Physiotherapy for Pusher Syndrome focuses on helping the patient re-learn their true vertical and overcome the misperception of their body’s orientation.

Advanced physiotherapy

• • Weight Shifting Exercises: Gradually practicing controlled weight shifts towards the non-paretic side, often with visual feedback, to challenge their altered perception.
• Specific Exercise Progression:-
  • Supine Positioning: Starting with exercises in supine if pushing is severe, gradually progressing to sitting and standing.
  • Sitting Balance Activities: Exercises that promote symmetrical weight bearing and controlled trunk movements while seated. This can involve placing the non-paretic foot flat on the floor and encouraging the patient to push down through it to feel more stable on that side, rather than pushing away.
  • Standing Balance and Gait Training: Progressing to standing exercises, incorporating activities that challenge balance and require maintaining an upright posture, such as:-
  • Body Weight Supported Treadmill Training (BWSTT): This can be highly effective as it provides a safe, supportive environment for repetitive stepping and righting practice, while allowing therapists to facilitate correct alignment.
  • Functional Activities: Integrating upright posture into everyday functional tasks (e.g., transfers, reaching, dressing).
• Sensory Stimulation:-
  • Somatosensory Stimulation: Techniques like neck muscle vibration, tactile or thermal stimulation of the affected side, or using unstable surfaces to augment feedback about their body position.
  • Tactile References: Using a therapist’s hands-on facilitation or tactile targets (e.g., a wall, a plinth) to provide a reference point for the midline.
• Cognitive and Perceptual Training:
  • Awareness Training: Helping patients become aware of their disturbed perception of upright body position through consistent feedback and guided self-assessment.