健侧倾斜训练对脑卒中后Pusher综合征患者平衡功能的效果

doi:10.3969/j.issn.1006-9771.2025.02.012

Abstract

Abstract:

Objective To observe the effect of healthy side tilt training on balance function in patients with Pusher syndrome (PS) after stroke.

Methods From February, 2021 to November, 2023, 40 patients with PS after stroke in People's Hospital of Bayingolin Mongolian Autonomous Prefecture were selected. They were divided into control group (n = 20) and experimental group (n = 20) in accordance with the order of the patients' admission. The control group received comprehensive training for paralyzed limbs combined with sitting balance training, and the experimental group received comprehensive training for paralyzed limbs combined with healthy side tilt training, for three weeks. They were assessed with Burke Lateropulsion Scale (BLS), Fugl-Meyer Assessment-Balance (FMA-B) and modified Barthel Index (MBI) before and after treatment.

Results After treatment, BLS score significantly decreased in both groups (t > 12.603, P < 0.001), and was lower in the experimental group than in the control group (t = -2.559, P < 0.05). The scores of FMA-B and MBI were significantly increased in both groups (|Z| > 3.941, |t| > 12.082, P < 0.001), and FMA-B score was higher in experimental group than in the control group (Z = -2.538, P < 0.05).

Conclusion Comprehensive training for paralyzed limbs combined with healthy side tilt training can effectively improve the balance function and postural control of patients with PS after stroke, and improve the activities of daily living.

Key words: stroke, Pusher syndrome, healthy side tilt, balance function

CLC Number:

R743.3

MA Wenwen, WEN Yanzheng, Manripati ROZI, CUI Boya, Suyinqimei . Effect of healthy side tilt training on balance function in patients with Pusher syndrome after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 225-230.

Figures/Tables 4

Table 1

Table 2

Comparison of BLS score between two groups pre- and post-treatment"

组别	n	测试	$x - ± s$	t值	P值
对照组	20	前测	11.70±2.51	13.414	< 0.001
		后测	7.75±2.22
试验组	20	前测	13.25±2.88	12.603	< 0.001
		后测	6.00±2.77
治疗前两组均值差			-1.55±3.36	-2.061	0.053
治疗后两组均值差			1.75±3.06	-2.559	0.019

Table 2

Table 3

Table 4

Comparison of MBI score between two groups pre- and post- treatment"

组别	n	测试	$x - ± s$	t值	P值
对照组	20	前测	28.75±16.77	-14.658	< 0.001
		后测	39.25±16.40
试验组	20	前测	22.25±15.76	-12.082	< 0.001
		后测	48.50±11.25
治疗前两组均值差			6.50±23.74	1.225	0.236
治疗后两组均值差			-9.25±21.23	-1.949	0.066

Table 4

References 36

[1]	孙海欣, 王文志. 中国脑卒中患病率、发病率和死亡率调查结果发表[J]. 中华神经科杂志, 2017, 50(5): 337.
	SUN H X, WANG W Z. Survey results of prevalence,incidence and mortality of stroke in China published[J]. Chin J Neurol, 2017, 50(5): 337.
[2]	YAMAGUCHI T, SATOW T, KOMURO T, et al. Transcranial direct current stimulation improves pusher phenomenon[J]. Case Rep Neurol, 2019, 11(1): 61-65. doi: 10.1159/000497284 pmid: 31543787
[3]	刘宝祥, 刘敏, 王欣, 等. 下肢负重振动联合悬吊治疗对脑卒中后Pusher综合征的疗效观察[J]. 中国康复, 2023, 38(4): 213-216.
	LIU B X, LIU M, WANG X, et al. Effects of lower limb weight-loading vibration combined with sling training on post-stroke Pusher syndrome[J]. Chin J Rehabil, 2023, 38(4):213-216.
[4]	BERGMANN J, KREWER C, SELGE C, et al. The subjective postural vertical determined in patients with Pusher behavior during standing[J]. Top Stroke Rehabil, 2016, 23(3): 184-190. doi: 10.1080/10749357.2015.1135591 pmid: 27077977
[5]	ROSENZOPF H, KLINGBEIL J, WAWRZYNIAK M, et al. Thalamocortical disconnection involved in pusher syndrome[J]. Brain, 2023, 146(9): 3648-3661.
[6]	刘四维, 关敏, 张静, 等. 倾斜综合征的研究进展[J]. 华西医学, 2019, 34(11): 1315-1320.
	LIU S W, GUAN M, ZHANG J, et al. Progress in research on pusher syndrome[J]. West Chin Med J, 2019, 34(11): 1315-1320.
[7]	于丽瑛, 毕可萍, 杨楠. 本体感觉训练联合躯干强化训练对脑卒中后倾斜综合征患者平衡能力的影响[J]. 国际医药卫生导报, 2019, 25(17): 3015-3017.
	YU L Y, BI K P, YANG N. Effect of proprioceptive training combined with trunk intensive training on balance ability in patients with post-stroke tilt syndrome[J]. Intl Med Health Guida News, 2019, 25(17): 3015-3017.
[8]	王海波, 陶媛媛, 李静, 等. 经颅直流电刺激协同患侧下肢强制性负重训练对脑卒中Pusher综合征的效果[J]. 中国康复理论与实践, 2023, 29(3): 269-274. doi: 10.3969/j.issn.1006-9771.2023.03.004
	WANG H B, TAO Y Y, LI J, et al. Effect of transcranial direct current stimulation combined with constraint-induced weight training of the affected lower limb on Pusher syndrome after stroke[J]. Chin J Rehabil Theory Pract, 2023, 29(3): 269-274.
[9]	PORZYCH P, RATUSZEK-SADOWSKA D, PYSKIR M, et al. Treatment of Pusher syndrome in a patient after extensive cerebral infarction caused by cerebral embolism-case report[J]. J Educ Health Sport, 2017, 7(8): 583-592.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管病一级预防指南2019[J]. 中华神经科杂志, 2019, 52(9): 684-709.
	Chinese Society of Neurology, Chinese Stroke Society. Guidelines for the primary prevention of cerebrovascular diseases in China 2019[J]. Chin J Neurol, 2019, 52(9): 684-709.
[11]	BABYAR S R, PETERSON M G E, REDING M. Case-control study of impairments associated with recovery from "Pusher syndrome" after stroke: logistic regression analyses[J]. J Stroke Cerebrovasc Dis, 2017, 26(1): 25-33. doi: S1052-3057(16)30296-8 pmid: 27614404
[12]	张通, 赵军, 李雪萍, 等. 中国脑血管病临床管理指南(第2版)(节选)——第8章脑血管疾病康复管理[J]. 中国卒中杂志, 2023, 18(9): 1036-1048.
	ZHANG T, ZHAO J, LI X P, et al. Chinese Stroke Association Guidelines for Clinical Management of Cerebrovascular Diseases (Second Edition) (Excerpt): Chapter Eight Cerebrovascular Disease Rehabilitation Management[J]. Chin J Stroke, 2023, 18(9): 1036-1048.
[13]	JANG S H, LEE H D. Recovery of an injured medial lemniscus with concurrent recovery of pusher syndrome in a stroke patient: a case report[J]. Medicine, 2018, 97(22): e10963.
[14]	ZHANG Q, ZHANG L, HE W, et al. Case report: visual deprivation in Pusher syndrome complicated by hemispatial neglect after basal ganglia stroke[J]. Front Neurol, 2021, 12: 706611.
[15]	BABYAR S R, PETERSON M G E, REDING M. Time to recovery from lateropulsion dependent on key stroke deficits: a retrospective analysis[J]. Neurorehabil Neural Repair, 2015, 29(3): 207-213. doi: 10.1177/1545968314541330 pmid: 25009223
[16]	PACI M, MACCHIONI G, FERRARELLO F. Treatment approaches for Pusher behaviour: a scoping review[J]. Top Stroke Rehabil, 2023, 30(2): 119-136.
[17]	OBRERO-GAITÁN E, FUENTES-NUNEZÚÑEZ D, MORAL-GARCÍA M D, et al. Misperception of body verticality in neurological disorders: a systematic review and meta-analysis[J]. Brain Behav, 2024, 14(5): e3496.
[18]	SAEYS W, HERSSENS N, VERWULGEN S, et al. Sensory information and the perception of verticality in post-stroke patients. Another point of view in sensory reweighting strategies[J]. PLoS One, 2018, 13(6): e199098.
[19]	PARDO V, GALEN S. Treatment interventions for Pusher syndrome: a case series[J]. NeuroRehabilitation, 2019, 44(1): 131-140. doi: 10.3233/NRE-182549 pmid: 30814367
[20]	黄林鹏, 周开斌, 梁天佳, 等. 前庭康复治疗对脑卒中Pusher综合征患者躯干控制及平衡功能的影响[J]. 广西医科大学学报, 2019, 36(7): 1164-1167.
	HUANG L P, ZHOU K B, LIANG T J, et al. The effects of vestibular rehabilitation on trunk control and balancing capacity in stroke patients with Pusher syndrome[J]. J Guangxi Med Univ, 2019, 36(7): 1164-1167.
[21]	黄怡, 潘翠环, 叶正茂, 等. 平衡训练对脑卒中 Pusher 综合征患者下肢运动能力的影响[J]. 中国康复, 2014, 29(3): 170-172.
	HUANG Y, PAN C H, YE Z M, et al. Effects of balance training on lower limbs motor function of stroke patients with Pusher syndrome[J]. Chin J Rehabil, 2014, 29(3): 170-172.
[22]	杜晓霞, 何静杰, 林煜凡, 等. 顶叶出血后Pusher综合征的康复1例报道[J]. 中国康复理论与实践, 2021, 27(5): 615-620. doi: 10.3969/j.issn.1006-9771.2021.05.016
	DU X X, HE J J, LIN Y F, et al. Features and rehabilitation of Pusher syndrome after parietal lobe hemorrhage: a case report[J]. Chin J Rehabil Theory Pract, 2021, 27(5): 615-620.
[23]	王海波, 李建军, 倪波业. 单跪立位躯干强化训练对脑卒中Pusher综合征患者平衡功能的影响[J]. 中国康复理论与实践, 2016, 22(9): 1049-1051. doi: 10.3969/j.issn.1006-9771.2016.09.014
	WANG H B, LI J J, NI B Y. Effects of single kneeling trunk intensive training on balance in patients with Pusher syndrome after stroke[J]. Chin J Rehabil Theory Pract, 2016, 22(9): 1049-1051.
[24]	沈蓉, 袁爱红, 解鸿宇, 等. 头针结合强制负重训练对脑卒中后倾斜综合征患者倾斜症状及平衡功能的影响[J]. 安徽中医药大学学报, 2023, 42(3): 59-63.
	SHEN R, YUAN A H, XIE H Y, et al. Effect of scalp acupuncture combined with forced weight: bearing training on tilt and balance in patients with Pusher syndrome after stroke[J]. J Anhui Univ Chin Med, 2023, 42(3): 59-63.
[25]	NOLAN J, JACQUES A, GODECKE E, et al. Post-stroke lateropulsion terminology: pushing for agreement amongst experts[J]. Ann Phys Rehabil Med, 2022, 65(6): 101684.
[26]	杨梦蕤, 邱志勇. 健侧主动控制训练在脑卒中后倾斜综合征中的应用效果[J]. 中国当代医药, 2022, 29(10): 81-84.
	YANG M R, QIU Z Y. Application effect of contralateral active control training in post -stroke Pusher syndrome[J]. Chin Mod Med, 2022, 29(10): 81-84.
[27]	李育梅. 经颅直流电刺激联合健侧主动控制训练对脑卒中后倾斜综合征康复效果的影响[J]. 河南医学研究, 2023, 32(12): 2195-2199.
	LI Y M. Effect of transcranial direct current stimulation combined with contralateral active control training on the rehabilitation of post-stroke tilt syndrome[J]. Henan Med Res, 2023, 32(12): 2195-2199.
[28]	AUBERT H. Eine scheinbare bedeutende Drehung von Objecten bei Neigung des Kopfes nach rechts oder links[J]. Arch Pathol Anatom Physiol Klin Med, 1861, 20(3): 381-393.
[29]	MENG L, TSANG R C C, GE Y, et al. rTMS for poststroke pusher syndrome: study protocol for a randomised, patient-blinded controlled clinical trial[J]. BMJ Open, 2022, 12(8): e064905.
[30]	KOTER R, REGAN S, CLARK C, et al. Clinical outcome measures for lateropulsion poststroke: an updated systematic review[J]. J Neurol Phys Ther, 2017, 41(3): 145-155. doi: 10.1097/NPT.0000000000000194 pmid: 28628548
[31]	BARRA J, MARQUER A, JOASSIN R, et al. Humans use internal models to construct and update a sense of verticality[J]. Brain, 2010, 133(Pt 12): 3552-3563. doi: 10.1093/brain/awq311 pmid: 21097492
[32]	DAI S, PISCICELLI C, MARQUER A, et al. Improving orientation with respect to gravity enhances balance and gait recovery after stroke: DOBRAS cohort[J]. Ann Phys Rehabil Med. 2024, 67(1): 101767.
[33]	NOLAN J, JACQUES A, GODECKE E, et al. Clinical practice recommendations for management of lateropulsion after stroke determined by a Delphi expert panel[J]. Clin Rehabil, 2023, 37(11): 1559-1574.
[34]	VAN CRIEKINGE T, TRUIJEN S, SCHRÖDER J, et al. The effectiveness of trunk training on trunk control, sitting and standing balance and mobility post-stroke: a systematic review and meta-analysis[J]. Clin Rehabil, 2019, 33(6): 992-1002. doi: 10.1177/0269215519830159 pmid: 30791703
[35]	GALEOTO G, IORI F, DE SANTIS R, et al. The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review[J]. Top Stroke Rehabil, 2019, 26(3): 236-245. doi: 10.1080/10749357.2019.1574060 pmid: 30774018
[36]	王梦寰, 孔雨柔, 谢敏, 等. 经皮迷走神经刺激联合任务导向训练改善卒中后偏瘫患者上肢功能的研究[J]. 中国康复医学杂志, 2024, 39(6): 782-790.
	WANG M H, KONG Y R, XIE M, et al. Transcutaneous auricular vagus nerve stimulation combined with task-oriented training to improve upper extremity function in post stroke hemiplegia[J]. Chin J Rehabil Med, 2024, 39(6): 782-790.

组别	n	性别/n		年龄/岁	病程/周	脑卒中类型/n		偏瘫侧/n
组别	n	男	女	年龄/岁	病程/周	脑梗死	脑出血	左	右
对照组	20	8	12	63.65±10.64	4(2, 10.75)	13	7	16	4
试验组	20	11	9	61.50± 10.06	4(2, 5)	10	10	16	4
t/χ²/Z值		0.902^a		0.771^b	-0.803	0.921^a
P值		0.342		0.445	0.422	0.337		1^d

Effect of healthy side tilt training on balance function in patients with Pusher syndrome after stroke

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 4

References 36

Related Articles 15

Metrics

Comments

Recommended 0

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	20	前测	2.0(0, 5.0)	-3.959	< 0.001
		后测	5.0(3.25, 8.0)
试验组	20	前测	2.0(1.0, 4.0)	-3.941	< 0.001
		后测	7.5(7.0, 9.0)
治疗前两组差值				-0.168	0.869
治疗后两组差值				-2.538	0.011

[1]	WANG Xiaojun, WANG Hani, YU Hong, LI Yuanmei, ZHOU Yuda. Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 218-224.
[2]	QIN Qing, LIU Ye, YE Haiyan, LI Chen, CHEN Di. Robot-assisted therapy for upper limb of stoke: a bibliometrics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(1): 85-98.
[3]	ZHANG Lu, MA Jiangping, YANG Erli, CHEN Qiuhua, DONG Lijun, YIN Xiaobing. Application of cognitive-motor dual-task training in stroke: a bibliometrics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1034-1042.
[4]	LUO Hong, XU Li. Effect of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper extremities motor function in patients with cerebral hemorrhage: a randomized controlled trial based on resting state-functional magenetic resonance imaging [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1060-1068.
[5]	WANG Min, FANG Lantian, HUANG Chenyi. Effect of modified graded motor imagery on upper limb motor function for stroke patients: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1069-1073.
[6]	XIE Dandan, CHEN Shanjia, LEI Lei, YU Guo, YU Jiahui, ZHAO Jiapei, HE Xiaokuo. Characteristics of brain activation during treadmill walking with visual feedback in healthy subjects and hemiplegic patients: a functional near infrared spectroscopy study [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1074-1081.
[7]	LI Dong, ZHANG Hao, LIU Nan, WANG Xinyue, XU Miao. Effect of cognitive-motor dual-task training on balance function and gait in convalescent stroke patients: a randomized contolled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1082-1091.
[8]	YU Tingting, CAI Fuliang, MIAO Guihua, GU Chen, PENG Yuan. Effect of structured therapy and education based on personal strength on ischemic stroke: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 965-971.
[9]	LIANG Tianjia, LONG Yaobin, LU Liyan, ZHOU Jinying, HUANG Fucai, HUANG Linpeng, WU Yingchao, LONG Yaoxiang, WEI Xiaocui, LIU Zhong. Effect of rope-assisted proprioceptive neuromuscular facilitation combined with rope-assisted brain-computer interface training on upper limb function in stroke patients with hemiplegia: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 972-978.
[10]	WANG Zhe, WAN Qin, HUANG Zhaoming, WANG Yongli, QIAN Hong. Characteristics of speech prosody function in adults with non-fluent aphasia after stroke [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 979-992.
[11]	DUAN Linru, ZHENG Jiejiao, CHEN Xi, LI Yan. Analysis of relevant factors for fall risk in stroke patients [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 811-817.
[12]	LUO Wei, HE Yi, ZHANG Qingsu. Relationship between motor function of articulation organs and speech intelligibility in poststroke dysarthria [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 818-822.
[13]	HE Aiqun, LI Jingbo, HE Maoli, YE Simei, SONG Qiushuang, LIU Haiou, XIE Youshu. Effect of occupational skills relearning on hemiplegic arm function after stroke: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 823-830.
[14]	CHEN Chen, MENG Zhaoxiang, YANG Kang, ZHANG Minjie, ZUO Ya'nan, WANG Kui, ZHANG Xibin, QUAN Yifeng, JIN Xing. Effect of intelligent mirror glove task-oriented training combined with low-frequency repetitive transcranial magnetic stimulation on hand function in patients with stroke: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 831-838.
[15]	REN Xiaomin, WEI Hui, YUE Shouwei, YIN Sen. Risk factors of stroke in nine hospitals of six cities in Shandong, China: a case-control study [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 839-847.