Pusher Syndrome

On my neuro placement I am currently treating a patient who has had a L TACI and presents with R sided hemiparesis, hemisensory loss, Aphasia and is also a mild pusher. Treatments have consisted of UL and LL facilitation of nornal movement, SIMMS and foot mobs, reaching activities to the L and standing with the tilt table as well as supported standing with 2 assist. The recent two treatments have been similar but had very different results when standing. The first Rx concentrated on reaching to improve her alignment and SIMMS and foot mobs. We only stood her twice with assistance x 2 and she performed the stand reasonably well with some slight lean to the R and Pushing to the right. The more recent Rx consisted mainly of sit to stand practice with 2 x max assist and the outcome was severe pushing to the right with very poor alignment in standing. So why the difference from one day to the next. On reflection it was the preparation that occurred prior to the standing that made the difference. The longer period spend preparing the foot for standing and working on alignment paid off and the end result was a better sit to stand than the last Rx when not much time was spent on the foot or on alignment. We must remember that we need to do the hard work in preparingt he patient before you attempt at training the functional task.