脑卒中后倾斜综合征的研究进展

Research progress of pusher syndrome after stroke

关键词:  脑卒中  倾斜综合征  神经解剖机制  康复评定  康复治疗

Key words:  stroke  pusher syndrome  neuroanatomical mechanism  rehabilitation assessment  rehabilitation therapy

摘要:

倾斜综合征（pusher syndrome，PS）是一种在脑卒中患者中少见的并发症，其特征是体位倾斜，主动推向患侧，并抵制被动纠正不正确的体位。临床上，他们更容易摔倒，因为他们把体重从非偏瘫侧推到偏瘫侧，这种对身体方向的误解使患者很难移动体重和保持姿势，延长恢复功能所需的时间。在脑卒中康复中，有PS的患者会受到这种行为的影响，极大地阻碍了治疗，延长了康复进程。因此，迫切需要有效减少倾斜行为的创新治疗方法。本文主要综述国内外关于PS的神经解剖机制，综合分析比较SCP、M-SCP、BLS、PASS、4PPS量表的临床适用性，以及PS新兴的康复训练。包括交互式视觉反馈训练、前庭康复训练、减重支持训练、经颅直流电刺激、经颅磁刺激，这些训练分别干预了平衡控制系统的不同方面，均表现出积极的训练效果。

Abstract:

Pusher syndrome (PS) is a rare complication in stroke patients, which is characterized by leaning posture, actively pushing to the affected side, and resisting passive correction of incorrect posture. Clinically, they are more likely to fall down because they push their weight from the non-hemiplegic side to the hemiplegic side, which makes it difficult for patients to move their weight and keep their posture and extends the time required to restore functions. In stroke rehabilitation, patients with PS are affected by this behavior, which greatly hinders the treatment and prolongs the rehabilitation process. Therefore, there is an urgent need for innovative treatment methods to effectively reduce tilting behavior. This article mainly reviews national and international studies on the neuroanatomical mechanisms of PS and comprehensively analyzes and compares the clinical applicability of SCP, M-SCP, BLS, PASS and 4PPS scales. The emerging rehabilitation trainings for patients with PS include interactive visual feedback training, vestibular rehabilitation training, weight loss support training, transcranial direct current stimulation and transcranial magnetic stimulation. These trainings, which interfere with different aspects of the balance control system respectively, show a positive training effect and provide a reference for the clinical rehabilitation path of PS patients.