procedures in the management of postural orientation deficits in patients with poststroke pusher behavior: a pilot study.

BACKGROUND
Pusher behavior (PB) is a little-known postural control disorder characterized by alterations in the perception of body orientation in the coronal (roll) plane. Poststroke PB poses many short- and long-term concerns in clinical practice leading to the longer length of hospital stay and slower functional recovery. The literature on specific rehabilitation training in PB is scant. The aim of this pilot study was to compare the outcomes after postural orientation training using visual and somatosensory cues versus conventional physiotherapy in patients with poststroke PB.


METHODS
Sixteen patients with PB were enrolled. Eight patients received postural orientation training employing visual and somatosensory cues. Seven patients received conventional physiotherapy. Each patient underwent 20 (50 min/d) individual treatment sessions (5 d/week for 4 weeks). Primary outcome measure was the Scale for Contraversive Pushing (SCP). Secondary outcome measures were the European Stroke Scale (ESS), and the Postural Assessment Scale for Stroke (PASS). Outcomes were assessed at admission, after 1 week, post-treatment, and at 1-month follow-up.


RESULTS
No significant between-group differences were measured on primary and secondary outcome measures. Significant within-group changes in performance were noted in both groups. The magnitude of the differences between the postural orientation training and the conventional physiotherapy effects, as measured on the SCP and the PASS, suggests the value of the former approach.


CONCLUSIONS
Training employing visual and somatosensory cues might reduce pusher behavior severity and improve postural control in poststroke pusher behaviour.